The home environment as fall risk factors among community-dwelling frail older people: A systematic review

Abstract

Purpose Falls are accidents that seriously affect the health of older people (Ferrer et al., 2014). Falls among older people are mostly caused by environmental factors and situations (Tsai et al., 2014). The home environment is increasingly being emphasized as a key factor in home falls among frail older people because while non-frail older people have a high exposure to outdoor environmental risks, frail older people are exposed to indoor environmental risks (Lord et al., 2006). However, few studies have investigated the specific and detailed environmental factors related to home falls among community-dwelling frail older people. Previous systematic reviews include only some components, such as exercise, without considering environmental modifications (El-Khoury et al., 2013; Simek et al., 2012). This study aimed to explore and synthesize empirical studies that looked at the environmental factors of home falls among community-dwelling frail older people. Method We performed a systematic review to draw comprehensive conclusions regarding environmental factors related to home falls by searching the MEDLINE, CINAHL, EMBASE, and Cochrane Library, as well as grey literature databases. We searched by combining the following keywords: (1) ‘aged’ AND ‘frailty’, (2) ‘risk factors’ OR ‘home environment’, (3) ‘accidental falls’, and (4) ‘community’ without limitations on either the study type or language. Results and Discussion Of the 7699 studies initially retrieved from the electronic databases, six intervention and six non-intervention studies were included in the analysis. Seven out of the 12 studies (58.3%) assessed environmental hazards using relevant assessment tools. Interventions were provided for the bathroom/toilet (66.7%); bedroom (66.7%); living room (50%); and for slipping and tripping (83.3%) which were identified as frequent fall location and situations through non-intervention studies. Only two intervention studies (33.3%) mentioned individualized approaches to older people or participation of older people, and in all three studies (50.0%) that were significant, the intervention was provided by a multidisciplinary expert team. The findings indicate that standardized environmental evaluations should be provided using structured assessment tools, and that the intervention process requires the participation of older people with multidisciplinary experts.