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Am Fam Physician. 2003;68(8):1657-1658

Only one study has shown that home modifications can prevent falls in older persons; all other studies have shown no benefit in home modification without other interventions. Nikolaus and Bach examined the effectiveness of a home-assessment program to prevent falls.

Patients at a geriatric hospital were randomized to home assessment by an intervention team or no home visit. Participants in the home visit group received an assessment before discharge and at least one additional home visit (mean, 2.6). Patients were contacted monthly to obtain information on falls and fall-related injuries.

The study included 360 community-dwelling, frail, older persons who were functionally limited but cognitively intact. Subjects had multiple chronic conditions or functional deterioration. After one year, mortality was similar in both groups. The reported fall rate was 31 percent lower in the intervention group than in the control group, but the proportion of persons who fell frequently was similar in both groups. Reported fall injuries were similar in both groups. The intervention program had a different effect on participants with and without a history of falls. For persons who had fallen in the past year, the proportion of persons who had fallen could be reduced, with a 37 percent lower fall rate in the intervention group compared with the control group. Participants who made at least one recommended modification had a significant reduction in the rate of falls.

The intervention reduced reported falls by 31 percent in frail, older persons. When only persons who had fallen in the previous year were included, falls among persons who fell frequently also could be reduced, but falls were not reduced in persons whose falls had been less recent. The authors speculate that people who had fallen recently are more likely to respond to an intervention program because of perceived vulnerability. It is unclear which home modifications are most effective.

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