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Do home adaptation interventions help to reduce emergency fall admissions? A national longitudinal data-linkage study of 657,536 older adults living in Wales (UK) between 2010 and 2017

Joe Hollinghurst, Helen Daniels Orcid Logo, Rich Fry Orcid Logo, Ashley Akbari Orcid Logo, Sarah Rodgers, Alan Watkins Orcid Logo, Sarah Hillcoat-Nalletamby, Neil Williams, Silviya Nikolova, David Meads, Andy Clegg

Age and Ageing, Volume: 51, Issue: 1

Swansea University Authors: Joe Hollinghurst, Helen Daniels Orcid Logo, Rich Fry Orcid Logo, Ashley Akbari Orcid Logo, Alan Watkins Orcid Logo, Sarah Hillcoat-Nalletamby

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DOI (Published version): 10.1093/ageing/afab201

Abstract

Backgroundfalls are common in older people, but evidence for the effectiveness of preventative home adaptations is limited.Aimdetermine whether a national home adaptation service, Care&Repair Cymru (C&RC), identified individuals at risk of falls occurring at home and reduced the likelihood o...

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Published in: Age and Ageing
ISSN: 0002-0729 1468-2834
Published: Oxford University Press (OUP) 2021
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URI: https://cronfa.swan.ac.uk/Record/cronfa58465
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Abstract: Backgroundfalls are common in older people, but evidence for the effectiveness of preventative home adaptations is limited.Aimdetermine whether a national home adaptation service, Care&Repair Cymru (C&RC), identified individuals at risk of falls occurring at home and reduced the likelihood of falls.Study Designretrospective longitudinal controlled non-randomised intervention cohort study.Settingour cohort consisted of 657,536 individuals aged 60+ living in Wales (UK) between 1 January 2010 and 31 December 2017. About 123,729 individuals received a home adaptation service.Methodswe created a dataset with up to 41 quarterly observations per person. For each quarter, we observed if a fall occurred at home that resulted in either an emergency department or an emergency hospital admission. We analysed the data using multilevel logistic regression.Resultscompared to the control group, C&RC clients had higher odds of falling, with an odds ratio (OR [95% confidence interval]) of 1.93 [1.87, 2.00]. Falls odds was higher for females (1.44 [1.42, 1.46]), older age (1.07 [1.07, 1.07]), increased frailty (mild 1.57 [1.55, 1.60], moderate 2.31 [2.26, 2.35], severe 3.05 [2.96, 3.13]), and deprivation (most deprived compared to least: 1.16 [1.13, 1.19]). Client fall odds decreased post-intervention; OR 0.97 [0.96, 0.97] per quarter. Regional variation existed for falls (5.8%), with most variation at the individual level (31.3%).ConclusionsC&RC identified people more likely to have an emergency fall admission occurring at home, and their service reduced the odds of falling post-intervention. Service provisioning should meet the needs of an individual and need varies by personal and regional circumstance.
Keywords: older people, falls prevention, frailty, falls
College: Swansea University Medical School
Funders: This work was supported by Health and Care Research Wales [Projects: HRG-16-1325, SCF-18-1504]; the Dunhill Medical Trust [Project BEHA\41] and Health Data Research UK [HDR-9006], which receives its funding from HDR UK Ltd funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust. This research has also been supported by the ADR Wales Programme of work.
Issue: 1