Home adaptation interventions: The Occupational Therapist’s role

A major issue for the society

In Quebec, for the elderly population, falls are an important issue with a major impact on independance. 20 to 30% of the elderly will fall one time or more in a year. Falls are the main cause of hospitalization for the elderly and it is also a cause of transfer a person to long-term facility (40% of the admissions in long-term care center are caused by the falls). Although 50% of falls cause minor injuries, 5 to 25% can result in moderate to severe injury. It should be noted that 50% of falls take place at home.

Most falls inside the home occur in the bathroom. It has been shown that home adaptation is an intervention that reduces the number of falls by 20%, and 41% in seniors with visual impairment. Home adaptation is an intervention done by the occupational therapist to reduce environmental barriers in order to encourage the person to participate in his or her daily activities. Prior to home adaptation, the occupational therapist will conduct a functional assessment at home. Below is a brief overview of the evaluation process and possible interventions.

Evaluation

Certain characteristics present in the elderly or in its environment can increase its vulnerability to fall: the risk factors.

We distinguish between those intrinsic to :

• the person (age, sex, history of fall, physical impairment, visual deficit, orthostatic hypotension, urinary incontinence, depression, fear of falling)
• related to the behaviors (routine, recklessness)
• related to the physical environment (cluttered room, carpet, stairs)
• related to the socio-economic environment (immediate surroundings, human and financial resources of the person)

These risk factors are listed in a conceptual framework: the Haddon matrix. The occupational therapist will use it to determine the most appropriate interventions for the person. The occupational therapist will also have to make a functional assessment of the abilities, including balance and walking tests, good predictors of the risk of fall, fracture and disabilities. Situations proposed by the occupational therapist can highlight the person’s daily difficulties in carrying out personal care and home management.

Possible interventions

According to the assessment, the occupational therapist may suggest minor home adaptations and the use of assistive devices as needed to reduce the risk of falls. Here are some examples:

• De-clutter a room to facilitate access;
• Secure carpets/electrical wiring;
• Improve corridor lighting at night;
• Secure the bathroom (grab bars, raised toilet seat, non-slip mat, bath bench, shower chair)
• Emergency call system installation (eg Lifeline, SécurMÉDIC, etc.)

If you have any questions, don’t hesitate to contact our occupational therapists.

By Marie-Lyne Chayer, Occupational Therapist

Références

• Bégin, C., Boudreault, V., & Sergerie, D. (2007). La prévention des chutes dans un continuum de services pour les aînés vivant à domicile.

• Bégin et al. (2014). Chutes Chez les aînés au Canada deuxième Rapport.

• Gagnon, C., & Lafrance, M. (2011). Prévention des chutes auprès des personnes âgées vivant à domicile: analyse des données scientifiques et recommandations préliminaires à l’élaboration d’un guide de pratique clinique: Institut national de santé publique du Québec.

• Stark, S., Keglovits, M., Arbesman, M., & Lieberman, D. (2017). Effect of home modification interventions on the participation of community-dwelling adults with health conditions: a systematic review. American journal of occupational therapy