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Title: Environmental Assessment and Modification to prevent Falls in Older People
Author: Pighills, Alison Catherine
ISNI:       0000 0001 3490 3943
Awarding Body: University of York
Current Institution: University of York
Date of Award: 2008
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Falls in older people are frequent and associated with physical and psychological trauma. Due to an ageing population, prevalence is increasing. The government produced guidelines recommending that following falls people should receive an environmental assessment, aiming to reduce home falls hazards and subsequent falls. However, an association between environmental factors and falls has not been established, even though the cause of most falls is ascribed as environmental. Evidence suggests that interventions aiming to reduce environmental variables may be effective if professionally prescribed and targeted toward those at higher risk. This pilot tested the methods for a randomised controlled trial (RCT) to investigate the effectiveness of qualified occupational therapists compared to unqualified trained assessors in assessing and modifying the home environment of people at risk of falls. A three armed RCT design was used to pilot the methods for a multicentre trial and to investigate the effectiveness of occupational therapist (aT) or trained assessor (TA) led environmental assessment compared to a usual care control group. Fear of falling was the surrogate primary outcome measure and an analysis of covariance was carried out on the area under the curve at six months. Secondary outcome measures (falls and time to first fall) were analysed using negative binomial regression and survival analysis. Results: The intervention had no impact on fear of falling (p=O.6). Falls were fewer in the aT and TA groups compared to controls. Falls were significantly lower in the aT group, compared to controls, six months post assessment (RR=0.54, 95% CI: 0.34 to 0.86). Conclusion: Environmental assessment had no impact on fear of falling or falls post randomisation. However, professionally prescribed assessment significantly reduced the number of falls and increased time to first fall six months post environmental assessment. This result was arrived at through secondary analysis thus requires further empirical investigation.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available