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Reducing hazard related falls in people 75 years and older with significant visual impairment: how did a successful program work?
  1. S J La Grow1,
  2. M C Robertson2,
  3. A J Campbell2,
  4. G A Clarke2,
  5. N M Kerse3
  1. 1School of Health Sciences, Massey University, Palmerston North, New Zealand
  2. 2Department of Medical and Surgical Sciences, University of Otago Medical School, Dunedin, New Zealand
  3. 3School of Population Health, University of Auckland, Auckland, New Zealand
  1. Correspondence to:
 Dr M Clare Robertson
 Department of Medical and Surgical Sciences, Dunedin School of Medicine, PO Box 913, Dunedin, New Zealand; clare.robertson{at}


Background: In a randomized controlled trial testing a home safety program designed to prevent falls in older people with severe visual impairment, it was shown that the program, delivered by an experienced occupational therapist, significantly reduced the numbers of falls both at home and away from home.

Objectives: To investigate whether the success of the home safety assessment and modification intervention in reducing falls resulted directly from modification of home hazards or from behavioral modifications, or both.

Methods: Participants were 391 community living women and men aged 75 years and older with visual acuity 6/24 meters or worse; 92% (361 of 391) completed one year of follow up. Main outcome measures were type and number of hazards and risky behavior identified in the home and garden of those receiving the home safety program, compliance with home safety recommendations reported at six months, location of all falls for all study participants during the trial, and environmental hazards associated with each fall.

Results: The numbers of falls at home related to an environmental hazard and those with no hazard involved were both reduced by the home safety program (n = 100 participants) compared with the group receiving social visits (n = 96) (incidence rate ratios = 0.40 (95% confidence interval, 0.21 to 0.74) and 0.43 (0.21 to 0.90), respectively).

Conclusions: The overall reduction in falls by the home safety program must result from some mechanism in addition to the removal or modification of hazards or provision of new equipment.

  • falls prevention
  • elderly people
  • visual impairment
  • environmental hazards

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  • The project was funded by the Health Research Council of New Zealand. The funders had no role in the conduct, analysis, or reporting of the trial.

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