Do Home Safety Changes Prevent Falls? What the Trials Found

If you are about to buy a grab bar, a shower chair or a raised toilet seat, it is fair to ask whether changes like these prevent falls. The best answer we found is a Cochrane review by Lesley Gillespie and colleagues, published in 2012, which pooled 159 trials with 79,193 people. It reports that about 30% of people over 65 living in the community fall each year. It is older than the exercise review we cover separately, but its home safety findings are the main trial evidence we found on the question.

What the Review Found

Interventions that assessed the home and made changes reduced the rate of falls (risk ratio 0.81, 95% confidence interval 0.68 to 0.97; 6 trials, 4,208 people) and the risk of falling (risk ratio 0.88, 0.80 to 0.96; 7 trials, 4,051 people). The first figure means about 19% fewer falls than without the intervention.

• Who benefited most. The effect was larger in people at higher risk of falling, including those with severe visual impairment.
• Who delivered it. Home safety interventions appeared more effective when an occupational therapist delivered them.
• Cost. Of 13 trials with a full economic evaluation across all topics, one showed savings for a home safety assessment and modification program, in people who had already fallen.

What Did Not Work Alone

Trials of education about fall prevention, on its own, did not significantly reduce falls (risk of falling, risk ratio 0.88, 0.75 to 1.03; 4 trials, 2,555 people). Reading a checklist is not enough. The review also reports that multifactorial programs, which assess several risks for each person, reduced the rate of falls but not the risk of falling, and that vitamin D overall did not reduce falls. It found that an intervention to treat vision problems increased falls in the trial it reports, a reminder that a change that sounds safe may not be.

What It Does Not Tell You

• It names no products. The trials tested assessments and packages of changes, such as removing hazards and fitting rails and equipment. They do not say that a grab bar, a shower chair or a raised toilet seat alone prevents a fall.
• It does not rank the changes. We cannot say from this review which change did the work.
• It is from 2012. Newer reviews exist, and we did not read them.

What to Do with This

The finding that an occupational therapist's visit may work better than a checklist is the practical point. Ask your doctor about a home safety assessment by an occupational therapist, especially if you have already fallen or have poor vision. Then buy equipment to fit the problems they find. Our bathroom checklist and the CDC's "Check for Safety" list are useful before the visit. Our guides on grab bars, shower chairs and raised toilet seats cover the products. For the exercise evidence, see what the Cochrane exercise review found.

Shopping for One?

Sources

• Gillespie LD, et al.: Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012
• CDC: Facts About Older Adult Falls
• CDC: Check for Safety, A Home Fall Prevention Checklist for Older Adults (2017)