Relationship between home hazards and falling among community-dwelling seniors using home-care services

Evidence linking home hazards to falls has not been well established. The evidence-based approach to fall-risk assessment in longitudinal studies becomes difficult because of exposures that change during follow-up. We conducted a cohort study to determine the prevalence of hazards and to resolve whether they are linked to the risk of falls among 959 seniors receiving home-care services. A home hazards assessment was completed at entry and every six months thereafter using a standardized form. The adjusted (for a number of confounding factors) relationship between home hazards and falls was estimated using a survival model taking into account updated time-varying exposures and multiple events. Falls leading to a medical consultation were examined as a secondary outcome, hypothesized as a measure of severity. Home environmental hazards were found in 91% of homes, with a mean of 3.3 risks per individual. The bathroom was the most common place for hazards. The presence of hazards was significantly associated with all falls and fall-related medical consultations, and showed relatively constant effects from one fall to another. The current study is innovative in its approach and useful in its contribution to the understanding of the interaction between home environmental hazards and falls. Our results indicate that inattention to changes in exposure masks the statistical association between home hazards and falls. Each environmental hazard identified in the home increases the risk of falling by about 19%. These findings support the positive findings of trials that demonstrate the effectiveness of this home hazard reduction program, particularly for at-risk people. La présence d’éléments de risque au domicile des aînés est un déterminant des chutes qui semble évident. Pourtant, aucune étude observationnelle n’avait pu établir avec certitude de liens à cet égard. Certains chercheurs attribuent cette particularité au fait que les expositions peuvent changer pendant le suivi, fait dont les analyses doivent tenir compte. Notre étude entreprise auprès de 959 aînés recevant des services de soutien à domicile avait pour but d’établir la prévalence des risques environnementaux selon leur endroit dans la maison et de déterminer s’ils sont liés au risque de chutes. L’évaluation était caractérisée par la prise de mesures répétées de facteurs de risque personnels et environnementaux au domicile des participants ainsi que par une relance téléphonique mensuelle permettant de d