Evaluation of a Fall Prevention Program to Reduce Fall Risk and Fear of Falling Among Community-Dwelling Older Adults and Adults with Disabilities

Abstract

Purpose

The overarching goal of the program evaluation was to determine the reach and impact of the District-funded Safe At Home (SAH) modification program in reducing falls, fall injuries, and fear of falls among community-dwelling older adults and adults with disabilities. The SAH program has served over 6000 adults since 2016, the majority of whom are women (79%) and over age 60 (92%).

Materials and Methods

Letters were mailed in September 2022 to clients (n=492) who had home modifications completed between October 2021-March 2022 inviting them to participate in a brief phone survey about program satisfaction, falls, fall location, and severity. The validated Fall Efficacy Scale (FES) was administered pre (at first visit), post (at last visit), and during the phone survey (within 6 months to 1 year of program completion) to assess fear of falling. The response rate was 55% (n=241).

Results

Older adults (n=219) and adults with disabilities (n=22) reported high program satisfaction. Most clients, 79%, did not report a fall since the completion of the home modifications. The majority of falls reported, 76%, occurred inside the home. The average evaluation FES score was 32.5 (SD=22.6, range 10–100), indicating relatively low fear of falling. Higher FES scores were associated with a greater likelihood of reporting a fall (r=0.44, p < 0.001, n=51) and older age (r = 0.17, p < 0.01). FES scores were not related to gender. Evaluation FES scores were significantly lower than the pre-FES scores, indicating a reduction in fear of falling and positive impact of the home modifications (T(107) = 5.14, p < 0.001).

Conclusion

The client-centered SAH program demonstrates significant reductions in falls, fear of falling, and high satisfaction among clients. Recommendations include program expansion to offer other evidence-based components to reduce falls and support safe aging in place.

Keywords:

• program evaluation
• home modification
• fall efficacy scale
• FES
• injury
• prevention
• independent living

Acknowledgments

Thanks to the Safe at Home program participants for their time and willingness to complete the phone survey to support this evaluation. We also thank Louise Benning, Lily Duboff, Janvier Richardson, and Samuel Siktar for their many valuable contributions with data collection and analysis support. We express our gratitude to the DACL and Home Care Partners program staff for their support, especially Kathy Gessner, Melanie Johnson, Jessica Smith, Rinaldo Washington, and Elexa Waugh. Thank you to Anastasia Snelling for providing leadership, guidance, and support on all aspects of this project.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was supported by the District of Columbia Department of Aging and Community Living (DACL) (American University, ID 37313).