The Home Falls and Accidents Screening Tool (HOME FAST) was developed as a screening instrument for use in a community preventive care trial for older people. This paper describes the first stage of the development of this screening tool. The objectives of the study were (i) to review existing home safety measures, (ii) to field test an instrument containing a pool of home safety items with the goal of identifying those hazards associated with falls in the home and (iii) to select the items for inclusion in a 25-item tool using an expert panel.
The field testing took place in a rural area of Australia, where the pooled checklist was used to evaluate hazards within the homes of 83 older people. No individual hazards were associated with the risk of falls at home and, although participants who had experienced falls had a higher mean number of home hazards (mean = 13.7, SD 8.2), the differences between fallers and non-fallers was not significant. Items relevant to a rural population were indicated through field testing. Further psychometric testing of the HOME FAST and a meaningful method of scoring the checklist are now warranted.
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References
1.
ArcheaJ (1985) Environmental factors associated with stair accidents by the elderly. Clinics in Geriatric Medicine, 1 (3), 555–69.
2.
Australian Bureau of Statistics (1996) Falls risk factors for persons aged 65 years and over in New South Wales (Vol 4393.1). Sydney: Australian Bureau of Statistics.
3.
Australian Health Ministers Conference (1994) National Rural Health Strategy. Canberra: Australian Government Publishing Service.
4.
BaldwinRCravenRDimondM (1996) Falls: are rural elders at greater risk?Journal of Gerontological Nursing, 22 (8), 14–21.
5.
BowlingA (1997) Research methods in health. Buckingham: Open University Press.
6.
BuriH (1997) A group programme to prevent falls in elderly hospital patients. British Journal of Therapy and Rehabilitation, 4 (10), 550–57.
7.
CampbellAJBorrieMJSpearsGFJacksonSLBrownJSFitzgeraldJL (1990) Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study. Age and Ageing, 19, 136–41.
8.
CarpenterI (1996) Value of screening in old age. In: EbrahimSKalacheA, eds. Epidemiology in old age. London: BMJ Publishing Group.
9.
CarterSCampbellESanson-FisherRRedmanSGillespieW (1997) Environmental hazards in the homes of older people. Age and Ageing, 26, 195–202.
10.
Centre for Clinical Epidemiology and Biostatistics (1997) Preventive care trial. Establishment report. Newcastle, Australia: University of Newcastle.
11.
ClemsonL (1997) Home fall hazards and the Westmead Home Safety Assessment. West Brunswick, Australia: Co-ordinates Publications.
12.
ClemsonLRolandMCummingR (1992) Occupational therapy assessment of potential hazards in the homes of elderly people: an inter-rater reliability study. Australian Occupational Therapy Journal, 39, 23–26.
13.
ClemsonLCummingRRolandM (1996) Case-control study of hazards in the home and risk of falls and hip fractures. Age and Ageing, 25, 97–101.
14.
ClemsonLRolandMCummingR (1997) Types of hazards in the homes of elderly people. Occupational Therapy Journal of Research, 17 (3), 200–13.
15.
ClemsonLFitzgeraldMHeardR (1999) Content validity of an assessment tool to identify home fall hazards: the Westmead Home Safety Assessment. British Journal of Occupational Therapy, 62 (4), 171–79.
16.
CloseJEllisMHooperRGlucksmanEJacksonSSwiftC (1999) Prevention of falls in the elderly trial (PROFET): a randomised controlled trial. The Lancet, 353, 93–97.
17.
Community Occupational Therapists and Associates (1991) The SAFER Tool. Toronto: Community Occupational Therapists and Associates.
18.
CowardRLeeG (1985) The elderly in rural society. New York: Springer.
19.
CummingRThomasNSzonyiGSalkeldGO'NeillEWestburyCFramptonG (1999) Home visits by an occupational therapist for assessment and modification of environmental hazards: a randomised trial of falls prevention. Journal of the American Geriatrics Society, 47, 1397–1402.
20.
DeilyJ (1989) Home safety programme for older adults. Occupational Therapy in Health Care, 6 (1), 113–24.
21.
DelbecqAvan de VanA (1971) A group process model for problem identification and programme planning. Journal of Behavioural Science, 7, 465–92.
22.
DiGuiseppiC (1996) Counselling to prevent household and recreational injuries. In: US Preventive Screening Task Force, ed. Guide to clinical preventive services. 2nd ed.Baltimore: Williams and Wilkins, 659–85.
23.
FabacherDJosephsonKPietruszkaFLinderhornKMorleyJRubensteinL (1994) An in-home preventative assessment programme for independent older adults: a randomised controlled trial. Journal of the American Geriatrics Society, 42 (6), 630–38.
24.
GardnerMAltmanD (1988) Confidence intervals rather than p values: estimation rather than hypothesis testing. British Medical Journal, 292, 746–50.
25.
GillespieLGillespieWCummingRLambSRoweB (1999) Interventions for preventing falls in the elderly (Cochrane Review). The Cochrane Library, Issue 1. Oxford: Update Software.
26.
GissaneC (1998) Understanding and using descriptive statistics. British Journal of Occupational Therapy, 61 (6), 267–72.
27.
HahnAvan BeurenEKemptonASladdenTGarnerE (1996) Meeting the challenge of falls prevention at the population level: a community-based intervention with older people in Australia. Health Promotion International, 11 (3), 203–11.
28.
HarrisMBylesJHigginbothamNNairN (1997) Preventive programmes for older people: how effective are they?Australian Journal on Ageing, 15 (4), 148–53.
29.
HornbrookMStevensVWingfieldDHollisJGreenlickMOryM (1994) Preventing falls among community-dwelling older persons: results from a randomised trial. The Gerontologist, 34 (1), 16–23.
30.
IwarssonS (1996) Housing standards, environmental barriers in the home and subjective general apprehension of housing situation among the rural elderly. Scandinavian Journal of Occupational Therapy, 3 (2), 52–61.
31.
Kellogg International Work Group (1987) The prevention of falls in later life: a report of the Kellogg International Work Group on prevention of falls in the elderly. Danish Medical Bulletin, 34 (Suppl.4), 1–24.
32.
LarsonKStevens-RatchfordRPedrettiLCrabtreeJ (1996) The role of OT with the elderly. Bethesda, MD: American Occupational Therapy Association.
33.
LettsLMarshallL (1995) Evaluating the validity and consistency of the SAFER tool. Physical and Occupational Therapy in Geriatrics, 13 (4), 49–66.
34.
LettsLScottSBurtneyJMarshallLMcKeanM (1998) The reliability and validity of the safety assessment of function and the environment for rehabilitation (SAFER Tool). British Journal of Occupational Therapy, 61 (3), 127–32.
35.
LiddleJMarchLCarfraeBFinneganTDruceJSchwarzJBrooksP (1996) Can occupational therapy intervention play a part in maintaining independence and quality of life in older people? A randomised controlled trial. Australian and New Zealand Journal of Public Health, 20 (6), 574–78.
36.
LilleyJArieTChilversC (1995) Accidents involving older people: a review of the literature. Age and Ageing, 24, 346–65.
37.
LordSWardJWilliamsPAnsteyK (1993) An epidemiological study of falls in older community-dwelling women: the Randwick falls and fractures study. Australian Journal of Public Health, 17 (3), 240–45.
38.
LynnM (1986) Determination and quantification of content validity. Nursing Research, 35, 382–85.
39.
McDowellINewellC (1987) Measuring health — a guide to rating scales and questionnaires. New York: Oxford University Press.
40.
McEwanRDavisonNForsterDPearsonPStirlingE (1990) Screening elderly people in primary care: a randomised controlled trial. British Journal of General Practice, 40, 94–97.
41.
McLeanDLordS (1996) Falling in older people at home: transfer limitations and environmental risk factors. Australian Occupational Therapy Journal, 43, 13–18.
42.
MillsteadJ (1997) The contribution of occupational therapy to the fabric of Australian rural and remote communities. Australian Occupational Therapy Journal, 44, 95–106.
43.
NH&MRC (National Health and Medical Research Council) (1994) Falls and the older person. Series on Clinical Management Problems in the Elderly 6. Canberra: Commonwealth of Australia.
44.
NHS Centre for Reviews and Dissemination (1996) Effective health care — preventing falls and subsequent injury in older people. York: University of York.
45.
NorthridgeMNevittMKelseyJLinkB (1995) Home hazards and falls in the elderly: the role of health and functional status. American Journal of Public Health, 85, 509–15.
46.
NSW Department of Health (1992) Stay on your feet — a falls prevention programme for older people by older people. Sydney: NSW Department of Health.
47.
NSW Department of Health (1995) Falls prevention in older people campaign — report on the baseline survey. Sydney: NSW Department of Health.
48.
OliverRBlathwaytJBrackleyCTamakiT (1993) Development of the Safety Assessment of Function and the Environment for Rehabilitation (SAFER) Tool. Canadian Journal of Occupational Therapy, 60, 78–82.
49.
PaganoMGauvreauK (1993) Principles of biostatistics. Belmont, California: Wadsworth Inc.
50.
ParkerMTwemlowTPryorG (1996) Environmental hazards and hip fractures. Age and Ageing, 25, 322–25.
51.
RodriguezJBaughmanASattinRDeVitoCRaglandDBacchelliSStevensJ (1995) A standardised instrument to assess hazards for falls in the homes of older persons. Accident Analysis and Prevention, 27, 625–31.
52.
RogersJ (1989) The occupational therapy home assessment: the home as a therapeutic environment. Journal of Home Health Care Practice, 2 (1), 73–81.
53.
SattinRLambert-HuberDDeVitoCRodriguezJRosABacchelliSStevensJWaxweilerR (1990) The incidence of fall injury events among the elderly in a defined population. American Journal of Epidemiology, 131 (6), 1028–37.
54.
SawC (1996) Rural aspects of health and ageing. Journal of Occupational Science: Australia, 3 (3), 114–17.
55.
SlocumbEColeF (1991) A practical approach to content validation. Applied Nursing Research, 4, 192–200.
56.
SpencerJ (1991) The physical environment and performance. In: ChristiansenCBaumC, eds. Occupational therapy: overcoming human performance deficits. Thorofare, NJ: Slack.
57.
StataCorp (1997) Stata statistical software: Release 5.0. College Station, TX: Stata Corporation.
58.
SteinfeldESchroederSDuncanJFasteRCholletDBishopMWirthPCardellP (1979) Access to the built environment: a review of literature. Washington, DC: US Government Printing Office.
59.
StreinerDNormanG (1991) Health measurement scales — a practical guide to their development and use. New York: Oxford University Press.
60.
ThompsonP (1996) Preventing falls in the elderly at home: a community-based programme. Medical Journal of Australia, 164, 530–32.
61.
TinettiMBakerDMcAvayGClausEGarrettPGottschalkMKochMTrainorMHorwitzR (1994) A multifactorial intervention to reduce the risk of falling among elderly people living in the community. New England Journal of Medicine, 331 (13), 821–27.
62.
TudiverFFerrisL (1992) Creating an original measure. In: StewartMTudiverFBassMDunnENortonP, eds. Tools for primary care research. Newbury Park, CA: Sage.
63.
UrtonM (1991) A community home inspection approach to preventing falls among the elderly. Public Health Reports, 106, 192–95.
64.
van RossumEFrederiksCPhilipsenHPortengenKWiskerkeJNipschildP (1993) Effects of preventive home visits to elderly people. British Medical Journal, 307, 27–32.
65.
WalkerCStevensonM (1993) Reducing falls at home: a protocol for use with older people. Health Promotion Journal of Australia, 3 (3), 23–25.
66.
WeissJ (1988) The ‘Feeling Great!’ Wellness Programme for Older Adults. New York: Haworth Press.
67.
WhitakerJHornsbyJ (1986) A review of home visits by occupational therapists in a geriatric assessment unit. British Journal of Occupational Therapy, 49 (11), 365–66.
