Date Presented 04/05/19
Cognitive problems, physical disabilities, and visual-perceptual impairment can heighten the risk of falls and other safety hazards in the chronically ill, sheltered homeless. This study demonstrated that environmental modifications and training may have contributed to the reduction of home safety events in a small group of prematurely aged, sheltered homeless. OT services are needed to help this underserved population remain safe and maintain housing once received.
Primary Author and Speaker: Sharon Gutman
Additional Authors and Speakers: Derek Douglas, Amber Carmiencke, Lauren Freudman, Maria Huerta, Matthew McCaa, Sam Miller, Alisha Sherpa, Miles Viant, Diane Schreibman
PURPOSE: Chronic homelessness prematurely ages people and increases the risk of major systemic disease including cardiopulmonary, circulatory, and musculoskeletal disease. Although the association between chronic homelessness and disease has been well documented, little is understood regarding how disability impacts the sheltered homeless population’s ability to stay safe in and maintain temporary or permanent supported housing. Cognitive problems, physical disabilities, and visual-perceptual impairment can heighten the risk of falls and other safety hazards. The purpose of this pilot study was to determine if environmental safety modifications and training could reduce falls, near falls, ER visits, and hospitalizations in a small group of sheltered homeless adults residing in temporary housing, who were identified as prematurely aged and chronically ill, and who experienced multiple falls in the previous year. Our research question asked whether home safety training and modifications could decrease the frequency of the above noted home safety events occurring in a 1-year time period.
DESIGN: This study used a one group pretest-posttest design with data collected retrospectively 1-year before intervention and prospectively 1-year after intervention. Participants were a group of sheltered adults who had been identified by a housing agency director as prematurely aged, chronically ill, and having experienced multiple falls in the previous year. Inclusion criteria consisted of (1) shelter residency for at least 1 year so that a 1-year fall history could be obtained; (2) attaining a home safety score at the 95th percentile or above on the Safety Assessment of Function and the Environment for Rehabilitation (SAFER), indicating the presence of disability that posed severe safety risk; (3) having a history of chronic homelessness; (4) having independent legal guardian status; and (5) speaking English as a primary or secondary language.
METHOD: The frequency of five home safety events was tallied and collected retrospectively 1-year pre-intervention and prospectively 1-year post-intervention: fall frequency, near fall frequency, ER visits secondary to a fall, hospitalizations secondary to a fall, and total home safety events. The provision of environmental modifications occurred over 3 weeks and was accompanied by individual 1-hour training sessions for each participant in the appropriate use of equipment and supplies. Information about each participant’s home safety events 1-year prior to intervention implementation was collected retrospectively by a housing agency director. One year after intervention implementation, the housing agency director provided a written record of all participant documented home safety events that occurred in the year after intervention provision. Data were analyzed categorically using a McNemar test; effect sizes were calculated using Cohen’s d.
RESULTS: Ten participants completed the study. Comparisons of mean frequencies for five home safety events between pre- and post-intervention were found to be statistically significant with large effect sizes: falls (p<.004, d=3.03), near falls (p<.04, d=0.84), ER visits (p<.007, d=2.27), hospitalizations (p<.01, d=1.66), and total home safety events (p<.000, d=1.431).
CONCLUSION: This study demonstrated that environmental modifications and training may have contributed to the reduction of home safety events in a small group of sheltered homeless identified as chronically ill and having fall histories. The study provides preliminary support for the need for occupational therapy services to help this underserved population remain safe in and maintain housing placement once received.
References
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