A Comparison of Home Safety Education Methods to Prevent Falls: Healthcare Professional and Self-Directed Learning Sumandeep Saharan (Investigator), Machiko R Tomita, Ph.D. (Advisor) Department of Rehabilitation Science, School of Public Health and Health Professions, University at Buffalo ABSTRACT Objectives: Home safety education by healthcare professionals (HP) to prevent falls has evidence to be effective, but that of self-directed learning (SDL) by older adults, themselves, is unknown 1. Methods: This study compared effects of these two educational approaches through a two- group pretest-posttest design. Both groups used a Home Safety Self-Assessment Tool booklet that helps users identify fall risk factors in the home, find local resources for home modifications and useful products, and keep a log for home hazard reduction activities. The HP intervention provided detailed education for fall prevention in participants’ home while the SDL group was provided an instruction sheet regarding use of the booklet. Results: At follow-up, HP group reduced fear of falling (p.05). However, the HP intervention resulted in more home hazard reductions (M=8.4, SD=6.3) than SDL (M=4.1, SD=6.2) (p=.005). Conclusions: Within SDL, those with previous falls removed home hazards more than non- fallers (p<.014). Therefore, SDL using the booklet was effective in raising awareness of home hazards, in general and effective for people with previous falls in actual home hazard reduction. BACKGROUND Purpose The purpose of this study is to identify and compare the effectiveness of home safety education through SDL and home safety education provided by HP in community dwelling older adults with and without history of falls. Model The Transtheoretical Model of Behavior Change 2 Research Questions 1.Is there a difference between the two methods of home safety education (SDL and education provided by HP) in reducing the fear of falling among community-dwelling older adults with and without history of falls? 2.Is there a difference between HPs home safety education and SDL in bringing about change of stage in Transtheoretical Model among community dwelling older adults with and without history of falls? 3.Is there a difference between the two methods of home safety education (SDL and education provided by HP) in the number of home hazard reduction in community- dwelling older adults with and without history of falls? METHOD Study Design A two-group pretest-posttest design was used to compare two different home safety educational approaches. The time interval between pre-test and post-test was one month. Participants Data for 62 community-dwelling older adults aged 60 and above from Western New York were analyzed. Participants with cognitive impairments were not included for the study. Procedure for Analysis 1. Chi-Square and t-test statistics for sample characteristics. 2. Paired t-test, Wilcoxon signed-rank test, and Independent t-test for pre-test and post-test, and between SDL and HP. 3. ANCOVA for differences between SDL and HP. Measurement Demographics and other background information, Falls Efficacy Scale, Level of Stages of Change (Transtheoretical Model), Home Safety Self Assessment Tool (HSSAT) v3. RESULTS SUMMARY The most common hazards that were recognized in the home environment included the presence of clutter in various areas, inadequate lighting, slippery bathtub, inadequate footwear, and loose rugs. At follow-up the average number of hazards were reduced to 6.8 from 9.4 in each home. At the end of the follow-up visit most of the participants significantly reduced their home hazards. But this indicates that hazards still exist. SUMMARY AND CONCLUSION The type of hazards removed by the participants suggest that cost of modifications and the ease of making the changes are important factors for their decision to make a change. It is also evident that history of falls has an impact on the home hazards reduction. It was found that HSSAT v.3 is an effective tool for creating awareness about the home hazards and motivating older adults even when it is used by themselves without healthcare professionals. However, it was useful for actual home hazard reduction only for older adults with previous falls. Healthcare providers intervention was effective for home hazard reduction for older adults, in general, regardless their fall history. Health Professionals Mean (SD) or Frequency (%) Self-directed Learning Mean (SD) or Frequency (%) Difference Age 74.5 (8.79)79.3 (9.55) t = (p=.045) Gender Male =9 (75.0%) Female=27 (54.0%) Male=3 (25.0%) Female=23 (46.0%) χ² = (p=.186) Race Black= 8, White= 28, Native American= 0, Hispanic= 0, Others= 0 Black= 10, White= 12, Native American= 1, Hispanic= 2, Others= 1 χ² = (p=.055) Living Status Alone= 13 With Someone= 23 Alone= 19 With Someone= 7 χ² = (p=.004) Exercise No= 15, Yes= 21No= 7, Yes= 19 χ² = (p=.231) Medication List No= 12, Yes= 24No= 7, Yes= 19χ² =.292 (p=.589) Figure 1: Change in the Level of Fear of Falling Figure 2: Stage in Transtheoretical Model REFERENCES 1.Cumming, R. G., Thomas, M., Szonyi, G., Salkeld, G., O'Neill, E., Westbury, C., & Frampton, G. (1999). Home visits by an occupational therapist for assessment and modification of environmental hazards: a randomized trial of falls prevention. Journal of the American Geriatrics Society, 47(12), Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change. Applications to addictive behaviors. American Psychologist, 47(9), Table 1: Demographics Table 2: Ten Most Home Hazards Removal Made SDL HP SDL HP HP vs SDL HP SDL Figure 3: Home Hazard Reduction 1. Removed Clutter (Living Room)6. Installed nightlight (Bedroom) 2. Removed Clutter (Bedroom)7. Removed/rearranged furniture 3. Removed Clutter (Hallway)8. Wearing shoes with non-skid sole 4. Removed scatter rug (Kitchen)9. Secured rug to floor (Living Room) 5. Added bathmat (Bathroom)10. Removed Clutter (Bathroom)