& Susan Stark, PhD, OTR/L, FAOTA A Home Safety Self-Assessment Tool for Older Adults before Surgery: A Feasibility Study Stacey J. Dahm, MSOT/S, Emily Somerville, OTR/L, Hannah Maybrier, Michael Avidan, MB, BCh, & Susan Stark, PhD, OTR/L, FAOTA

Falls are a serious concern for older adults after surgery. Older adults are the fastest growing segment of the population (Prevention, 2011). Older adults receive 1/3rd of all surgical procedures (Beers, 2000). Older adults have a higher risk for falls after surgery, yet are typically not targeted for fall prevention (Amador & Loera, 2007). Falls are the primary cause of long-term disability, premature institutionalization, and injury-related mortality in the older adults (Sattin, 1992).

Home Hazard Evaluations Home hazard evaluations target a reduction in environmental fall hazards. Environmental home hazards are related to fall risk (Lord, Menz, &Sherrington, 2006). Self-assessments may help access more older adults who do not receive occupational therapy services. The Home Environment Survey (HES) was a reliable method for self-identifying home hazards (Morgan et al., 2005).

Created at the University of Buffalo by Machiko R. Tomita. Content validity (.98), test-retest reliability (.97), and interrater reliability (.89) have been established (Tomita, Saharan, Rajendran, Nochajski, & Scheritzer, 2014). A focus group indicated that older adults would use the HSSAT to assess their homes and would consider making modifications (Horowitz, Nochajski, &Schweitzler, 2013). No research shows the feasibility of this approach with the post-surgical population.

Purpose of this study To assess the feasibility of using a self-administered Home Safety Self-Assessment Tool (HSSAT) in a population of older adults before surgery.

Methods: This is a sub-study of the Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndrome study (ENGAGES). Participants were recruited at the Center for Preoperative Assessment and Planning (CPAP) at Barnes Jewish Hospital in St. Louis. Eligible participants were community dwelling people over 60 years old who were scheduled to have an elective major surgery. Participants were provided with the HSSAT and asked to conduct the assessment prior to surgery.

Table 1. The Home Safety Self-Assessment Tool (HSSAT) HSSAT Sections Description 1) Instructions, checklist to identify home hazards, and common solutions for each area of the home The safety checklist illustrates 66 home hazards and lists common solutions for hazards in the following areas of the home: entrances to the front door, entrances to the back/side door, hallways/foyers, living room, kitchen, bedroom, bathroom, staircases, and laundry room/basement. 2) Total number of home hazards form Summarizes the number of home hazards found in each room and total number of fall hazards. 3) Assistive Devices and Helpful Products to Prevent Falls Includes descriptions and pictures for recommended devices. 4) “How To” Home Improvement Instruction Includes steps to make common home improvement changes with before and after pictures. 5) Tips for Fall Prevention List of 17 general suggestions to reduce fall risk. 6) Housing Resources for St. Louis area Provides listings of business in the greater St. Louis area that provide home modifications and durable home medical equipment. 7) Action Log Summarizes established action plans to reduce environmental fall hazards.

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Methods At 30 days post surgery participant’s reported (via telephone) the feasibility of completing the HSSAT

Demographic Characteristics of Participants Percent (n) Gender   Male 55.6 (10) Race White 94.4 (17) African American 5.6 (1) Age 60-64 27.8 (5) 65-69 70-74 22.2 (4) 75-79 This study is ongoing. 63 participants have been enrolled in the study. 18 have completed the 30 day follow-up. Participants were an average of 70.1 years (SD =6.1) n= 18

Results: Completion of the HSSAT 2 participants filled out the HSSAT. 1 Male and 1 Female Caucasian Ages 64 and 73 One participant made changes to their home. Felt their home was safer because of the changes. Both felt the information was useful and appropriate for this population.

Post-Intervention Survey Results of People who Did Not Complete the HSSAT (n=16) Survey Question % Yes % No % Unsure Did you find the information in the fall prevention packet useful? 50.0 31.3 18.8 Do you plan to use the HSSAT in the future?* 14.3 35.7 Did having this tool make you more aware of fall hazards in your home environment?* 21.4 57.1 Do you feel that your home is a safer place with the changes you have made?* 64.3 Would you recommend the HSSAT to patients with similar conditions?* *n=14   64.3% of the participants who did not complete the HSSAT reported they may fill it out in the future.

Discussion The HSSAT is not a feasible fall prevention strategy for older adults scheduled to have an elective surgery. Stressful/busy time Need for direct health services More home hazards were removed by OT(Sarharan et al.). Interrater reliability established with two OT’s (Tomita et al., 2014). Older adults vary by how many home hazards they identify (Tomita et al., 2014). Variables affect how older adults respond to HSSAT Our study sample had no falls in the past 90 days. Older adults with no fall history did not remove home hazards (Sarharan et al.). Readiness to Change 88.9% did not complete the HSSAT. 35.7% will not complete. 64% may complete. Interrater reliability was established with two occupational therapists (Tomita et al., 2014) – may suggest they are more accurate at identifying home hazards. During past studies, ots provided and explained how to use the HSSAT before the older adults did it. Some particpants recognized many risk factors and others did not notice as many indicating older adults are not a homogenous group and variables can affect how they respond to HSSAT questions. – shows that ots are more accurate and we need to look into specific populations for HSSAT use. – or caregivers.(Tomita, 2014) More time may be needed to make changes: 1 study said 78% of changes were made at 3mo post ot. (tomita Rahendron)

Limitations Ongoing project/ findings to date Small sample size (n=18) 94.4% Caucasian Non-representative of St. Louis Area We do not have access to the completed paper HHSAT assessment. Some people were unable to go home between consent and surgery. Survey question was worded, “Did you complete the HSSAT before surgery”.

Future Research Record # of falls for individuals who completed HSSAT. Compare to falls of person who received an OT home visit. Analyze if completion is impacted by prior fall risk and state of change. Future follow-up participants have a fall history. Caregiver Involvement Receptivity of having HSSAT conducted by health professionals. Since this population is at a high risk for falls, they may require a more directed approach for home fall prevention, such as having a trained professional conduct the home hazard assessment.

Thank you! staceydahm@wustl.edu ©2010

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