The influence of home modifications on falls in community-dwelling older adults: A systematic review

To reduce fall risk in the homes of community-dwelling older adults, various home modifications (e.g. grab bars, handrails, raised toilets) are recommended. These home modifications might enable older adults to remain independent and are purported to reduce falls. The combined and independent impact on falls is poorly constructed. The objective of this review was to understand the independent and combined influence of the type and location of home modifications on fall-related outcomes in community-dwelling older adults. Three databases (Web of Science, CINAHL, Medline) were searched to identify relevant randomized controlled trials. Studies were synthesized in a narrative (descriptive) results summary grouped by fall outcome, and categorized according to the specific home modifications. Of the 209 studies evaluated, nine met inclusion criteria and were from four different countries. The most common home modifications made were grab bar and handrail implementation. The results suggest that secure rails reduce the number of fallers and fall rates among community-dwelling older adults and implementing a combination of home modifications might reduce the number of fallers or cause no change. Future studies should develop strategies to improve intervention adherence and use a combination of technologies in a randomized control study design.