Development of the Japanese version of the Westmead Home Safety Assessment for the elderly in Japan

Falling of older adults with cognitive impairment: a new home environment evaluation chart and a preliminary examination in the Wakuya Project

It is important to evaluate the home environment because most fractures in older adults are caused by falls indoors. However, previous studies have not separated individual abilities from environments. Also, the interrelationship between falls, cognitive function, and home environments has not been clarified.

Objectives

The purpose of this study was to develop an evaluation method specific to the home environment and examine the effects of environment and cognitive impairment on falls.

Methods

This was a case-control study analyzing 95 older adults living in the community. A Visiting Checklist for the Home Environment (VICHe) was developed and examined for reliability and validity. Inter-rater reliability (IRR) was examined by determining Cohen's kappa and the intra-class correlation coefficient. Guttman's split-half method was used for internal consistency, and Cronbach's alpha coefficient was obtained. Criterion-related validity was confirmed by Spearman's rank correlation coefficient with the Fall Risk Index's (FRI) total score of the environmental factor items. As a preliminary study, trends in the number of falls by cognitive function and home environment were examined.

Results

The VICHe obtained validity, but the IRR was inadequate. In contrast, the version that focused on the on-floor environment (VICHe-OFI) showed IRR for all items and validity through correlations with the FRI. The number of fallers increased in the cognitive impairment group when the home environment was bad.

Conclusions

Reliability and validity of the VICHe-OFI were obtained. Preliminary examination using this scale indicates that falls in the home of the elderly may be more affected by the home environment as cognitive function declines.

What are the common areas of risk and their characteristics found in intermediate care from an occupational therapy perspective? A scoping review

Introduction

Engaging with risk is a certain and unavoidable part of occupational therapy. Intermediate care services are mostly accessed by older people with complex needs, yet little is known in the literature about the extent, type and nature of risk involved in these services.

Method

A scoping review was systematically conducted to map the common areas of risk (risk domains) from an occupational therapy perspective. Thematic analysis was conducted in order to identify the risk characteristics related to the literature reviewed.

Results

25 journal articles were identified and arranged into 10 risk domains: Falls, discharge, practice errors, activities of daily living, pressure care, frailty management, patient handling, loneliness, nutritional care and language barriers. Three risk characteristics were identified: (1) Risk awareness and identifying risk, (2) decision-making under risk and (3) improving safety.

Conclusion

Occupational therapists play a diverse role in migrating risk for older people which is not fully explored beyond addressing deficits in functional ability and hazardous environments. The process of how risk is controlled and reconciled with occupation and how positive risk-taking is facilitated are implicit and not directly addressed within the literature reviewed. The findings reveal gaps in knowledge and provide a foundation for further research.

Environmental hazards as risk factors for trips and slips at home among Japanese older people: A pilot study toward the development of a self-assessment tool for the home environment

AIM

Housing structures differ according to the local culture, climate, and lifestyle, and these unique characteristics usually act as potential hazards for falls, trips, and slips. The purpose of this study was to identify environmental hazards in a Japanese house and their association with falls, trips, and slips among older people.

METHODS

A total of 97 older people aged ≥75 years were included in this cross-sectional study. The number of environmental hazards was measured using a 46-item tool designed specifically for this study, and the associations of environmental hazards with falls, trips, and slips were analyzed using univariate and multivariate logistic regressions.

RESULTS

All houses had at least one environmental hazard, and 3-30 environmental hazards were identified. Although the number of environmental hazards was not associated with falls experienced during the past 6 months, a greater number of environmental hazards at home was correlated with the daily experience of trips and slips (odds ratio [OR]: 1.10; 95% confidence interval [CI]: 1.02-1.18). The association remained significant even after adjusting for demographic characteristics and other fall risk factors (OR: 1.11; 95% CI: 1.02-1.21).

CONCLUSION

We found that Japanese housing structures had unique environmental hazards that might cause trips and slips in older people. Appropriate housing assessments and modifications may help to promote aging-in-place among older people. Geriatr Gerontol Int 2022; 22: 305-310.