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

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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).

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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).

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• 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.

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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.

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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.

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Table 1. The Home Safety Self-Assessment Tool (HSSAT)HSSAT Sections Description1) 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 areaProvides 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

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Demographic Characteristics of Participants

• This study is ongoing.

• 63 participants have been enrolled in the study.

• 18 have completed the 30 day follow-up.

Characteristic 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 27.8 (5)

70-74 22.2 (4)

75-79 22.2 (4)

n= 18

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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.

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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 50.0

Did having this tool make you more aware of fall hazards in your home environment?*

21.4 57.1 21.4

Do you feel that your home is a safer place with the changes you have made?*

21.4 64.3 14.3

Would you recommend the HSSAT to patients with similar conditions?*

64.3 14.3 21.4

*n=14      

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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.

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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”.

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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.

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Thank you!

staceydahm@wustl.edu

©2010

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References• Amador, L. F., & Loera, J. A. (2007). Preventing postoperative falls in the older adult. J Am Coll Surg,

204(3), 447-453. doi: 10.1016/j.jamcollsurg.2006.12.010• Beers M.H., B. R. (2000). The Merck Manual of Geriatrics (3rd ed.). Whitehouse Station, NJ: Merck

Research Laboratories.• Horowitz, B. P., Nochajski, S. M., & Schweitzer, J. A. (2013). Occupational therapy community

practice and home assessments: use of the home safety self-assessment tool (HSSAT) to support aging in place. Occup Ther Health Care, 27(3), 216-227. doi: 10.3109/07380577.2013.807450

• Lord, S. R., Menz, H. B., & Sherrington, C. (2006). Home environment risk factors for falls in older people and the efficacy of home modifications. Age Ageing, 35 Suppl 2, ii55-ii59. doi: 10.1093/ageing/afl088

• Morgan, R. O., DeVito, C. A., Stevens, J. A., Branche, C. M., Virnig, B. A., Wingo, P. A., & Sattin, R. W. (2005). A self-assessment tool was reliable in identifying hazards in the homes of elders. Journal of Clinical Epidemiology, 58(12), 1252-1259. doi: DOI 10.1016/j.jclinepi.2005.04.001

• Prevention, N. C. f. C. D. C. a. (2011). Healthy Aging: Helping people to live long and productive lives and enjoy good quality of life.

• Sarharan, S., Tomita, M. A comparison of ohme safety education methods to prevent falls: healthcare professionsal and self-directed learning.

• Sattin, R. W. (1992). Falls among Older Persons - a Public-Health Perspective. Annual Review of Public Health, 13, 489-508. doi: DOI 10.1146/annurev.pu.13.050192.002421

• Tomita, M. (2013). Home Safety Self Assessment Tool (HSSAT) (Vol. 4). University of Buffalo: Occupational Therapy Geriatric Group.

• Tomita, M. R., Saharan, S., Rajendran, S., Nochajski, S. M., & Schweitzer, J. A. (2014). Psychometrics of the Home Safety Self-Assessment Tool (HSSAT) to Prevent Falls in Community-Dwelling Older Adults. Am J Occup Ther, 68(6), 711-718. doi: 10.5014/ajot.2014.010801