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Provide special consideration to patients who are at an increased risk for falls due to impaired cognition or vision or to decreased strength or balance.
The Occupational Therapy Practice Guidelines for Home Modifications defines home modifications as adaptations to environments that are intended to increase use, safety, security, and independence.undefined#ref6">6 Modifications may include, but are not limited to, the use of medical equipment or universally designed products, architectural modifications or major home renovations, and education of the patient regarding new strategies to use in the home environment.6
Therapeutic intervention that includes home modifications may prevent premature long-term care by supporting aging in the home,3 as well as improve the patient’s functional performance and reduce the risk of falls and physical demands on caregivers.4 Additionally, home adaptations may reduce costs while older adults age in the home.6
When considering home modifications, the patient’s physical functionality is one of the main factors for the therapist to keep in mind.5 The therapist must also take into consideration the patient’s perception of the home modifications, readiness to change the environment, and costs.4 The therapist must work with the patient or caregiver (or both) and have the patient’s consent before making any changes in the home.
The home bathroom poses many risks for falls with and without injury and, in most cases, is a needed area of focus for home adaptations.3 Correct installation of grab bars by the toilet and shower has been identified as an important preventive measure to increase safety. Although the Americans with Disabilities Act has specific recommendations for grab bar installation, considering the patient’s individual needs through an assessment of the patient’s shower and toilet transfers is important.3 Grab bars may be installed horizontally, vertically, or transversely and should be fixed to the studs in the wall. Other considerations for grab bars include ensuring that the bars can accommodate the patient’s weight and preference for the diameter of the bar for comfortable fit in the hand. Seating in the shower, the use of bath rugs and tub mats, and the height of the toilet seat are additional areas to consider for home adaptations in the bathroom. These modifications make the bathroom safer for the patient, which is especially important because the bathroom is one of the most common sites for falls in the home.
Take note of preexisting conditions such as visual or hearing impairment, neuromuscular dysfunction, fatigue or reduced energy, and postural hypotension.
Kim, H. and others. (2014). Home modification by older adults and their informal caregivers. Archives of Gerontology and Geriatrics, 59(3), 648-656. doi:10.1016/j.archger.2014.07.012 (classic reference)*
Stevens, J.A., Mahoney, J.E., Ehrenreich, H. (2014). Circumstances and outcomes of falls among high risk community-dwelling older adults. Injury Epidemiology, 1(1), 5. doi:10.1186/2197-1714-1-5 (classic reference)*
*In these skills, a “classic” reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.
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