Effects of Home Modifications on Falls and Participation in PACE

1. Study Purpose Background Results References Methods Discussion Effects of Home Modifications on Falls and Participation in PACE Jennifer Gardner, OTD, OTR1, Claire Mulry, OTD, OTR1, Holly Hardaway, OTR2, Kimberly Syers1, Kelly Scimeca1, Christopher Curcio1, Monica Shah1, & Louis Herrera11Kean University, Union, NJ; 2Independent Domain, LLC, Franklin Park, NJ • Aging in Place • Older adults are the fastest growing demographic in the United States(U.S. Department of Health and Human Services, 2012) • Many older adults wish to reside at home in the community (Wiles, Leibing, Guberman, Reeve, & Allen, 2012). • Older adults living at home are at a risk for falls (Center of Disease Control and Prevention, 2012) • Program of All-inclusive Care for the Elderly (PACE) • Provides health care for people 55 years or older whose disability level makes them eligible for nursing home care but who choose to reside in the community (Mukanmel & Temkin-Greenerow, 2007) • Care is provided by an interdisciplinary team that includes: physicians; nurses; occupational, physical and recreational therapists; nutritionists; dentists and social workers (Hansen & Hewitt, 2012) • Funded by Medicare and found to improve quality of care and access to services (Wieland, Boland, Baskins & Kinosian, 2010) • Home Modification • Defined as any change made to the home environment (including physical, cultural, social, virtual and/or temporal environments) based on the recommendations of a home safety assessment performed by an occupational therapist. The purpose of the current study was to examine the relationship between home modifications and their impact on falls and participation in a group of community dwelling PACE participants from LIFE St Francis in Trenton, NJ. • 5 participants completed the study • 4/5 participants reported 0 falls since their home modification • 100% of the participants reported an increase in their ability to do the things they need and want to do since the home modifications • 4/5 reported an increase in their confidence to do the things they need and want to do since homemodifications • No statistically significant correlationswere found between falls and home modifications or falls and participation • Despite no statistically significant correlation between home modifications and falls, all participants reported increased confidence in participation after home modifications were implemented • The findings demonstrate potential for home modifications to enhance client participation in occupations • Future researchers should: • Use a larger sample size to allow for greater generalizability • Include a pre and post test • Include those who have a mild to moderate cognitive deficits Home Modification by Environment • Inclusionary Criteria • Enrollment in PACE August 2012 – January 2013 • Implementation of home modifications based on recommendations of a home safety assessment • English speaking • SLUMS exam score in normal range • Outcome Measures • Demographics • Age Range: 58-73 • Gender: 3 Female, 2 Male • Race: 100% Caucasian • Fall Frequency • Home Modifications Implemented • Participation Survey • Data Analysis • Spearman rank correlation of relationship among number of falls and Likert scores related to ability, confidence and number of home modifications. Centers for Disease Control and Prevention. (2012). Falls among older adults: An overview. Retrieved from http://www.cdc.gov/HomeandRecreationalSafety/ Falls/adultfalls.htmlHansen, J. C., & Hewitt, M. (2012). PACE provides a sense of belonging for elders. Generations, 36(1), 37-43. Mukamel, D., Peterson, D., Temkin-Greener, H., Delavan, R., Gross, D., Kunitz, S., & Williams, T. (2007). Program characteristics and enrollees' outcomes in the Program of All-Inclusive Care for the Elderly (PACE). The Milbank Quarterly, 85(3), 499-531. U. S. Department of Health and Human Services. (2012). Healthy people 2020: Improving the health of Americans. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/overvi ew.aspx?topicid=31Wiles, J., Leibing, A., Guberman, N., Reeve, J., & Allen, R. (2012). The meaning of "aging in place" to older people. The Gerontologist,52(3), 357-366. Wieland, D., Boland, R., Baskins, J., & Kinosian, B. (2010). Five-year survival in a program of all-inclusive care for elderly compared with alternative institutional and home- and           community-based care. Journals of Gerontology Series A: Biological Sciences & Medical Sciences, 65(7), 721-726. doi:10.1093/gerona/glq040 Number of Respondents Number of Respondents Since the changes have been made to my home to make it safer, my confidence in doing the things that I need to do has increased: Since the changes have been made to my home to make it safer, my confidence in doing the things that I want to do has increased: Number of Respondents Number of Respondents