Falls are a significant concern for older people and the NHS, however there is little evidence for the effectiveness of services to make adaptations at home. Researchers in Wales have used health records to show the benefits of these interventions and the people most at risk of serious falls.

The challenge

Providing sustainable care for an increasingly ageing population is a key policy challenge in the UK and many developed countries. Many older people prefer to remain living in their own homes for as long as possible, which can be supported by home adaptation services.

Falls are one of the most common issues for older people. It is estimated that falls cost the NHS more than £2.3 billion per year, with 30 per cent of people aged over 65 and 50 per cent of people aged over 80 falling at least once per year. Home adaptation services aim to reduce falls at home, but there is a lack of high-quality evidence to support the widespread commissioning of these services.

The solution

Researchers supported by HDR UK created a dataset to study fall outcomes following home adaptation interventions. To do this, they looked at older people who had been supported by Care & Repair Cymru (C&RC), a charity in Wales that provides home adaptation services.

The team looked at electronic health records of over 600,000 older people in Wales, of whom 120,000 had received a home adaption service. Over the period covered by the data, they analysed if a fall occurred at home that required an emergency department or hospital admission.

Impact and outcomes

The researchers found that the people who used C&RC were almost twice as likely to have a fall compared to the control group. This demonstrates that C&RC reaches those who are at higher risk, many of whom had had a fall just before using the service. After the home adaptation, falls of C&RC clients decreased by 3 per cent per quarter.

The study, published in the journal Age and Ageing, also found that falls were more likely in people who were older, frailer, living in more deprived areas and female. The team are studying the data further to understand the effects of the local environment on fall risks.

Dr Joe Hollinghurst, the lead author of the paper, said:

“This was the first study we are aware of to conduct research into falls prevention at such a large scale. We hope our paper strengthens the evidence base for providing falls prevention services and leads to policy implications for providing interventions pro-actively.”

Impact committee

The impact committee thought that the researchers had made good use of the data to show the benefits of the services without the need for a clinical trial. They also noted that the work has the potential to influence national policy in this area.

Read the full paper