Functional impairment
Difficulty with activities of daily living (ADLs), IADLs
Poor physical health
Need for assistive devices
Postsurgical conditions
Low vision
Schizophrenia
Fear of falling^[1]Stark, S., Keglovits, M., Arbesman, M., & Lieberman, D. (2017). Effect of home modification interventions on the participation of community-dwelling adults with health conditions: A systematic … Reference List
History or risk of falls^[2]Stark SL, Somerville EK, Morris JC. In-Home Occupational Performance Evaluation (I-HOPE). Am J Occup Ther. 2010 Jul-Aug;64(4):580-9. doi: 10.5014/ajot.2010.08065. PMID: 20825129; PMCID: PMC2939744.

Barriers to Interventions

Finances
Renting compared to ownership of properties
Availability of professionals, e.g., handymen

Interventions

Barrier removal resulted in a 36% reduction falls for an intervention group.^[3]Davison, J., Bond, J., Dawson, P., Steen, I. N., & Kenny, R. A. (2005). Patients with recurrent falls attending Accident & Emergency benefit from multifactorial intervention—A randomised … Reference List
Education
Balance and strength training
Low vision: additional lightning
Home modifications and renovations – “Participants who received home modifications also experienced fewer difficulties performing daily activities.”^[4]Petersson, I., Kottorp, A., Bergstro¨m, J., & Lilja, M. (2009). Longitudinal changes in everyday life after home modifications for people aging with disabilities. Scandinavian Journal of … Reference List^[5]Petersson, I., Lilja, M., Hammel, J., & Kottorp, A. (2008). Impact of home modification services on ability in everyday life for people ageing with disabilities. Journal of Rehabilitation … Reference List
- Grab bars
- Bath seats
- Hand-held shower heads
- Removal of bathtubs for walk-in showers
- Ramp installation^[6]Stark SL, Somerville EK, Morris JC. In-Home Occupational Performance Evaluation (I-HOPE). Am J Occup Ther. 2010 Jul-Aug;64(4):580-9. doi: 10.5014/ajot.2010.08065. PMID: 20825129; PMCID: PMC2939744.
Adaptive equipment, e.g., reacher devices
Assistive technology, e.g., smart home^[7]Tomita, M. R., Mann, W. C., Stanton, K., Tomita, A. D., & Sundar, V. (2007). Use of currently available smart home technology by frail elders: Process and outcomes. Topics in Geriatric … Reference List^[8]Mann, W. C., Ottenbacher, K. J., Fraas, L., Tomita, M., & Granger, C. V. (1999). Effectiveness of assistive technology and environmental interventions in maintaining independence and reducing … Reference List
Occupational therapy training
- “Include comprehensive assessment of person and environmental factors that influence occupational performance, including task analysis to identify environmental barriers and supports.”
- “Include training older adults and their caregivers to safely use environmental supports and reestablish habits and routines.”
- “Provide assessment of and recommendations to clients and caregivers, along with adequate training, education, and follow-up for effective home modification interventions to improve participation.”^[9]Stark, S., Keglovits, M., Arbesman, M., & Lieberman, D. (2017). Effect of home modification interventions on the participation of community-dwelling adults with health conditions: A systematic … Reference List

Take-Home Message

“A client-centered intervention plan that includes a mix of exercise, education, home modifications, and assistive technology is supported by the best evidence for fall prevention and occupational performance in community-dwelling older adults.”^[10]Chase, C. A., Mann, K., Wasek, S., & Arbesman, M. (2012). Systematic review of the effect of home modification and fall prevention programs on falls and the performance of community-dwelling … Reference List

Home Modification Checklist

General

Entrances and exits
Walkways
Curb cuts
Driveways
Porch
Windows
House number visibility
Bushes and shrubs posing risks
Working doorbell
Doors: swinging direction, width and clearance, weight, thresholds
Floor level changes
Hallway width
Stairs
Railings
Floor surfaces
Clutter reduces

Bathroom

Covered water pipes
Controls and faucets accessible
Drains accessible
Mirror height adequate
Shelves and sink basin storage functional
Transfers in and out of showers and bathtubs (grab bars)
Toilet height
Toilet paper accessible
Flushing accessible
Toilet transfers safe
Space for caregivers
Anti-slip mats

Kitchen

Task lighting appropriate
Storage access available, e.g., shelving
Reachability of items in the refrigerator
Hot water pipes covered
Hot-proofed surfaces
Switches and outlets accessible
Adequate counter surfaces
Enough knee clearance at worksites
Adequate color contrast or tactile controls
Sturdy step stool
Clean kitchen area
Commonly used items and foods most accessible

Living Spaces

Wide enough pathways
Secured throw rugs
Access space between furniture
Rails or armrests available for transfers
Switches and outlets accessible
Functional storage and closet
Adequate lighting
Furniture at an appropriate height
Clearance between furniture
Level floor surfaces

Storage Spaces

Lights installed
Adjustable rods and shelves available
Enough space and clearance to access closet

Windows

Handles and locks are accessible
Blinds and blackout curtains for sleep and reduction of glare

Laundry

Worksite available for sorting and folding clothes
Clothesline at a convenient height
Washer and dryer at a convenient height and location
Controls for appliances accessible

Basement

Well-lit areas
Combustible materials and hazardous waste requiring removal
Pathway clear to access utilities
Fall hazards reduced

Safety and Comfort

Heating and cooling thermostat controls are accessible
Presence of functioning smoke and CO alarms
Fire extinguishers accessible
Water heater adjusted to safe temperature to reduce burns (120 degrees F)
Scalding water safety shut-off valves at water fixtures
General lighting is adequate and available where needed
Exits available and clear for emergencies

Funding and Resources

Some local governments may provide grants to install home modifications if justified.

References [+]

References
↑1, ↑9	Stark, S., Keglovits, M., Arbesman, M., & Lieberman, D. (2017). Effect of home modification interventions on the participation of community-dwelling adults with health conditions: A systematic review. The American Journal of Occupational Therapy, 71(2), 7102290010p1-7102290010p11.
↑2, ↑6	Stark SL, Somerville EK, Morris JC. In-Home Occupational Performance Evaluation (I-HOPE). Am J Occup Ther. 2010 Jul-Aug;64(4):580-9. doi: 10.5014/ajot.2010.08065. PMID: 20825129; PMCID: PMC2939744.
↑3	Davison, J., Bond, J., Dawson, P., Steen, I. N., & Kenny, R. A. (2005). Patients with recurrent falls attending Accident & Emergency benefit from multifactorial intervention—A randomised controlled trial. Age and Ageing, 34,162–168. https://doi.org/10.1093/ageing/afi053
↑4	Petersson, I., Kottorp, A., Bergstro¨m, J., & Lilja, M. (2009). Longitudinal changes in everyday life after home modifications for people aging with disabilities. Scandinavian Journal of Occupational Therapy, 16, 78–87. https://doi.org/10.1080/11038120802409747
↑5	Petersson, I., Lilja, M., Hammel, J., & Kottorp, A. (2008). Impact of home modification services on ability in everyday life for people ageing with disabilities. Journal of Rehabilitation Medicine, 40, 253–260. https://doi.org/10.2340/16501977-0160
↑7	Tomita, M. R., Mann, W. C., Stanton, K., Tomita, A. D., & Sundar, V. (2007). Use of currently available smart home technology by frail elders: Process and outcomes. Topics in Geriatric Rehabilitation, 23, 24–34. https://doi.org/10.1097/ 00013614-200701000-00005
↑8	Mann, W. C., Ottenbacher, K. J., Fraas, L., Tomita, M., & Granger, C. V. (1999). Effectiveness of assistive technology and environmental interventions in maintaining independence and reducing home care costs for the frail elderly: A randomized controlled trial. Archives of Family Medicine, 8, 210–217. https://doi.org/10.1001/archfami.8.3.210
↑10	Chase, C. A., Mann, K., Wasek, S., & Arbesman, M. (2012). Systematic review of the effect of home modification and fall prevention programs on falls and the performance of community-dwelling older adults. The American Journal of Occupational Therapy, 66(3), 284-291.