Home modification interventions can improve function for older adults, reduce risk of falls, and reduce demands on caregivers

Stark S, Keglovits M, Arbesman M, Lieberman D.  Effect of home modification interventions on the participation of community-dwelling adults with health conditions: A systematic review  American Journal of Occupational Therapy. 2017; 71(2) : 1-11.

Review question

• What is the effectiveness of home modification interventions to improve participation outcomes for community-living adults and older adults?

Background

• As the number of individuals struggling to complete activities of daily living (ADL) increases due to aging, the demand for effective and safe home environments continues to grow. 
• Having functional limitations without adequate environmental supports can lead to disability. To improve the capacity of clients to complete their activities of daily living, occupational therapists use home modifications to improve functional outcomes (including reducing the risk of falls).
• Previous studies have found that home modifications can improve the performance and safety of individuals with functional limitations. However, they have not discussed evidence within the scope of occupational therapy targeting adults with dementia-related disorders. Thus, this review aims to expand the existing body of evidence by identifying effective home modification interventions made by occupational therapists to improve home and community participation.

How the review was done

• A detailed search of a number of electronic databases was conducted to identify studies published between 1990-2017. Studies that focused on community-dwelling participants ages 18 years and older with health conditions affecting daily activities and home modification interventions within the scope of occupational therapy practice were included in the review.
• A total of 180 studies were identified and 36 were included in the review after assessments for eligibility.
• This review was funded in part by the American Occupational Therapy Association.

What the researchers found

• The review found strong evidence that home modifications can improve function for people with a variety of conditions, including those with increased frailty, who had a hip repair surgery, with low vision and schizophrenia.
• Types of home modification supports varied depending on the condition (ranging from making simple home repairs, adapting houses for people with disabilities, and integrating new assistive technologies). For example, lighting adaptations for individuals with low vision resulted in significant improvements in quality of life.
• Home modifications were found to reduce the demand on caregivers and reduce the risk of falls while improving the capacity of individuals to complete their activities of daily living.

Conclusion

• This review provides an up-to-date practical guide of home modification interventions that can be led by occupational therapists. Data suggests that occupational therapists are the most effective in conducting home modification assessments.
• Limitations of this review include the small sample sizes and inconsistent methodologies used by the included studies. Further research is recommended to address the intensity of home modification interventions, factors affecting adherence to these interventions, the role of home modifications in interventions that have many other components, and the effectiveness of home modifications in different populations.