Barriers and Facilitators to Home Modifications for Fall Prevention in Adults over the age of 50: A Systematic Review

Abstract Content - Introduction Falls are the leading cause of preventable death in older adults and can also lead to psychological consequences, including concerns about future falls. Although literature traditionally focuses on those over 65 yrs, recent research shows adults as young as 50 yrs could be at risk. Most falls occur at home and are often due to environmental hazards. Despite evidence supporting a 38% reduction in falls through home modifications, their efficacy in not fully understood. Exploring barriers and facilitators to home modifications aimed at reducing falls and concerns about falling, could better inform future interventions. Methods As part of a mixed-methods systematic review, six electronic databases were searched on February 4th 2024: Scopus, PubMed, CINAHL, MEDLINE, SportsDiscus and Psycinfo. The search explored studies on home modifications for adults over 50 living at home, without residential health or rehabilitation services, specifically aimed at reducing falls incidences and concerns about falling. Barriers and facilitators to home modifications were explored from the perspectives of fallers, those at risk of falling, families, caregivers and key stakeholders. Results Thirteen of the 31 papers included in the full systematic review were focused on barriers and facilitators to home modifications. For barriers, five themes were identified: cost; stigma associated with ageing and disability; lack of awareness; fear of change and professional incompetence and inconsistency. Five themes were identified for facilitators: support from family and caregivers; early planning; involvement in decision making professional collaboration and enhanced caregiver well-being. Conclusion These findings underscore the need for multi-faceted approaches to home modifications, addressing both practical and psychological issues. Only three studies included adults 50+ yrs, with little known about the barriers and facilitators for this age onwards. Future interventions should encompass a person-centered approach, focus on increasing affordability, raising early awareness, fostering supportive networks, and ensuring high-quality professional services.