Modification of the home environment for the reduction of injuries
Abstract
Background
Injury in the home is extremely common, accounting for around a third of all injuries. The majority of injuries of children under five and people aged 75 and over occur at home. Multi‐factorial injury prevention interventions have been shown to reduce injuries in the home. However, few studies have focussed specifically on the impact of physical adaptations to the home environment and the effectiveness of such intervention needs to be ascertained.
Objectives
To review the evidence for the effect on injuries of modification of the home environment with a primary focus on interventions to reduce physical hazards.
Search methods
We searched the following databases: APId, ASSIA, British Nursing Index, CINAHL, Cochrane Library databases, Dissertation Abstracts, EMBASE, HealthSTAR, ICONDA, ISI Science (and Social Science) Citation Index, MEDLINE, National Research Register, PREMEDLINE, SIGLE and Urbadisk. Conference proceedings and reference lists were scanned. Experts in the field and trialists were contacted. Searches were not restricted to English language. Handsearching of relevant journals was not conducted.
Selection criteria
Randomised controlled trials, non‐randomised controlled trials, controlled before‐and‐after studies and interrupted time series studies.
Data collection and analysis
All abstracts were screened by two reviewers for relevance, outcome and design. Two reviewers independently evaluated methodological quality and extracted data from each eligible study.
Main results
We found 28 published trials and one unpublished study. Trials were not sufficiently similar to allow for the combination of data by statistical analyses, so this review takes a narrative form. Studies were divided into three groups based on the primary population sample: children, older people and the general population. None of the 11 childhood studies demonstrated a reduction in injuries that might have been due to environmental adaptation in the home. One study reported a reduction in injuries and in hazards but the two could not be linked. The majority of studies used hazard reduction as the outcome. Of the 15 studies in older people, none demonstrated a reduction in injuries due to hazard reduction, although two demonstrated a reduction in falls that could be due to hazard reduction. In the mixed age group there were two trials; neither demonstrated an effect on injuries.
Authors' conclusions
There is insufficient evidence to determine the effects of interventions to modify environmental home hazards. Further interventions to reduce hazards in the home should be evaluated by adequately designed randomised controlled trials measuring injury outcomes. Recruitment of large study samples to measure effect may be a major consideration for future trials.
PICOs
Plain language summary
More evidence needed to show whether or not altering the physical home environment to remove potential hazards reduces injuries
Injuries in the home are very common. Most of the injuries of older people and children under five occur at home. Many people are encouraged to alter their home to try to reduce such injuries. Common alterations include the installation of locks on cupboards and covers on electrical sockets, improvement of lighting in halls and stairways, and the removal of rugs and other falls hazards. The review found that there is insufficient evidence from trials to show that such changes reduce the number of injuries in the home. Home alterations need to be evaluated by larger and better designed trials.
