Case-control study of hazards in the home and risk of falls and hip fractures

The importance of environmental hazards in the home as risk factors for falls and fractures is uncertain. A case-control study was conducted, involving people aged 65 years and over referred to an occupational therapy department for home assessment. There were 52 subjects with a recent hip fracture, 43 fallers (subjects with two or more falls in the past year but no hip fracture), and 157 non-fallers (subjects without hip fracture and with fewer than two falls in the past year). Subjects' homes were assessed for environmental hazards by occupational therapists using a structured home assessment form comprising 35 potential hazards. Overall, the homes of fallers were no more hazardous than the homes of non-fallers. However, fallers with cognitive impairment had significantly more hazards in their homes than non-fallers with cognitive impairment. A wide range of environmental hazards was associated with hip fractures. Many of the findings of this study could be due to bias inherent in the case-control design. To overcome the inadequacies of observational studies for the investigation of home hazards and falls, randomized trials are recommended to determine if removing hazards reduces the risk of falls and fractures.