Impact of Built Environment on Fear of Falls among older adults: A Systematic Review

Objective(s): To summarize research on the association between built environmental factors and evidence based home modification solutions in with reduction of falls risk and fear of fall (FoF) and how home design criteria are different from the ADA Guidelines.

Data Sources: Google Scholar, EBSCO, PubMed & Science Direct from Jan 2000-2023

Study Selection: AA screened abstracts based on criteria: Original peer reviewed research, mentioned one or more indoor environmental factors, includes outcome measures for falls hazards, fall risks, and FOF. Twenty articles were selected for full text review that identified the factors that add to FOF within the home environment and interventions that reduce the fall risk.

Data Extraction: Standardized data extraction table was used for gather information on the author’s name, publication year, purpose, study location, study characteristics (i.e., study design, sample size, age, target population), statistical methods, list of indoor environmental factors, description of falls hazards & falls risk factors, and measurement tool for FOF.

Data Synthesis: Seven studies explored the impact of home modifications/adaptations and falls risk and fear of falling. Three studies analyzed home environment factors that contribute to falls risks. Studies also reported falls and fear of falling related activity avoidance and their relationship with certain barriers in the home environment for performing activities of daily living. Five of twenty articles specifically explored the limitations of ADAAG guidelines to address specific needs of older adults, especially those with significant mobility limitations. These studies suggest that there is a need for evidence based design guidelines that are more appropriate for a home setting and which could be personalized to the case specific needs of the older adults.

Conclusions: Home environmental factors have a strong association with FOF, and there is a need for structured protocols to manage fall risks in older adults in home settings. There is a need for collaboration of OT’s with architects to develop accessible designs, which could help formulate guidelines for ADA provisions in residential settings.

Author(s) Disclosures: None