JMIR Publications

ABSTRACT

Background:

Falls are the leading cause of injury-related death among adults aged 65 years and older. Falls and fear of falling in turn threaten older adults’ ability to live independently and often lead to self-imposed activity restriction, social isolation, decreased cognitive and physical function, and, paradoxically, an increased risk of serious falls. There has been extensive research on interventions that can reduce the risk of fall-related injury and mortality in older adults. One tool, home safety assessments, has been shown to significantly decrease the rate and risk of falling by up to 36%, along with reducing serious fall-related complications, including hip fractures and death. Despite their efficacy, there has been very low adoption and poor implementation of home safety assessments. Better understanding of the diverse factors that contribute to poor uptake of this intervention is critical for improving adoption.

Objective:

This formative research study aimed to: (1) develop a deeper understanding of the perspectives and needs of community-dwelling older adults who may benefit from home safety assessments, and (2) identify novel design opportunities to guide the development and implementation of more effective home safety assessment techniques and practices.

Methods:

This is an explanatory qualitative research study utilizing methods from the initial “inspiration” stage of the human-centered design process. Qualitative data was obtained through semi-structured interviews with 28 purposefully sampled older adults and diverse stakeholders, including clinicians (physical therapists, occupational therapists, geriatricians, surgeons, etc.), family members of elders, engineers, senior living community administrators, interior designers, and payers. Interview notes were inductively analyzed by the research team to develop insights and identify design opportunities.

Results:

Once key insights were developed in the course of this study, three novel design opportunities were proposed: 1) return a sense of control and autonomy to older adults in the home safety assessment process and any suggested modifications; 2) reframe how home safety assessments are perceived by users so that older adults can become fully engaged in the broader process of safely aging in place, while also protecting themselves and preserving their dignity and independence; and 3) increase access to and use of home safety assessment tools using a wide range of the alternative and novel technology.

Conclusions:

The design opportunities revealed by this study depend on empathy and deep understanding of the lived experiences of older adults. Older adults’ resistance to the physical, social, and emotional changes associated with aging may be worsened by their minimal inclusion in the decision-making process surrounding home modifications following a home safety assessment. Therefore, change in the form of user empathy and inclusion, technological advance such as home safety assessment apps, more accessible assessment professionals, and more tailored interventions, should be used together to protect our aging population from falls. Clinical Trial: none