HotShOT: Home Safety Occupational Therapy

According to the Centers for Disease Control (CDC), 2.8 million older adults were treated in the emergency department for fall related injuries. Most falls are caused by a combination of risk factors, with more risk factors leading to an increased risk for falling.

People undergoing a total hip replacement can be seen as having an increased risk of falling. Once an individual discharges home from the hospital, it is during this continued post-operative period where pain and weakness continues to effect their walking ability. Additionally, if the patient has a history of falling, has a fear of falling, has visual deficits, and/or neuropathy, risk of falling increases.

Evaluating a patient's fear of falling and educating patient's regarding home safety may lead to a patient feeling increased confidence when completing daily activities with increased safety awareness.

The purpose of this study is to evaluate the use of the Home for Life mobile application to examine home safety and fall risk for patients who have undergone hip replacement surgery and are being discharged to their home.

Study Aims:

1. The first aim of this study is to assess whether completion of a home safety assessment within an acute care setting will facilitate carryover and reduce a person's actual and perceived risk of falling. The Home Safety Assessment tool will be used to make adaptation recommendations to a person's home setting based on their real and perceived risk of falling in different rooms within the home (entrance, bedroom, bathroom at a minimum). A home safety assessment is a standard in the clinical care provided by occupational therapist (OT). The use of the home safety application being an alternative method of gathering the information is for research purposes in this study and is not currently used in daily operations. During the initial evaluation, the occupational therapist will bring a tablet into the room. The tablet will have the downloaded user-friendly application. The therapist will guide the client through the components of the application, identifying different rooms in their home and asking questions pertaining to their real and perceived risk of falling within these rooms. Information obtained during this process will then be stored on RedCap.
2. The second aim of this study will be to determine if recommended adaptations in home safety impacted perceived risk of falling.
3. The third aim of this study will be to determine if the patient had a fall within two weeks post discharge.

• Home for Life mobile application (Other): Utilize home application to provide the participant with an understanding and recommendations to potentially decrease home hazards that may lead to risk of falls in their home.

Primary outcomes

• Relationship of Use of Home safety assessment and Perceived Risk of Falling [Identified during Initial evaluation]: Number of participants who identified perceived risk of falling and number of participants who used of home safety application

Secondary outcomes

• Actual Fall and Use of application/adaptations [2 weeks of hospital discharge]: Relationship of participant actual fall within 2 weeks of hospital discharge and use of home safety application/adaptations. Number of participants who utilized home safety application/adaptation and number of participants who had an actual fall

Sex: All, ages: 65 Years to any

Inclusion Criteria:

* Elective total hip arthroplasty
* Discharge destination from acute care hospital is to home
* ≥ 65 years old
* Prior to admission, independent in activities of daily living

Exclusion Criteria:

* Hip replacement due to trauma
* Discharge plan to skilled nursing facility, long term care hospital or inpatient rehabilitation facility

• Richard Riggs, MD, Study chair, Cedars-Sinai