Home Hazard Removal Program

$665,000 grant awarded to study effects of customized home modifications on fall prevention

by Stephanie Stemmler  •  November 11, 2019

Left to right:  Carlyn Foster was unable to transfer in/out of the tub safely until grab bars were installed at appropriate heights at the recommendation of Susy Stark, PhD, OTR/L, FAOTA.

For more than a decade, Susy Stark, PhD, OTR/L, FAOTA, associate professor of occupational therapy, neurology and social work, has been researching how tailored, environmental interventions such as home modifications can reduce the risk of falling among older adults.

The translational research effort is significant because falls are the leading cause of death from injury among older adults aged 65+, with most of the falls occurring inside the home.* The U.S. Department of Housing and Urban Development (HUD) projects that medical expenditures related to fall injuries will approach $60 billion by 2020.

“We need to consider falls a true hazard that can impede an older adult from successfully aging in place in their own home,” says Stark. “We’ve found that just improving physical function isn’t enough. The question we need to ask is how do we change behaviors and a person’s environment to decrease fall risk?”

Since 2010, HUD has consistently funded research in the Home Hazard Removal Program (HARP), which is part of Stark’s Participation, Environment and Performance Laboratory in the Program in Occupational Therapy. The latest funding is a five-year, $665,000 grant that will keep the research going through at least the end of 2020.

Stark and her research team at Washington University already have found that simple home modifications can reduce fall risk, but they discovered that those modifications need to be customized to each individual, who then must be coached to change behavior and use those modifications.

“We know the most common barriers, but they are always a little different from person to person,” says Stark. “What’s really effective, for example, is when we note that a particular person shuffles their feet and then we suggest removing throw rugs or, depending upon a person’s height, we recommend that grab bars or hand railings be installed at different heights. The trick is identifying what is the risk, what changes need to be made, and how to educate these older adults to actually implement the modifications we recommend.”

Significant decrease in fall risk
In communities where Stark and her team successfully had older adults understand and make home modifications, the risk of falling was reduced by 30 percent. Now she’s taken that research further, translating the findings into an implementation manual and an innovative algorithm that she says will enable occupational therapists to assess where someone is in terms of their own understanding of fall risk. Explains Stark, “We have to meet people on their own readiness level and educate them so that they change their behavior and implement the modifications we suggest.”

Stark is advocating for including the algorithm and fall prevention education in the core curriculum for occupational therapy training nationwide. She’s also hoping to expand her research into HUD communities across the country.

This year, HUD is earmarking an additional $10 million in fiscal 2019 for competitive grants focused on low-cost, high-impact home modifications that would enable low-income seniors to remain in their homes. The allocation comes after HUD released a comprehensive report, “Overcoming Obstacles to Policies for Preventing Falls by the Elderly” in 2017, which noted that fall prevention education and cost-effective home modifications are critical elements to support aging in place.

“HUD is excited about our work and the potential for an initiative that can reduce the number of falls,” Stark says. “A senior HUD advisor contacted us in August and told us to start planning for a site visit here so that they can determine if HARP is scalable into larger communities and can be embedded into HUD housing policies.”

Her goal in the HARP II study, which began last year and includes a larger number of older adults, is to reduce the number of falls among participating older adults by 15-20 percent.

“There are relatively few older adult communities that have successfully implemented intervention and home modification programs to reduce fall risk,” she stresses. “We’re in the right position to change that.”

Stark also is researching how falls impact other health issues. Last year, the National Institute of Aging awarded Stark a $3.4 million R01 grant to see if falls are a potential marker of preclinical Alzheimer’s disease, a focus Stark has been pursuing for the past five years.

*Centers for Disease Control and Prevention, National Center for Injury Prevention and Control


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