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INTRODUCTION
One in three older people living in the community will
experience a fall this year (El-Faizy & Reinsch, 1994). An
important area of risk for falls by older people is the home
environment and the way in which older people use the
home (Connell & Wolf, 1997; Josephson, Fabacher, &
Rubenstein, 1991). This makes safety in the home a public
health issue of national and international importance.
Falls represent a major cause of injury in older populations in the United States (Connell & Wolf, 1997). Similar
patterns of morbidity and mortality exist in Australia (Australian Institute of Health and Welfare [AIHW] and Commonwealth Department of Health and Family Services
[DHFS], 1997; McLean & Lord, 1996), Canada (Ploeg et
al., 1994), and the United Kingdom (Donald & Bulpitt,
1999). Quality of life for older people is also affected by
falls, through a subsequent fear of falling (McLean & Lord,
1996). Such fear of falling represents a major contributing
factor to nursing home admissions (Tinetti & Williams,
1997).
Home modification and change in behavior when using
the home are central strategies to prevent falls (Christenson,
1990a; National Health and Medical Research Council
[NHMRC], 1993). Both strategies aim to make the home
and home-related behavior safer by minimizing hazards
and risk-taking.
Community nurses play a vital role in the early identifi-
169
Mean
1,165
674
488
455
474
157
21
5
40.9
42.6
14.1
1.9
0.4
303
863
26.0
74.0
66
300
534
168
52
39
5.7
25.7
45.8
14.4
4.5
3.3
148
104
91
82
68
12.7
8.9
7.8
7.0
5.8
*High dependency was determined by using three items from the Community Nursing Minimum Dataset activity of daily living
scale (ACCNS, 1994; 1997). High dependency occurs when the client is dependent (score greater than 1) in transfer and bathing/
showering, dressing, or toileting.
Low dependency was inferred when the client was independent (score of 1) in transfer, bathing/showering, dressing, or toileting.
TABLE 2. Characteristics of Items in Home-Screen Best Solution: Principal Component Analysis Using Varimax Rotation Method
with Kaiser Normalization for Two Factors Using Ten Items
Item
Home-safe
Rooms/halls are free of clutter
Rooms/halls have good daylight
Rooms/halls have good night lighting
Floor coverings in home are even, firm, and nonslip
Bathing/showering facilities and items are easy to access and use
Home-behavior
Person moves carefully through the house
Person wears footwear correctly
Person takes care when doing things at home
Person puts lights on at night if getting up
Shoes usually worn at home fit well and have good traction on heels and soles
Mean
SD
ITC
Factor 1
Factor 2
7.89
8.10
8.34
8.36
8.36
2.59
2.39
2.27
2.28
2.38
0.67
0.70
0.72
0.63
0.50
0.78
0.84
0.82
0.76
0.60
0.16
0.11
0.20
0.17
0.34
8.04
7.78
7.86
8.19
7.62
2.58
2.99
2.67
2.99
3.00
0.67
0.67
0.65
0.44
0.58
0.20
0.23
0.14
0.01
0.31
0.81
0.75
0.81
0.65
0.65
DISCUSSION
Health promotion in older people remains an important
and developing role for public health nurses (Davis, 1994).
Falls prevention and tools that assess the potential for
falls, should be included in any comprehensive nursing
assessment of community-living older people (Lange,
1996; Moss, 1992; Williams & Nolan, 1993). This study
sought to develop and test a short screening tool that could
be used by community nurses to assess home environments
and home behavior that may constitute a risk for falls. This
research fills a gap in the nursing literature (Willis, 1998).
The Home-screen was designed to prompt nurses to act
on these risks through referral to specialist services such
as occupational therapy and targeted nursing interventions
to reduce the hazard. These interventions could replicate
or extend nursing falls prevention programs already presented in the literature (Mah, 1996; Ploeg et al., 1994;
Schlapman, 1990; Schoenfeld & Van Why, 1997; Tideiksaar, 1989; Weber, Kehoe, Bakoss, Kiley, & Dzigiel, 1996).
We acknowledge that more comprehensive home hazards
assessment tools exist, in particular the WeHSA (Clemson,
1997), but these tools require specialist professional skill
and considerable time to complete.
This sample of older community-living Australians represent a group of older men and women with high functionality and mainly fair or poor health; a group of older people
susceptible to falls.
The primary aim of this study was to examine the quality
of the instrument through psychometric investigation of
the validity and reliability of Home-screen. The final solu-
vides these nurses with a valuable tool to heighten awareness, frame intervention programs, seek specialized help
where available, and confirm successful actions when enacted. Making the home safe for older people not only
reduces older peoples morbidity and mortality, but also
adds to their quality of life by reducing their fear of falling.
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