| Abstract|| |
Background: Geriatric population is vulnerable to domestic accidents. Safety-related provisions/behavior in domestic environment can reduce the risk of accidents. Aim and Objective: To know the safety practices followed at home by people above 60 years age and to assess few epidemiological factors associated with their risk of domestic accident. Study Design: A community-based cross-sectional study. Materials and Methods: Using Lot Quality Technique, 135 elderly (out of 196; at 7% desired level of accuracy, 95% desired confidence level), willing to participate, were interviewed for their practices towards accident prevention. Observations were made regarding safety provisions within homes. The data was recorded in predesigned, pre-tested, semi-structured proformas, based on Home Safety Checklist Tool. Statistical Analysis Used: SPSS package version 17. Fisher's Exact test applied for statistical significance of factors related to accident risk in domestic environment. Results: Elderly from joint families significantly keep passage of bedroom to bathroom free from obstacles, telephone cords away from walking area and use stool to reach high cupboard (P < 0.0005). In nuclear families, stairway was kept adequately lighted (P < 0.05). Literate elderly put away things back to its place after using, walk in room without obstacles, keep soap reachable during bath, keep stairways in good condition, use doormats to wipe feet (P < 0.05). Habit of not cleaning up spills (85.2%), walking on wet floor (60.7%), and no grab bars in bathrooms (53.3%) were observed. Conclusion: Provision and use of home safety measures/practices with needful awareness and attitude are important to prevent domestic accidents amongst elderly.
Keywords: Elderly, grab - bars, home safety, lighting, mats, stairway, walking
|How to cite this article:|
Aras RY, Narayan V, D'souza ND, Veigas I. Assessment of accident risk among elderly in domestic environment: A cross-sectional study in rural south Karnataka, India. Ann Trop Med Public Health 2012;5:565-8
|How to cite this URL:|
Aras RY, Narayan V, D'souza ND, Veigas I. Assessment of accident risk among elderly in domestic environment: A cross-sectional study in rural south Karnataka, India. Ann Trop Med Public Health [serial online] 2012 [cited 2020 Aug 14];5:565-8. Available from: http://www.atmph.org/text.asp?2012/5/6/565/109267
| Introduction|| |
The growth rate of the older population (1.9%) is significantly higher than that of the total population (1.2%).  Between 1996 and 2016, Indian population above 60 years of age will increase from 62.3 million to 112.9 million.  In 2001, 75% of elderly in India were living in rural areas. 
The assessment of home brings out problems that are not readily apparent during an office interview.  Understanding the environment is critical when working with elderly. 
This study regarding home safety measures and practices was conducted to assess the accident risk factors among elderly at home.
| Materials and Methods|| |
A community-based cross-sectional study was conducted from 1 st May to 14 th August 2011; in a population aged 60 years and above, from Kotekar Panchayat and Kasaba Bengare area, two rural areas of Mangalore, Karnataka. Using Lot Quality technique (WHO, 1996)  for survey, considering 7% desired level of accuracy and 95% desired level of confidence, 196 elderly were selected initially. However, after explaining them the purpose of study and assuring the confidentiality of their responses and after taking written consent, 135 individuals willing to participate, were interviewed for their practices towards accident prevention. The house is considered as sampling unit. Observations were also made regarding safety provisions within the house.
Based on Home Safety Checklist Tool  (further modified for Indian culture.), semi-structured tool is designed to include basic epidemiological data and the variables concerned with - House keeping safety, bathroom safety, precautions regarding stairway, lighting, personal behaviors etc. Initial pilot study was done on 30 elderly, and the tool is modified and further validated before application to study participants.
Data was analyzed using SPSS version 17. Fisher's Exact test applied for statistical significance of factors related to accident risk in domestic environment. P < 0.05 was considered to be statistically significant.
| Results|| |
The mean age of all the participants was 67.8 years with SD = 6.834. Among the participants, 25% were illiterate, 36% were just literate, and remaining 39% have studied up to high school and above. Religion-wise distribution showed 68.9% Hindu, 25.9% Muslim and 5.2% Christian. In this study, 63.7% (n = 86) were females and 36.3% (n = 49) were males.
Among the house safety items/practices recorded, [Table 1], switches near every door, lights in hallway from bedroom, outdoor area free from tripping, kept outdoor clean from leaves, know safest way of walking when can't avoid walking on slippery surface, take time to balance when changing position, daily contact with friend or neighbor were observed among more than 70% of participants / in their houses.
The type of family was found to have some effect on freedom from risk of domestic accidents among old people [Table 2]. Elderly from joint families significantly keep passage of bedroom to bathroom free from obstacles, keep telephone cords away from walking area, and use stool to reach high cupboard (P < 0.0005). In nuclear families, stairway was kept adequately lighted (P = 0.037). Literate elderly put away things back to its place after using (P = 0.013), walk in room without obstacles (P = 0.01), keep soap reachable during bath (P = 0.049), keep stairways in good condition ( = 0.046), and use doormats to wipe feet ( = 0.011, [Table 2]).
|Table 2: Distribution of safety practices according to type of family and literacy |
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| Discussion|| |
The theme  for world health day 2012 is "Ageing and Health," which makes us aware about the increasing life expectancy and the social transformation leading to challenges in the health of old people. It is observed that given a choice, most elderly would prefer to remain in their home. , Older people need to take special precautions to ensure a safe living environment. Most accidents at home can be prevented by the elimination of the hazards.
Environmental assessment and modification can promote mobility and reduce the likelihood of falling. The percentage of falls among community-dwelling older adults increases from 25% at the age of 70 years to 35% after the age of 75 years.  The goals of the environmental assessment are to promote mobility, to ensure continued independence, and to improve the quality of life.
Female to male ratio in this study was comparable to another hospital-based geriatric study (Barua et al, 2007) at Karkala, Karnataka where 60% were females and 40% were males.  The Sex ratio of Mangalore population is 1041.  In this study, 68.9% were Hindu, 25.9% were Muslim and 5.2% were Christians. Hinduism is accounted for 80.5% of the population of India (Census 2001),  and majority of population of Mangalore is also Hindu.  Literacy rate of study population was 65.2%, and Mangalore statistics shows that 71% of population of Mangalore is educated and high literacy rate was recorded amongst the rural population of Mangalore.  In this study, 74.1% of the participants were living with their spouses and remaining 25.9% were widow / widowers. In a Karkala (Karnataka, India) study,  78.6% elderly were married and 21.4% were either unmarried or widowed.
Steel et al,  noted that there is a belief that understanding the environment is critical when working with older adults. Yet, for someone whose mobility is compromised and whose sight and hearing may be impaired, the home environment can be a help or a hindrance. Issues of safety such as fall risk and access to emergency services can best be accomplished by evaluating the living environment. Loose rugs, inadequate lighting, lack of grab bars in the bathroom, inaccessible telephone, cords in walkways, obstruction in walkways, lack of working smoke alarms are some potential hazards to look for.  In this study, 53.3% of houses of participants do not have grab bars in bathroom and 46.6% do not have handrail extending full length of staircases. However, Rubber mat in bathroom (60.7%), switches near every door (86.7%), reachable light switch from bed (55.6%), lights in hallway from bedroom (71.1%), outdoor area free from tripping (79.3%), outdoor clean from leaves (73%), take time to balance when changing position (71.9%), keeping daily contact with friend or neighbor (79.3%) are some of the positive findings in this study.
The home safety is an important issue, especially for older people with functional impairment. Emergent care for injury caused by falls or accidents at home is one of the most frequently occurring adverse events reported for patients receiving skilled home health care services.  Thirty percent of people age 65 and older living in the community fall each year. One in 5 of these fall incidents require medical attention.  Falls are the leading cause of injury-related deaths for this population.  However, no death was recorded from fall in this study.
Improving older people's safety and quality of care by educating and assisting caregivers (families and providers) is an approach tested in several randomized control trials.  Archbold and colleagues  pilot tested preparedness, enrichment, and predictability (PREP), a formal nursing intervention designed to prepare family caregivers to provide care. While the study had many limitations, preliminary evidence on the effectiveness of the intervention suggested that families benefit from being informed and prepared. 
Although there is strong evidence of effective fall prevention interventions for the general over 65 population, ,, knowledge of fall prevention in home health care is limited. For the general older population living in the community, evidence suggests that individualized home programmes for muscle strengthening and balance retraining, complex multidisciplinary, multifactorial health/environmental risk factor screening and intervention, home hazard assessment and modification can all reduce the incidence of falls.  In this study, 71.9% of old people were careful enough and take time to balance when changing position.
The document on home safety for senior citizens  also gives emphasis on general safety standards, kitchen safety, stairway and hall safety, living room safety, bathroom safety, and outdoor safety standards. However, a literature review located only three studies testing interventions to prevent falls. ,, Their findings suggest that risk factor screening and intervention using a valid and reliable instrument aimed at improvement of gait and balance may reduce injury and emergency care for falls. Using a checklist is a time-efficient and comprehensive method for assessing environmental needs.  The home safety checklist is one tool  that was used to ascertain potential hazard in this study.
This study of the assessment of the risk factors (provisions and practices) for accidents within the home environment can give the researchers impetus to think that minor modifications in the home environment can make a major difference in the life of homebound older people to prevent accidents as some elderly persons will experience decreasing ability to carry out the activities of daily living due to both normal aging and pathological processes that occur more frequently with advancing age.
| Acknowledgement|| |
The authors are grateful to Chancellor, Vice- Chancellor, and the Registrar of Yenepoya University for their encouragement for this research study. We also thank Director Research and Principal, Yenepoya Medical College for permitting us to publish this paper.
We appreciate the help rendered by the interns and paramedical workers of the Department of community medicine, Yenepoya Medical College; during this study.
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Radha Y Aras
Department of Community Medicine, Yenepoya Medical College, Yenepoya University, Deralakatte, Mangalore - 575 018, Karnataka
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2]