Does occupational therapist led home environmental assessment and modification reduce falls among high-risk older people?
Falls prevention
Current interventions as of 14/02/2018: Main OTIS trial: Participants will be randomly allocated 2:1 in favour of the control group to receive either: 1. Usual care from their GP or other healthcare professional and a falls prevention leaflet; or 2. One home environmental assessment and modification to identify personal fall related hazards by an occupational therapist, in addition to usual care and a falls prevention leaflet. Up to 12 participants from a particular site will be randomised at a time in a single block according to when sites state they have capacity to undertake intervention appointments and for how many participants. The allocation ratio used may go up to 3:1 in a block if the OTs have reduced capacity to carry out the assessments. Pen sub-study: Participants will be randomised in a 2:1 ratio in favour of the control group to receive no pen or to receive a pen with their trial invitation pack. Invitation letter sub-study: Participants due to be sent an invitation pack in the first mail out from the Yorkshire Health Study will be randomised 1:1 to receive either an invitation letter with their name handwritten on or an invitation letter with their name printed. Text sub-study: Trial participants will be randomised 1:1 to receive either a personalised text message or a non-personalised text message from the York Trials Unit at the time their four month follow-up questionnaire is due to be received. Added 12/06/2020: Social incentive sub-study: Participants will be randomised in a 1:1:1:1 ratio to receive either a pen alone, a pen and cover letter containing social incentive text, no pen and a standard cover letter or a social incentive cover letter alone. Previous interventions: Main OTIS trial: Participants will be randomly allocated 2:1 in favour of the control group to either: 1. Usual care from their GP or other healthcare professional and a falls prevention leaflet 2. In addition to usual care and a falls prevention leaflet, the inter
Current participant inclusion criteria as of 14/02/2018: Main OTIS study: 1. Aged 65 years and over 2. Willing to receive a home visit from an Occupational Therapist 3. Community dwelling 4. Have at least one risk factor for a fall in the next 12 months i.e., either one fall in the past 12 months or report a fear of falling on their screening questionnaire If a respondent is initially assessed as being ineligible because they have not had a fall within the past 12 months and do not report a fear of falling, but otherwise fulfil the eligibility criteria and consent to being re-contacted, they will be rescreened at a later date and given the opportunity to take part in the study if they subsequently have a fall or report a fear of falling and therefore, meet the inclusion criteria. OTIS qualitative study: Occupational Therapists delivering the OTIS intervention, clinical leads who run falls prevention services/care of older people services and services external to the trial will be eligible to be involved in the qualitative study. Pen sub-study: Any patient identified in the GP mail out as eligible to receive an OTIS trial invitation pack will be entered into the pen sub-study. Invitation letter sub-study: Participants who are due to be mailed out an invitation pack about the OTIS trial in the first mailout by the Yorkshire Health Study will be entered into the invitation latter sub-study. Text sub-study: Participants who provide a mobile phone number and consent to be contacted by this method, and who are due to be sent their four month follow-up questionnaire, will be included in this sub-study. Added 12/06/2020: Social incentive cover letter and/or pen sub-study: Any participant due to receive their 12-month questionnaire Previous inclusion criteria: Main OTIS study: 1. Aged 65 years and over 2. Willing to receive a home visit from an Occupational Therapist 3. Community dwelling 4. Have at least one risk factor for a fall in the next 12 months i.e., ei
Current exclusion criteria as of 14/02/2018: Main OTIS trial: 1. Unable to walk 10 feet today, even with a walking aid if needed 2. Unable to give informed consent e.g., due to suffering from dementia or Alzheimer’s disease 3. Living in residential or nursing home 4. Unable to read or speak English and have no friend or relative who is able to translate/interpret for them 5. Had an OT assessment for falls prevention in the previous 12 months 6. Are on a waiting list for an occupation therapy assessment 7. Have not returned one completed falls calendar in the 3 months prior to randomisation Pen sub-study: Participants in the REFORM, CASPER and Yorkshire Health Study cohorts and the SCOOP study will be excluded from the sub-study. Text sub-study: Participants who withdraw from the OTIS main trial follow-up before their 4-month questionnaire is due will be excluded from this sub-study. Invitation letter sub-study: Participants who have not agreed to be contacted about future studies. Previous exclusion criteria: Main OTIS trial: 1. Unable to walk 10 feet today, with a walking aid if needed 2. Unable to give informed consent e.g., due to suffering from dementia or Alzheimer’s disease 3. Living in residential or nursing home 4. Do not speak English 5. Had a home assessment in the previous 12 months as a result of falling 6. Are on a waiting list for an occupation therapy assessment 7. Have not completed one falls calendar in the 3 months prior to randomisation Pen sub-study: Participants in the REFORM, CASPER and Yorkshire Health Study cohorts and the SCOOP study will be excluded from the sub-study. Text sub-study: Participants who withdraw from the OTIS main trial follow-up before their 4-month questionnaire is due will be excluded from the mail out.