Yale Bulletin and Calendar

May 3-17, 1999

Volume 27, Number 31

The homes of many older people are rife
with easily eliminated hazards, says study

In what is believed to be the first population-based study of its kind, Yale researchers have discovered that many older people have physical hazards in their homes that easily could be eliminated.

Potential environmental hazards such as poor lighting, exposed electrical cords, throw rugs and insufficient bathroom grab rails or stairway banisters are present in the homes of most older people, the study reveals.

The research is particularly significant because it is based on data collected through visits to the homes of older persons living in New Haven, as opposed to information obtained from secondary sources, according to Dr. Thomas M. Gill, assistant professor of medicine at the School of Medicine's Program on Aging, who served as chief investigator for the study. Results of the research were published in last month's American Journal of Public Health.

"The home environment can either facilitate function or constrain function," says Gill, a Robert Wood Johnson Generalist Physician Faculty Scholar and a Beeson Physician Faculty Scholar in Aging Research. "Baby boomers are now facing the challenge of how to care for their aging parents. The environment has to be a part of that equation."

The study looked at 1,000 people age 72 and older who were living in New Haven in 1989. All were participants in of Project Safety, a study funded by the National Institute on Aging. As part of that study, researchers looked at variables that might influence the day-to-day functioning of senior citizens, including physical hazards in the home that could lead to a fall. Information was collected by a trained research nurse, who assessed each room in the home for potential environmental
hazards.

Dr. Mary Tinetti, professor of medicine and of epidemiology and public health, and director of the Program on Aging, assembled the group studied in Project Safety. Seventy-two percent of the participants were female, and 84 percent were white. Sixty-nine percent lived alone. The study included people living in houses, apartments, condominiums and age-restricted housing, such as senior-citizen complexes.

Homes were checked for a total of 20 potential hazards. The most common problem -- found in 77.9 percent of the homes -- was loose throw rugs, mats or some other kind of tripping hazard (such as a cord or curled carpet edge) on the floor. Sixty-one percent of the homes had no grab bars in the tub or shower. Two or more hazards were found in 59 percent of the bathrooms.

Included among the other environmental hazards discovered were dim lighting; shadows or glare in rooms and/or along stairs; kitchen light switches that were unclearly marked; and no stairway night light.

In a paper published in the January issue of the Journal of the American Geriatrics Society, Gill and his research team also compared the number of hazards found in the home of physically impaired older persons with those in the homes of older persons with relatively unrestricted mobility. The researchers found no significant difference between the two groups.

Two of the hazards cited -- a low-lying chair and obstructed pathways -- actually were found to be more prevalent among older persons with limited physical capabilities. "That really surprised us," says Gill, noting that the findings suggest senior citizens need to be more aware of home safety.

According to Gill, the everyday function of frail older persons may be enhanced, and the potential for disabling accidents may be decreased, by assessing the home for potential hazards and then minimizing those hazards.

"We need to consider the effect of the home environment on everyday function," says Gill. For example, people need more "push," or strength, to rise from a chair that is low to the ground than from a higher seat. Therefore, low-lying chairs -- which were found in 17.9 percent of the homes examined -- automatically increase the likelihood that older people will need assistance getting to their feet. If a person needs assistance with an everyday task such as rising from a chair, that person, by definition, is unable to live independently, notes Gill. He adds that simply replacing the low chair with one that sits a few inches higher from the floor could make a big difference.

Gill believes his group's study could have far-reaching implications. "We used a very sophisticated sampling technique that allows us to produce a sample that is population-based," he explains. "The representative sample of older persons in New Haven can be generalized to other comparable urban settings."

Research such as this could be used to help determine how resources earmarked for the elderly will be allotted, says Gill. For instance, the study "points to the importance of home assessment with regard to older people," he says. "Already, many Medicare recipients are eligible for home care services. As part of that, a home safety assessment could be ordered.

"What we have done is to show that there's a potential problem," says Gill. "The next step is to determine whether we can do something about the problem."

Analyzing the data along with Gill and Tinetti were Christianna S. Williams, the supervising data analyst, and Julie T. Robison, a former research affiliate at the department of epidemiology and public health.

In addition to grants from the National Institute on Aging, work on the study was funded by an award from the Gaylord Rehabilitation Research Institute.

-- By Felicia Hunter

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The homes of many older people are rife with easily eliminated hazards, says study
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