A. Purpose. The overall goal of this line of research is to improve Veterans' home safety. For this SPiRE proposal we will test the feasibility of partnering with caregivers to video-record the Veteran's home for subsequent professional home-safety evaluations. This approach has the potential of being a cost effective method of reaching a large number of Veterans for which this intervention is currently not available. In addition, we will investigate compliance barriers and facilitators to professionally prescribed home-safety modifications. This study will lead to a future large-scale study in which we will use the procedures and information obtained in this study to develop an intervention to increase Veteran's home-safety and avoid falls. B. Background. For many older adults, home represents a safe, secure, and controlled environment and provides a means of connectedness to family and community and a way of keeping up the appearance of competence and health. When presented with alternative living arrangements, older adults overwhelmingly choose living at home. However, age related frailty and disability can result in falls and other accidents in the home. This is particularly relevant i the context of older Veterans who need to re-adapt to their home environment after a hospital stay. There is a need to develop strategies that can improve home-safety and facilitate older adults to stay in their homes while meeting the physical challenges of aging and disease. Tele-rehab has been successfully used in a number of interventional studies to deliver cognitive and physical training and to offer educational materials and support. Yet, we have no evidence supporting the use of remote technology to conduct home-safety evaluations or the optimal way of employing this technology for distance home-assessment. Therefore, this pilot study will test the feasibility of using video recordings to professionally evaluate Veterans' home-safety. Furthermore, we will explore Veterans' compliance barriers and facilitators to recommended environmental modifications. C. Methods and Research Plan. For this proposal our goal is to investigate the use of distance technologies to deliver home-safety evaluations and compare this innovative approach with traditional on-site evaluations. In addition, we will investigate compliance barriers and facilitators; crucial for developing interventions to improve adoption of recommended environmental modifications.
Our specific aims are: 1) to develop and test a pre-discharge tele- home-assessment protocol that caregivers can use to record the Veteran's environment for subsequent expert evaluation, 2) to compare on-site home-safety evaluations to home-safety evaluations using caregiver video-recording of the home, and 3) investigate compliance with professionally prescribed environmental modifications, and identify compliance barriers and facilitators. These investigations will support a new approach for conducting home-safety evaluations and provide crucial information for developing interventions to improve compliance with professionally prescribed home-safety modifications.
Professional home evaluations and subsequent environmental modifications can increase home-safety. Unfortunately, many of the Veterans who live in rural areas reside some distance away from their closest medical centers. Consequently, it can be time prohibitive and costly for staff to perform adequate in-home safety assessments and make appropriate recommendations for home modifications when frail, elderly Veterans are returning home after an inpatient stay. This SPiRE proposal aims at examining whether a care- giver can act as the 'eyes' of a therapist and obtain meaningful home-safety assessment data for subsequent professional evaluation. Furthermore, this proposal will investigate barriers and facilitators to compliance wit prescribed home-safety recommendations. This work can influence practice by providing evidence to support an alternative approach to traditional on-site home-safety evaluations and providing crucial information about strategies to improve compliance.
