Relationship between home hazards and falling among community-dwelling seniors using home-care services.

BACKGROUND: Evidence linking home hazards to falls has not been well established. The evidence-based approach to fall-risk assessment in longitudinal studies becomes difficult because of exposures that change during follow-up. We conducted a cohort study to determine the prevalence of hazards and to resolve whether they are linked to the risk of falls among 959 seniors receiving home-care services. METHODS: A home hazards assessment was completed at entry and every six months thereafter using a standardized form. The adjusted (for a number of confounding factors) relationship between home hazards and falls was estimated using a survival model taking into account updated time-varying exposures and multiple events. Falls leading to a medical consultation were examined as a secondary outcome, hypothesized as a measure of severity. FINDINGS: Home environmental hazards were found in 91% of homes, with a mean of 3.3 risks per individual. The bathroom was the most common place for hazards. The presence of hazards was significantly associated with all falls and fall-related medical consultations, and showed relatively constant effects from one fall to another. IMPLICATIONS: The current study is innovative in its approach and useful in its contribution to the understanding of the interaction between home environmental hazards and falls. Our results indicate that inattention to changes in exposure masks the statistical association between home hazards and falls. Each environmental hazard identified in the home increases the risk of falling by about 19%. These findings support the positive findings of trials that demonstrate the effectiveness of this home hazard reduction program, particularly for at-risk people.

Profiles and correlates of aggressive behaviour among adults with intellectual disabilities.

BACKGROUND: Despite the heterogeneity in aggressive behaviours observed among individuals with intellectual disabilities (ID), little attention has been paid to the identification of typologies of aggression among individuals with mild or moderate ID and their associated factors. OBJECTIVE: The goal of the present study was to identify profiles of aggressive behaviour and their psychosocial correlates. METHOD: In this cross-sectional study of 296 adults with mild or moderate ID, information was gathered through interviews with the ID participants, their case manager and a significant other. Client files were also reviewed. RESULTS: Multiple correspondence analysis followed by hierarchical cluster analysis generated six distinct profiles of aggressive behaviour in this sample. The 'violent' group clearly stood out as lacking social and vocational involvement, having more severe mental health problems, high levels of impulsivity and antisocial tendencies compared with all other groups. DISCUSSION: The identification of distinct profiles of aggressive behaviour offers new possibilities for studying risk factors and eventually targeting specific risk prevention strategies.