Research explores how indoor modifications can affect safety of wheelchair users

by Scott J. Turner

The presence of even one indoor modification, such as easy-to-open doors, in the home of a wheelchair user translates into fewer injurious falls, according to Brown research findings.

The research, which draws attention to access and safety problems in the homes of disabled persons, was conducted by Katherine Berg, adjunct associate professor of community health; Susan Allen, associate professor of medical science; and Marilyn Hines, >a former project analyst at the Center for Gerontology and Health Care Research.

Previously little was know about the link between home modifications and injurious falls among people who use a wheelchair. One study, conducted more that 20 years ago, found that just 10 percent of disabled adults lived in homes modified to improve their access and mobility.

Home environments that foster independence and that make it easier to move around should be considered a basic need for disabled persons, said Allen, a coauthor of the study published in the American Journal of Public Health.

The trio examined 1994-95 survey data from 525 wheelchair-using adults. About 38 percent of those surveyed said they had fallen at least once in the past year and 47 percent of those who fell reported that they had suffered a fall-related injury.

The researchers looked at the prevalence of five structural modifications in the home environment: bathroom alterations, widened doorways and/or hallways, kitchen modifications, railings, and easy-to-open doors. They found that the presence of any of the modifications was associated with a lower incidence of falls involving injury.

Overall, only 4 percent of those surveyed had all five of the features and 36 percent had none. About 48 percent of people injured in a fall reported having none of the modifications compared to 34 percent of those who did not experience a damaging fall.

Health providers can help educate patients by asking them to identify modifiable problems in the home environment, said the researchers. Such questions might include whether a wheelchair fits through a bathroom door, how patients transfer to and from bed and move about the home, how they access the toilet, and whether they avoid any rooms or other areas.

The authors said that safety and access would improve if home modifications were reimbursable under Medicare, Medicaid and other health insurers. They also called for greater movement in society toward "barrier-free universal design environments" for wheelchair users. In 1994, 1.6 million community-dwelling Americans reported using a wheelchair for mobility, according to the study.