Home safety audits have consistently proven to be effective in reducing the risk and rate of falls when conducted by occupational therapists (OTs; Clemson et al. 2008b). The Westmead is an iterative approach to assessment and intervention whereby the OT moves through the home environment with the client jointly identifying hazards and risky behaviors, problem-solving solutions, and assisting to prioritize actions (Clemson 1997). In randomized trials of this intervention, falls have been reduced both at home and in the community (Campbell et al. 2005; Cumming et al. 1999), suggesting there is generalization of hazard awareness and safety behaviors beyond the home environment.

Stepping On is a multifaceted falls prevention program for the community-residing elderly (Clemson and Swann 2008). The program was developed by OTs in 2003. It evolved from a review of evidence-based interventions, contributions from content experts, and the views of older participants. It is different from a tailored approach where therapists assess risk factors and prescribe interventions based on risk assessment. In Stepping On, the older person is encouraged to have ownership of which strategies are relevant to them. Homework and follow-up support their engagement in relevant preventive strategies.

The LiFE program (Clemson et al. 2014) fills a gap for those older people who have struggled with maintaining regular exercise on a set time each week and provides another choice of an evidence-based program that reduces falls risk. Taught on home visits, movements which improve balance or increase hip, knee, and ankle strength are embedded in routine daily activities and done multiple times each day. LiFE activities or movements are closely aligned to functional activity. The participant learns the principles behind the program and engages with the therapist in planning weekly activities and upgrades. The LiFE program demonstrated significant improvements in balance and also resulted in improved functional capacity and more energy (Clemson et al. 2012).

A fall is defined as an event, including a slip or a trip where the person loses their balance and inadvertently lands on the ground or floor or other lower level. It is important to understand people’s perception of their fall, what they think could have caused the fall, and what they think could be done to stop a future fall.

The programs aim to reduce falls and fulfill one or more of the following:

Falls are a common and serious problem for older people . Some 30–35 % of persons who are age 70 or older fall each year (O’Loughlin et al. 1993). Injurious falls are a leading cause of hospitalization and can lead to social isolation and premature institutionalization (Tinetti and Williams 1997). Risk factors for falls include poor balance, reduced lower leg strength, poor vision, chronic disorders, depression, and sleep disturbances (Deandrea et al. 2010). Fear of falling is also a common occurrence, with reported incidence of 30–70 % and increasing with age (Vellas et al. 1997). It is more prevalent in those who report multiple falls, poorer health, or unsteady balance (Lack 2005). Core interventions known to have an impact supported by meta-analyses are exercise, environmental adaptation, and medication management (Gillespie et al. 2012).

The prevention intervention is performed by home visits or group based in community venues. Venues chosen should be in an accessible place in the community, situated near public transportation.

It is important that theory underpins each of these programs and from which these specific preventive strategies are derived. Each has a different conceptual model, but overlap in that they use principles of self-efficacy , personal control, and enable a sense of ownership of solutions or strategies.

The following assessment tools are recommended for use in a quality home safety intervention:

Stepping On, led by a therapist as group facilitator, runs for seven 2-h sessions with a follow-up home visit (or telephone) contact and a booster 3-month session. Key content areas include home-based balance and strength exercises, home and community safety , coping with visual loss and regular visual screening, medication management, footwear audits, mobility mastery, and sleep hygiene. Content experts who are skilled in relevant aspects of falls prevention introduce some of the key content areas. For example, we include a physiotherapist to teach the exercises in the initial stages of the program and a mobility officer from the Guide Dogs Association to introduce the strategies for coping with low vision . Information is shared and reinforced within the context of the group by the OT facilitator. Each session provides time for reflection and sharing accomplishments and ends in planning action and homework for the next week. The balance and strength training is practiced or reviewed each week, and one session includes a community mastery experience (usually just outside the venue) during which community mobility and discrete skills (e.g., negotiating grass or curb ramps) are practiced.