Health-related safety: a framework to address barriers to aging in place

Maintaining safety in the home and community is a national public health concern, especially for older adults who "age in place." In this article, we introduce a multicausal concept called "health-related safety," which is defined as the minimization of the probability of preventable, unintended harm in community-dwelling individuals. Derived from the modern patient safety movement, health-related safety attributes adverse health events in the home and community to systematic breakdowns in the societal system, not to the commission of errors by particular individuals. Extending beyond health care institutions, the health-related safety framework is composed of multiple levels: micro (consumers and providers); mezzo (homes and communities); and macro (policies). Because the societal system is complex with inherent risks, health-related safety will require a culture shift and system redesign, new tools of risk assessments and management, and continuous safety improvement. We propose a research agenda to further refine the health-related safety framework by using empirical evidence and to develop appropriate mathematical and practical models from safety sciences to support this initiative. This article moves the field forward by applying systems thinking and safety sciences to health-related safety in the home and community, thereby paralleling what researchers have begun to do with patient safety in health care systems.