Aim: To identify the level of uptake of Occupational Therapists' home environmental audit recommendations by older community dwellers and the factors that contribute to adherence. Methods: Design and setting: Cohort nested within an RCT that compared two models of care for fall prevention located in Brisbane, Australia. Participants: Community-dwelling older people >60 at risk of falls (n = 80). Interventions: An environmental audit and recommendations by an Occupational Therapist. Results: Of the recommendations made, 55% were completed by 6 months. Increasing number of comorbidities was a significant predictor of adherence with recommendations. Recommendations requiring external providers were more likely to be completed than those relying on the client or family member. Conclusion: Occupational therapists need to consider a wide range of intrinsic and extrinsic factors, which may contribute to adherence with home modifications.