Abstract
Despite world-wide emphasis on falls prevention, falls and their consequences remain a major health issue for older people, and their health care providers. Many systematic reviews have been undertaken to evaluate the impact of intervention programmes on falls reduction, however, relatively little research provides a voice for older people’s own perceptions of such programmes. To readdress this imbalance the current research utilized a purposive sampling method to recruit a hard to reach group of older people who had received a post-fall health and social-care programme to investigate their experiences of the programme. Semi-structured interviews with eight housebound people aged over 65 who had fallen were undertaken, and data analysed using interpretative phenomenological analysis. Four themes were identified: losing independence; losing confidence; losing social identity; managing a changed self. Despite a tailored intervention programme minimal improvement in participants’ psychological adjustment to falls was noted. Outcomes from this study are of interest to health and social-care staff who deliver falls prevention programmes. Staff need to enhance constructive adjustment to the older person’s altered circumstances and ensure behaviours do not exacerbate their clients’ loss of independence. This should assist older people’s ability to positively manage their sense of self, allowing them to find continuing meaning in their daily lives.
Similar content being viewed by others
References
American Geriatrics Society, British Geriatrics Society, American Academy of Orthopedic Surgeons Panel on Falls Prevention (2001) Guideline for the prevention of falls in older persons. J Am Geriatr Soc 49:664–672
Arfken C, Lach H, Birge S, Miller P (1994) The prevalence and correlates of fear of falling in elderly persons living in the community. Am J Public Health 84:565–570
Ballinger C, Payne S (2000) Falling from grace or into expert hands? Alternative perspectives about falls in older people. Br J Occup Ther 63:573–579
Ballinger C, Payne S (2002) The construction of the risk of falling among and by older people. Ageing Soc 22:305–324
Berg W, Alessio H, Mills E, Tong C (1997) Circumstances and consequences of falls in independent community-dwelling older adults. Age Ageing 26:261–268
Bunn F, Dickinson A, Barnett-Page E, McInnes E, Horton K (2008) A systematic review of older people’s perceptions of facilitators and barriers to participation in falls-prevention interventions. Ageing Soc 28:449–472
Campbell A, Borrie M, Spears G, Jackson S, Brown J, Fitzgerald J (1990) Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study. Age Ageing 19:136–141
Coyle J (2000) Exploring the meaning of ‘dissatisfaction’ with health care: the importance of ‘personal identity threat’. Sociol Health Illn 221:95–124
Department of Health (2001) National service. Framework for older people. Department of Health, London
Fineman N (1994) Health care providers’ subjective understandings of old age: implications for threatened status in late life. J Aging Stud 8:255–270
Gagnon N, Flint A, Naglie G, Devins G (2005) Affective correlates of fear of falling in elderly persons. Am J Geriatr Psychiatr 13:7–13
Gates S, Lamb S, Fisher J, Cooke M, Carter Y (2008) Multifactorial assessment and targeted intervention for preventing falls and injuries among older people in community and emergency care settings: systematic review and meta-analysis. Br Med J 336:130–138
Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH (2009) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2. doi:10.1002/14651858.CD007146.pub2
Greve W, Wentura D (2003) Immunizing the self: self-concept stabilization through reality-adaptive self-definitions. Pers Soc Psychol Bull 29:39–50
Health Education Board for Scotland (2003) The construction of the risks of falling in older people: lay and professional perspectives. http://www.healthscotland.com/documents/browse/352/0.aspx Accessed 12 November 2005
Hill K, Schwarz J (2004) Assessment and management of falls in older people. Intern Med J 34:557–564
Holstein J, Gubrium J (1998) Phenomenology, ethnomethodology, and interpretive practice. In: Denzin N, Lincoln Y (eds) Strategies of qualitative enquiry. Sage, London, pp 137–157
Howland J, Lachman M, Walker Peterson E, Cote J, Kasten L, Jette A (1998) Covariates of fear of falling and associated activity curtailment. The Gerontologist 38:549–555
Jung D, Lee J, Lee S (2009) A meta-analysis of fear of falling treatment programs for the elderly. West J Nurs Res 31:6–16
Kong K, Lee F, Mckenzie A, Lee D (2002) Psychosocial consequences of falling: the perspective of older Hong Kong Chinese who had experienced recent falls. J Adv Nurs 37:234–242
Kressig R, Wolf S, Sattin R, O’Grady M, Greenspan A, Curns A, Kutner M (2001) Associates of demographic, functional, and behavioural characteristics with activity-related fear of falling among older adults transitioning to frailty. J Am Geriatr Soc 49:1456–1462
Lach H (2005) Incidence and risk factors for developing fear of falling in older adults. Public Health Nurs 22:45–52
Lee F, Mackenzie L, James C (2008) Perceptions of older people living in the community about their fear of falling. Disabil Rehabil 30:1803–1811
Li F, Fisher K, Harmer P, McAuley E, Wilson N (2003) Fear of falling in elderly persons: association with falls, functional ability, and quality of life. J Gerontol 58B:283–290
Lilley J, Arie T, Chilvers C (1995) Accidents involving older people: a review of the literature. Age Ageing 24:346–365
Lothian K, Philp I (2001) Care of older people: maintaining the dignity and autonomy of older people in the healthcare setting. Br Med J 322:668–670
McKinlay A, McVittie C (2011) Identities in context: individuals and discourse in action. Wiley-Blackwell, Oxford
Myers A, Powell L, Maki B, Holliday P, Brawley L, Sherk W (1996) Psychological indicators of balance confidence: relationship to actual and perceived abilities. J Gerontol 51A:37–43
Owens T (2006) Self and identity. In: Delamater J (ed) Handbook of social psychology. Kluwer Academic/Plenum Publishers, New York, pp 205–232
Scheffer A, Schuurmans M, Van Dyk N, Van Der Hooft T, De Rooij S (2008) Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing 37:19–24
Smith J, Osborn M (2008) Interpretative phenomenological analysis. In: Smith J (ed) Qualitative psychology. A practical guide to research methods, 2nd edn. Sage, London, pp 53–80
Strategy for Osteoporosis and Falls Prevention (2006) NHS greater glasgow strategy for osteoporosis and falls prevention 2006–2010. http://library.nhsgg.org.uk/mediaAssets/library/nhsggc_strategy_osteoporosis_falls_prevention_2006-2010.pdf Accessed 25 June 2007
Strauss A, Corbin J (1998) Basics of qualitative research: techniques and procedures for developing grounded theory, 2nd edn. Sage, Thousand Oaks
Swift C (2001) Falls in late life and their consequences-implementing effective services. Br Med J 322:855–857
Tinetti M, Powell L (1993) Fear of falling and low self-efficacy: a cause of dependence in elderly persons. J Gerontol 48A:35–38
Tinetti M, Speechley M (1989) Prevention of falls among the elderly. N Engl J Med 320:1055–1059
Tinetti M, Richman D, Powell L (1990) Falls efficacy as a measure of fear of falling. J Gerontol 45B:239–243
Tinetti M, Mendes de Leon C, Doucette J, Baker D (1994) Fear of falling and falls-related self-efficacy in relationship to functioning among community living elders. J Gerontol 49A:140–147
Ward-Griffin C, Hobson S, Melles P, Kloseck M, Vandervoort A, Crilly R (2004) Falls and fear of falling among community-dwelling seniors: the dynamic tension between exercising precaution and striving for independence. Can J Aging 23:307–318
Yardley L, Smith H (2002) A prospective study of the relationship between feared consequences of falling and avoidance of activity in community-living older people. The Gerontologist 42:17–23
Zijlstra G, van Haastregt J, van Rossum E, van Eijk J, Yardley L, Kempen G (2007) Interventions to reduce fear of falling in community-living older people: a systematic review. J Am Geriatr Soc 55:603–615
Author information
Authors and Affiliations
Corresponding author
Additional information
Responsible Editor: D.J.H. Deeg.
Rights and permissions
About this article
Cite this article
Stewart, J., McVittie, C. Living with falls: house-bound older people’s experiences of health and community care. Eur J Ageing 8, 271–279 (2011). https://doi.org/10.1007/s10433-011-0202-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10433-011-0202-8