An uncertain grip on earth: the concerns of physically disabled adults who experience falls.

Abstract

This thesis explores matters related to disabled adults who experience falls, a topic that remains a gap in the literature although research into falls in elders began over fifty years ago. It seeks to understand the perceptions and interpretations of falls in physically disabled adults, the impact they have on their lives, how they are distinct and how they change over time.

In keeping with its standing as a poorly theorised topic, I chose a qualitative methodology to explore these experiences with the participants. After consultation with Māori and disability groups, volunteers were recruited for semi-structured interview, following the publication of articles in pānui (Māori newsletters) and the local newspaper. Seventeen participants were interviewed, beginning an ongoing process designed to develop theories about falling. As a disabled researcher I returned to each participant at least twice as we built up and elaborated our concepts about falls into multi-layered stories, using the methodology of constructivism. Narrative enquiry was used as the methodology of choice.

The analysis of the data generated insights that were shaped into three sections of findings: the bodily consequences of falls; an environmental perspective that was inclusive of a disability framework; and the evolution in the experiences of falls over the life course. There were three philosophies that characterised how falls were perceived and participants moved seamlessly between them. Some participants considered falls as a natural part of living and adapted accordingly. Others understood falling as an inherent part of their disability, whilst a third group interpreted them as a progression of disability. Each interpretation held the potential for the participants and me to construct a deeper understanding of our disabilities and ourselves.

Issues that held particular meaning were brought together in the discussion. Managing falls required a “trade-off” between the potential harm of a fall and the benefits of exercise. Going to the gym to improve physical fitness was a strategy used by several participants. During their disability they usually experienced both stable periods and variable risk from day to day. Invisible triggers for falls, such as pain, fatigue and lack of sensation, were often unnoticed and poorly understood by others. Weighing up changes in strength and ability and dealing with uncertainty were part of an undetectable process. Many participants had had fractures and had been given little information about their entitlements. As they grew older, they were becoming more concerned about their risk of falling and the possibility of fractures. Follow-up studies are needed.