Community-Dwelling Older People and Falls Reporting: A Qualitative Descriptive Study

Abstract

One third of people aged over 65 years fall each year. Falls, and their consequences, are major concerns for individuals, health care providers and funders in terms of injury, reduced independence, and financial costs. Some risk factors for falls are modifiable if health professionals know people are falling. Not reporting falls is a well-known phenomenon, however the extent of the problem, and reasons for non-reporting, are not well understood. In the context of developing a falls-prevention service for community-dwelling older people the aim of this research was to explore why older people may not report falls to health professionals. Qualitative description was used to explore what influenced older people, living alone at home, to report a fall. A purposive sample of ten community-dwelling older people were recruited through community nursing services and interviews of these participants provided the research material. Thematic analysis was used to identify factors influencing reporting of falls. Three themes were derived from this analysis: ‘Consequences determine what participants classify as a fall’, ‘Minimisation - Don’t mention the ‘F’ words’, and ‘Sharing and acquiring knowledge of a fall’. These themes were understood within the context of ‘Occupational independence’, which reflected the participants desire to remain independent with their daily occupations, and remain at home. Classifying a ‘fall event’ as a fall was dependent on consequences of the fall. Participants’ perceptions of what constituted a fall were different from international research-based definitions. A number of fall events that were described met international definitions of a fall, but were not considered as falls by the participants. Participants strongly valued remaining independent at home, and fall events not affecting a person's ability to manage were viewed as inconsequential. Participants reported talking about falls with their contemporaries; however, falls were mentioned in passing, or as a joke, in order to minimise fuss. General Practitioners (GPs) were rarely told about falls and participants saw no reason to report a fall if they continued to manage at home. GPs were not viewed as having a role in falls prevention, but viewed as only having a role in dealing with consequences of falls, such as broken bones or ongoing pain. These results suggest older people may not see the need to report a fall if it has no consequences for them. Within clinical settings a shared understanding of falls should not be assumed. When health professionals ask about falls, older people may be helped to recall and report events if reminded this includes occasions where they have fallen without injury. A fall is a complex concept that is still not accurately described in a way that is congruent with, and encompasses, the understanding of researchers, clinicians, and older people. A better definition of the concept is an area for further research. Any proposed definition of falls needs to incorporate the older persons’ perspective in order for falls reporting be valid, and better represent older peoples’ experience in both clinical practice and research.