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Falls and Fear of Falling among Community-Dwelling Seniors: The Dynamic Tension between Exercising Precaution and Striving for Independence

Published online by Cambridge University Press:  31 March 2010

Catherine Ward-Griffin ,
Sandra Hobson ,
Pauline Melles ,
Marita Kloseck ,
Anthony Vandervoort  and
Richard Crilly
Catherine Ward-Griffin*
Affiliation:
University of Western Ontario
Sandra Hobson
Affiliation:
University of Western Ontario
Pauline Melles
Affiliation:
St. Joseph's Health Centre
Marita Kloseck
Affiliation:
University of Western Ontario
Anthony Vandervoort
Affiliation:
University of Western Ontario
Richard Crilly
Affiliation:
University of Western Ontario
*
Requests for offprints should be sent to: / Les demandes de tirés-à-part doivent être adressées à : Catherine Ward-Griffin, RN, PhD, Faculty of Health Sciences, University of Western Ontario, London, ON N6A 5C1. ([email protected])
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Abstract

The purpose of this phenomenological study was to explore the everyday experience of community-dwelling elders, with particular attention to seniors' perceptions of safety, fear of falling, independence, and quality of life. We also aimed to identify contextual factors that influence the health of elders who had fallen and/or had a fear of falling. Data from in-depth interviews with a purposeful sample (n = 9) of elders were analysed using interpretative analysis procedures. Both individual and team analysis was undertaken until interpretations of the experiences of the participants were inductively developed and crystallized into a holistic interpretation of the participants' shared experience. The holistic experience was comprised of two opposing, dynamic life forces: exercising precaution and striving for independence. Within each life force, participants used five major strategies that simultaneously constrained and expanded their life space. Health-promoting practice and policy implications, as well as areas for further research, are discussed.

Résumé

L'objet de cette étude phénoménologique est d'explorer le vécu quotidien des aînés résidant dans la communauté, notamment la perception qu'ils ont de leur sécurité, leur peur de tomber, leur autonomie et leur qualité de vie. Nous avons également cherché à cerner les facteurs contextuels qui influent sur la santé des personnes âgées ayant fait une chute et/ou craignant de faire une chute. Nous avons analysé, au moyen de procédures d'analyse interprétative, les données tirées d'entrevues approfondies menées auprès d'un échantillon représentatif (n = 9) d'aînés. Nous avons poursuivi notre analyse individuelle et d'équipe jusqu'à ce que les perceptions du vécu des participants puissent être induites et cristallisées en une interprétation holistique de leur expérience commune. Cette expérience holistique s'appuyait sur deux forces vitales antagonistes : « prudence avant tout » et « poursuite de l'autonomie ». Pour chaque force vitale, les participants ont utilisé cinq grandes stratégies qui limitaient et élargissaient à la fois leur espace vital. L'ouvrage traite aussi des retombées des pratiques et politiques de promotion de la santé, et d'autres voies de recherche possibles.

Keywords

agingfallselderlyhealth promotioninjury preventionvieillissementchutespersonnes âgéesaînéspromotion de la santéprévention des blessures
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 23 , Issue 4 , Winter/Hiver 2004 , pp. 307 - 318
Copyright
Copyright © Canadian Association on Gerontology 2004

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References

American Geriatrics Society, British Geriatrics Society, & American Academy of Orthopaedic Surgeons Panel on Falls Prevention. (2001). Guideline for the prevention of falls in older persons. Journal of the American Geriatrics Society, 49, 664–672.Google Scholar
Aminzadeh, F., & Edwards, N. (1998a). Exploring seniors' views on the use of assistive devices in fall prevention. Public Health Nursing, 15, 297–304.CrossRefGoogle ScholarPubMed
Aminzadeh, F., & Edwards, N. (1998b). Perceptions, attitudes, and social norms influencing fall prevention: Views of British-Canadian and Italian seniors (CRHU Monograph Series). Ottawa: University of Ottawa, Community Health Research Unit.Google Scholar
Asche, C., Galagher, E., & Coyte, P. (1999). The cost of falling among seniors in Canada. Unpublished manuscript.Google Scholar
Arfken, C., Lach, H.W., Birge, S.J., & Miller, P.J. (1994). The prevalence and correlates of fear of falling in elderly persons living in the community. American Journal of Public Health, 84, 565–569.CrossRefGoogle ScholarPubMed
Ballinger, C., & Payne, S. (2002). The construction of the risk of falling among and by older people. Ageing and Society, 22, 305–324.CrossRefGoogle Scholar
Bandura, A. (1978). Self-efficacy: Toward a unifying theory of behavioral change. Advanced Behavioral Research and Therapy, 1, 139–161.CrossRefGoogle Scholar
Berg, W.P., Alessio, H.M., Mills, E.M., & Tong, C. (1997). Circumstances and consequences of falls in independent community-dwelling older adults. Age and Ageing, 26, 261–268.CrossRefGoogle ScholarPubMed
Borkan, J.M., Quirk, M., & Sullivan, M. (1991). Finding meaning after the fall: Injury narratives from elderly hip fracture patients. Social Science & Medicine, 33(8), 947–957.CrossRefGoogle ScholarPubMed
Bruce, D., Devine, A., & Prince, R. (2002). Recreational physical levels in healthy older women: The importance of fear of falling. Journal of the American Geriatrics Society, 50, 84–89.Google Scholar
Bryant, L.L., Corbett, K.K., & Kutner, J.S. (2001). In their own words: A model of healthy aging. Social Science and Medicine, 53, 927–941.CrossRefGoogle Scholar
Canada Safety Council (n.d.). Aging Canadians value good living and independence. Retrieved 18 November 2003 from http://www.safety-council.org/info/seniors/fallprev.htmlGoogle Scholar
Cwikel, J., & Fried, A.V. (1992). The social epidemiology of falls among community-dwelling elderly: Guidelines for prevention. Disability and Rehabilitation, 14, 113–121.CrossRefGoogle ScholarPubMed
Day, L., Fildes, B., Gordon, J., Fitzharris, M., Flammer, H., & Lord, S. (2002). Randomised factorial trial of falls prevention among older people living in their own homes. British Medical Journal, 325, 128–134.CrossRefGoogle ScholarPubMed
DuPertuis, L.L., Aldwin, C.M., & Bossé, R. (2001). Does the source of support matter for different health outcomes? Findings from the normative aging study. Journal of Aging and Health, 13, 494–510.Google Scholar
Edwards, N., Céré, M., & Leblond, D. (1993). A community-based intervention to prevent falls among seniors. Family Community Health, 15(4), 57–65.CrossRefGoogle Scholar
Edwards, N., Lockett, D., Aminzadeh, F., & Nair, R. (2003). Predictors of bath grab-bar use among community-living older adults. Canadian Journal on Aging, 22(2), 217–227.Google Scholar
Everard, K.M., Lach, H.W., Fisher, E.B., & Baum, M.C. (2000). Relationship of activity and social support to the functional health of older adults. Journal of Gerontology: Social Sciences, 55B, S208–S212.CrossRefGoogle Scholar
Franzoni, B., Rozzoni, R., Boffelli, S., Frisoni, G.B., & Trabucchi, M. (1994). Fear of falling in nursing home patients. Journal of Gerontology, 40, 38–44.CrossRefGoogle ScholarPubMed
Gagnon, N., & Flint, A.J. (2003). Fear of falling in the elderly. Geriatrics and Aging, 6(7), 15–17.Google Scholar
Gallagher, E.M. (1994). Falls in the elderly. Victoria, BC: School of Nursing, University of Victoria. Retrieved, 11 November 2003 from http://www.coaguvic.ca/publications/pdfs/falls_and_the_elderly.pdf.Google Scholar
Horton, K., & Arber, S. (2004). Gender and the negotiation between older people and their carers in the prevention of falls. Ageing and Society, 24, 75–94.Google Scholar
Howland, J., Lachman, M.E., Peterson, E.W., Cote, J., Kasten, L., & Jette, A. (1998). Covariates of fear of falling and associated activity curtailment. The Gerontologist, 38, 549–555.CrossRefGoogle ScholarPubMed
Josephson, K.R., Fabacher, D.A., & Rubenstein, L.Z. (1991). Home safety and fall prevention. Clinics in Geriatrics Medicine, 7, 707–730.CrossRefGoogle ScholarPubMed
Kellogg International Work Group on Health and Aging. (1987). The prevention of falls in later life. Danish Medical Bulletin, 34(Suppl. 4), 1–24.Google Scholar
Kong, K.S., Lee, F.F., Mackenzie, A.E., & Lee, D.T. (2002). Psychosocial consequences of falling: The perspective of older Hong Kong Chinese who had experienced recent falls. Journal of Advanced Nursing, 37, 234–242.CrossRefGoogle ScholarPubMed
Kuzel, A., & Like, P. (1991). Standards of trustworthiness for qualitative studies in primary care. In Norton, P.G. Stewart, M., Tudiver, F., Bass, M., & Dunn, E. (Eds.). Primary care research, traditional and innovative approaches. Newbury, CA: Sage.Google Scholar
Li, F., Fisher, K.J., Harmer, P., McAuley, E., & Wilson, N.L. (2003). Fear of falling in elderly persons: Association with falls, functional ability, and quality of life. Journal of Gerontology: Psychological Sciences, 58B, P283–P290.Google Scholar
Lincoln, Y.S., & Guba, E.G. (1985). Naturalistic inquiry. Sage: Beverly Hills, CA.CrossRefGoogle Scholar
Luukinen, H., Koski, K., Laippala, P., & Kivela, S.L. (1995). Risk factors for recurrent falls in the elderly in long term institutional care. Public Health, 109, 57–65.CrossRefGoogle ScholarPubMed
Lyons, R.A., Sander, L.V., Weightman, A.L., Patterson, J., Jones, S.A., Lannon, S., et al. (2002). Modification of the home environment for the reduction of injuries. The Cochrane Library, 4, 1–17.Google Scholar
McCollam, E.M. (1995). Evaluation and implementation of a research-based falls assessment innovation. Nursing Clinics of North America, 30, 507–514.CrossRefGoogle ScholarPubMed
Malik, N. (2000). Death, disability, institutionalization—All preventable consequences of falls: Mobility devices and good caregivers facilitate recovery and deter more falls. Geriatrics and Aging, 3(6), 8–36.Google Scholar
McMurray, A. (2003). Community health and wellness: A sociological approach (2nd ed.). Sydney, Australia: Mosby.Google Scholar
McWilliam, C.L., Ward-Griffin, C., Sweetland, D., Sutherland, C., & O'Halloran, L. (2001). The experience of empowerment in in-home services delivery. Home Health Services Quarterly, 20(4), 49–71.CrossRefGoogle ScholarPubMed
Morse, J. (1991). Strategies for sampling. In Morse, J. (Ed.). Qualitative nursing research: A contemporary dialogue (2nd ed., pp. 127–145). Newbury Park, CA: Sage.CrossRefGoogle Scholar
Morse, J., & Field, P.A. (1995). Qualitative research methods for health professionals (2nd ed.). London: Sage.Google Scholar
Myers, A.M., Powell, L.E., Mali, B.E., Holliday, P.J., Brawley, L.R., & Sherk, W. (1996). Psychological indicators of balance confidence: Relationship to actual and perceived abilities. Journal of Gerontology: Medical Sciences, 51A, M37–M43.Google Scholar
Nakamura, D.M., Holm, M.B., & Wilson, A. (1998). Measures of balance and fear of falling in the elderly: A review. Physical and Occupational Therapy in Geriatrics, 15(4), 17–32.Google Scholar
Nevitt, M. (1997). Falls in the elderly: Risk factors and prevention. In Masdeu, J.C., Sudarsky, L., & Wolfson, L. (Eds.), Gait disorders of aging: Falls and therapeutic strategies (pp. 13–36). Philadelphia, PA: Lippincott-Raven.Google Scholar
Patton, M. (2002). Qualitative research and evaluation methods (3rd ed.). Thousand Oaks, CA: Sage.Google Scholar
Patrick, L., Leber, M., Scrim, C., Gendron, I., & Eisener-Parsche, P. (1999). A standardized assessment and intervention protocol for managing risk for falls on a geriatric rehabilitation unit. Journal of Gerontological Nursing, 25(4), 40–47.Google Scholar
Peterson, E., Howland, J., Keilhofner, G., Lachman, M.E., Assmann, S., Cote, J., et al. (1999). Falls, self-efficacy and occupational adaptation among elders. Physical and Occupational Therapy in Geriatrics, 16(1/2), 1–16.Google Scholar
Perry, B.C. (1982). Falls among the elderly living in high-rise apartments. The Journal of Family Practice, 14, 1069–1073.Google ScholarPubMed
Riley, R. (1992). Accidental falls and injuries among seniors. Health Reports, 4, 341–354.Google ScholarPubMed
Roberts, R.E., Kaplan, G.A., Shema, S.J., & Strawbridge, W.J. (1997a). Does growing old increase the risk for depression? American Journal of Psychiatry, 154, 1384–1390.Google Scholar
Roberts, R.E., Kaplan, G.A., Shema, S.J., & Strawbridge, W.J. (1997b). Prevalence and correlates of depression in an aging cohort: The Alameda County study. Journal of Gerontology: Social Sciences, 52B, S252–S258.Google Scholar
Robson, E., Edwards, J., Gallagher, E., & Baker, D. (2003). Steady as you go (SAYGO): A falls-prevention program for seniors living in the community. Canadian Journal on Aging, 22(2), 207–216.CrossRefGoogle Scholar
Salkeld, G., Cameron, I.D., Cummings, R.G., Easter, S., Kurrie, S.E., & Quine, S. (2000). Quality of life related to fear of falling and hip fracture in older women: A time trade off study. British Medical Journal, 320, 341–346.CrossRefGoogle ScholarPubMed
Seeman, T.E., Lusignolo, T.M., Albert, M., & Berkman, L. (2001). Social relationships, social support, and patterns of aging in healthy, high functioning older adults: MacArthur studies of successful aging. Health Psychology, 20, 243–255.CrossRefGoogle ScholarPubMed
Smartrisk. (1998). The economic burden of unintentional injury in Canada. Retrieved on 18 November 2003 from http://www.smartrisk.ca/uploads/cf127134791602109375.pdfGoogle Scholar
Steinmetz, H.M., & Hobson, S.J.G. (1994). Prevention of falls among the community-dwelling elderly: An overview. Physical and Occupational Therapy in Geriatrics, 12(4), 13–28.Google Scholar
Tinetti, M.E., Mendes deLeon, C.F., Doucette, J.T., & Baker, D.I. (1994). Fear of falling and fall-related efficacy in relationship to functioning among community-dwelling elders. Journal of Gerontology: Medical Sciences, 49, M140–M147.Google Scholar
Tinetti, M.E., & Powell, L. (1993). Fear of falling and low self-efficacy: A cause of dependence in elderly persons. Journal of Gerontology, 48, 35–38.Google Scholar
Tinetti, M., & Speechley, M. (1989). Prevention of falls among the elderly. The New England Journal of Medicine, 320, 1055–1059.Google Scholar
Tinetti, M., Speechley, M., & Guinter, S.F. (1988). Risk factors for falls among elderly persons living in the community. The New England Journal of Medicine, 319, 1701–1707.CrossRefGoogle ScholarPubMed
Vandervoort, A.A. (1995). Biological and physiological changes. In Pickles, B., Compton, A., Cott, C., Simpson, J.M., & Vandervoort, A.A. (Eds.), Physiotherapy with older persons (pp. 67–80). London: Saunders.Google Scholar
Vellas, B.J., Wayne, S.J., Romeron, L.J., Baumgartner, N.R., & Garry, J.P. (1997). Fear of falling and fall-related efficacy in relationship to functioning among community-living elders. Age and Ageing, 26, 189–193.Google Scholar
Walker, J.E., & Howland, J. (1991). Falls and fear of falling among elderly persons living in the community: Occupational therapy interventions. The American Journal of Occupational Therapy, 45, 119–122.CrossRefGoogle ScholarPubMed
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(1), 17–23.Google Scholar