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“People are Getting Lost a Little Bit”: Systemic Factors that Contribute to Falls in Community-Dwelling Octogenarians

Published online by Cambridge University Press:  09 June 2015

Dorothy Gotzmeister ,
Aleksandra A. Zecevic ,
Lisa Klinger  and
Alan Salmoni
Dorothy Gotzmeister*
Affiliation:
The School of Graduate and Postdoctoral Studies, Western University
Aleksandra A. Zecevic
Affiliation:
School of Health Studies, Faculty of Health Sciences, Western University
Lisa Klinger
Affiliation:
School of Occupational Therapy, Faculty of Health Sciences, Western University
Alan Salmoni
Affiliation:
School of Kinesiology, Western University
*
*La correspondance et les demandes de tirés-à-part doivent être adressées à: / Correspondence and requests for offprints should be sent to: Dorothy Gotzmeister, OT Reg. (Ont.), MSc, The School of Graduate and Postdoctoral Studies International and Graduate Affairs Building, Room 1N07 Western University 1151 Richmond Street London, ON N6A 3K7 ([email protected])
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Abstract

Octogenarians living in the community are the fastest-growing demographic in Canada. Simultaneously, they have the highest prevalence of falls and nine times greater risk of injury due to a fall. To understand how to improve the safety of octogenarians’ aging-in-place, a systems approach is essential. Understanding how societal factors interact and affect the older adult can help care custodians identify and remove safety deficiencies that bring about falls. The purpose of this study was to identify system-wide factors contributing to falls in community-dwelling octogenarians. Eight falls were investigated using the systemic falls investigative method. Participants ranged in age from 83–90 years. Across-case analyses identified 247 contributing factors, grouped within four distinct themes: (a) everyday living has become risky; (b) supervision limitations; (c) health care system disconnects; and (d) poor fall risk identification and follow-up. This qualitative study provides systemic insights into how and why falls occur in community-dwelling octogenarians.

Résumé

Les octogénaires qui habitent aux communautés sont la caractéristique la plus croissante dans la démographie du Canada. Au même temps, ils ont la plus forte prévalence des chutes et neuf fois plus de risques de blessures dues à une chute [par rapport a qui]? Une approche systématique est essentielle pour améliorer la sécurité des octogenaires qui vieillissent en place (chez soi). Comprendre comment les facteurs sociaux interagissent et affectent les aînés peuvent aider à identifier et éliminer les carences en matière de sécurité qui provoquent des chutes. Le but de cette étude était d'identifier les facteurs dans l'ensemble du système qui contribuent aux chutes chez les octogénaires qui habitent aux communautés. Huit chutes ont été étudiées en utilisant une méthode systématique d'examiner les chutes (MSEC). Les participants étaient âgés de 83 à 90 ans. Les analyses à travers des cas ont identifiées 247 facteurs contributifs, regroupés au sein de quatre thèmes distincts: (a) la vie quotidienne est devenu plein de risque; (B) la surveillance est limitée; (C) le système de soins de santé montre la déconnexion; et (d) l'identification et le suivi des chutes est défectueux. Cette étude qualitative permet des apércus systématiques sur comment et pourquoi les chutes se produisent chez les octogénaires dans les communautés.

Keywords

agingaging-in-placecase studiescauses of fallscommunity carehealth-related safetyinvestigative methodvieillissmentvieillissant chez-soiétudes de cascauses de chutessoins communautairessécurité liée à santéméthode systématique d'enquête
Type
Canadian Institutes of Health Research–Institute of Aging: Profile/Instituts de recherche en santé du Canada–Institut du vieillissement : Profil
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 34 , Special Issue 3 , September 2015 , pp. 397 - 410
Copyright
Copyright © Canadian Association on Gerontology 2015 

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References

Akyol, A. (2007). Falls in the elderly: What can be done? International Nursing Review, 54, 191–196.Google Scholar
Canada Mortgage and Housing Corporation. (2010). About your house: Accessible housing by design — living spaces. Retrieved (30 May 2012) from http://www.cmhc-schl.gc.ca/en/co/acho/acho_002.cfm#principles Google Scholar
Canadian Caregiver Coalition. (2008). A framework for a Canadian caregiver strategy. www.ccc-ccan.ca. Retrieved (20 June 2011) from www.ccc-ccan.ca Google Scholar
Carstairs, S., & Keon, W. (2009). Canada’s aging population: Seizing the opportunity. Ottawa, ON: The Senate.Google Scholar
Cesari, M., Landi, F., Torre, S., Onder, G., Lattanzio, F., & Bernabei, R. (2002). Prevalence and risk factors for falls in an older community-dwelling population. The Journals of Gerontology, 57(11), M722–M726.Google Scholar
Chang, J., Morton, S., Rubenstein, L., Mojica, W., Maglione, M., Suttorp, M., et al. (2004). Interventions for the prevention of falls in older adults: Systemic review and meta-analysis of randomized clinical trials. British Medical Journal, 328(7441), 680–699.Google Scholar
Chase, C., Mann, K., Wasek, S., & Arbesman, M. (2012). Systematic review of the effect of home modification and fall prevention programs on falls and the performance of community-dwelling older adults. American Journal of Occupational Therapy, 66, 284–291.CrossRefGoogle ScholarPubMed
Creswell, J. (2013). Qualitative inquiry and research design: Choosing among five approaches (3rd ed.). Thousand Oaks, CA: Sage.Google Scholar
Dekker, S. (2006). The field guide to understanding human error. Aldershot, England: Ashgate.Google Scholar
Dollard, J., Barton, C., Newbury, J., & Turnbull, D. (2012). Falls in old age: A threat to identity. Journal of Clinical Nursing, 21, 2617–2625.Google Scholar
Doran, D., Hirdes, J., Blais, R., Baker, R., Pickard, J., & Jantzi, M. (2009). The nature of safety problems among Canadian homecare clients: Evidence from the RAI-HC reporting system. Journal of Nursing Management, 17(2), 165–174. doi:10.1111/j.1365-2834.2009.00974.x.Google Scholar
Folstein, M., Folstein, S., & McHugh, P. (1975). Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189–198. doi:10.1016/0022-3956(75)90026-6.Google Scholar
French, S., Reynolds, F., & Swain, J. (2001). Practical research: A guide for therapists (2nd ed.). London, UK: Butterworth-Heinemann.Google Scholar
Gillespie, L., Robertson, M., Gillespie, W., Lamb, S., Gates, S., Cummings, R., et al. (2009). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 2009, Issue 2. Art No.:CD007146. DOI: 10.1002/14651858.CD007146.pub2.Google Scholar
Gitlin, L., Winter, L., Dennis, M., Corcoran, M., Schinfeld, S., & Hauck, W. (2006). A randomized trial of a multicomponent home intervention to reduce functional difficulties in older adults. Journal of the American Geriatrics Society, 54(5), 809–816.Google Scholar
Gopaul, K., & Connelly, D. (2012). Fall risk beliefs and behaviours following a fall in community-dwelling older adults: A pilot study. Physical and Occupational Therapy in Geriatrics, 30(1), 53–72.Google Scholar
Gotzmeister, D. (2013). Factors that contribute to adverse events involving care dependent community dwelling older adults and their caregivers. Retrieved (9 March 2013) from http://ir.lib.uwo.ca/etd/1163/ Google Scholar
Green, D., & Sawyer, A. (2010). Managing risk in community care of older people: Perspectives from the frontline. Australian Social Work, 63(4), 375–390.Google Scholar
Henriksen, K., Dayton, E., Keyes, M., Carayon, P., & Hughes, R. (2008). Understanding adverse events: A human factors framework. In Hughes, R. (Ed.), Patient safety and quality: An evidence-based handbook for nurses (prepared with support from the Robert Wood Johnson Foundation) AHRQ Publication No. 08-0043. Rockville, MD: Agency for health care Research and Quality.Google Scholar
Henriksen, K., Joseph, A., & Zayas-Caba, T. (2009). The human factors of home health care: A conceptual model for examining safety and quality concerns. Health Care, 5(4), 229–236.Google Scholar
Hollander, M., Miller, J., MacAdam, M., Chappell, N., & Pedlar, D. (2009). Increasing value for money in the Canadian healthcare system: New findings and the case for integrated care for seniors. Healthcare Quarterly, 12(1), 38–47.CrossRefGoogle ScholarPubMed
Incident Analysis Collaborating Parties. (2012). Canadian incident analysis framework. Retrieved (30 October 2012) from http://www.patientsafetyinstitute.ca/English/toolsResources/IncidentAnalysis/Documents/Canadian%20Incident%20Analysis%20Framework.PDF Google Scholar
Institute for Life Course and Aging. (2007). Aging in place: Bridgeport LHIN literature review. Toronto: University of Toronto.Google Scholar
Institute of Medicine (IOM). (1999). To err is human: Building a safer health system. Washington, DC: National Academy Press.Google Scholar
Johnson, K. (2006). Adverse events among Winnipeg home care clients. Healthcare Quarterly, 9(Special Issue), 127–134.Google Scholar
Lang, A., & Edwards, N. (2006). Safety in home care: Broadening the patient safety agenda to include home care services. Edmonton, AB: Canadian Patient Safety Institue.Google Scholar
Lang, A., Edwards, N., & Fleiszer, A. (2008). Safety in home care: A broadened perspective of patient safety. International Journal for Quality in Health Care, 20(2), 130–135.Google Scholar
Lau, D., Scandrett, K., Jarzebowski, M., Holman, K., & Emanual, L. (2007). Health-related safety: A framework to address barriers to aging in place. The Gerontologist, 47(6), 830–837.Google Scholar
Lundberg, J., Rollenhagen, C., & Hollnagel, E. (2009). What-you-look-for-is-what-you-find– The consequences of underlying accident models in eight accident investigation manuals. Safety Science, 47, 1297–1311. doi:10.1016/j.ssci.2009.01.004.Google Scholar
Masotti, P., Green, M., & McColl, M. (2009). Adverse events in community care: Implications for practice, policy and research. Healthcare Quarterly, 12(1), 69–76.Google Scholar
Masotti, P., McColl, M., & Green, M. (2010). Adverse events experienced by homecare patients: A scoping review of the literature. International journal for Quality in Health Care, 22(2), 115–25. doi:10.1093/intqhc/mzq003.CrossRefGoogle ScholarPubMed
Miller, J., Hollander, M., & MacAdam, M. (2008). The continuing care research project for Veterans Affairs Canada and the Government of Ontario: Synthesis report. Victoria, BC: Hollander Analytical Services Ltd.Google Scholar
Miyagi, M. (2005). Serious accidents and human factors. Breaking the chain of events leading to an accident: Lessons learned from the aviation industry. West Sussex, England: John Wiley & Sons.Google Scholar
National Research Council. (2011). Health care comes home: The human factors. Committee on the role of human factors in home health care, board of human-systems integration, division of behavioural and social sciences and education. Washington, DC: National Academies Press.Google Scholar
Northridge, M., & Levick, N. (2002). Preventing falls at home: Transforming unsafe spaces into healthy places for older people. Generations, 26(4), 42–47.Google Scholar
Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatic Society. (2011). Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. Journal of the American Geriatric Society, 59, 148–157.Google Scholar
Peel, N. (2011). Epidemiology of falls in older age. Canadian Journal on Aging, 30(1), 7–19.Google Scholar
Purkis, M., Ceci, C., & Bjornsdottir, . (2011). Patching up the holes: Analyzing paid care work in homes. In Benoit, C., & Hallgrimsdottir, H. (Eds.), Valuing care work: Comparative perspectives (pp. 89–106). Toronto: University of Toronto Press.Google Scholar
Reason, J. (1990). Human error. New York, NY: Cambridge University Press.Google Scholar
Safer Healthcare Now! (2010). Reducing falls and injuries from falls getting started kit. Toronto, ONo: Author.Google Scholar
Scott, V., Lockhart, S., Gallagher, E., Smith, D., Asselin, G., Belton, K., et al. (2007). Canadian falls prevention curriculum: Resource manual. Victoria, BC: Public Health Agency of Canada, Population Health Fund Project.Google Scholar
Scott, V., Wagar, L., & Elliot, S. (2010). Falls and related injuries among older Canadians: Fall-related hospitalizations and intervention initiatives. Prepared on behalf of the Public Health Agency of Canada, Division of Aging and Seniors. Victoria, BC: Victoria Scott Consulting.Google Scholar
Sears, N. (2008). Harm from home care: A patient safety study examining adverse events in home care. Toronto: University of Toronto.Google Scholar
Sinha, S. (2013). Living longer, living well: Highlights and key recommendations from the report submitted to the Ministry of Health and Long-term care and the ministry responsible for seniors on recommendations to inform a senior strategy for Ontario. Toronto, ON: Ontario’s Senior Strategy. Retrieved (1 March 2013) from http://www.health.gov.on.ca/en/common/ministry/publications/reports/seniors_strategy/docs/seniors_strategy.pdf Google Scholar
Smartrisk, . (2009). The economic burden of injury in Canada. Toronto, ON: Smartrisk.Google Scholar
Speechley, M. (2011). Unintended falls in older adults: A methodological historical review. Canadian Journal on Aging, 30(1), 21–32.Google Scholar
Stake, R. (2005). Qualitative case studies. In Denzin, N., & Lincoln, Y. (Eds.), Handbook of qualitative research (3rd ed., pp. 443–466). Thousand Oaks, CA: Sage.Google Scholar
Tinetti, M., Christianna, S., & Williams, M. (1997). Falls, injuries due to falls, and the risk of admission to a nursing home. New England Journal of Medicine, 337, 1279–1284.Google Scholar
Waldron, N., Hill, A., & Barker, A. (2012). Falls prevention in older adults: Assessment and management. Australian Family Physician, 41(12), 930–935.Google Scholar
Waugh, F. (2009). Where does risk feature in community care practice with older people with dementia who live alone. Dementia, 8(2), 205–222.Google Scholar
Wilhelmson, K., Duner, A., Eklund, K., Gosman-Hedstrom, G., Blomberg, S., Hasson, H., et al. (2011). Design of a randomized controlled study of a multi-professional and multi-dimensional intervention targetting frail elderly people. BMC Geriatrics, 11(24), 1–10.Google Scholar
Woods, D., & Cook, R. (1999). Perspectives on human error: Hindsight biases and local rationality. In Durso, F. (Ed.), Handbook of applied cognition (pp. 141–171). West Sussex, England: John Wiley & Sons.Google Scholar
Zecevic, A., Salmoni, A., Lewko, J., & Vandervoort, A. (2007). Seniors Falls Investigative Methodology (SFIM): A systems approach to the study of falls in seniors. Canadian Journal on Aging, 26(3), 281–290. doi:10.3138/cja.26.3.281.CrossRefGoogle Scholar
Zecevic, A., Salmoni, A., Lewko, J., Vandervoort, A., & Speechley, M. (2009). Utilization of the seniors falls investigation methodology to identify system-wide causes of falls in community-dwelling seniors. The Gerontologist, 49(5), 685–696.Google Scholar