Introduction
Background
Aims and objectives
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Interview older people who have experienced a fall, and their carers to establish what actions they take when they fall, and, how and why they make those decisions
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Interview healthcare providers to establish how they support older people in managing future falls, and what factors influence their actions.
Methods
Sampling and recruitment
Data collection
Analysis
Results
Type of participant – Older people | Number | Sex M:F |
Older people with experience of having a fall | 12 | 5:7 |
Spouse of participants | 4 | 1:3 |
Living arrangements: | ||
Lives with spouse | 7 | |
Lives alone | 3 | |
Lives alone in sheltered housing | 2 | |
Age range of participants (average) | 65-89 (78) | |
Type of participant – Healthcare staff | Number | Sex M:F |
Paramedic staff | 5 | 3:2 |
Therapy staff (occupational and physio) | 7 | 2:5 |
The environment
“I’ve always had someone available to help me out and so, that hasn’t been a problem as yet but if I was to fall outside I am certain I’d have to call for someone to help me” Participant #1
“If we can get him onto all fours and then if there is a chair nearby and he can sort of push himself up on the chair as well as me lifting [wife]” Participant #2 spouse
“I was very fortunate ‘cos my grandson called in, he calls in quite a bit and makes a sandwich or something you know and he said ‘hi Nana’ I said ‘can you come up here and help me’ and he got me up but it was a struggle” Participant #4
Many reported not wanting to ‘bother’ anyone.“I know there’s benches there [on that walk] and then there’s the low walls that way. I sort of go in my mind what’s where. ... So, if I did have a fall, I’m not saying it’s going to be in that precise, but if I did, I knew I could help myself but there’s not always people about” Participant #5
One Paramedic summed up what many of our older participants said.“Well I suppose if you have passed out then you would think that perhaps something was untoward and you needed to do something … . The victim is always reluctant oh don’t make a fuss but obviously the onlooker knows that there’s a problem.” Participant #3
“The person who’s fallen quite often is embarrassed to have to call … that’s what I’ve found so far, is, elderly generation, they don’t want to be a bother … . they just want to get up.” Ambulance service staff #5
“Giving generic advice to people in clinic isn’t that helpful if it doesn’t relate to their situation so seeing people in their homes and being able to adapt to their environment and their needs and their presentation is where I feel we make the biggest impact.” Therapist focus group
Physical ability
“most of the time I have had the strength, it’s only in the last couple of years now that I don’t have the strength in my, once my knees get below a certain point they won’t take my weight so I can’t get up above that point to do it now” Participant #9
“I think once or twice you’ve fallen and you’ve got your, you’ve crawled to a tree and pulled yourself up holding onto a tree but which you can probably still do now I don’t know. Maybe not [wife]” Participant #2 spouse
This “skilling up” approach not only addressed physical strength but also supported the final concept of self-efficacy. Older people corroborated this strength building ability.“In certain patients, maybe see them for a month or so, and try and build them back up a little bit if they haven’t had much exercise for a while, and then they might reach a point where they will be able to [learn backward chaining techniques].” Therapist focus group
“[therapist name] says now that my legs are weak and I’ve got to try and strengthen that so, that’s what I am doing now I am going to exercise classes on a Tuesday morning” Participant #3
“The physio has been helping me a little bit... With me getting up and getting down. Before I used to just, I’d have to drop down and I’ve got more strength in my leg now it’s sort of helping me. Like in the house if I have a fall in the house, I can lift myself up better” Participant #5
Self-efficacy
“I do find it difficult to get up. I do worry about it, especially, if I am on my own... I am a bit funny about this getting up business because in autumn … I went to balance classes … they were prepared to show any of us how to get up you know from the floor. I didn’t want to do it, it was funny really... but I am funny about those sorts of things. I am trying not to fall now anyway that’s the main thing. [why didn't want to try learning to get up?] I am not sure to be honest I know there was an elderly gentleman he was about my age and he seemed very frail, but he went through it with the physio...which I thought was wonderful.” Participant #5
“But not [send an ambulance] just because I’m on the floor. I know I’m on the floor and I can’t get up and it’s really annoying, and if you are down there for three hours it’s very, very annoying … I am not frightened of falling again because you can’t go through your life being frightened.” Participant #9
“They say … I can get up myself it’s absolutely fine I am independent … you speak to family … it comes out … they can’t get up. I am not sure of the reasons you know sometimes there’s a cognitive impairment and people don’t remember that they can’t get up. Family members tell me before that you know that dad’s, dad has a lot of pride he’s not going to tell you if he can’t do something” Therapist focus group
Decision context
Having the ‘know-how’
“I thought well how do I get you up?...So, I thought let’s go onto YouTube … and looked it up and I said right you’ve got to get up on your knees and crawl to the chair or I might have put a stool or a kitchen chair there for him to use and get up. He said I can’t, I said you’re going to have to … Yeah, you’ve got to do it, and he did do it.” Participant #12 spouse
“I think if as a paramedic I had some more skills in how to encourage people to get off the floor, that that would be useful.” Ambulance service staff #4
“'I must admit, one thing that I am aware of is the potential for patients to help themselves up in some situations. I think I quite often in the past worked on the assumption that if they were easily able to do that then they probably would have done it already, although that isn’t probably a very good assumption to make because I think people quite often don’t move because they’ve been advised not to move, rather than because they are unable to move. So, … I would say that I’ve been relatively quick to give people help to get up... and thinking about it now, I think I have been too ready to do that rather than trying to find ways that I could encourage them or support them to get themselves off the floor.” Ambulance service staff #4
“We see the people who are more frail and more vulnerable for the most part - we see people at the top of the pyramid, whereas those who would probably benefit most from the get up off the floor training are likely to be people who aren’t coming to our services. We might need to think more creatively about how we provide that training for them.” Therapist focus group.
A balancing act
“I think when they’ve had a long lie [before being able to get up] that can have a massive psychological impact on their fear of moving forwards.” Therapist focus group
“We’re talking about reaching a group when they have already had a fall, and there’s probably a group of people … who could benefit from that information before they are going to have that first fall … timing to implement change for people getting them to take on information is really, really crucial.” Therapist focus group
“The rehab stage … isn’t the time to be putting them on the floor because they’re actually recovering … but maybe three months down the line then that could be practised with them to really consolidate that information but it’s the timing” Therapist focus group
“The first priority was to get to the person and deal with them in a timely fashion and the second, sort of, benefit hopefully would be that we wouldn’t need an ambulance so we could keep an ambulance on the road that could attend somebody who was in dire need” Ambulance service staff #1
“As soon as I’ve got them at the point where they are telling me that they are not in pain then I’ll try and move them straightaway.” Ambulance service staff #3