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Literature Review: Falls in old age – a threat to identity a qualitative study

Literature Review

Older peoples’ uptake of evidence based falls prevention recommendations ranges from 46% to 67%, less than desired (Cumming et al. 2001, Larsen et al. 2001, Shandro et al. 2007). One barrier to older people engaging in falls prevention activities is their perception that falls prevention information and strategies are relevant to other older people and not themselves (Yardley et al. 2006a, Bunn et al. 2008). In one study, health professionals reported difficulty in encouraging older people who were at a high risk of falling to participate in falls prevention activities when older people did not view themselves as likely to fall (van Haastregt et al. 2002). Population studies have found that the majority of community dwelling older people view falls as a potential problem for people in their age group but only a minority believe this extends to themselves (Lord et al. 1994, Hahn et al. 1996, Kempton et al. 2000, Gill et al. 2005, Zecevic et al. 2006, Hughes et al. 2008).


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Much of the research of falls and falls prevention arises from biomedical and clinical researchers and has not attempted to understand older people’s perspectives towards falling using qualitative research methods. The small body of published qualitative research has identified that older people avoid and distance themselves from being labelled as ‘at risk of falling’ (Cameron & Quine 1994, Health Education Board for Scotland 2003, McInnes & Askie 2004, Yardley et al. 2006a, Yardley et al. 2006b, Bunn et al. 2008). These studies also suggest use of the term fall is itself problematic for this group who may not consider the event a ‘fall’, even when they have fallen. It has also been found that often older people attribute their falls as caused by something external to self and hence they were not at fault. Alternatively that they were in control of falling and therefore they would be in control of preventing future falls.

Rather than this paradox be understood as a reflection of older people’s ‘true’ beliefs, it may have an important psycho-social function (Hanson et al. 2009). By presenting falls as not being personally relevant, older people resist being defined as old and therefore avoid negative stereotypes of ageing (Ballinger & Payne 2002, Health Education Board for Scotland 2003, Yardley et al. 2006a, Yardley et al. 2006b). Qualitative studies have also suggested that elements of older people’s identity is threatened by acknowledging that falls are personally relevant, particularly older people’s identity as being autonomous, competent and independent (Ballinger & Payne 2000, Health Education Board for Scotland 2003, Yardley et al. 2006b). Hanson et al (2009) went one step further and suggested that theoretically, falling could be an attribute related to stigma. It therefore would be understandable if older people present as if falls are not personally relevant, and consequently is an important focus of study. 


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To develop an understanding as to why older people appear to believe that falls are not relevant to them, the authors focused on older people’s perception of their falls risk in comparison to other older people. As no research with this focus was found, there was a need to develop an explanation grounded in the experiences and beliefs of older persons.

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