The Great Balancing Act – perspectives from older people on falls risk

Dr Kristy Robson is a Lecturer in Podiatry at Charles Sturt University, a regional university in Australia. In this blog she shares a recent Age and Ageing publication that explores the behavioural decisions older people make when they knowingly and unknowingly undertake activities or tasks that pose a risk of falling. She tweets @KristyRobson2

Fall related injuries in older people constitute a significant public health issue in Australia and internationally. Falling represents the leading cause of unintentional injury in this population with approximately one third of older adults falling each year. Effective management of falls in older populations has proven to be challenging. Despite the substantial focus on falls prevention by the Australian government over the last decade the age standardised hospital admission rates attributed to falls continue to increase. The complexity of managing falls risk in the diverse populations found within Australia, coupled with an ageing population and finite resources, drives the need to better understand factors that can influence falling from the perspective of the older person. Understanding falls risk from the perspective of the older person may provide valuable knowledge in informing a more comprehensive approach to falls prevention for this population group.

In this study we interviewed older people who had fallen in the previous 12 months to understand their perceptions associated with falling. The findings suggested that there were six key themes that highlighted the challenges surrounding older people and their risk of falls. These were:

  • the role that independence played in decision making regarding risk
  • the influence of their previous falls experience
  • older people’s level of understanding of risks
  • the ability and willingness to engage with support
  • the need or desire to cover up a fall history
  • the influence of finances in managing risk.

Most significantly, the findings revealed that in managing individual risk, older people faced a multifaceted balancing act with trying to manage their own level of falls risk. This balancing act involved a complex interplay between all of the competing influences identified in the six key themes, influencing older people to knowingly and unknowingly undertake activities or tasks, which sometimes placed them at further risk of falling.

Preventing injurious falls is a key priority area in health care. Our current approach to falls risk management relies heavily on our ability to identify an older person at risk of falling and then instigate appropriate physical and environmental interventions to mitigate this risk, before injury occurs. However, it is noted that there has been limited focus in the literature on the behavioural risk factors associated with falling. Understanding the perception of falling from the perspective of the older person may provide greater opportunities for health professionals to instigate early falls prevention strategies before significant injury occurs. As such, consideration of the multifaceted issues older people face when managing their falls risk, including behavioural risk factors, is vital to successfully reducing rates of fall related injuries in this population.

Read the Age and Ageing Paper:  Exploration of older people’s perceptions of behavioural factors associated with falls

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