Exploring Older Adult ED Fall Patients’ Understanding of Their Fall: A Qualitative Study

Abstract

Study Objective: We sought to gain understanding of older adult, emergency department (ED) fall patient perspectives and emotions about antecedent falls, and to gain better understanding of their attitudes toward falls prevention interventions. Methods: We conducted a qualitative study between July 2015 and January 2016 to examine the perspective of older adults who had recently fallen and were in the care of ED providers in an urban, level-one teaching hospital. We included non-demented, community-dwelling, older adults based on a convenience sample. Interviews were semi-structured, consisting of open-ended questions, utilizing a piloted interview guide. Interviews were audio-recorded and transcribed. Codes were generated inductively, organized into categorizes, subthemes, and ultimately prominent themes. Once we achieved thematic saturation, we stopped enrollment. Results: Our final sample was 63 patients. Patients blamed falls on the environment, on themselves, on a freak accident, or on a medical condition but never noted a multifactorial rationale. Patients have variable emotions about current fall and varying perceptions of future fall risk, ranging from extremely concerned to not at all concerned. Patients demonstrated a range of receptiveness to ED interventions aimed at preventing falls, with very little input as to what those interventions should be. Conclusions: Although perceptions are varied, older adults tend to be more receptive to intervention and more concerned about their future fall risk in the ED than in a community setting, making the ED an appropriate setting for intervention. However, ED physicians will first have to educate patients that fall risk is multifactorial, and that patients require multifactorial risk assessment and targeted fall reduction intervention.