The Lived Experience of Being at Risk for Falling in the Hospital Among Older Adults

Abstract

Background: Inpatient falls are a persistent problem and despite research efforts during the last decade, inpatient fall rates have not significantly decreased. Older adults have an estimated 50% greater inpatient fall rate than younger adults, and older adults’ fall risk perceptions affect their adherence to fall prevention recommendations. Purpose: The aim of this study was to gain a deeper understanding of the lived experience of being at risk for falling in the hospital among older adults. Methods: Recently hospitalized older adults, who were at risk for falling in the hospital, were purposely sampled for this interpretive phenomenological study. Participants were interviewed twice using online video-conferencing within two weeks of hospital discharge. The audio-recorded and transcribed interviews were analyzed using van Manen’s methodology. The Health Belief Model, which was expanded with the concepts of independence, fear of falling, embarrassment, dignity, and positivity effect served as the theoretical framework. Results: Nine participants (n = 9) aged 65 years and older (female = 55%, age range = 67 – 86) participated in the study. Every participant had experienced fall prevention interventions while hospitalized. Five major interpretive themes emerged during the analysis: Relying on Myself, Managing Balance Problems in an Unfamiliar Environment, Struggling to Maintain Identity, Following the Hospital Rules, and Maintaining Dignity in the Relationships with Nursing Staff. These themes describe how the participants carefully planned how to mobilize in their hospital rooms, in order to avoid falling. This process was influenced by their struggling to remain independent and accepting perceived age-related changes. The participants followed hospital fall prevention rules out of politeness, which caused feelings of physical restriction and helplessness. They experienced both positive and negative relationships with nursing staff that influenced their fall risk behavior and dignity. Conclusions: Hospitalized older adults struggled to maintain their independence, dignity, and identity while being considered at risk for falling. The participants employed their self-efficacy to manage balance problems in the hospital, and these findings have not been previously documented in the literature. Fall prevention interventions supporting hospitalized older adults’ self-management of fall risk are needed.