Falls in old age: A threat to identity

Aim and objective. This study aimed to understand older people's perceptions of their and other older peoples' falls risk, to increase understanding of why older people might not believe falls are relevant to themselves. Background. One-third of the people aged ≥65years (older people) fall yearly. Many older people do not participate in falls prevention programmes because they purport they are not personally vulnerable. Design. A qualitative study was conducted, guided by the tenets of grounded theory. Method. Semi-structured interviews were conducted with nine community-dwelling older people living in metropolitan Adelaide, South Australia. The interview explored participant's direct and indirect experience of falling, their perceived chance of falling in the next 12months and that of others of the same age and sex to themselves and their reasons for this. Results. Participants carefully presented themselves as being 'not the type who fall', who they view negatively. They believed their or their friends past or future falls were (or could be) because of factors outside of their personal control or because they were not paying attention at that moment of falling, as opposed to being the type of person who falls. They used these explanations as strategies to maintain or protect their identity as being physically competent. Conclusions. Older people know that falling can be viewed negatively. Falling is a threat to their identity as the type of person who does not fall. This explanation is consistent with self-presentation theory, where people use accounting strategies in social interaction to create a desired impression. Relevance to clinical practice. Falls prevention messages are likely to be rejected if the target group associate the message with a negative identity. These findings can assist nurses to understand older people's reluctance to engage in falls prevention and can stimulate thinking regarding alternative engagement strategies.