Older Adults' Perceptions of Clinical Fall Prevention Programs: A Qualitative Study

Objective. To investigate motivational factors and barriers to participating in fall risk assessment and management programs among diverse, low-income, community-dwelling older adults who had experienced a fall. Methods. Face-to-face interviews with 20 elderly who had accepted and 19 who had not accepted an invitation to an assessment by one of two fall prevention programs. Interviews covered healthy aging, core values, attributions/consequences of the fall, and barriers/benefits of fall prevention strategies and programs. Results. Joiners and nonjoiners of fall prevention programs were similar in their experience of loss associated with aging, core values they expressed, and emotional response to falling. One difference was that those who participated endorsed that they “needed” the program, while those who did not participate expressed a lack of need. Conclusions. Interventions targeted at a high-risk group need to address individual beliefs as well as structural and social factors (transportation issues, social networks) to enhance participation. 1. Background Falls are common among older adults [1], and their consequences often devastating and costly [2–4]. Evidence-based interventions are available to prevent falls [5–7]; however, we have observed that care-seeking by older adults to reduce their likelihood of falling is less than expected. Others have also observed that few older adults engage in proven behaviors to reduce fall risk after a fall [8–11]. Explanations identified through qualitative research with older persons have included an underestimation of personal susceptibility to falling [11], a sense of fatalism or a belief that falls occur due to bad luck [12], an attribution of falls to external (rather than within-person) causes [12], a belief that falls are accidental [13], a belief that falls are an inevitable consequence of aging [12], and a belief that one already knows what to do to prevent falls [13]. The majority of published research has been conducted with persons from Scandinavia, Britain, New Zealand, and Australia [10, 11, 13], and thus it is unknown whether the explanations for this phenomenon, as observed in these studies, are generalizable to elders residing in the United States. Additionally, most research has been conducted with samples that have not been fully characterized in terms of educational level and socioeconomic status [10–13] and with persons who may or may not have experienced a fall [10, 11]. Thus, it is also unclear whether the findings apply to elders of different ethnic backgrounds, to low-income elders,