Lotte Evron

Barriers to participation in a hospital-based falls assessment clinic programme: an interview study with older people:

Aims: To gain new knowledge about barriers to participation in hospital-based falls assessment. Methods: Semi-structured interviews with 20 older people referred to falls assessment at a hospital-based clinic were conducted. A convenience sample of 10 refusers and 10 accepters was collected. Those who refused referral were recruited in relation to a systematic falls screening programme performed by preventive home visitors. Accepters were selected among 72 participants successively completing the falls assessment clinic programme. The time between the interviews was 12 months; different levels of knowledge were expected, owing to accepters’ participation in the programme. Interview transcriptions were thematically analysed. The analysis was directed towards identification of barriers to falls assessment. Results: Barriers to participation were categorized as being either within or outside the falls clinic, and included administration, time, communication, attitudes to fall prevention, and expected future costs. Accepters completing the programme expressed a feeling of being ‘‘met’’ in the system and maintaining authority over their own life, while the refusers expressed concern about the healthcare system taking over their life. Conclusions: This study indicates that older at-risk patients acknowledge their falls problem, but refuse to participate in hospital-based assessment programmes because they expect to lose their authority and to be caught up in the healthcare system. In order to transform the findings of this study to a public health message, we have to consider moving the focus of falls prevention strategies from disease control to the domain of health promotion in order to engage older adults in preventive healthcare.

Establishing a new falls clinic – conflicting attitudes and inter‐sectoral competition affecting the outcome

Falls clinics are a newer model for falls management among the elderly. Few studies have addressed the impact of the strategy on falls prevention in the healthcare system. The aim of the present study was to describe the social processes that affect the implementation of new strategies in falls management. A newly established falls clinic was chosen as an instrumental case to describe the systematic and comprehensive approach to falls prevention among the elderly. The investigation had a qualitative case study research design with triangulation of sources and methods, including interviews, participant observation and analysis of documents. The study was conducted from January 2006 to June 2007 at a newly established falls clinic at a Danish hospital. Data were analysed qualitatively according to four main themes: The concept of falls, success/failure, competition and expertise. The study showed that the falls clinic was embedded in a context where interests varied at different levels of the organizational hierarchy. In contrast to the political agenda for falls prevention, patients and professionals did not associate falls with chronological age. The biomedical structure of the falls clinic and the hegemonic mode of handling falls prevention may have facilitated falls prevention services and patient trajectories across sectors, but if falls are associated with chronic disease secondary to an unhealthy lifestyle, the individual patient becomes responsible for the falls problem. This may subsequently prevent the patients from seeking timely help from the healthcare system, or patients may drop out of the existing programmes. Future research needs to look at sustainability and dropping out in relation to falls prevention programmes.