A Phenomenology of Fall Prevention: Lived-Identity and Careful Practice in Community Outreach Care
Abstract
The increasing number of injurious falls amongst older people living in the community is continuously portrayed as a major public health problem facing the Canadian health care system. As additional resources are allocated for community-based fall prevention programs, health service providers are increasingly expected to understand and enact fall prevention in effective and meaningful ways. The aim of this two-phase interpretive phenomenological study was to enhance understandings of the taken-for-granted meanings that characterize everyday practices of community-based fall prevention in order to foster more sensitive, tactful, and meaningful approaches to fall prevention with older people.
In the first phase of this study, I engaged nine older people living independently in the community in individual phenomenological interviews to explore the meaning of the experience of anticipating falling. In the second phase of this study I engaged six health professionals working on a community outreach team in phenomenological interviews exploring the meaning of the experience of enacting fall prevention with older people in the community.
The findings of this two-phase study overall give rise to four key insights that may inform the refinement of fall risk assessment and fall prevention practice for physiotherapists and other service providers. First, a phenomenological ethics of caring was central to enacting fall prevention for service providers in the community. Second, lived-identity was central to the experience of anticipating falling for older people. Third, meaningful risk-taking was essential to older peoples’ quality of life and enactment of their lived-identity. Finally, the meaning of anticipating falling was learned experientially through older peoples’ experience of falling or witnessing others experience falls. Understanding these key insights, service providers might seek to adopt a transformative learning approach to fall prevention that focuses on affirming an appreciative understanding of lived-identity, meaningful risk, and meaningful caution in older peoples’ lives. Erich Fromm’s distinction between having and being orientations to lived-identity may be used to provide insight into the enactment of such a transformative approach to fall prevention.