Abstract
ObjectiveDespite consistent evidence for the positive impact of contingency planning for falls in older people, implementation of plans often fail. This is likely due to lack of recognition and knowledge about perspectives of older people about contingency planning. The objective of this research was to explore the perspectives of older people living in the community about use of contingency planning for getting help quickly after a fall.MethodA systematic literature search seeking qualitative research was conducted in April 2014, with no limit placed on date of publication. Medline, EMBASE, Ageline, CINAHL, HealthSource- Nursing/Academic Edition, AMED and Psych INFO databases were searched. Three main concepts were explored and linked using Boolean operators; older people, falls and contingency planning. The search was updated until February 2016 with no new articles found. After removal of duplicates, 562 articles were assessed against inclusion and exclusion criteria resulting in six studies for the meta-synthesis. These studies were critically appraised using the McMaster critical appraisal tool. Bespoke data extraction sheets were developed and a meta-synthesis approach was adopted to extract and synthesise findings.FindingsThree themes of ‘a mix of attitudes’, ‘careful deliberations’ and ‘a source of anxiety’ were established. Perspectives of older people were on a continuum between regarding contingency plans as necessary and not necessary. Levels of engagement with the contingency planning process seemed associated with acceptance of their risk of falling and their familiarity with available contingency planning strategies.ConclusionAvoiding a long lie on the floor following a fall is imperative for older people in the community but there is a lack of knowledge about contingency planning for falls. This meta-synthesis provides new insights into this area of health service delivery and highlights that implementation of plans needs to be directed by the older people rather than the health professionals.
Highlights
The proportion of older people is growing and there is an associated expectation that older people living in the community who are at risk of falls will increase [1]
Avoiding a long lie on the floor following a fall is imperative for older people in the community but there is a lack of knowledge about contingency planning for falls
This meta-synthesis provides new insights into this area of health service delivery and highlights that implementation of plans needs to be directed by the older people rather than the health professionals
Summary
The proportion of older people is growing and there is an associated expectation that older people living in the community who are at risk of falls will increase [1]. Older people living at home are often unable to get up following a fall, with one study finding that 30% of older people who fell remained on the floor for over an hour [3]. Falls resulting in a person remaining on the floor for one hour or more (a long lie) may result in complications of muscle weakness, development of pressure areas, pneumonia, dehydration, missing medicines and hypothermia [4,5,6]. Following a long lie on the floor, a self-imposed reduction in mobility and social isolation can impact upon quality of life and place increased demands upon carers [6, 7]. There are a range of recognised strategies which constitute contingency planning for falls, including; personal alarm response systems (PERS), automated fall detectors (AFD), pagers, mobile phones, Global Positioning Systems (GPS), phone checking services, and neighbour/family alert or checking systems [2]
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