Falls among the elderly: environmental limitations and functional losses

Teixeira, Darkman Kalleu da Silva; Andrade, Luana Machado; Santos, Jessica Lane Pereira; Caires, Ediane Santos

doi:10.1590/1981-22562019022.180229

Abstract

Objective

: To identify the intrinsic and extrinsic factors that predispose the elderly to falls and to discuss the consequences of these events in their lives.

Method

: A descriptive, exploratory study with a qualitative approach was carried out in a city in the southwest region of Bahia, Brazil. The target audience was composed of elderly people living in the area covered by the Family Health Strategy of this city. Data collection took place from April to June 2018 through a semi-structured, scripted interview. The content analysis technique proposed by Laurence Bardin was used to analyze and organize the information.

Results

: From the analysis of the interviews the main factors that predisposed the elderly to falls emerged, and these were methodologically divided into intrinsic and extrinsic. There were also post-fall events, such as the fear of falling again and the need to inhabit the same place where the fall occurred, as this is a domestic environment which, for social reasons, cannot be modified as recommended by preventive educational actions.

Conclusion

: The results show that falls among these elderly people occurred in the domestic environment due to structural (extrinsic) issues, and are less influenced by health problems (intrinsic). It can therefore be concluded that the need to inhabit the same place where the fall occurred, without it being modified, generates a fear of falling again, limiting independence and reducing functional capacity, and making effective intersectoral actions essential.

Keywords:
Accidental Falls; Aging; Health of the Elderly

[1] Correspondence
Darkman kalleu da Silva Teixeira darkmankalleu93@gmail.com

Extrinsic factors	Intrinsic Factors
“I was taking a shower, when suddenly, when I left the bathroom, I missed the rug at the door and I slipped” (P07).	“The medicines are there, there’s no way I can remember, they so many medicines! Sometimes there are four, then there were times there were five, today there are six, apart from the insulin, with insulin there are seven” (P04).
“In the yard, when leaving the bathroom. I went out and tripped on a rock, my legs aren’t so good” (P03).
“A pillar, two fingers thick, I fell down, like a step” (P04).	“It seems that I felt dizzy and there was nothing I could do, if the girl (granddaughter) hadn’t come I would have died there” (P09).
“It happened when I was taking a shower and I don't know what happened, I made it easy, my sandal slipped in and I took a step backwards and fell, hitting my spine on the toilet” (P11).	“Three for blood pressure and two for diabetes, apart from cholesterol which isn't here” (P06).
“The sandal got caught on the cement like this, going upwards, and I tripped” (P06).	“I take several, two for blood pressure, two for cholesterol and one for the heart, I’m not taking the one for diabetes, one I have to fast and two I take at night, eight medicines, because I took the diabetes one too” (P09).
“When I went backwards, I slipped and fell” (P02).
“I stumbled and slipped, I stumbled because of the step” (P08).
“I hit my head on the door and went backwards, there was a ramp, I couldn't balance myself and I fell” (P10).	“The dizziness isn’t it, the dizziness!” “For high blood pressure I take several, I take about six medications a day” (P01).

Fear of falling	Modification of environment post-fall	Reduction of functional capacity
“I'm afraid of falling in the bathroom. I’m afraid of it happening again, because I already suffered a fall and didn’t change the environment” (P11).	“Yes, you have to take a shower, comb your hair, go inside and come back carefully, don't you?” Environmental modification: “No, I didn't do it, I just take care, right?” (P01).	“The job I did the most, reduced. The damage is that my expenses have increased, I pay more for the medicines I buy because of the pain of the accident I had in my leg, the monthly expenses increased” (P07).
“I’m very afraid. Because it seems that the pain is inside me and it seems like it will happen again” (P07).	"I do go there, I do." Environmental modification: “I didn't make any changes, it's still the same” (P03).	"The fall? It was just at the surgery. The lack of memory, the lack of balance” (P04).
“I was afraid of it happening again” (P09).	“Yeah, I go there! Because that's how it is, you have to take a shower.” Environmental modification: “No, it's still the same” (P09).	“It was very bad for me because I used to go to more places before” (P06).
“We always have it, don't we? Fear! We get to this age, any carelessness or misstep and we risk a fall” (P08).	"Yes, I go to the same bathroom." Environmental modification: “I didn't install any safety measures, the bathroom is the same” (P11).	“Yeah, after this fall I got really bad. It seems that I got even weaker than I already was” (P02).
“Yes, I'm afraid. Fear, because anything we fall into, our legs are weak” (P03).	“In the yard, yes, there is no other way. But no in other places, today I can't even go to church.” Environmental modification: “No. I didn't do anything in the yard, it's still the same, the same” (P06).	“After the fall I had to buy medicine, I hurt my back and my arm got worse because I was already injured” (P08).