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At holde balance Betingelser for og perspektiver i forhold tilforebyggelse af fald blandt gamle mennesker
Nordic Council of Ministers, Nordic School of Public Health NHV.
2012 (Danish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [da]

Baggrund. Faldulykker blandt gamle mennesker er et folkesundhedsproblem i Danmark, Norden såvel som i den vestlige verden. Forebyggelse af fald har været grebet an i en befolkningsorienteret adfærdsmotiverendeog –regulerende modus. Denne faldforebyggelsestankegang er i opbrud.

Formål. At beskrive hvorledes fald,faldhændelser og at miste balanceopleves og håndteres af gamle mennesker, der bor i selvstændig bolig. Studiet har ligeledes fokus på at undersøge sammenhænge i den faldforebyggende indsats med udgangspunkt i hvad de, der er faldet, har oplevet. Studiet bidragertil udvikling af sundhedsfremmende og faldforebyggende indsats i forhold til den enkelte og til den samlede indsats.

Metode. Afhandlingenbygger på fire delstudier (I-IV). I de fire studier anvendes fortolkende fænomenologiskfilosofisk tilgang og analytisk metode. I et studie (III) sker det i en case study ramme og er suppleret med kritisk diskursanalytisk analyse og fortolkning af dokumenter. I alt blev ni kvinder og fire mænd (75-94 år) narrativt interviewetom at falde. To social-og sundhedshjælperen blev individuelt interviewet, de deltog også i fokusgruppeinterview sammen med to social-og sundhedsassistent kolleger og en sygeplejerske, der alle kom ihovedpersonernes hjem irelation til den faldforebyggende indsats.

Resultater. For at kunne håndtere det sårbare, skrøbeligeog dødens nærhed ved fald udviklede fortællerne forskellige metoder til at klare situationer for at kunne tilpasse egne ressourcer til konteksten og opnå følelser af velvære (I). Frygt eller bekymring for at falde var altid usynligt tilstede og blev håndteret forskelligt. På den ene side blev frygten konkretiseret i en bekymring for at befinde sig i en nedværdigende situation på den anden side var frygten en eksistentiel udfordring og tegn på dødens nærhed (II). Hovedpersonerne forventede personlige relationer, indflydelse og valgmuligheder i samarbejdet med sundhedspersonale om forebyggelseaf fald. Løsninger skulle forhandles og balancerede mellem professionel og personlig omsorg (III). De, der var faldet viste ikke stor appetit på mad men spiste for at være i live. Appetitten viste sig i at have indflydelse i sociale relationer både til social-og sundhedspersonalet, til familie og naboer og med udgangspunkt i oplevelse af sociale tilhørsforhold have samfundsmæssig indflydelse.

Konklusion. Forebyggelse af fald må fremover indebære også sundhedsfremmetankegang og tager udgangspunkt i betydninger og kontekst for på denne måde ikke blotat være multifaktoriel, men også multidimensionel med eksistentielt perspektiv

Abstract [en]

Background. Falls among older persons are a public health problem in Denmark, the Nordic countries and the rest of the Western world. In a population perspective fall-prevention has been characterised by an individual behavioural modificationand a regulating mode. This kind of fall-prevention discourseis nowbreaking up.

Aim. To describe how community-dwelling older adults experience and handle falls, falling and loss ofbalance. The focus is also on examination offalls as contextual phenomena with the older adults’ experiences. This study will contribute to develop health promotion and fall-prevention to individuals and to the fall-prevention as so.

Methodology. This thesis consists offour studies/articles (I-IV). Interpretative phenomenology as philosophical and analytical method was used. In one study (III) case study methodwas used as a framework,complemented bycritical discourse-analytic interpretation of documents. Within thefour studies nine women and four men (75-94 years old) were interviewed in narrative in-depth interviews about falling. In article III,five health and social workers and a nurse were interviewed.

Results. In coping withfalling accidents, vulnerability, frailty and death imminence the participants developed various methods ofmanagingeveryday lifeat home. They describedadaptive resourcesused to achieve an adequate quality oflife andexperiencea feeling of well-being (I). Fear of fallingwas always present and was met in differentways. On one handwas worry aboutungraceful situationsnot able to manage on your own; on the other hand was the willto live with the fear.(II). The two protagonists, dependent onhome-care developed their own strategies for preventingfalls. The health professionals created a supportive network; a platform of continuity where the efforts of the older persons and the staff complemented each other. The staff had no clear approachto addressing issues raised by accidental falls or the prevention of falls (III).Eating and appetite on foodwerenot trivial everyday routines. The participants showed no particular interest in eating but ateto stay alive. Even if they had little appetite forfood, the participants showed great appetite forestablishing social relationships withfamily, neighbours and health care staff,as well as appetite forestablishing an influence in these relations and in local communities and society.

Conclusion. In the future,fall-prevention must takea health promotion approach and contextualise falling accidents withexperiences and meanings as point of reference. Fall-prevention will be not only multifactorial,but also multidimenssional and existential

Place, publisher, year, edition, pages
Nordic School of Public Health NHV Göteborg, Sweden , 2012. , 51 p.
Series
NHV Reports and Doctor of Public Health-Theses, ISSN 0283-1961 ; NHV Report 2012:8
Keyword [en]
O ld age, fall - prevention, health promotion, interpretive phenomenology, social connectedness, appetite
Keyword [da]
Aldring, faldforebyggelse, appetit, sundhedsfremme, fortolkende fænomenologi, social indflydelse, hjemmets betydning
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3768ISBN: 978-91-86739-42-3 (print)OAI: oai:DiVA.org:norden-3768DiVA: diva2:787178
Public defence
2012-09-20, Nordic School of Public Health NHV, Göteborg, Sweden, 13:00 (Danish)
Opponent
Supervisors
Available from: 2015-02-09 Created: 2015-02-09 Last updated: 2015-02-09Bibliographically approved
List of papers
1. Indispensable chairs and comforting cushions: — Falls and the meaning of falls in six older persons lives
Open this publication in new window or tab >>Indispensable chairs and comforting cushions: — Falls and the meaning of falls in six older persons lives
2010 (English)In: Journal of Aging Studies, ISSN 0890-4065, E-ISSN 1879-193X, Vol. 24, no 2, 88-95 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to illuminate the meaning of falls for older adults in an everyday perspective. In narrative in-depth interviews, four women and two men, 80–94 years old, told their stories from a daily-life perspective; they had experienced falling several times. The methodological approach used was interpretive phenomenology, in order to grasp the meaning of the participants' situations and everyday practices. The women had learned and used a special technique; they had disciplined their bodies with exercises and training activities, although they suffered from several chronic illnesses. In order to cope with the falling episodes, the women had equipped sofas and chairs with cushions to soften the process of getting up again, whereas the two men sat in a chair moving as little as possible. In handling the falls, each participant showed individual coping strategies and adaptive resources to achieve a life, experiencing a feeling of being well

Keyword
Falls; Meaning; Interpretive phenomenology; Older persons
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3764 (URN)10.1016/j.jaging.2008.11.003 (DOI)
Available from: 2015-02-09 Created: 2015-02-09 Last updated: 2017-12-04Bibliographically approved
2. Fear of falling from a daily life perspective;: narratives from later life
Open this publication in new window or tab >>Fear of falling from a daily life perspective;: narratives from later life
2012 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 26, no 1, 38-44 p.Article in journal (Refereed) Published
Abstract [en]

Fear of falling is a well-known condition in later life. The aim of this study was to illuminate the experiences and the meaning of fear of falling in a daily-life context. The method used was a qualitative study inspired by interpretive phenomenology. In narrative interviews, five community-dwelling women over 80 years of age told about their fear of falling from a daily-life perspective. The overall thematic analysis resulted in three main themes: the meaning of managing daily life necessities; keeping in contact with the outside; living with fear. The findings showed that to live with fear of falling was to discipline daily life, and to learn to live with the challenge of a vulnerable bodily condition and of losing control at different levels: from falling, from incontinence, from dirt and from the stigma of being in a humiliating situation. The women created a perception of independence while they were dependent on help and community care and on news from the outside. At an existential level, they coped with their fear by strengthening their will. The conclusion was that the older women studied accepted the condition of fear of falling. They shared the ability to cope in various ways with the limitations of their bodily capacity and their imbalance.

Keyword
fear of falling; falling; hermeneutic phenomenology; narratives; lived experience; later life
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3765 (URN)10.1111/j.1471-6712.2011.00901.x (DOI)
Available from: 2015-02-09 Created: 2015-02-09 Last updated: 2017-12-04Bibliographically approved
3. Appetite and falls: Old age and lived experiences.
Open this publication in new window or tab >>Appetite and falls: Old age and lived experiences.
2012 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 7Article in journal (Refereed) Published
Abstract [en]

Falling among older adults is a well-known public health problem but the association between falling and appetite is seldom studied although poor nutritional status is accepted as a risk factor for falls. On this background the aim of this study was to understand how older adults, who have fallen several times within a year, related their experiences of appetite as a phenomenon in everyday life. In narrative in-depth interviews, eight women and four men contributed with their stories. Using interpretative phenomenology the thematic analysis resulted in three main themes: appetite for food; appetite for social relations and appetite for influence. Eating was not trivial everyday routine and required self-regimentation. Meals were not an object of desire, but of discipline out of the wish to survive. Feelings, reflections and ambivalence were bound to the lack of appetite on food. The participants were oriented towards the forbidden, the delicious and to everyday food as a strengthener and as medicine. In their dependency on help, home was the framework for establishing social relations as means of social support. As well as family and neighbours, the significant others were persons on whom the participants were dependent. Personal relationships and mutual dependencies may ensure social security in lives characterised by contingency and maintain influence in daily life. Falling is both a dramatic and a trivial incident where life and death could be at stake. From this perspective, connectedness was prominent in all fall stories. The quest for influence and a sense of social connectedness was the incentive to re-enter local community arenas and to express solidarity. In health-care practice multi-factorial fall-prevention should be complemented with a multi-dimensional approach in order to balance the medical approach with humanistic and societal approaches towards fall-prevention.

Keyword
Falling, everyday life, older people, social support, interpretive phenomenology
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3767 (URN)10.3402/qhw.v7i0.11540 (DOI)22389651 (PubMedID)
Available from: 2015-02-09 Created: 2015-02-09 Last updated: 2017-12-04Bibliographically approved
4. The balance of life : Two case studies on falls and fall-prevention in older persons
Open this publication in new window or tab >>The balance of life : Two case studies on falls and fall-prevention in older persons
2011 (English)Article in journal (Refereed) Published
Keyword
Ageing, accidents and falls, falls prevention, home care, case study research .
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3766 (URN)
Available from: 2015-02-09 Created: 2015-02-09 Last updated: 2015-02-09Bibliographically approved

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