Conclusiones

This quotation is taken from Tony’s narrative and relates to the changes that he described making following his falls in an attempt to prevent further falls. This theme presents findings relating to accounts of changes in behaviour and to the home environment that care-recipients and carers described making, to prevent falling over again. These environmental changes were not intended only to

171 make the home safer for the care-recipient but also to make it easier for them to continue their everyday activities following their fall.

Tony (care-recipient) talked at great length about the changes he made to his behaviour, implying that he retained a level of control over falling. Not only did he describe situations where he was more careful; such as holding onto both banisters when using stairs but he also expressed how much more vigilant he had become to the extent of curtailing activities and ‘sitting on the sidelines’. A common thread through Tony’s (care-recipient) and Susan’s (wife and carer) first and second interviews was their love of bird-watching. However Tony also identified an awareness of his difficulty with dual-tasking and the strategies he used to control such situations. By the third interview, Tony’s narrative not only included a premeditation of disaster but also hinted at how restricted Tony’s attention had become in his efforts to avoid falling:

“Say walking through a strange bit of woodland or something like that, I’d miss all the flowers and the birds and things. (laughs) Because I’m always looking for something to trip over or to avoid tripping over”. (l.1986)

It is interesting that Tony suggested that he first looked for something to trip over, before trying to avoid it. It is, perhaps, that Tony had a fatalistic belief that he would fall, rather than believing that he would not. Tony’s lack of confidence in his own ability to remain upright and an awareness of the vigilance required indicated that he would choose to avoid activities and avoid being with others, to minimise his risk of falling:

“I mean if I was like at the seaside ... and somebody said ‘Come down on the beach collect shells or something’, I’d I think invariably decline because of the unevenness of the sand, but also if there were pebbles, the washed up pebbles that you get in corners ... Sometimes it’s the whole beach... I sit at the top, wait for them to come back. (Tony, care-recipient, l.1239)

During this last interview Tony and Susan also describe that Tony had decided to give up the bird watching as he was now too slow:

172

“Tony: Haven’t been on a bird-watching …

Susan: Not since June we went and you said you didn’t want to go again.

Tony: Yeah.

Susan: Not an organised one, because he couldn’t keep up....

Tony: ...Couldn’t keep up with the rest of them ... I mean they rushed off to see something, by the time I got there they were coming back again, you know.” (l.2006)

From Tony’s narrative, one could perceive him as being one of the washed up pebbles on the beach, discarded and ignored by others as a result of his change in behaviour and attempt to stay in control. One can also suggest that not only did Tony (care-recipient) find that his speed of walking was affected by his avoidance of falls, but also through the effort involved in being extra vigilant in identifying potential hazards, it became impossible for him to participate and enjoy his hobby. Derek (carer, FG1) and Joyce (carer, FG3) also both described a slowing down and being more aware of where they themselves were walking.

Like Tony, Wendy (care-recipient) described how she needed to see where she was putting her feet when walking.

Other changes to routine and behaviour in the aftermath of a fall were discussed. Neil initially considered that very few changes had been made after Rita’s falls (his mother and care-recipient) but then corrected this by saying:

“...Because I used to come and go. I had a girlfriend I was seeing you know … and uh … well I came back you know and I’m living with her (Rita) permanently now you know. Well I can’t see her go in a home... So ever since I’ve been a 24 hour carer since December.... So I’m on 24 hour. Actually when I say 24 hours I am 24 hours.” (Neil, carer, l.373)

In this narrative Neil described profound changes to his own life in order to care for his mother. He shared how he ensured that his mother Rita, did not walk anywhere in the house without his assistance to prevent her from falling.

173 Some participants described changes that they had made to their home environment to reduce the risk of falling. Both Patrick and Karl (carers) had had a downstairs toilet installed for their wives so they didn’t have to climb the stairs too often. Both of them had also tried to make the stairs safer by fitting extra rails, with Derek (carer) described how he fitted a gate at the top of the stairs to prevent his wife from falling down. However not all participants felt that major changes were appropriate. Norma perceived that making changes to the stairs was unnecessary for Bob even though he had fallen down them before. She said:

“Well I don’t think it needed any change. But I do try and take things away from the bottom, in case he did fall” (l.502).

Although Tony’s narrative clearly conveys a highly cautious behaviour, the change in behaviour in the desire to prevent falls happening again, or to deal with the consequences of falling, was apparent in all narratives. Many of the carers seemed to become more vigilant to prevent falls, with their increased vigilance of the care-recipient rippling out into their own lives and behaviour. For some, the most obvious described changes were behavioural whereas others described changing the environment to reduce risks and make it safer.

6.3.3 Falling and dementia: “we’re having a bit of a problem with her