Being out of control: “Something did it, or myself”

This statement was made by George when he was considering how he had fallen. Like George, the majority of the participants articulated both intrinsic and

161 environmental reasons and experiences of falling. In many instances participants gave many rationales for the same experience as they perhaps were not really sure why they fell. Indeed care-recipients and carers often suggested differing reasons for the same fall. Here one can consider that these were co-constructions of the experience in the moment with the interviewer. The many differing rationales being co-created for the same event also reinforces the phenomenological position that participants are not necessarily accessing a single ‘factual’ reality, but are highly engaged in meaning-making.

Participants attributed various factors external to themselves for their falls. They described tripping over their cat, a door mat, their pyjamas, over uneven pavements as well as cigarette papers and catching their feet on the kerb when crossing the road. Indeed Karl (carer) recounted how Eileen (his wife and care-recipient) tripped when crossing the road pulling Karl over with her. This was echoed in an experience by Peter (carer) who was pulled down into an excavation of a pavement by his wife when she tripped and fell in. Wendy (care-recipient) blamed her varifocal glasses for her increasing number of falls.

George’s account of one of his falls seems to describe a less specific extrinsic, but yet malevolent force that he fought to remain upright. He said:

“...No, I kept off the ground...” (l.1668)

and then later:

“...but it never got the whole of my body...” (l.1766)

then later again he reiterates:

“...I go against these things trying to get me flat, and I am trying to hold myself up. Not drop over.” (George, care-recipient, l.1831).

This sensation of being controlled by an external force was echoed by other participants. Bob (care-recipient) recalled how he was pushed forward when he stumbled, and when discussing how she slipped off the bed, Vera (care-recipient) explained “...but it sort of turned me halfway...” (l.104). Bernard’s

162 exasperation with Wendy (his wife and care-recipient) was clear in the dialogue below, however Wendy defended her behaviour as being out of her control:

“Bernard: you are inclined of walking into a pool of water rather than...

Wendy: ...walk round it

Bernard: ...go over and round it. Very often I say ‘now follow me’ but you don’t.

You go somewhere else.

Wendy: Well I don’t walk through puddles though. Not deliberately.

Bernard: No, no but you are attracted to them.” (l.641).

The lack of control and sense of powerlessness over the falls experience was also expressed by Eileen who described that she “didn’t have a chance – I just fell”

(l177).

In these instances it can be seen that participants felt that something external to themselves – either an invisible force or something in their environment caused them to fall. Indeed these participants convey a sense of helplessness or being threatened by a fall.

Intrinsic reasons for falling were also given, either by the care-recipient themselves or by their carers, as suggestions for the fall. These reasons for falling have an element of self-blame, with Bridget (care-recipient) saying:

“Oh I know I should lift my feet a bit more” (l.811).

This was echoed by Tony (care-recipient) and also by Paul (son carer) about Vera (recipient), and by Marion (carer) about Eamonn (husband and care-recipient). Rushing to the toilet was seen as a potential cause by Tony, George (care-recipients) and Kathryn (carer). Participants also articulated somatic reasons for their falls such as being ill, problems with their feet and giddiness.

Others considered being tired yet Patrick puzzled over the possible reasons for Sheila’s falls, rejecting tiredness as an adequate explanation:

163 “But she wasn’t tired when she smashed her head; she wasn’t tired when she broke her left arm. And her right arm she wasn’t tired” (Patrick, carer, l.1764).

Here Patrick seemed to be putting a great deal of effort into trying to make sense of Sheila’s falls. One also gets a sense of Patricks’ frustration at the inexplicability of falling and how powerless he feels about the regular harm being experienced by his wife, as a result of these inexplicable falls.

In Tony (care-recipient)’s narrative he unfavourably compared his skills to that of a hurdler, suggesting that he lacked the cognitive or sensory awareness to regain his balance adequately:

“...sometimes my foot hits something, a step I’m trying to make, um, is not completed properly, uh but um my …um, gearbox up here is telling me the balance, um, if you um watch a hurdler, which I’m not, if you watch a hurdler, on TV, they’re really quite out of balance when they’re going through the motions, what they’re doing, but they have this facility to regain the proper balance on landing...” (Tony, care-recipient, l.348).

Bridget (care-recipient) also implied a lack of cognitive awareness, reasoning that she was always busy thinking of other things:

“...The old brain is always moving, or thinking about shopping or something, you know...” (Bridget, care-recipient, l.816).

Not paying attention or thinking of more than one thing was also suggested by other participants as being implicated in falls. Vicki (carer) suggested on more than one occasion that her father George (care-recipient) was more at risk of falling when dividing his attention. She said:

“... but I think that he had two things on his mind and that’s not a good idea in his case...” (Vicki, carer, l.510).

The contribution of thinking of other things as a cause of falls was discussed at some length by Tony (care-recipient). He suggested that he could have fallen

164 because he was distracted by his wife pointing something out to him, or as a keen birdwatcher, by the sound of a bird. He described an “overlap” of concentration from one task to another and also stated how he found it difficult to think of more than one thing at once in other situations:

“There are a lot of other things beyond falling…. Er, um, if you’re writing something down and you think of something else, then you forgot what you were going to write” (Tony, care-recipient, l.444).

Christine, one of the spouse carers also described how thinking of other things, particularly in her caring role, also made her more vulnerable to falling:

“...there’s so many things to think of and you’re thinking of somebody else as well as yourself...” (Christine, carer, FG1, l.366).

Indeed, in some of the carers’ narratives it was a surprise to hear them talk about their own experiences of falling. In these narratives, the interrelatedness of the carer and care-recipient became painfully more apparent. Whereas Christine attributed her fall to thinking about the “other” (her husband and care-recipient), Patrick’s story of his fall immediately truncates the caring relationship he has with Sheila, as he was admitted to hospital. Moreover once home, feelings of powerlessness in the caring relationship were conveyed as he shared his inability to care for Sheila as he wished.

In these narratives the consideration of external and sometimes malevolent forces were articulated as reasons for the participants’ falls. In a few instances participants considered that there were reasons that were potentially within their control, such as not rushing or picking their feet up when walking. In many other circumstances participants’ attributions for falling were related to failures within their body – either due to temporary illness or as part of the ageing process (such as problems with divided attention), or role overload. However in some instances where it was difficult to ascertain why a fall happened, there was a sense of frustration and helplessness, as experienced by Patrick.

165 6.2.4 Summary of findings to higher level theme 1

This higher level theme has presented findings appertaining to the falls experiences and events of both the individuals with dementia who fell and also the individuals that cared for them. In some instances carer participants also talked about their own falls. Whereas the carers seemed to remember the

“facts” of the fall (e.g. date, time, place), the care-recipient had embodied and disembodied recollections of these experiences. The sudden and surprising nature of falling were conveyed by all those participants that fell, however participants searched for reasons for the falls, not only to rationalise the experience and perhaps to increase their sense of control, but also to try and prevent them from happening again.

6.3 Reactions, responses and coming to terms with events: “I was frightened for her”

Higher level theme two presents findings related to participants’ feelings and emotions related to falling and its immediate consequences. The title quotation comes from Karl’s (carer) narrative, when he related his fear of the consequences for his wife following her fall. Fear of the consequences of future falls was also present in the findings. How participants expressed their experiences of changes to behaviour and the environment in reaction to the falls event will be considered here. Finally, the reckoning presence of dementia in the participants’ narratives will be presented, and how these experiences are intertwined with their falls experiences. Table 6.2 indicates the prevalence of these themes amongst participants.

166 Table 6.2 Prevalence of themes for higher level theme 2 across

participants.