Objective: The current state of science on falling among older adults supports a notion that the most significant outcome of a serious fall is fracture or injury. This idea is reflected in the history taking approach and armamentarium of interventions available to clinicians to manage falling which is often ineffective, specified for unique populations, not holistically derived and limited to structural support solutions (such as canes or walking aides). Appropriate management of older adults with serious falls requires however, an exploration of their experience and perception of this phenomenon. Few published research studies exist that explore the experience of a fall from the older adult's perspective. The purpose of this research was to examine the lived experiences and meaning of serious falls to older adults who have fallen and to determine from their perspective if falling means more than injury or fracture. Design/Methods: A qualitative research design utilizing van Manen's (1990) methodological approach was selected to examine the lived experience and meaning of serious falls to a purposive sample of 19 independent community-residing older adults from a continuing care retirement community (CCRC) located in northeastern United States between years 2000-2001. Older adults over age 65 with a history of a fall within the previous 6 months were enrolled and responded to questions: what was your experience of a serious fall and what is the meaning of a serious fall to you? during semi-structured, tape-recorded interviews. Data were collected from 2 seperate interviews, transcribed and reviewed with participants for clarity, verification and validity as established by the phenomenological nod. Using both the highlighting and sententious approach, data were colded according to words, phrases and concepts for both descriptions of a serious fall and the meaning of a serious fall. The procedure for thematic analysis involved transforming words, concepts and phrases into themes and theme categories through immersion, clarification/verification, searching literary sources, idiomatic phrases and validiating with secondary sources. Findings: The sample consisted of 17 females and 2 males with an average age of 83 years (ranging in age from 67 to 98 years). Self-reported medical problems included osteoarthritis (63%), hypertension (47%) and osteoporosis (27%). Most lived alone (31% widowed; 21% single, never married) and 42% lived with spouses. Nearly three-quarters of the sample were independent in walking (36% required no assistance and 42% required minimal assistance with steps) compared to 36% who required the use of a cane, walker or motorized wheelchair for walking. Fall histories indicated that most (74%) experienced 1 or 2 falls, often outdoors (74%). All participants voiced experiences of a "changed life", the overarching theme which emerged from the 6 thematic categories describing a serious fall: confinement, suddenness, traumatic, agner/frustration, helpless and fear and from the 3 thematic categories representing the meaning of a serious fall: aging, fear of potential disability and actions taken to avoid falls. Except for two participants, the impact and meaning of a serious fall were unrelated to physical injury. This finding underscore's the researcher's assumption, based in existentialism, that the perception of a serious fall is individually determined adn not solely related to the occurence of physical injury post-fall. Conclusions: The new emergent nine themes and resultant "changed life" indicate that a serious fall is a significant event to independent community residing older adults that is often irrespective of physical injury. As clinicians, the perceptions we hold about the meaning of a serious fall influence our approach and management of falling. An examination of the phenomenon of a "serious fall" suggests that it means much more than physical injury, a notion that current practice is predicated upon. Implications: This research offers an opportunity for changing the standard fall assessment and management approach which has been strongly influenced by a medical model. Given these new findings, fall assessment and management should not minimize the older adults life experiences and perception of the impact of the fall in daily life, but maximize personal disclosure. Nursing implications for practice include therapeutic use of self to help identify the older adults percpetion of the experience through a change in history taking that embraces a holistic person-oriented approach. This shift in the clinician's approach to falls can lead to targeted educational efforts and interventions that are liekly to benefit older Americans by fostering acceptance of an intervention because it is based on one's own identified experiences, perceptions and needs in daily life.
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