Tuesday, 4 December 2012

'Being the subject of falls' by Bill Bytheway

This is a subjective account of two related experiences: having a fall and being interviewed about that fall.

In March (2012), out of the blue, I was approached by a friend-cum-gerontologist, asking me if I would be willing to join a focus group of older people to discuss falls: ‘The aim is to have a fairly informal talk with a small group of people, over 65 years old who have had a fall outdoors within the last year. We want to hear people’s experiences, views and ideas’. Apparently they were a little short of men.

Occasionally of course, older gerontologists reflect on the challenge of interpreting their own personal experiences of ‘being of an age’. Generally however, one has to pass a certain birthday such as your 65th, before being invited ‘out of the blue’ to be a representative ‘older person’. This was my first such experience and I agreed to take part, both through curiosity and with a sense of obligation to fellow researchers. Upon entering the designated room at the appointed hour, the other participants were waiting. It seemed probable (but I may be wrong) that they had been recruited through local groups of older people – Age Concern or whatever – and that I was the only one who had been contacted through other networks. They had what was for me the familiar ‘look’ of a group of ‘older people’ brought together to discuss age-related issues.

We each recounted our personal experience of having had a recent fall and the part that we thought age may have played in this. As I remember – several months later – all the other falls were ascribed to ‘classic’ later life circumstances and weaknesses. I offered an account of my accident (see below) as objectively as possible but probably I said it was the kind of fall I’ve been having all my life, thereby dissociating the experience from age. After some open discussion (which tended to veer off the topic of falls), the meeting closed. We were asked if we were willing to be interviewed at a later date and, if possible, taken to where the fall had occurred. I agreed. I came away from the group feeling somewhat distant from the other older people there. Whereas my fall had resulted from lifelong risky habits (see below), the others were ‘talking up’ the peculiar circumstances they had found themselves in, in their old age.

In October, I was asked if I was available to be interviewed. Come the hour, there were two researchers on my doorstep. I invited them in for a cup of tea. One, let’s call her Ann, the researcher employed on the project, was visiting Swansea for a couple of days. I’d guess she was about 30 years of age, perhaps a little less. The second, Sue, lived in Swansea and was perhaps 40 to 50. In June I had celebrated my 70th birthday and was somewhat sensitive to matters of age. Sue had been at the focus group in March, but not Ann. Perhaps I should point out that there was no reference in the exchanges that followed to the fact that I was a retired gerontologist.

With the tea drunk, Ann brought out a standard, thankfully brief, questionnaire. The questions were not particularly unusual and I don’t now remember any of them. I was a little relieved when the time came to visit the site of my fall. We got up, donned our coats and set off.

At this point, it seems sensible to describe the location of the accident and then what happened, before returning to the interview. I fell quite close to where I live in Swansea. There are two four-sided blocks of typically Welsh terraces between my home and the dentist’s. To get there I walk up a fairly steep road, crossing three roads that tend to follow the contours. To cross the third there is an old-fashioned Zebra crossing and, immediately in front, there is a long terrace. At the nearer end, there is our local health centre and at the other our dentist’s. The distance from home to dental surgery is about 300 yards. In many ways, where we live is an ideal setting for later life: easy access by foot or bus to most services, and a relatively pedestrian-friendly environment.

(cc) Draig

That day, for reasons I can’t remember, I only set off to the dentist’s around the time I was due to be there. As a result I set off up the hill in a hurry. I was rushing if not exactly running. I remember thinking I was making good progress and even that I was rather fitter than I thought I was.

Half way there, there is a momentary respite, since the road to cross provides a break in the climb up the hill. At the other side, however, the pavement is at its steepest. Moreover, there are channels built into it to enable rainwater to drain away from the adjacent front gardens, and a long strip of the pavement had been re-layed following the burying of internet cables. So at this point the pavement has a steep and uneven surface. Shortly after resuming my climb, my right foot caught on something and I fell forward. In re-telling the story I claim that, when going up hill, the pavement in front is nearer than it would be on the flat. And so, as I stumbled and my left hand went out, the pavement was closer to my head. Although my hand broke my fall, it did not prevent my forehead from hitting the pavement. I can remember seeing my hand going out and then finding myself sprawled on the ground. I think I was aware at that point that my forehead was bleeding and possibly I found and applied a paper tissue. It was at this moment however, that a tall young male student, coming down the hill, stopped to ask ‘Are you alright?’ The immediate reaction of course is to think what a stupid question that is, but of course it was kindly meant: he was offering to help, possibly to get me back on my feet. Feeling embarrassed and cross, I declined the offer, thanked him and started back up the hill again.

I had fifty yards or so in which to decide what to do next. I could feel a bump swelling and there was some bleeding to stem. My mind considered ‘popping’ in to the Health Centre to get the gash dressed. Then I realised that there was no chance this might be done quickly; perhaps I should return home. But I wanted to get to the dentist’s, didn’t feel too bad and so carried on. When I got there I was able to clean myself up a little and, when I was called, my dentist found an ice bag in his fridge. So I sat there, in the chair, holding this bag to my head, whilst he examined my teeth.

I have told the story a number of times since it has a comic charm, not least the image of me finally making it to the dentist’s chair. But it’s not unrelated to the question of age. Arguably the initial distraction which led to me rushing was age-related – failing to remember an appointment when busy doing other things. And then perhaps I would not have fallen so badly, if at all, had I been 30 or so years younger. And, faced with the young student, I may have felt humiliated as a result of my failings seemingly due to age.  

This then is the story of the fall which I was happy to re-tell. Ann and Sue were not the first to hear it and, as with all ‘good stories’, despite wanting to produce an accurate account, I may simplify or dramatise it in the re-telling. Ann asked me about possible changes in my behaviour. Did I now avoid walking up the hill?  Do I think a walking stick might reduce the risk of falling? And so on. When we reached the spot where it happened, I tried ‘forensically’ to identify the guilty obstacle on the pavement that had ‘caused’ me to fall, but this didn’t prompt any further questions. It was a fairly cold day and soon it seemed I had supplied them with sufficient information for their research.

Now, I ask myself were Ann and Sue operating within the ‘decline’ model of age? It’s widely recognised that falling in later life is a significant risk factor, and that a fall can precipitate many years of ill-health, poor mobility or social isolation. I wouldn’t dispute this. The aim of the research, according to the project’s information leaflet, was “to find out how older people’s quality of life might be improved by making outdoor environments easier to use and less likely to cause people to slip, trip, or fall”. Looking back now, it seems to me that their research was not aimed at finding out how that particular fall might have been prevented by, for example, improvements to the pavement. Rather it was how older people such as myself might avoid experiencing similar accidents in the future. To that end their questions were focused on my own possible failings and risky behaviours rather than the quality of the immediate environment in which I had fallen.

I like the idea of research being undertaken ‘in situ’ and so I’d been looking forward to re-living the experience of the fall. Disappointingly this had not happened but who know what the consequences might have been had I had the chance!

Bill Bytheway

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