The Gerontologist Advance Access published online on June 12, 2009
The Gerontologist, doi:10.1093/geront/gnp059
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Utilization of the Seniors Falls Investigation Methodology to Identify System-Wide Causes of Falls in Community-Dwelling Seniors
2 School of Health Studies, Faculty of Health Sciences, The University of Western Ontario, London, Canada
3 School of Kinesiology, Faculty of Health Sciences, The University of Western Ontario, London, Canada
4 Centre for Research in Human Development, Laurentian University, Sudbury, Canada
5 School of Physical Therapy, Faculty of Health Sciences, The University of Western Ontario, London, Canada
6 Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Canada
1 Address correspondence to Aleksandra A. Zecevic, PhD, Faculty of Health Sciences, The University of Western Ontario, HSB 220, London, ON, Canada N6A 5B9. E-mail: azecevi2{at}uwo.ca
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Abstract |
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Purpose: As a highly heterogeneous group, seniors live in complex environments influenced by multiple physical and social structures that affect their safety. Until now, the major approach to falls research has been person centered. However, in industrial settings, the individuals involved in an accident are seen as the inheritors of system defects. The objective of the present study was to investigate safety deficiencies that contributed to falls in community-dwelling seniors using a systems approach. Design and Methods: The investigations were conducted using the Seniors Falls Investigation Methodology (SFIM), an adapted version of a method used to examine transportation accidents, such as airplane crashes. Fifteen seniors, who experienced a fall or near fall, participated in multiple case studies. A cross-case synthesis was used to summarize findings and identify common patterns of causes and safety deficiencies. Results: Falls and near falls are a result of latent unsafe conditions, and unsafe acts and decisions combined in a diverse set of circumstances. If not identified and removed, these unsafe conditions can cause falls for other seniors. Implications: This study provided compelling evidence that causes of falling are systemic and develop over time. It demonstrated that the systems approach is needed to expand the focus from the individual to multilayered organizational and supervisory causes. The SFIM demonstrated capability to identify causes of falls that will allow better prevention and management programs, hence advancing seniors’ safety. SFIM shows great potential for implementation in organized settings, such as hospitals and long-term care homes.
Keywords: Human factors, Systems approach, Accident investigations, Swiss cheese model, Safety deficiencies
Received August 20, 2008; Accepted October 24, 2008
Decision Editor: Nancy Schoenberg, PhD
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