Listening with a narrative ear: Insights from a study of fall stories in older adults.

OBJECTIVE: To determine the value of adding a patient narrative to the clinical assessment of falls in the elderly.

DESIGN: Qualitative study of interviews.

SETTING: A fall prevention clinic in Calgary, Alta.

PARTICIPANTS: Fifteen older adults on a wait list for assessment by the fall clinic and the physiotherapists who assessed them.

METHODS: Participants' stories were audiorecorded and later transcribed and summarized. Stories were collected using open-ended questions, first inviting participants to tell the interviewer about themselves, and then the circumstances of their falls and their reflections on them. In a subsequent visit, transcriptions or summaries were returned to patients for member checking. Narratives were read and analyzed by all 4 investigators using a narrative approach and a close-reading technique. With the patients' additional consent, stories were shared with the fall prevention team for their insights and reactions. Interviews with physiotherapists were audiorecorded and transcribed.

MAIN FINDINGS: The narrative analysis provided new insights into the attitudes about and perceptions of the causes of falls, their effects, and rehabilitation. Close reading exposed presentation of self, locus of control, and underlying social and emotional issues.

CONCLUSION: The addition of patient narratives to clinical assessments offers clinicians an understanding of patients' perspectives, which can be used to better engage patients in rehabilitation.