"You have just got to be careful"-A Qualitative Study Disentangling Health Beliefs and Behaviors Regarding Falls Among Community-Dwelling Older Adults in Singapore.

OBJECTIVES: Understanding older adults' health beliefs regarding falls is important for the design of participant-centric programs. Although there is evidence on older adults' perceptions toward falls and falls prevention, there is insufficient understanding of older adults' adaptive responses to cope with falls. In addition, these perceptions are understudied within the context of Asia for the development of programs in Asia. METHODS: In-depth interviews were conducted with 30 community-dwelling older adults (aged 60 and older) in Singapore. The Health Belief Model, adapted to falls and falls prevention, helped guide interviews. RESULTS: Our findings uncovered a discordance between perceived susceptibility to falls and actual physical ability, influencing the actions toward falls prevention. Adaptive responses to falls were encapsulated as the concept "being careful" in this context. This manifested in two groups: those who monitor their physical health due to perceived high risk and those who only manage external hazards due to perceived low risk. In addition, we examined cues to actions: caregiver and clinician support, managing chronic pain, and prioritizing social roles; and discussed their implications for future program development. The findings also highlighted the importance of engaging family and caregivers in falls prevention efforts, a strategy that resonates deeply across Asian sociocultural contexts. DISCUSSION: Falls prevention practices should integrate tailored education and behavioral strategies based on older adults' perceived susceptibility to falls. In Asian contexts and other cultures with a strong focus on family, caregiver-supported interventions in addition to personalized interventions should also be optimized to encourage participation and sustain adherence.

Duke Scholars

Author David Bruce Matchar Medicine, General Internal Medicine