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Appraisals of elderly community dwelling women : a qualitative study of their experience of a fall Patterson, Kathryn A.


Falls represent a major health problem for elderly women. In the present study, I conceptualized a fall as a distressing event and focused on the appraisal process depicted in Lazarus and Folkman's (1984) transactional model. Meaning is a key element in the appraisal process, thus I drew on the Satir Model because it offers a method for accessing the meaning elderly women make of a fall and ongoing concerns about falling in terms of their behaviors, feelings, perceptions, expectations, and yearnings. Fourteen community dwelling women, aged 75 to 94, took part in one of three 1 to 1.5 hour focus group meetings. Eleven of these women participated in a follow-up 1.5 hour personal interview. The focus groups and interviews were audio-taped and transcribed. The text was analyzed by means of the constant comparative method used in grounded theory (Strauss & Corbin, 1990). Data analysis methods included open coding, constant comparative analysis, and memo writing. Additionally, attention was paid to theoretical sensitivity throughout the analysis. Results revealed that, for the women in the study, there were complex psychological processes connected to the fall. From the women's descriptions, five meta-themes emerged representing the fall itself, the context of the fall, the wants that were at stake because of the fall, the changes related to the fall, and factors contributing to resistance and compliance of those fall-related changes. The meaning they made of the fall was suffused with feelings, perceptions, and expectations. Although yearnings were difficult to determine, behaviour played a key role in the meaning made of the fall. According to the women's accounts, the fall was distressing; however, they did not consider fallrelated changes and limits as daily hassles. Instead, they placed an emphasis on adjusting to these changes and limits and moved forward with their lives. The findings highlighted the systemic, interactive nature of the appraisal process and the iceberg framework of the Satir Model. Understanding some of the psychological consequences of a fall within the context of these women's lives provides valuable information to help counselling psychologists when working with elderly women who have experienced a fall.

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