摘要：Objectives. We examined older people’s attitudes about falls and implications for the design of fall-prevention awareness campaigns. Methods. We assessed data from (1) computer-assisted telephone surveys conducted in 2002 with Australians 60 years and older in Northern Rivers, New South Wales (site of a previous fall-prevention program; n=1601), and Wide Bay, Queensland (comparison community; n=1601), and (2) 8 focus groups (n=73). Results. Participants from the previous intervention site were less likely than were comparison participants to agree that falls are not preventable (odds ratio [OR]=0.76; 95% confidence interval [CI]=0.65, 0.90) and more likely to rate the prevention of falls a high priority (OR=1.31; 95% CI=1.09, 1.57). There was no difference between the groups for self-perceived risk of falls; more than 60% rated their risk as low. Those with a low perceived risk were more likely to be men, younger, partnered, and privately insured, and to report better health and no history of falls. Focus group data indicated that older people preferred messages that emphasized health and independence rather than falls. Conclusions. Although older people accepted traditional fall-prevention messages, most viewed them as not personally relevant. Messages that promote health and independence may be more effective. Educational or awareness-raising strategies are commonly utilized in multistrategy fall-prevention programs. 1 , 2 Although substantial evidence supports the effectiveness of multistrategy programs in reducing rates of falls, the particular contribution of educational input 2 and the impact of specific messages are less researched. Traditional awareness-raising strategies in interventions for the prevention of falls have utilized 2 main messages: (1) falls are a significant health issue for older people (aged 65 years and older), and (2) falls are preventable. These messages have been utilized to counteract the common misconceptions that falls are only an issue for frail older persons and that falls are accidental and, therefore, not preventable. 3 However, the lack of personal relevance of these messages for the older individual has been identified as an important obstacle to awareness-raising goals. As Hill et al. (2004) wrote, There is an important assumption underlying the belief that education programs for older people are effective in reducing falls rates, namely that older people acknowledge that they are personally at risk of falls. 2 (p10) Older persons often have an overly positive perception of their state of health in general 4 and their risk of falls in particular. 5 In fact, they will actively disassociate themselves from the “old” label and the associated ageist stereotypes. 6 – 8 For instance, Braun found that although older people who lived in the community considered falls to be an important, preventable health issue and understood the significance of risk factors in the context of older persons, they minimized their personal susceptibility. 5 Similarly, through focus groups, Yardley et al. found that older people often supported fall-prevention advice for others, but not for themselves personally. 9 Aminzadeh and Edwards reported that although older participants recognized many functional and safety gains from using a walking aid, the majority (including those who reported fear of falling, a history of falls, or problems with their back, hip, and knee joints) believed they did not need such a device. 10 Falls often have negative connotations for older people. Associated with physical injury, functional impairment, psychological trauma, loss of independence, and death, falls are commonly viewed as a symbol of aging and an issue for frail older persons or “oldest old.” 3 , 10 , 11 Whereas a service provider may consider falls in terms of physical risk management, older people are often more concerned about the risk to their personal and social identities. 6 Similarly, although seniors fear functional limitations that result from a fall, they are also concerned about social embarrassment, indignity, and damage to their confidence. 12 These negative perceptions have been recognized as major factors in older people’s reluctance to admit both susceptibility to falls and the need for preventive behaviors. 10 , 12 Those with good physical and mental health and a limited history of falls are most likely to reject their personal risk of falling. 3 , 5 Prevention of falls is not always a conscious priority issue for older persons. A majority of focus group participants, when asked if they were concerned about having a fall, indicated that it was not something they had considered. 13 Similarly, a survey of older persons found that falls were only of moderate concern, compared with other health issues. 5 Quantitative interviews and focus groups and small questionnaire-based surveys of older community members have indicated that health promotion messages related to the prevention of falls may be negatively perceived. However, to our knowledge, no study has assessed the specific long-term impact of traditional messages about falls in an intervention context. We also sought to expand the limited amount of research related to message content and targeted subgroups. Specifically, we sought to examine the longer-term impact of traditional fall-prevention messages utilized in a community-based, fall-prevention intervention; to evaluate the demographic, health, and fall-related characteristics associated with a low perceived personal risk of falling; and to evaluate older people’s reactions to 3 message options, which focused on falls, independence, or health.
