“It's my own fault”: Accounts and consequences of falling when living with rheumatoid arthritis

Introduction: Rheumatoid Arthritis (RA) leads to biomechanical joint changes which increases risk of falling. The consequence of falling may be physical injury. However, as important can be the psychological consequences including fear of falling. Methods: Participants were recruited from a larger prospective study which explored the incidence of falls in people with RA. Purposive sampling considered age, sex, time since diagnosis and fall history. The recruitment site was a regional hospital. Data from semi-structured qualitative interviews and, after each fall, brief telephone interviews. Thematic analysis methods were used to investigate the psychological and social impact of falling in people with RA. Results: Twelve participants were interviewed (aged 64-85, mean 74 years: 6 had fallen between 1-23 times: 6 had no reported fall in last 12 months). Data was supplemented with telephone notes from 287 post-fall telephone calls. Three themes were developed: 1) The falls Imaginary illustrates that fear of falling is not dependent on experience; 2) Agentic risk management reports on the ways people self-manage and display resilience when at risk of falling; 3) The absence of the health professional explores the ways in which people reported being unsupported by health care services. Conclusion: Fear of falling when living with RA is tangible in those who have and have not fallen. This fear may limit opportunities for full participation in life. However some people display personal resourcefulness continuing to live purposeful lives. Understanding personal responses to falling will support the development of community interventions specific to this high risk group.