The beginning of the end: A qualitative study of falls among HIV+ individuals

Abstract

Falls are an important concern for individuals living with HIV (HIV+). The purpose of this study was to understand perceptions of HIV+ individuals who had fallen regarding what caused their falls, prevention strategies that they used, and the impact of falls on their lives. Qualitative Description was the approach best suited to our study. We conducted in-depth interviews with 21 HIV+ individuals aged 47 to 71 years who had fallen within the past two years and who received care in a primary care/HIV clinic. Participants identified causes of falls as intrinsic (HIV, opportunistic infections, antiretroviral therapy, substance use, polypharmacy) or extrinsic (icy sidewalks, wet floors). Among those who felt that their falls could be prevented, prevention strategies included physical therapy and avoiding extrinsic fall risk factors. Some participants, however, felt that their falls could not be prevented. While some participants responded adaptively to falls, for many, the experience of falling was connected with deep feelings of loss and suffering. For these individuals, falls were understood to be “the beginning of the end” and a source of social isolation, changing family roles, diminished sense of self, and stigma.

Falls in people living with HIV: a scoping review

“…Six studies (43%) used longitudinal prospective cohort design, 16 24 27–30 four studies (29%) used cross-sectional design, 26 31–33 one study was a secondary analysis of data from a longitudinal prospective cohort study, 34 one study was a longitudinal retrospective analysis of patient databases, 35 while another used qualitative methods. 1 One systematic review was also included. 36 Four studies (29%) 24 27 30 32 had samples consisting of both PLWH and HIV-seronegative participants (SNP).…”

“…Another study 28 identified peripheral neuropathy as a potential confounder for the association between falls and frailty in PLWH. In one qualitative study, 1 PLWH reported peripheral neuropathy in addition to opportunistic infections, spinal stenosis, arthritis, stroke, hepatic encephalopathy as being causes of their falls. Only one study 24 failed to find an association between peripheral neuropathy and falls and attributed it to their relatively younger cohort being potentially better able to compensate for neuropathies or possibly less sensitive tests being used to determine peripheral neuropathy.…”

“…A patient-centred approach is important by considering their concerns and involving them in the decision-making process of their treatment. 1 …”

“…Though not included in this study, PLWH should be consulted when developing clinical practice guidelines. A patient-centred approach is important by considering their concerns and involving them in the decision-making process of their treatment 1…”

“…Falls are an emerging concern among people living with HIV (PLWH) because of the adverse effects on their health outcomes,1 and is currently being increasingly investigated. Improved access to combinations of antiretroviral therapy (cART) has increased the number and life expectancy of PLWH and reduced the incidence of human immune deficiency virus (HIV) infections 2.…”