Factors Contributing to Falls Among Unhoused People With HIV & Substance Use: A Grounded Theory Qualitative Study

Improved antiretrovirals increase life expectancy for people living with HIV (PWH) while accelerating aging and fall risk due to polypharmacy, substance use, low physical activity, and frailty combined with typical age-related physical changes (Erlandson et al, 2019). A phenomenological qualitative study sought to understand the experience of falls and types of intervention desired as part of a parent study to develop a fall prevention intervention for PWH (Shinn et al, 2022). Key informants (n=5) were purposively selected for diversity in fall severity, identity, substance use, and age until saturation was reached to inform the content of four homogenous focus groups (n=20). Semi-structured interviews (60 min) were recorded in person and focus groups (90 min) were recorded via ZOOM. Interviews identified perceived causes and precursors to falls while focus groups discussed prevention strategies and the need for acceptable and feasible interventions. All data were analyzed via constant comparative analysis. Key informant interviews were triangulated with focus groups and the literature. The data was further analyzed by MSOT students (n=75) in research classes to identify occupational performance issues. Five themes were identified from key informants: Causes, adaptive equipment, environmental factors, strategies to adapt and unmet needs. Homogenous groups of individuals were selected for focus groups based on level of support, fall severity, older age, use of adaptive devices. The virtual focus groups provided information about the feasibility of delivering a fall prevention intervention remotely as all participants were able to meet by phone and several shared that participating in person would not have been possible due to transportation, health, or child care needs. Participants expressed concerns about falls and interest in interventions to reduce fall risk. This is the first qualitative study of PWH and substance use to explore the lived experience of falling.

References

Erlandson, K. M., Zhang, L., Ng, D. K., Althoff, K. N., Palella, F. J., Kingsley, L. A., Jacobson, L. P., Margolick, J. B., Lake, J. E., Brown, T. T. (2019). Risk factors for falls, falls with injury, and falls with fracture among older men with or at risk of HIV infection. JAIDS Journal of Acquired Immune Deficiency Syndromes, 81(4), e117–e126. https://doi.org/10.1097/QAI.0000000000002074

Shin, D., Gill, S. V, Kim, T. W., Magane, K. M., Mason, T., Heeren, T., Winter, M., Helfrich, C., Saitz, R. (2022). Study protocol for a pilot randomized trial of a virtual occupational therapy fall prevention intervention for people with HIV and alcohol use. Substance Abuse: Research and Treatment, 16(1), 117822182211455. https://doi.org/10.1177/11782218221145548