Qualitative analysis.

The semi-structured interviews were digitally audio-recorded and transcribed verbatim and imported into NVivo (QSR International Pty Ltd). The transcripts were anonymised and checked for accuracy. The data were analysed using an inductive thematic approach (Braun & Clarke, 2021) to extract meaningful insights from the interview data. The aim of this method was to explore and identify patterns, themes, and insights that emerged directly from the data, without being constrained by pre-existing theories or predetermined coding schemes.

The interview transcripts were thoroughly read to gain a comprehensive understanding of the data, immerse in the content and to identify initial impressions and ideas. After becoming familiar with the data, initial codes were generated to capture meaningful concepts, ideas, or patterns within the dataset. These codes were generated in an open-ended manner, allowing for a flexible and exploratory analysis. The initial codes were reviewed, refined, and organised into potential themes.

The data was continuously reviewed and discussed (C.M., C.G., T.O., and R.F.) until a consensus was reached on the final themes and subthemes. This iterative review process facilitated the refinement and consolidation of codes, ensuring a comprehensive and coherent representation of the interview data.

Frequency analysis.

The stair assessment element of the study employed a frequency analysis to examine the occurrence and distribution patterns of the variables under investigation.

Impact of lockdown on physical activity and routine.

Older adults articulated a notable shift in their daily routines during the COVID-19 lockdown, resulting in a decline in physical activity and exercise. This transitioned towards a more sedentary lifestyle, influencing both their indoor and outdoor activities. Despite participants initial efforts to maintain outdoor physical activity, such activities diminished with the onset of adverse weather conditions and subsequent lockdowns. Although this observation is not particularly unusual, the previous classes or activities that would get older adults out of the house during the colder and darker months were unavailable due to the lockdown restrictions. While some attempted to shift their exercise routines to online classes as a substitute, most participants faced challenges with this transition having long term affects. The lack of physical activity during lockdown contributed to overall physical well-being concerns among participants and while only a few participants reflected on falls, the ones who did commonly expressed uncertainty about the causes of these falls. A few participants often suggested a probable link between reduced exercise during lockdown and the occurrence of their falls. This connection between sedentary behaviour and health concerns is an aspect of the broader challenges faced by older adults during the pandemic.

Emotional and social impact of lockdowns.

With the rapid spread of the virus and limited understanding of its implications, older adults often found themselves dealing with the emotional and social repercussions of lockdown and social distancing measures. Public transportation was regarded as a potential hotspot for virus transmission due to close quarters and shared spaces, which lead to the participants’ fearing leaving the house. Furthermore, participants frequently articulated feelings of isolation, frustration, and a longing for social interactions. This frustration of the loss of social engagement due to lockdown led one participant to experience a fall. This sentiment of frustration was echoed when the participants discussed how they coped with the discomfort of lockdown by immersing themselves in household projects as a distraction. The emotional complexity of living through a lockdown was shown to be a challenge. Especially when the participants spoke about major life changes, such as the loss of a spouse, the absence of familiar gatherings, and the change in the dynamics of human interaction during lockdown.

Home environment hazards.

Participants identified various elements such as the presence of a stair lift, rugs on the floor, tight turns, and lighting as potential hazards contributing to incidents and falls. For instance, the lack of a continuous banister and slippery surfaces were cited as factors in several falls. The participants’ experiences underscored the importance of considering not only the visual aspects of safety features, but also their tactile properties, in assessing and addressing fall risks on stairs. Rugs, especially on wooden floors, were noted as trip hazards, and the tactile properties of safety features like bannisters were highlighted as important for preventing falls. However, many participants struggled to recall what their stairs looked like or acknowledge their stairs as the reason for their falls and injuries.

Behavioural hazards.

Some respondents attributed their falls to their own actions, such as running or jumping on the stairs. These responses suggest a behavioural aspect linked to the falls experienced rather than the design of the stairs being considered the sole causal factor. Participants frequently discussed various situations where unsafe behaviours, such as carrying too many items or heavy loads, wearing inappropriate footwear, or rushing downstairs, led to falls and injuries. The narratives of these stair fallers reflected a mix of casual attitudes towards stair use, a lack of awareness about the risks involved, and the absence of a clear recollection of the fall adds an element of unpredictability to their behaviour. These incidents illustrate how unsafe behaviours on stairs can lead to severe outcomes and underscore the importance of addressing behavioural risks to prevent stair-related falls among older adults.

Consequences of falls and injuries on stairs.

Older adults reported about the physical and emotional tolls of stair-related falls. Participants frequently described feeling stiff, sore, and bruised after their falls, with some sustaining severe injuries such as cracked arms, bruised limbs, and haematomas. Not only were these consequences echoed by the older adults who had experienced a stair fall, but we also found that an injury was sustained from an older adult who experienced a near fall. The immediate reactions to these falls were often marked by surprise, confusion, and fear, leading them to re-evaluate their actions and behaviours on stairs. The physical impact of these falls included mobility limitations and prolonged recovery periods, significantly affecting their daily lives and activities. In some cases, initial falls led to additional, more serious falls, resulting in extended hospital stays and further complications. In addition to physical consequences of falls, emotional responses were common among participants, reflecting self-blame and regret regarding the circumstances of their falls. Despite recognising the risks and emotional impact, some participants admitted to continuing unsafe behaviours after experiencing a fall, suggesting challenges in modifying behaviour. These findings present a multifaceted story of falls, injuries, emotional responses, and the lasting impact on the participant’s mobility and independence.

Use of handrails for stability.

Participants widely reported that handrails played a pivotal role in their safety and stability when navigating stairs and often emphasised how they’d made conscious efforts in using the handrails to prevent falls. Some participants came to realise that they adapted their behaviour as they aged, becoming more inclined to use handrails for stair safety. This observation highlights a common trend among older adults to prioritise safety measures such as handrail usage as they navigate stairs, reflecting a broader recognition of the importance of injury prevention and fall mitigation strategies with age. Additionally, the role of the handrail was not just seen as a supportive and preventative measure by older adults but actually helped them mitigate the impact of a fall. The willingness of older adults to adapt and utilise handrails when feeling unsteady was captured by most respondents. Despite varying levels of autonomy in using handrails, participants actively sought support from them to ensure a sense of safety during stair navigation.

Caution and awareness for non-fallers.

The majority of participants who did not experience a stair fall reported on their conscious efforts and awareness of potential risks and hazards when using the stairs, as well as their proactive measures to ensure safety. Respondents often emphasised their increased level of concern and adaptive behaviours to reduce the potential for falls, particularly when carrying items up or down the stairs. Additionally, participants discussed how dim lighting affected their ability to navigate the stairs safely. The consistent mention of being more “cautious” among all non-faller participants indicates a shared recognition of the potential risks associated with multitasking while on the stairs.

Physical health and fitness as factors in preventing falls on stairs.

Older adults highlighted the role of physical health and fitness in preventing falls on stairs. They often suggested that the older adults who were physically fit might find it easier to maintain balance and be more stable when using stairs, potentially reducing the risk of falls. Participants who engaged in regular exercise, such as yoga, Pilates, or running, reported better balance and quicker reactions to potential hazards, attributing their enhanced stability and fall prevention to their fitness levels. While the majority of participants highlighted the importance of physical fitness, respondents who had experienced a stair fall acknowledged the potential impact of underlying health conditions, on stair safety. The older adults who maintained good physical fitness tended to feel more confident and secure when using stairs, while those with underlying health conditions were more aware of the potential risks and took preventive measures to address them. This reflects a broader awareness among older adults of the potential impact of health conditions on their safety and mobility.

Routine adaptations after a fall.

Older adults who had experienced a fall reported that they adapted their routines to prioritise safety, by becoming more vigilant about potential hazards in their environment, such as uneven surfaces and steps, and adjusted their behaviour to mitigate and avoid these risks. For example, instead of navigating hazardous routes, they chose safer alternatives, such as using facilities on a single level. This change in routine highlights the reactive measures taken by older adults to prevent future falls, showcasing their heightened caution and deliberate actions after a fall. Moreover, participants reflected on the psychological transformation they’ve undergone, acknowledging that they became more cautious and careful as a result of their experiences. Additionally, older adults frequently delved into their specific and individualised routines that they had developed to enhance stair safety after a fall. Although older adults frequently reported on their individualised routines, it conveyed an overall responsive effort rather than proactive measure to prioritise safety and prevent a reoccurring stair fall.

Home design and safety concerns.

Respondents often expressed safety concerns regarding their living environment. They often indicated a heightened awareness of the potential dangers associated with the specific architectural features of their home, such as narrow landings and tight staircases. It was common for the respondents to discuss their narrow staircase. However, only a few participants discussed their narrow staircase in the context of the consideration and decision-making process regarding the stair lift in their home. Furthermore, the idea of future-proofing their homes was mentioned by multiple respondents, indicating a shared recognition of the importance of planning ahead for ageing-related changes. Older adults often offered practical solutions, such as installing additional handrails, to enhance safety and support during stair use. Concerns about architectural features, like steep entryway steps, were also raised, and older adults emphasised the need for more accessible designs. When asked about the barriers to ageing in their current homes, many older adults identified stairs as a significant challenge, although not necessarily the most immediate concern. They acknowledged the inevitability of ageing which prompted evaluations of their living situations.

Financial considerations and concerns in ageing.

Participants discussed an array of expenses linked to ageing. A focal aspect of financial consideration revolved around the expenses tied to adapting home environments for safety and accessibility. While some participants expressed determination to manage the financial costs, others reflected on their financial ability to upgrade their homes as they age differently. Many expressed concerns about the affordability of such upgrades when attempting to make their homes more age friendly. Beyond home modifications, respondents also touched upon the financial considerations associated with potential future care needs. The prospect of residing in care homes involves significant financial planning, and often participants expressed concerns about these potential costs. This sheds light on the intricate financial landscape that older adults must navigate as they contemplate their future living arrangements. Additionally, the financial considerations extended to day-to-day expenses, including energy costs. Economic challenges, such as increases in energy costs or uncertainties about income, were mentioned, highlighting the impact of broader economic factors on older adults’ daily decisions and behaviours. Moreover, respondents often expressed their emotional and practical aspects of ageing, and the desire to remain independent. Frustration and feelings of dependence on others for assistance were discussed, reflecting the challenges older adults face in overcoming sensory limitations alone. This tension between the desire for many older adults to maintain independence, the acknowledgment of the potential benefits of safety measures and the implementation of these safety features, was resounding. Many participants emphasised the importance of preserving their ability to make choices and decisions.

Seeking and receiving care services.

A few participants described their experiences with the receiving care services, indicating their active engagement in efforts to mitigate the risk of falls. Likewise, receiving care services, such as accessing a guide dog had benefits of increasing activity levels and positive effects on respondents’ well-being. However, access to and seeking care during the COVID-19 pandemic was somewhat challenging for the respondents. Among the respondents who received care services during the pandemic, there was shared a sense of risk and anxiety associated with any form of external contact, due to the fear of contracting COVID-19. Overall, these findings reflect older adults’ proactive approach to maintaining their health and independence by seeking and receiving different types of care and assistance as they age. It also highlights the impact of the fear of contracting COVID-19 had on respondents receiving care services, despite their potential need for assistance.

Emotional attachment to the home and reluctance to move into care homes.

The emotional attachment to the home and reluctance to move into care homes were consistently reported. Many of the older adults included sentiments of comfort, security, and the significance of homeownership. Participants often reflected on the idea that their homes are places with deep emotional and practical importance in their lives. Moreover, the respondents often expressed strong reservations and aversion to the idea of leaving their current homes to live in care homes or assisted living facilities. The respondents’ reservations about care homes stemmed from concerns about the quality of care, the potential loss of independence, and the regimented nature of such facilities. Furthermore, participants expressed a preference for facing end-of-life issues in their familiar home environment rather than moving into care homes. This was a common response to the idea of moving into a care home. Older adults often expressed reluctance to consider alternatives such as moving into care homes, emphasising the importance of maintaining control over their own lives and decisions, even in matters related to the end of life.