Patient perspectives of a fall leading to emergency department visit during the COVID-19 pandemic: A qualitative study in Northern Ontario

Background and objectives Falls are a leading cause of injury-related emergency department (ED) visits and hospitalizations across Canada and can result in decline in function and quality of life for an older adult. The COVID-19 pandemic placed severe strain on EDs and hospitals across Canada. This study aimed to understand the experience of older adults who presented to the ED as a result of having a fall during a COVID-19 surge. This may help generate hypotheses and ideas about how to provide optimal care in the midst of pandemic-related healthcare system disruption. Methods A purposive sampling strategy identified nine participants over age 65 in a medium population centre in Northern Ontario, Canada. Qualitative semi-structured interviews sought information regarding patient demography and function prior to their fall, the circumstances and communication surrounding their fall, and information about their post-fall recovery. Qualitative thematic analysis of the data was completed. Results Three main themes were identified: patients minimized their fall risk; the challenge of interacting with the healthcare system in a time of limited resources; and complex care navigation and fragmentation within the healthcare system. Discussion Participants were uncertain about the significance of a fall. Post-fall care was directed by the participant, and little coordination or education was provided at the point of contact with the health care system. Participants were hesitant to present to the ED. Participants expressed vulnerability when reflecting on their experience and acknowledged the systemic pressures experienced by their healthcare workers during the COVID-19 pandemic.