35

Falls have a high morbidity and mortality rate. The current medical literature recommends systematic screening and identification of risk factors to apply preventative measures. Nevertheless, most falls remain unreported. What are the determining factors in causing patients of sixty-five years and older to declare their falls to their doctor? How do they consider falls? For nine months, the lead author acted as a replacement general practitioner. He systematically asked elderly patients if they had fallen within the past twelve months, and, if so, if they reported it to their substitute colleague. He divided them into two groups: “reported fallers” and “unreported” and conducted twelve comprehensive interviews. Several criteria appear to influence the reporting of falls: the type of fall (non-accidental); symptoms after the fall (dizziness, trauma, pain); trauma location (head); and being encouraged to see a doctor by a close relation. The feeling guilt may favor underreporting. Direct medical questioning by the doctor seems to encourage reporting. The patient’s expectations during a medical appointment for a fall are: full clinical examination; prescription review; prescription of physiotherapy; advice; and reassurance. The practitioner may at times induce fear, which does not favor the reporting of another fall. Falling represents a type of decline for the patient; talking about it is a kind of intimate confidence. In order to develop a preventative policy for falls, declaration is necessary, encouraged by an appropriate communication that takes into account the representations underlined by the interviews.