Older adults' perceptions of their fall risk in the hospital: An integrative review

Abstract

Aims and objectives: The objectives of this review are to determine what is currently known about older adults' perceptions of their own fall risk in the hospital and associated factors and explore how perceived fall risk in the hospital is assessed.

Background: Every year, up to one million patients suffer an accidental fall in the hospital. Despite research efforts during the last decade, inpatient fall rates have not significantly decreased, and about one third of inpatient falls result in injuries. Limited evidence suggests that assessing hospitalised patients' perceptions of their fall risk and engaging them in their own fall prevention can reduce inpatient falls.

Design: An integrative review.

Methods: An electronic literature search was conducted in the Cumulative Index of Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Embase, Google Scholar, OpenGrey, ProQuest Dissertations & Theses Global, PsycINFO and PubMed. Data extraction and quality assessments were independently performed by two reviewers. PRISMA guidelines were followed for reporting this review.

Results: Twenty-two studies met the inclusion criteria. The findings suggest that hospitalised older adults inadequately estimate their own fall risk. Most participants did not perceive themselves as at risk for falling in the hospital. Educational and motivational interventions can change the patients' perceptions of their own fall risk in the hospital and engage them in fall prevention. The desire to remain independent and feeling vulnerable were associated with fall risk, and the relationship with nursing staff may affect how hospitalised patients perceive their own fall risk.

Conclusions: Hospitalised adults, and specifically older adults, do not adequately estimate their own fall risk. Factors associated with these perceptions must be further explored to develop assessment tools and interventions to decrease inpatient fall rates.

Relevance to clinical practice: Nurses' understanding and assessment of hospitalised adults' perception of their own fall risk is important to consider for reducing inpatient falls.

Keywords: accidental falls; adults; experience; hospitalised; inpatient; integrative review; older adults; perceptions.