Adult Inpatients’ Perceptions of Their Fall Risk: A Scoping Review

Abstract

Patient falls in hospitals continue to be a global concern due to the poor health outcomes and costs that can occur. A large number of falls in hospitals are unwitnessed and mostly occur due to patient behaviours and not seeking assistance. Understanding these patient behaviours may help to direct fall prevention strategies, with evidence suggesting the need to integrate patients’ perspectives into fall management. The aim of this scoping review was to explore the extent of the literature about patients’ perceptions and experiences of their fall risk in hospital and/or of falling in hospital. This review was conducted using a five-stage methodological framework recommended by Arksey and O’Malley. A total of nine databases were searched using key search terms such as “fall*”, “perception” and “hospital.” International peer-reviewed and grey literature were searched between the years 2011 and 2021. A total of 41 articles, ranging in study design, met the inclusion criteria. After reporting on the article demographics and fall perception constructs and measures, the qualitative and quantitative findings were organised into five domains: Fall Risk Perception Measures, Patients’ Perceptions of Fall Risk, Patients’ Perceptions of Falling in Hospital, Patients’ Fear of Falling and Barriers to Fall Prevention in Hospital. Approximately two-thirds of study participants did not accurately identify their fall risk compared to that defined by a health professional. This demonstrates the importance of partnering with patients and obtaining their insights on their perceived fall risk, as this may help to inform fall management and care. This review identified further areas for research that may help to inform fall prevention in a hospital setting, including the need for further research into fall risk perception measures.

‘I don't want to impose on anybody’: Older people and their families discuss their perceptions of risk, cause and care in the context of falls

“…Further, Swedish research has found that older people see falling as an inevitable fact of existence but believe that there is ‘ more to life than risk avoidance ’ (Gustavsson et al, 2018). Furthermore, healthcare professionals have observed differences between individuals' perceptions of their risk of falling and their own assessments (Dabkowski et al, 2022). The implications that follow are that risk–based messaging for falls prevention may not be the ideal way to communicate necessary information, given that people are unlikely to identify themselves as at risk and differ in their goals for maintaining their wellbeing.…”

“…Engaging in meaningful conversations with older people to identify what they want is therefore necessary. Feelings of disempowerment, loss of control and threats to self‐identity frequently accompany a hospitalisation, and personal considerations of independence and dignity may influence a patient's desire to do what is medically advised (Dabkowski et al, 2022). Research examining the perspectives of older people on what dignity means in acute care centre on the themes of autonomy (involvement in decisions), safety and respect (Kerr et al, 2020).…”

“…Two recent reviews reported on adult inpatient perceptions of falls (Dabkowski et al, 2022; Dolan et al, 2022). These reviews highlight that the majority of participants did not consider themselves at risk for falling (Dabkowski et al, 2022; Dolan et al, 2022).…”

“…Two recent reviews reported on adult inpatient perceptions of falls (Dabkowski et al, 2022; Dolan et al, 2022). These reviews highlight that the majority of participants did not consider themselves at risk for falling (Dabkowski et al, 2022; Dolan et al, 2022). Furthermore, prominent themes addressed participant concerns about self‐identity, dignity, autonomy and independence (Dabkowski et al, 2022).…”

“…These reviews highlight that the majority of participants did not consider themselves at risk for falling (Dabkowski et al, 2022; Dolan et al, 2022). Furthermore, prominent themes addressed participant concerns about self‐identity, dignity, autonomy and independence (Dabkowski et al, 2022). Previous research highlights that older adults have a variety of responses to falls prevention, from a high level of engagement to ambivalence or denial (Kiyoshi‐Teo et al, 2020).…”