MODELING EDUCATIONAL STRATEGIES FOR PREVENTING FALLS IN HOSPITALIZED OLDER ADULTS

MODELADO DE ESTRATEGIAS EDUCATIVAS PARA LA PREVENCIÓN DE CAÍDAS EN PERSONAS MAYORES HOSPITALIZADAS

ABSTRACT

Objective:   to determine the content to be included in the process of modeling educational strategies for preventing falls in hospitalized older adults.

Method:  this is a methodological study developed in three stages: 1) integrative review on key elements that trigger falls in hospitalized older adults; 2) focus groups with nurses, hospitalized older adults and companions; 3) determination of the content to be addressed in preventing falls in hospitalized older adults by combining the key elements identified in previous stages, represented in a conceptual map.

Results:  a total of 14 publications were included, and the participants in the focus group sessions were 15 nurses, nine older adults and 11 companions. The publications indicated 24 key elements that trigger falls, and the focus group sessions indicated a total of 27 key elements. The results were represented in a conceptual map with thematic categories related to patient limitations and characteristics of the environment, each with subcategories.

Conclusion:  shared construction of the content to be considered in modeling health education strategies for preventing falls in hospitalized older adults made it possible to consider aspects of the scientific literature and the reality in which the strategy could be developed.

DESCRIPTORS:
Patient safety; Accidents due to falls; Older adults; Hospitalization; Risk factors; Health education

RESUMO

Objetivo:   determinar o conteúdo a ser contemplado no processo de modelagem de estratégias educativas para prevenção de quedas em pessoas idosas hospitalizadas.

Método:  estudo metodológico, desenvolvido em três etapas: 1) revisão integrativa sobre elementos-chave desencadeadores de quedas em pessoas idosas hospitalizadas; 2) grupos focais com enfermeiros, pessoas idosas hospitalizadas e acompanhantes; 3) determinação do conteúdo a ser abordado na prevenção de quedas em pessoas idosas hospitalizadas por meio da junção dos elementos-chave identificados em etapas anteriores, representados em um mapa conceitual.

Resultados:  foram incluídas 14 publicações, e os participantes das sessões de grupo focal foram 15 enfermeiros, nove pessoas idosas e 11 acompanhantes. As publicações apontaram 24 elementos-chave desencadeadores de quedas, e as sessões de grupo focal, um total de 27 elementos-chave. A junção dos resultados foi representada em um mapa conceitual com categorias temáticas relativas a limitações do paciente e características do ambiente, cada qual com subcategorias.

Conclusão:  a construção compartilhada do conteúdo a ser contemplado na modelagem de estratégias de educação em saúde para prevenção de quedas em pessoas idosas hospitalizadas possibilitou considerar aspectos da literatura científica e da realidade na qual a estratégia poderá ser desenvolvida.

DESCRITORES:
Segurança do paciente; Acidentes por quedas; Idoso; Hospitalização; Fatores de risco; Educação em saúde

RESUMEN

Objetivo:   determinar los contenidos a incluir en el proceso de modelado de estrategias educativas para la prevención de caídas en adultos mayores hospitalizados.

Método:  estudio metodológico, desarrollado en tres etapas: 1) revisión integradora sobre elementos clave que desencadenan caídas en ancianos hospitalizados; 2) grupos focales con enfermeras, ancianos hospitalizados y acompañantes; 3) determinación del contenido a abordar en la prevención de caídas en ancianos hospitalizados mediante la combinación de los elementos clave identificados en etapas anteriores, representados en un mapa conceptual.

Resultados:  Se incluyeron 14 publicaciones y los participantes en las sesiones de grupo focal fueron 15 enfermeras, nueve personas mayores y 11 acompañantes. Las publicaciones identificaron 24 elementos clave que desencadenan caídas y las sesiones de grupos focales identificaron un total de 27 elementos clave. Los resultados se combinaron en un mapa conceptual con categorías temáticas relacionadas con las limitaciones de los pacientes y las características del entorno, cada una con subcategorías.

Conclusión:  la construcción compartida de los contenidos a considerar en el modelado de estrategias de educación en salud para la prevención de caídas en ancianos hospitalizados posibilitó considerar aspectos de la literatura científica y de la realidad en que la estrategia podría ser desarrollada.

DESCRIPTORES:
Seguridad del paciente; Accidentes por caídas; Anciano; Hospitalización; Factores de riesgo; Educación para la salud

INTRODUCTION

Older adults present physiological and functional changes related to the aging process which favor the occurrence of adverse events, such as falls. Falls represent the second leading cause of death by unintentional injury in the world, and are related to the higher frequency of fatal outcomes in older adults^1-3.

The contexts in which falls can be triggered are diverse, ranging from domestic environments to unfamiliar ones, such as public roads and institutions. Thus, each type of environment presents specific elements which favor their occurrence^2-3.

There are peculiarities in hospitals due to environmental and situational aspects, represented by an unfamiliar environment associated with complaints or discomfort caused by illnesses, therapeutic procedures and diagnoses². Older adults are more vulnerable to adverse events and remain hospitalized for longer when compared to people in other age groups. Actions to identify the risk of falls and prevent their occurrence should be emphasized⁴.

Fall prevention in hospitalized older adults can be aided by implementing educational strategies aimed at staff, hospitalized individuals and family members on universal precautions, in addition to additional care for individuals classified as high risk. Such measures do not require purchasing specialized equipment or significant changes in hospital infrastructure, and are therefore low-cost for the institution^2-3,5.

Accordingly, health education for fall prevention is a measure to be adopted upon admission and during the hospital stay. In this sense, guidance on the risk of the event occurring, associated damages and preventive measures is suggested⁵. However, the need to detail the process of constructing and evaluating health education strategies is emphasized, aiming to identify possibilities for implementation and considering the particularities inherent to the scenarios and target audience^6-7.

In this context, the focus group technique is an ally in defining the content to be addressed due to the possibility of understanding the perceptions and attitudes of participants in relation to the object of study based on group debate^8-9.

Thus, the objective of this study was to determine the content to be contemplated in the process of modeling educational strategies for preventing falls in hospitalized older adults.

METHOD

This is a methodological study conducted in three stages: 1) an integrative literature review, with the objective of identifying key elements for falls, supported by national and international publications on the topic under study; 2) a descriptive qualitative study, performed through focus groups with nurses, hospitalized older adults and companions, which sought to investigate experiences involving falls in hospitalized older adults, as well as identify the elements that trigger these falls; 3) preparation of a conceptual map with the content to be addressed in the educational strategy based on the consolidation of the results of the previous stages. The conceptual map referred to in stage 3 will be validated by expert judges in the next stage of the study, scheduled for execution in the second half of 2025.

The guiding question of the integrative literature review was the following: what are the key elements that trigger falls in hospitalized older adults? Data collection was performed through an online search in the following primary databases of scientific productions: Cummulative Index to Nursing and Alied Health Literature (CINAHL); Scopus Elsevier (Scopus); Medical Literature Analysis and Retrieval System Online (MEDLINE); e Web of Science. Medical Subject Headings (MeSH) were combined with boolean operators to represent the following search key: (“accidental falls” OR “falls” OR “falling”) AND ("risk factors") AND (“hospitalization” OR “inpatient”) AND (“aged” OR “elderly”). The search was conducted in January 2025.

The results were exported to EndNote to detect duplications and then to Rayyan to proceed to the study selection and evaluation stages by two independent reviewers. Publications in academic journals from 2020 to 2024 were included. Studies in pediatric and psychiatric units, reviews, book chapters, theses, dissertations, editorials, and letters to the editor were excluded. The publications included had their information recorded in an electronic spreadsheet containing the following items: title; main author; language; year of publication; journal; objective; study design; level of evidence; results; and conclusion.

The focus group sessions on fall prevention in hospitalized individuals were held at a teaching hospital located in the Northeast of Brazil from June to November 2019, with participants consisting of nurses, hospitalized older adults, and caregivers. The guiding questions were: what are the experiences involving falls in hospitalized older adults? What are the factors that trigger falls in hospitalized older adults?

The nurses invited were those who worked in the Patient Safety Unit and Medical-Surgical Inpatient Units of a university hospital located in the Northeast of Brazil. Nurses who had worked for less than a year in the aforementioned sectors and those who were away from work during the data collection period were excluded. Older adults who had spent at least 24 hours in the medical clinic of the same institution were invited. Those confined to bed, with hemodynamic instability, with contact or respiratory precautions, or reverse isolation were excluded. Companions who were with people aged 60 or over in the medical clinic and who had remained in the hospital for at least 24 consecutive hours were invited. Those who accompanied highly dependent patients and who could not leave the ward during the collection period were excluded. A total of 15 nurses participated and the sessions were held in June and August 2019. The sessions with nine older adults and 11 companions were held in October and November of the same year. A focus group session was held with each group of participants.

The focus group technique was conducted according to composition, tools and operationalization criteria. Thus, the data collection team was composed of a moderator and two observers, and each meeting followed pre-defined steps such as: opening the session; presenting the participants/warm-up dynamics; clarification about the dynamics of participatory discussion; establishing rules; debate; summary; and closing the session^10-11.

The identification of key elements which trigger falls in hospitalized older adults in the focus group sessions occurred through submitting documents with transcriptions of the audio recordings of the discussions in the focus group sessions to the semi-automatic tool for building ontology in Portuguese (PorOnto). All transcripts of the focus group sessions were manually reviewed by two independent researchers, thus ensuring fidelity of the content. Data triangulation was used, comparing the results of the transcriptions with notes made by the observers during the meetings. In addition, the preliminary findings were validated through team discussion, with a collective review of the categories identified in the PorOnto software. This collaborative approach sought to minimize possible interpretative biases, ensuring greater validity and reliability of the inferences made.

The study followed the ethical and legal precepts required by Resolution No. 466/12, and was submitted to and approved by the Research Ethics Committee.

RESULTS

The initial search of the databases resulted in identifying 2,083 publications. Of these, 639 were excluded due to duplication; then, 1,363 were excluded after reading the titles and abstracts; finally, 14 remained after reading the full text. Chart 1 presents the key elements identified in the results of the included studies.

Chart 1 -
Distribution of key elements triggering falls in hospitalized older adults according to the results of the publications included in the integrative literature review. João Pessoa, PB, Brazil, 2025.

Key elements which trigger falls	Publication identification
Medication effects*	Noh HM et al.12; Rose G et al.13; Torii H et al.14; Zhang XM et al.15; Bernet NS et al.16; Silva MN et al.17; Nguyen LT et al.18
Physical limitations*	Noh HM et al.12; Rose G et al.14; Nguyen LT et al.18; Lee FS et al.19
Previous fall*	Noh HM et al.12; Zhang XM et al.15; Bernet NS et al.16; Lee FS et al.19; Wu L, Zhou L20; Silva YFAG et al.21
Comorbidities*	Noh HM et al.12; Rose G et al.13; Silva MN et al.17; Nguyen LT et al.18; Lee FS et al.19
Help with daily activities*	Rose G et al.13; Bernet NS et al.16; Nguyen LT et al.18
Advanced age*	Bernet NS et al.16; Haor B et al.22
Cognitive changes*	Zhang XM et al.15; Silva MN et al.17
Mental state changes*	Noh HM et al.12; Bernet NS et al.16; Silva YFAG et al.21
Sensory changes*	Silva MN et al.17; Wu L, Zhou L20
Body-attached medical devices†	Nguyen LT et al.18
Postoperative†	Bernet NS et al.16; Silva YFAG et al.21
Use of mobility devices†	Rose G et al.13; Nguyen LT et al.18; Lee FS et al.19
Emotional changes*	Zhang XM et al.15; Bernet NS et al.16
Balance changes*	Wu L, Zhou L20
Unfamiliar environment†	Silva YFAG et al.21
Altered urinary elimination*	Nguyen LT et al.18
Lack of caregiver†	Haor B et al.22
Low education level*	Silva MN et al.17
Malnutrition*	Ishida Y et al.23
Hydroelectrolytic disorders*	Hyohdoh Y et al.24
Fear of falling*	Dadgari A et al25
Slippery floor†	Silva YFAG et al.21
Low bed rails†	Silva YFAG et al.21
Lack of safety bars†	Lee FS et al.19

• Note: * key elements triggering falls related to characteristics of the hospitalized person; †key elements triggering falls related to environmental and situational characteristics.

A total of 24 key triggers for falls were identified, with the effects of medications, physical limitations, previous falls, and comorbidities being cited by four or more studies. Help with daily activities, advanced age, cognitive dysfunction, and altered mental state were cited by three studies. The remaining key elements were present in the results of two or one study.

It is noteworthy that 16 (66 %) of the key elements identified in the studies were related to characteristics of the hospitalized person, represented by: comorbidities; physical limitations; previous falls; help with daily activities; effects of medications; advanced age; cognitive; mental; sensory changes; emotional and balance changes; low education level; malnutrition; hydroelectrolytic disorders; altered urinary elimination; and fear of falling.

The remaining key elements were related to environmental and situational characteristics, represented by: postoperative period; use of medical devices connected to the body and for mobility; unfamiliar environment; absence of caregiver; slippery floor; low bed rails; and absence of safety bars.

Three focus group sessions were held with three different audiences: one with nurses; one with hospitalized older adults; and another with companions of hospitalized older adults. A total of 15 professionals participated in the session with nurses; of these, three worked in the Patient Safety Unit and 12 in the Medical-Surgical Inpatient Units. Regarding the participants’ characteristics, 14 (93.3 %) were female, their age ranged from 28 to 56 years, with an average of 39 years, with prevalence in the age groups of 30 to 39 years (40 %) and 40 to 49 years (33.3 %). The time since completing their undergraduate nursing course ranged from at least six years to 33 years, with an average of 16 years and a higher prevalence among those with more than 10 years of training (86.7 %, or 13 participants). The highest academic qualification was in specialization courses, with eight (53.3 %) participants, followed by master’s degrees, with six (40 %) participants.

Furthermore, nine participants were present in the focus group session with hospitalized older adults. These participants were similar in gender composition, with five (55.6 %) males and four (44.4 %) females, an average age of 68.8 years, ranging from 60 to 84 years and a higher prevalence in the age groups of 60 to 69 years and 70 to 79 years, with four (44.4 %) participants. A higher prevalence of one to four years of formal study was observed regarding education level, with seven (77.7 %) participants, and a monthly income of one to three minimum wages, reported by six (66.7 %) participants.

In addition, 11 participants were present for the focus group session with companions of hospitalized older adults. They were of both sexes, six (54.5%) were male and five (45.5 %) were female, with a higher prevalence in the 40-49 age group, with five (45.5 %) participants. Regarding their education, individual monthly income and relationship with the patient, six (54.5 %) participants had one to four years of education, income of one to three minimum monthly salaries, and they were family members of the patients.

Next, submitting the audio recordings of the focus group sessions to the PorOnto tool enabled identifying terms linked to key elements which trigger falls in hospitalized older adults. These were divided into categories and subcategories of elements that trigger falls. The categories identified referred to key elements that trigger falls related to the individual and the environment, each with their respective subcategories.

Table 1 presents the subcategories of key elements that trigger falls distributed according to the data origin and appearance frequency (f).

Table 1 -
Distribution of key elements triggering falls in hospitalized older adults according to data collection category and appearance frequency in PorOnto (f). João Pessoa, PB, Brazil, 2025.

Key elements that trigger falls	FGN* (f)	FGHOA† (f)	FGC‡ (f)	Total (f)
Inadequate bathroom§	60	27	34	121
Advanced age§	38	11	8	57
Medical-hospital devices connected to the patient	41	-	15	56
Use of mobility devices§	26	14	16	56
Effects of medications§	40	6	6	52
Low bed rails§	19	18	5	42
Small nursing ward space§	12	7	20	41
Altered mental state	36	-	2	38
Lack of caregiver	31	6	-	37
Slippery floor§	9	5	19	33
Chronic diseases	14	17	-	31
Difficulty walking	15	-	13	28
Changes in vital signs	25	3	-	28
Obstructed walking paths	12	-	09	21
Inadequate footwear and clothing	15	04	-	19
History of falls§	05	07	07	19
Inadequate lighting	13	-	06	19
Preparation for exams and preoperative care§	10	06	03	19
Impaired balance	05	09	-	14
Postoperative care	09	-	-	09
Pain	05	-	02	07
Dressing/bandaging on limbs	06	-	-	06
Altered emotional state	-	-	05	05
Risk denial	-	-	05	05
Decreased hearing acuity	04	-	-	04
Altered urinary elimination	-	-	03	03
Hydroelectrolytic disorders	02	-	-	02

• Note: * FGN: focus group with nurses; †FGHOA: focus group with hospitalized older adults; ‡FGC: focus group with companions; §key elements triggering falls identified in FGN, FGHOA and FGC.

A total of 27 key elements which trigger falls were identified in the focus group sessions. Of these, the following key elements were mentioned by the three groups of participants: inadequate bathroom; advanced age; use of mobility devices; side effects of medications; low bed rails; ward with limited space; and slippery floor.

There was variation in the key element identification among the groups of participants, with 24 identified by the group of nurses. The key elements not mentioned were risk denial, altered emotional state, and altered urinary elimination. Then, 14 key elements were identified in the group of hospitalized older adults, and 18 key elements in the group of companions.

The combination of the elements identified in the integrative literature review and focus group sessions determined the content to compose the modeling of health education strategies for fall prevention. In turn, raising awareness among hospitalized older adults about the risks of falls should consider key elements which trigger falls distributed into two thematic categories: patient limitations and environmental characteristics.

The limitations of the older adults were divided into three subcategories of key elements: physiological; cognitive; and behavioral. The thematic category entitled “Environmental characteristics” presented subcategories referring to infrastructure, equipment configuration, and hospital routine. Figure 1 corresponds to a conceptual map that represents the modeling of health education strategies for fall prevention content with its categories and subcategories of key elements which trigger falls in hospitalized older adults. The key elements are categorized in order to identify the source: integrative literature review; focus group sessions; or both.

Figure 1 -
Conceptual map of the content to be addressed in health education strategies for preventing falls in hospitalized older adults. João Pessoa, Paraíba, PB, Brazil, 2025

DISCUSSION

The specific content in the process of modeling health education strategies is relevant to meet the needs of the target population in developing targeted and effective strategies. In addition, it can contribute to meeting the cultural and social particularities of individuals, promoting greater engagement and understanding of information^6-7.

Planning health education strategies should consider the information related to the specific content to be addressed associated with the particularities of the target audience: older adults²⁶. In this sense, participation of the target audience in identifying the specific content can favor implementing this strategy by reflecting the peculiarities in a way that is close to reality.

Thus, the interactive discussions and exchange of meanings provided by the focus group sessions presented positive results in generating data for the research. The discussion topics with the appropriate depth, justifications and questions allow the participants to evaluate the different points of view in order to generate consensus or ways of dealing with disagreement^9-11. The teaching-learning process to promote fall prevention must provide older adults with the perspective of acquiring new experiences and recognizing those already existing, aiming at adherence to preventive behaviors².

Given that the conceptual map presented the central theme “Raising awareness of hospitalized older adults about the risk of falls”, it is understood that the purpose will be directed towards older adults using the information to recognize the causes of the problem or seek possibilities to minimize it while understanding the particularities.

It is worth noting that there are elements related to the risk of falls inherent to the characteristics of the hospitalized person, as well as their health condition, which, associated with environmental elements, will be present in the hospital context. Therefore, raising awareness of the person at risk of falls is a relevant strategy.

The physiological changes related to the aging process were considered. As age progresses, the risk of falls identified through scales also increases^1,16,22. There is a greater incidence of chronic-degenerative diseases, limited mobility, decreased balance and sensory perception¹³.

Cognitive and behavioral aspects are relevant due to limitations in understanding the preventive guidelines provided, denial of risk of falls, and fear of falling. Cognitive changes are related to a risk of repetitive falls, so hospitalized individuals should be monitored for changes such as mental confusion and delirium in order to investigate drug reactions^15,17. In addition, both exposure to risk situations due to failure to recognize one’s own limitations and excessive hesitation in performing certain tasks due to fear²⁵ are behaviors which should be considered in preventive activities.

Furthermore, aspects of the physical structure and maintenance of hospital equipment, such as adequate lighting, characteristics of the ward, safety bars in bathrooms and corridors, and the presence of well-maintained walking / mobility devices should be considered in the educational approach because they influence the occurrence of falls²⁷.

In this sense, it is understood that physiological, environmental, and behavioral elements act synergistically, favoring the occurrence of falls. It is important to note that in addition to the hospitalization process consisting of a change of environment in which the older adult will be inserted, it also presents particularities regarding treatment and the execution of self-care activities. Such particularities cause greater impact on the older person in relation to people of other age groups due to their limitation in the adaptation process related to mobility and orientation^17,20.

Therefore, raising awareness about the presence of these elements that trigger falls is a valid strategy to issue warning signs so that older adults can help prevent this incident. This perspective converges towards building a critical awareness of the key elements which are already known about hospitalized older adults, but that must be perceived in order to implement preventive behaviors.

The process of recognizing the risk elements for falls by nurses, hospitalized older adults and their caregivers promotes recognizing key elements related to the reality in which they intend to act. In turn, the scientific knowledge identified in the integrative literature review was confirmed and enriched by the focus group participants with the purpose of bringing the content closer to the daily lives of the people involved.

The search in the scientific literature and the focus group sessions were relevant because they included the various sources of information related to the topic. The relationship of scope and complementarity between the data collection methods was explained in the conceptual map. Identification of the triggers for falls by all those involved in the care in this study, including the hospitalized older adult, has the potential to contribute to preventing this event. This approach allows emphasis on the characteristics of the aging process and the environment based on the reality in which the educational strategy will be applied.

The possibilities for educational approaches based on the identified content are varied. The association between health knowledge and technological means is an alternative considered due to the playful and attractive characteristics provided by the graphic resources used in developing strategies which use this association. In this context, health education strategies aimed at and designed for older adults are called gerontechnologies. These present positive results regarding knowledge acquisition, awareness regarding certain behaviors and self-care practices²⁷.

Gerontechnologies can enable reflection on health topics based on the reality in which the person is inserted in association with an appropriate design for the older adult. Thus, they have the potential to contribute to greater autonomy and empowerment, in addition to preventing events that interfere with health and quality of life, such as falls^26,28.

The limitations of this study are related to the results, which reflect the local reality and are not subject to generalizations, and are related to the use of the focus group technique, which seeks to understand the particularities of the participants who have experience in a given reality.

CONCLUSION

The content to be addressed in modeling health education strategies for preventing falls in hospitalized older adults will provide compatibility with the needs of the target audience, respecting their specificities. The identified key elements which trigger falls were divided into thematic categories: patient limitations and characteristics of the environment. Each category presented developments in subcategories of key elements that aimed to specify the risk to be addressed in the future educational strategy. It is noteworthy that the conceptual map presented in this study offered possibilities which go beyond identifying the content of health education strategies for preventing falls in hospitalized older adults. Finally, given that it allows an objective visualization of the key elements, it can be used for management, care and teaching purposes.

REFERENCES

• 1. Falcão RMM, Costa KNFM, Fernandes MGM, Pontes MLF, Vasconcelos JMB, Oliveira JS. Risk of falls in hospitalized elderly people. Rev Gaúcha Enferm [Internet]. 2019 [cited 2023 Jun 25];40(Spec):e20180266. Available from: https://doi.org/10.1590/1983-1447.2019.20180266
  » https://doi.org/10.1590/1983-1447.2019.20180266
• 2. World Health Organization (WHO). Step safely: Strategies for preventing and managing falls across the life-course [Internet]. 2021 [cited Jul 14 2022]. Available from: https://www.who.int/publications/i/item/978924002191-4
  » https://www.who.int/publications/i/item/978924002191-4
• 3. World Health Organization (WHO). Falls: fact sheet: WHO Media Center [Internet]. 2021. [cited 2022 Nov 14]. Available from: https://www.who.int/en/news-room/fact-sheets/detail/falls
  » https://www.who.int/en/news-room/fact-sheets/detail/falls
• 4. Schattner A. The spectrum of hospitalization-associated harm in the elderly. Eur J Intern Med [Internet]. 2023 [cited 2025 Jan 20];115:29-33. Available from: https://doi.org/10.1016/j.ejim.2023.05.025
  » https://doi.org/10.1016/j.ejim.2023.05.025
• 5. Albertini ACS, Fernandes RP, Püschel VAA, Maia FOM. Person-centered care approach to prevention and management of falls among adults and aged in a Brazilian hospital: A best practice implementation project. JBI Evid Implement [Internet]. 2023 [cited 2025 Jan 20];21(1):14-24. Available from: https://doi.org/10.1097/XEB.0000000000000356
  » https://doi.org/10.1097/XEB.0000000000000356
• 6. Sá GGM, Silva FL, Santos AMR, Nolêto JS, Gouveia MTO, Nogueira LT. Tecnologias desenvolvidas para a educação em saúde de idosos na comunidade: revisão integrativa da literatura. Rev Latino-Am Enferm [Internet]. 2019 [cited 2024 Jun 22];27:e3186. Available from: https://doi.org/10.1590/1518-8345.3171.3186
  » https://doi.org/10.1590/1518-8345.3171.3186
• 7. Puebla C, Fievet T, García J, Tsopanidi M, Clahsen H. Promoting social and collaborative language learning among older adults in the digital era: Development and evaluation of a smartphone app prototype using a design-thinking approach. Gerontechnology [Internet]. 2022[cited 2025 Jan 20];21(1):1-12. Available from: https://doi.org/10.4017/gt.2022.21.1.483.06
  » https://doi.org/10.4017/gt.2022.21.1.483.06
• 8. Denny E, Weckesser A. How to do qualitative research? Qualitative research methods. BJOG: Int J Obstet Gynaecol [Internet]. 2022 [cited 2024 Jun 20];129:1166-7. Available from: https://doi.org/10.1111/1471-0528.17150
  » https://doi.org/10.1111/1471-0528.17150
• 9. Zacharia B, Pai PK, Paul M. Focus group discussion as a tool to assess patient-based outcomes, practical tips for conducting focus group discussion for medical students - learning with an example. J Patient Exp [Internet]. 2021 [cited 2024 Apr 10];8. Available from: https://doi.org/10.1177/23743735211034276
  » https://doi.org/10.1177/23743735211034276
• 10. Hall JN, Mitchel N, Halpin S, Kilanko GA. Using focus groups for empowerment purposes in qualitative health research and evaluation. Int J Soc Res Methodol [Internet]. 2023 [cited Jan 18 2025];26(4):409-23. Available from: https://doi.org/10.1080/13645579.2022.2049518
  » https://doi.org/10.1080/13645579.2022.2049518
• 11. Manzano A. Conducting focus groups in realist evaluation. Evaluation [Internet]. 2022 [cited 2025 Jan 25];28(4):406-25. Available from: https://doi.org/10.1177/13563890221124637
  » https://doi.org/10.1177/13563890221124637
• 12. Noh HM, Song HJ, Park YS, Han J, Roh YK. Fall predictors beyond fall risk assessment tool items for acute hospitalized older adults: A matched case - control study. Sci Rep [Internet]. 2021 [cited 2023 Jun 11];11:1503. Available from: https://doi.org/10.1038/s41598-021-81034-9
  » https://doi.org/10.1038/s41598-021-81034-9
• 13. Rose G, Decalf V, Everaert K, Bower WF. Toileting‐related falls at night in hospitalised patients: The role of nocturia. Australas J Ageing [Internet]. 2020 [cited 2024 Jul 12];39(1):e70-6. Available from: https://doi.org/10.1111/ajag.12696
  » https://doi.org/10.1111/ajag.12696
• 14. Torii H, Ando M, Tomita H, Kobaru T, Tanaka M, Fujimoto K, et al. Association of hypnotic drug use with fall incidents in hospitalized elderly patients: An case-crossover study. Biol Pharm Bull [Internet]. 2020 [cited 2023 Nov 15];43(6):925-31. Available from: https://doi.org/10.1248/bpb.b19-00684
  » https://doi.org/10.1248/bpb.b19-00684
• 15. Zhang X-M, Jiao J, Guo N, Bo H-X, Xu T, Wu X-J. Association of polypharmacy with falls among older Chinese inpatients: A Nationwide cohort study. Geriatr Gerontol Int [Internet]. 2021[cited 2025 Jan 15];21(9):810-817. Available from: https://doi.org/10.1111/ggi.14245
  » https://doi.org/10.1111/ggi.14245
• 16. Bernet NS, Everink IH, Schols JM, Halfens RJ, Richter D, Hahn S. Hospital performance comparison of inpatient fall rates; the impact of risk adjusting for patient-related factors: A multicentre cross-sectional survey. BMC Health Serv Res [Internet]. 2022 [cited 2025 Jan 15];22(1):225. Available from: https://doi.org/10.1186/s12913-022-07638-7
  » https://doi.org/10.1186/s12913-022-07638-7
• 17. Silva MN, Camargo YS, Silva TR, Silva AMB, Santos DF, Antunes DE. Prognostic factors of falls in hospitalized adults and elderly: An epidemiological and clinical analysis. Injury Int J Care Injured [Internet]. 2024 [cited 2025 Jan 23];55(12):111966. Available from: https://doi.org/10.1016/j.injury.2024.111966
  » https://doi.org/10.1016/j.injury.2024.111966
• 18. Nguyen LT, To KG, Tang TC, Pham TN, Thanh LBN, Thai TT. Risk factors and profiles of falls among inpatients in vietnam: A multicenter nested case-control study. Risk Manag Healthc Policy [Internet]. 2024 [cited 2025 Jan 23];17:2229-39. Available from: https://doi.org/10.2147/RMHP.S471895
  » https://doi.org/10.2147/RMHP.S471895
• 19. Lee FS, Sararaks S, Yau WK, Ang ZY, Jailani A-S, Karim ZA, et al. Fall determinants in hospitalised older patients: A nested case control design - Incidence, extrinsic and intrinsic risk in Malaysia. BMC Geriatr [Internet]. 2022 [cited 2025 Jan 23];22(1):179. Available from: https://doi.org/10.1186/s12877-022-02846-6
  » https://doi.org/10.1186/s12877-022-02846-6
• 20. Wu L, Zhou L. Clinical Intervention Effect of a Predictive Model Constructed Based on Risk Factors for Falls in Elderly Patients during Hospitalization. Comput Math Methods Med [Internet]. 2022 [cited 2025 Jan 23];2022:4983254. Available from: https://doi.org/10.1155/2022/4983254
  » https://doi.org/10.1155/2022/4983254
• 21. Silva YFAG, Diniz LPM, Teles MEV, Nascimento MF, Góis ARS. Nurses’ knowledge on fall prevention in the light of the nursing process. Rev Baiana Enferm [Internet]. 2022 [cited 2025 Jan 23];36:e43520. Available from: https://doi.org/10.18471/rbe.v36.43520
  » https://doi.org/10.18471/rbe.v36.43520
• 22. Haor B, Krychowiak A, Królikowska A. Balance and Gait Assessment and the Risk of Falls in Seniors During Hospitalization. J Neurol Neurosurg Psychiatry [Internet]. 2020 [cited 2023 Sep 30];9(4):127-31. Available from: https://doi.org/10.15225/PNN.2020.9.4.1
  » https://doi.org/10.15225/PNN.2020.9.4.1
• 23. Ishida Y, Maeda K, Nonogaki T, Shimizu A, Yamanaka Y, Matsuyama R, et al. Malnutrition at admission predicts in-hospital falls in hospitalized older adults. Nutrients [Internet]. 2020 [cited 2023 Jul 21];12(2):541. Available from: https://doi.org/10.3390/nu12020541
  » https://doi.org/10.3390/nu12020541
• 24. Hyohdoh Y, Hiyama M, Hatakeyama Y, Okuhara Y. Effect of mild hyponatremia on in-hospital falls of elderly hospitalized patients: A retrospective, cohort study. Arch Gerontol Geriatr [Internet]. 2024 [cited 2025 Jan 23];118:105315. Available from: https://doi.org/10.1016/j.archger.2023
  » https://doi.org/10.1016/j.archger.2023
• 25. Dadgari A, Hojati H, Mirrezaie SM. The relationship between the risk of falling and fear of falling among aged hospitalized patients. Nurs Pract Today [Internet]. 2020 [cited 2023 Oct 22];7(1):30-7. Available from: https://doi.org/doi.org/10.18502/npt.v7i1.2297
  » https://doi.org/doi.org/10.18502/npt.v7i1.2297
• 26. Tajudeen FP, Bahar N, Tan MP, Mustafa MBP, Saedon NI, Jesudass J. Understanding user requirements for a senior-friendly mobile health application. Geriatrics [Internet]. 2022 [cited 2025 Jan 26];7(5):110. Available from: https://doi.org/10.3390/geriatria7050110
  » https://doi.org/10.3390/geriatria7050110
• 27. Silva PQ, Viegas K. Avaliação da acessibilidade espacial em uma unidade hospitalar no sul do Brasil e implicações na saúde do idoso. Rev Ibero Americana Saúde Env Online [Internet]. 2023 [cited 2025 Jan 26];9(3):138-54. Available from: https://doi.org/10.60468/r.riase.2023.9(3).622.138-154
  » https://doi.org/10.60468/r.riase.2023.9(3).622.138-154
• 28. Oliveira FGL, Rodrigues VES, Neves IS, Brito MES, Pereira FGF, Machado ALG. Validation of the InterativaMENTE60+ game for cognitive stimulation of older adults. Rev Rene [Internet]. 2024 [cited 2025 Jan 26];25:e93398. Available from: https://doi.org/10.15253/2175-6783.20242593398
  » https://doi.org/10.15253/2175-6783.20242593398

NOTES

• ORIGIN OF THE ARTICLE
  Extracted from the dissertation - “Processo de design de serious game sobre prevenção de quedas em pessoas idosas hospitalizadas: definição de conteúdo”, presented to the Postgraduate Program in Nursing, Federal University of Paraíba, in 2020.
• APPROVAL OF ETHICS COMMITTEE IN RESEARCH
  Approved by the Ethics Committee in Research of the the Lauro Wanderley University Hospital/UFPB, opinions n.ͦ 2,958,750/2018 and n.ͦ 3,593,827/2019, Certificate of Presentation for Ethical Assessment 99957018.4.0000.5183.
• TRANSLATED BY
  Christopher J. Quinn
• DATA AVAILABILITY
  The entire dataset supporting the findings of this study is available upon request to the corresponding author [Rafaella Felix Serafim Veras]. The dataset is not publicly available because it is part of a master's thesis, some of which is still in the process of being published.

Edited by

• EDITORS
  Associated Editors: Sandra Maria Cezar Leal, Maria Lígia Bellaguarda
  Editor-in-chief: Elisiane Lorenzini.

Data availability

The entire dataset supporting the findings of this study is available upon request to the corresponding author [Rafaella Felix Serafim Veras]. The dataset is not publicly available because it is part of a master's thesis, some of which is still in the process of being published.

Publication Dates

• Publication in this collection
  17 Oct 2025
• Date of issue
  2025

History

• Received
  14 Nov 2024
• Accepted
  12 Mar 2025