Fall Risk Assessment and Prevention Strategies in Nursing Homes: A Narrative Review.

Abstract

Background/Objectives: Falls in nursing homes significantly affect residents' health and quality of life. Although considerable progress has been made in fall prevention strategies in acute care settings and community environments, research on fall risk assessment methods and prevention strategies in nursing homes remains scarce. Nursing homes provide long-term care for residents with high levels of dependency, presenting unique challenges in managing fall risks. Nevertheless, unlike hospitals, nursing homes face operational constraints, such as limited resources and staffing. These factors necessitate a tailored approach to fall risk management. This study aimed to summarize the current knowledge of fall risk assessment and prevention methods in nursing homes, clarify practical insights for implementation, and identify research gaps based on studies published over the past five years. Methods: This narrative review targeted studies published between 2019 and 2024 on fall risk assessment and prevention methods in nursing homes. A literature search was conducted using the PubMed and CINAHL databases, combining keywords such as "Accident Prevention", "Fall Risk Assessment", "Nursing Homes", "Long-Term Care", and "Aged". The inclusion criteria allowed the inclusion of peer-reviewed academic articles on fall risk assessment or prevention interventions in long-term care facilities published in English within the past five years. Studies focusing on community-dwelling older adults, hospitalized older adults, and review articles were excluded. Results: This review analyzed 55 studies; among them, 27 studies focused on fall risk assessment and 28 focused on fall prevention. Regarding fall risk assessment, widely used tools, such as the Morse Fall Scale, which is also utilized in medical settings, have been extensively examined. In addition, new predictive methods utilizing electronic health records (EHR) and wearable devices have been introduced. However, the limited number of reports highlights the potential challenges in developing indicators that consider the unique characteristics and feasibility of LTC facilities. Regarding fall prevention, studies have examined indirect approaches, such as environmental modifications, and direct interventions, such as exercise programs. Furthermore, staff education and organizational initiatives are crucial in implementing preventive measures. However, most studies have been conducted in experimental settings, with limited empirical research available to assess the practical applications of these strategies in real-world nursing home environments. Conclusions: Fall risk assessments in nursing homes lack practical indicators tailored to the specific characteristics of long-term care facilities. Although various digital technologies have been explored for fall prevention, empirical studies that validate their real-world applicability are lacking.