Disparity between perceived and physiological risks of falling among older patients in an acute care hospital

Background: Falls are the most frequent adverse events among hospitalised older adults. Previous studies highlighted that older adults might not understand the risk factors associated with falls and may have an altered perception of their actual risk. Aim: To describe differences between perceived and actual physiological risk of falling among older adults and to explore factors associated with the differences. Methods: : A prospective cohort study was done. Older adults (age 65 years and above) were interviewed one-toone at bedside. Morse Fall Scale (MFS) and other risk factors for falls were used to identify the patients’ physiological fall risks. Patients’ perceived risk of falls were assessed using the Falls Efficacy Scale-International (FES-I). Results: Three hundred patients were recruited. Patients’ mean age was 75.3 (SD = ± 6.2). Majority were males (51.7%), lived with others (91.7%), and had received primary school education (35.3%). Based on the MFS, most patients had moderate fall risk (59.7%). Using the FES-I, more than half the patients (59%) interviewed had high concerns about falling. About one-third of the patients’ (31.3%) perceived risk matched with their physiological fall risk (Risk-Aware). Half of the patients’ perceived risks was higher than their physiological fall risk (50.7%) (Risk-Anxious), while the remaining patients’ perceived risks was reported to be lower than their physiological fall risk (18%) (Risk-Taker). Conclusion: Older patients are poor at recognizing their fall risks. Both patients’ perceived and actual fall risks should be evaluated in the inpatient setting in order to inform individualized fall prevention education and strategies.