# Factors influencing the self-awareness of falls in hospitalized older adults: a Q method study

## TL;DR

This study explores what influences older hospitalized patients' awareness of fall risks and identifies three distinct types of patients based on their perspectives.

## Contribution

The study introduces a novel Q-method approach to understand subjective factors influencing fall self-awareness in hospitalized older adults.

## Key findings

- Three distinct types of patients were identified: Fall-Derivative, Family-Oriented, and Healthy-State.
- Positive factors for fall self-awareness include attention to prevention, self-care ability, and disease type.
- Negative factors include literacy levels and social influences.

## Abstract

Recognizing the risk of falls is crucial for fall prevention among hospitalized older adults. However, awareness of fall risk in this population is generally poor. There is also a lack of research exploring the factors influencing their fall risk awareness from the patients’ subjective perspective.

Hospitalized patients aged 60 years or older were recruited from a tertiary hospital in Tianjin, China. Participants completed a Q-sorting task in which they ranked 34 statements regarding factors potentially influencing fall awareness. Following the sorting activity, post-sorting interviews were conducted to explore the reasoning behind their rankings and to further assess the factors shaping fall self-awareness. Principal component factor extraction was employed to analyze differences in statement rankings across participants. Additionally, descriptive analysis of the qualitative interview data was performed to elucidate the underlying reasons for these observed differences.

The analysis of the ranked results of 15 patients (mean age 68.5 ± 7.8 years; 73.3% male) revealed three statistically independent factors, representing distinct types of influences on fall self-awareness among hospitalized older adults: (1) Fall-Derivative Type (n = 7), (2) Family-Oriented Type (n = 2) and (3) Healthy State Type (n = 6). Positive influencing factors included the level of attention to fall prevention, self-care ability, and the type and number of diseases. In contrast, negative factors were associated with literacy levels and social.

Falls self-awareness in older inpatients is influenced by multiple factors and varies significantly based on individual cognition. Patients can be categorized into three types: Fall-Derivative, Family-Oriented, and Healthy-State. To enhance falls self-awareness and reduce fall rates, healthcare professionals should tailor their health education by first identifying the patient’s specific type and then providing personalized guidance accordingly.