Fall risk management strategies in nursing homes for older adults

Abstract

<b>Background</b>: Population aging represents a growing public health challenge, with falls being one of the leading causes of morbidity, mortality, and loss of autonomy among older adults. In nursing homes, the risk is exacerbated by physical, cognitive, and environmental factors, yet which interventions are most actionable in nursing homes remains unclear, requiring effective and evidence-based prevention strategies. <b>Objective</b>: We aimed to map the evidence on interventions in fall risk management among institutionalized older adults, highlighting assessment, exercise, environmental, and educational strategies. <b>Methods</b>: A scoping review was conducted according to JBI guidelines. The search was carried out in MEDLINE, CINAHL, Scopus, Cochrane, and Web of Science. The review included studies, published between 2019 and 2024, involving older adults (≥65 years) in nursing homes, focusing on nursing interventions for fall risk management. <b>Results</b>: The initial search identified 1146 records across electronic databases and gray literature sources. After removing duplicates and screening titles, abstracts, and full texts, 18 studies met the inclusion criteria and were included in this scoping review. The inclusion criteria were as follows: (i) fall risk assessment, using functional and clinical scales such as the Timed Up and Go (TUG), Berg Balance Scale (BBS), Morse Fall Scale, to identify predisposing factors; (ii) exercise programs, such as the Otago Exercise Program and multicomponent training, which demonstrated benefits in strength, balance, and mobility; (iii) environmental modifications, aimed at reducing extrinsic risks and promoting safer surroundings; and (iv) educational programs, targeting professionals, residents, and families, with positive effects on adherence to preventive practices and on strengthening the safety culture. <b>Conclusions</b>: Effective fall risk management in nursing homes requires an integrated, multidisciplinary, and person-centered approach, with nurses playing a central role in assessment, coordination, and implementation of interventions. However, gaps remain regarding standardization, validation of assessment tools specific to the institutional context, and evaluation of long-term outcomes.