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A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Public Health and Preventive Medicine".

Deadline for manuscript submissions: 31 December 2025 | Viewed by 32800

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Dr. Cristina Lavareda Baixinho

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Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Community Nurse Department, Nursing School of Lisbon, 1900-160 Lisbon, Portugal
Interests: falls; transitional care; knowledge transfer; home security; musculoskeletal disorders
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Prof. Dr. Andreia Costa

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Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Community Nurse Department, Nursing School of Lisbon, 1900-160 Lisbon, Portugal
Interests: social prescribing; health literacy; healthy aging; complex interventions; falls
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Prof. Dr. Maria Adriana Henriques

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Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Community Nurse Department, Nursing School of Lisbon, 1900-160 Lisbon, Portugal
Interests: healthy aging; complex interventions; falls; community health interventions; public health interventions; fundamental care; chronic disease
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Falls are globally recognized as a public health problem for older persons due to the harmful consequences they have on functionality and quality of life, as well as increased resource consumption and healthcare costs.

A society with an increase in older people, many of them with various frailty factors, needs to rethink social, health and urban policies to enable healthy ageing. Fall prevention is above all an individual responsibility, but the low health literacy of this population, the emphasis of some health systems on secondary rather than primary prevention, the multidimensionality of risk and the complexity of some interventions make it difficult to reduce the prevalence, risk and fear of falling.

In this Special Issue, dedicated to Fall Prevention and Geriatric Nursing, we challenge nurses and other professionals to disseminate studies, systematic reviews and experience reports focused on new interventions for fall prevention in different contexts and the education and training of health professionals and caregivers to implement preventive measures and strategies to mitigate the fear of falling.

Dr. Cristina Lavareda Baixinho
Prof. Dr. Andreia Costa
Prof. Dr. Maria Adriana Henriques
Guest Editors

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Keywords

accidental falls
aged
nursing
risk
health literacy
healthy ageing
complex interventions
health interventions
fundamental care
patient safety

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Published Papers (7 papers)

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Research

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14 pages, 268 KB

Open AccessArticle

Perceptions of Fall Prevention and Engagement in Social Prescribing Activities Among Older Adults: A Cross-Sectional Study in Portugal

by Cristiano Matos, Cristina Rosa Baixinho, Violeta Alarcão, Maria Adriana Henriques, Ricardo Oliveira Ferreira, Tiago Nascimento, Miguel Arriaga, Tatiana Alves, Paulo Nogueira and Andreia Costa

Healthcare 2025, 13(24), 3209; https://doi.org/10.3390/healthcare13243209 - 8 Dec 2025

Viewed by 208

Abstract

Background: Falls are a major cause of injury, functional decline, and reduced quality of life among older adults, posing a significant public health challenge. Social prescribing is gaining relevance in gerontology, offering structured strategies to engage individuals in preventive activities, including fall prevention strategies, through engagement in community-based activities. Aim: To examine older adults’ perception of the relevance of personal protection and development activities (e.g., prevention against falling) and compare sociodemographic, behavioural, and engagement profiles between those who agree and those who disagree with its relevance. Methods: A cross-sectional study was conducted with 613 older adults aged 65–93 years. Data collection included sociodemographic, health-related, and behavioural/social engagement variables (including perceptions regarding the benefits of social prescribing and interest in community-based activities). For this analysis, participants were dichotomized based on their agreement with the relevance of personal protection and development activities (e.g., prevention against falling). Of the 569 participants included, 538 (94.5%) agreed with its relevance and 31 (5.5%) disagreed. Descriptive and exploratory analyses were conducted to compare the two groups across variables. Multivariate logistic regression analyses were conducted to explore independent predictors of agreement across sociodemographic, behavioural, social prescribing, and health-related variables. Results: Significant differences were observed between the groups in awareness of active ageing (p = 0.018), volunteering (p < 0.001), participation in social and community activities (p < 0.001), and hobbies like gardening, fishing, or cooking (p = 0.002). Those who agreed with the importance of personal protection and development activities were significantly more likely to value a range of initiatives, including social activities in recreational organizations, physical activity in the community (e.g., hiking), artistic and creative activities (e.g., visual arts, music), technical or technological activities (e.g., do-it-yourself, computers), and cultural enrichment activities (e.g., visiting museums), (p < 0.001). Multivariate analyses showed no effects of sociodemographic or health-related factors, whereas behavioural and engagement-related variables—including volunteering, hobbies, and several social prescribing activities—significantly predicted agreement with the relevance of personal protection and development activities. Discussion: The findings suggest that older adults who perceive fall prevention as relevant are more actively engaged in diverse health-promoting activities, including volunteering, hobbies, and community-based programmes. This pattern may reflect higher health literacy, stronger social networks, and proactive attitudes towards ageing. Conclusions: Perceptions of fall prevention are closely linked to broader patterns of engagement in health-promoting activities among older adults. Recognizing and addressing differences in how these activities are valued can inform more inclusive and targeted gerontological interventions. Full article

(This article belongs to the Special Issue Fall Prevention and Geriatric Nursing)

9 pages, 414 KB

Open AccessArticle

Epidemiology of Falls Among Older Adults in Portugal: Analysis of Unintentional Injuries Reported by a National Emergency Surveillance System

by Tatiana Alves, Susana Silva, Paula Braz, Maria Papadakaki, Carlos Aniceto, Ricardo Mexia and Carlos Matias-Dias

Healthcare 2025, 13(10), 1160; https://doi.org/10.3390/healthcare13101160 - 16 May 2025

Cited by 1 | Viewed by 1299

Abstract

Background/Objectives: Falls occurring at home and during leisure time among elderly individuals represent a serious public health issue in Portugal and worldwide. These incidents have a significant impact on healthcare systems and social support structures, as well as the personal and family lives of the victims. There is also a recognized gap in awareness among older adults regarding fall prevention, particularly regarding environmental hazards, the need for home modifications, and the adoption of safety behaviors, including necessary adjustments in their home environments. The present study was developed to enhance our understanding of the circumstances in which falling occurs in elderly people. Methods: A cross-sectional epidemiological study was carried out, analyzing data collected through the national emergency-based injury surveillance system in 2023. Results: The proportion of falls increased across age groups, with 34.9% of total falls occurring in the group aged 85 and over. These differences were statistically significant (p < 0.001). In all age groups, falls were more frequent among women, representing between 63.6% and 69.0% of episodes. Approximately 65.9% of falls occurred at home. The likelihood of falling was higher among the oldest age group (85+) and in the home. Conclusions: The results of this study confirm that falls in elderly people tend to occur more frequently with advancing age, particularly in environments where the most time is spent. This study suggests that fall-prevention campaigns should be specifically targeted towards older females in the home environment, with particular consideration given to morning routines as part of the recommended interventions. Full article

(This article belongs to the Special Issue Fall Prevention and Geriatric Nursing)

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11 pages, 263 KB

Open AccessArticle

One-Year Changes in Depressive Symptoms and Cognitive Function Among Brazilian Older Adults Attending Primary Care

by Fernanda Maria Silva Rivoli, Antonio Pedro Gabriel Monteiro Galhardo, Giancarlo Lucchetti, Lízia Abreu Esper, Yan Lyncon Ribeiro, Gerson de Souza Santos, Helena José, Luís Sousa, Gail Low and Luciano Magalhães Vitorino

Healthcare 2025, 13(7), 807; https://doi.org/10.3390/healthcare13070807 - 3 Apr 2025

Cited by 1 | Viewed by 1392

Abstract

Background: Aging is a global phenomenon closely associated with changes in cognitive function and mental health. These conditions substantially burden public health systems and adversely affect the quality of life of older adults. This study aimed to examine changes in depressive symptoms and cognitive function over a 12-month follow-up period in a cohort of Brazilian older adults attending primary care. Methods: This observational longitudinal study included a randomized sample of individuals aged ≥60 years residing in São Paulo, Brazil, and registered at a Primary Healthcare Unit (PHU). Data collection involved administering a sociodemographic and health questionnaire along with two validated instruments: the Geriatric Depression Scale-15 (GDS-15) and the Mini-Mental State Examination (MMSE). Linear regression models were used for the analyses. Results: A total of 368 older adults were included, with 63% being men and a mean age of 74.65 years. After one year, depressive symptoms showed a notable increase, with the mean GDS-15 score rising from 5.97 to 7.48 (Cohen-d = 0.542). Likewise, there was a decrease in the mean MMSE score ranging from 19.11 to 18.88 (Cohen-d = 0.216). Adjusted regression analyses revealed that depressive symptoms at baseline (B = 0.696; p = 0.048; R² = 0.19) and cognitive function at baseline (B = 0.444; p < 0.001; R² = 0.26) were predictive of their respective deteriorations over the follow-up period. Conclusions: Depressive symptoms and cognitive decline place a significant burden on public health systems in aging societies. These findings underscore the importance of continuous monitoring and early intervention strategies to mitigate their impact and enhance the quality of life for older adults. Full article

(This article belongs to the Special Issue Fall Prevention and Geriatric Nursing)

12 pages, 274 KB

Open AccessArticle

Association between Falls, Fear of Falling and Depressive Symptoms in Community-Dwelling Older Adults

by Maria Eduarda Armando Pereira, Gerson de Souza Santos, Clara Rabite de Almeida, Kethlyn Cristina Santos Nunes, Monalisa Claudia Maria da Silva, Helena José, Luís Sousa and Luciano Magalhães Vitorino

Healthcare 2024, 12(16), 1638; https://doi.org/10.3390/healthcare12161638 - 16 Aug 2024

Cited by 9 | Viewed by 5393

Abstract

Background: Longevity increases pose public health challenges, especially in managing falls and their psychological impacts on older adults. Limited evidence exists on the relationship between a fear of falling (FOF), previous falls, and depressive symptoms among community-dwelling older adults. Objective: To evaluate the association between falls, FOF, and depressive symptoms in community-dwelling older adults. Methods: This cross-sectional study, conducted in 2018, included 400 older adults from a Basic Health Unit in São Paulo, Brazil. The Geriatric Depression Scale (GDS-15) and the International Falls Efficacy Scale (FES-I) were used, along with self-report questionnaires on fall history. Linear and logistic regression were used to analyze the relationships between variables. Results: The mean age was 75.2 (SD = 8.53) years, with 63.2% being female. Depressive symptoms were observed in 18.3% of the participants, while 90.5% reported a fear of falling (FOF). More than half (63.0%) experienced falls, with 49.5% occurring in the last year. Factors such as the female gender, negative health perceptions, and functional dependence were associated with depressive symptoms. Adjusted analyses indicated that both a fear of falling (FOF) (B = 0.043; p = 0.012) and a history of falls (B = 0.725; p = 0.015) were associated with depressive symptoms. Conclusions: Falls, FOF, and depressive symptoms are interlinked among older adults, underscoring the need for targeted interventions to improve their mental and physical health. Full article

(This article belongs to the Special Issue Fall Prevention and Geriatric Nursing)

8 pages, 241 KB

Open AccessArticle

Association between Polypharmacy and Hospitalization among Older Adults Admitted to Emergency Departments for Falls in Guadeloupe: A Retrospective Cohort Study

by Nadine Simo-Tabue, Laurys Letchimy, Ludwig Mounsamy, Leila Rinaldo, Larissa Vainqueur, Marie-Josiane Ntsama-Essomba, Guillaume Mallet, Denis Boucaud-Maitre and Maturín Tabue Teguo

Healthcare 2024, 12(15), 1471; https://doi.org/10.3390/healthcare12151471 - 24 Jul 2024

Viewed by 1956

Abstract

Introduction: Falls are a common geriatric syndrome in older people. Falls are associated with adverse health events such as dependency, unplanned emergency admissions and death. This study aimed to identify the factors associated with fall severity, such as diabetes, hypertension, heart disease, cognitive decline and polypharmacy, as well as sociodemographic characteristics in patients aged 70 years and over admitted to the emergency department in Guadeloupe. Method: A single-center, observational, retrospective study of patients aged 70 years and over admitted to the emergency department (ED) of the University Hospital of Guadeloupe for a fall between 1 May 2018 and 30 April 2019 was conducted. Fall severity was defined as the need for hospitalization. Bivariate analysis was used to determine the associations between fall severity and sociodemographic characteristics, comorbidities, history of falls and polypharmacy (defined as the daily use of at least five drugs). Polypharmacy was analyzed as a binary variable (>5 drugs daily; yes or no) in categories (0–3 (ref.), 4–6, 7–9 and ≥10 drugs). Results: During the study period, 625 patients who attended the ED for a fall were included. The mean age was 82.6 ± 7.6 years, and 51.2% were women. Of these, 277 patients (44.3%) were admitted to the hospital, and 3 patients (0.5%) died. In the bivariate analysis, only polypharmacy was associated with hospitalization for a fall (OR: 1.63 [95% CI: 1.33–2.02]). The odds ratios for the polypharmacy categories were 1.46 [95% CI 0.99–2.14], 1.65 [1.09–2.50] and 1.48 [0.76–2.85] for 4–6, 7–9 and ≥10 drugs, respectively. Conclusions: Polypharmacy was associated with hospitalization as a proxy for fall severity. A regular review of drug prescriptions is essential to reduce polypharmacy in older adults. Full article

(This article belongs to the Special Issue Fall Prevention and Geriatric Nursing)

13 pages, 602 KB

Open AccessArticle

Predictive Validity of the Johns Hopkins Fall Risk Assessment Tool for Older Patients in Stroke Rehabilitation

by Seungho Hong, Ji-Sook Kim and Young-Ah Choi

Healthcare 2024, 12(7), 791; https://doi.org/10.3390/healthcare12070791 - 6 Apr 2024

Cited by 1 | Viewed by 5255

Abstract

The aim of this retrospective, cross-sectional, observational study was to assess the frequency of falls and evaluate the predictive validity of the Johns Hopkins Fall Risk Assessment Tool (JHFRAT) among patients aged ≥65 years, transferred to the rehabilitation ward of a university hospital. The predictive ability was assessed using receiver operating characteristic curve analysis, and the optimal threshold was established using the Youden index. We analyzed the overall cohort (N = 175) with subacute stroke and the subgroup with a low unaffected handgrip strength (HGS; men: <28 kg, women: <18 kg). Overall, 135/175 patients (77.1%) had a low HGS. The fall rate was 6.9% overall and 5.9% for patients with a low HGS. The JHFRAT predictive value was higher for patients with a low HGS than that for the overall cohort, but acceptable in both. The optimal cutoff score for the overall cohort was 11 (sensitivity, 67%; specificity, 68%), whereas that for the subgroup was 12 (sensitivity, 75%; specificity: 72%). These results are expected to aid nurses working in rehabilitation wards in more effectively utilizing JHFRAT outcomes for post-stroke older patients with a low HGS and contribute to the development of more appropriate fall prevention strategies for high-risk patients in the future. Full article

(This article belongs to the Special Issue Fall Prevention and Geriatric Nursing)

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Review

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14 pages, 667 KB

Open AccessReview

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

by Takeshi Miura and Yuka Kanoya

Healthcare 2025, 13(4), 357; https://doi.org/10.3390/healthcare13040357 - 7 Feb 2025

Cited by 3 | Viewed by 15856

Abstract

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. Full article

(This article belongs to the Special Issue Fall Prevention and Geriatric Nursing)

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