"You just struggle on your own:" Exploring older consumers' perspectives about falls prevention education in hospitals.

Introduction While individualised falls preventive education has been effective in reducing hospital falls among older patients, there is a dearth of research exploring consumers' perspectives on hospital falls prevention education. Objective This study aimed to explore the knowledge of older consumers regarding preventing falls in hospital and their reflections on the education received during hospitalisation Methods A qualitative, exploratory study incorporating focus groups and semi-structured interviews was undertaken. The participants consisted of a purposively selected sample of community-dwelling consumers aged 65 and above (n=39 older adults and n=9 family carers of older adults) who had been admitted to a hospital within the past five years. Thematic analysis, incorporating deductive and inductive approaches, was applied and a capability-opportunity-motivation-behaviour model was utilised to comprehend the key determinants influencing the implementation of falls education for hospitalised older adults. Results Feedback from the participants (n=46, 25 females) revealed five key themes: distress and disempowerment resulting from hospital falls, anxiety and uncertainty regarding required behaviour while hospitalised, insufficient and inconsistent falls prevention education, inadequate communication, and underlying ageism attitudes. These themes converged to provide the overarching theme: support and education available to engage in safe falls prevention behaviour was not what we expected! Application of the behaviour change model indicated that older consumers often did not acquire falls prevention knowledge, awareness or motivation, and had limited opportunities to engage in falls preventive behaviour during hospitalisation. Discussion In summary, older consumers receive sporadic falls prevention education during hospital admissions, which fails to raise their awareness and knowledge of falls risks or their capability to engage in safe preventive behaviors. Conflicting messages contribute to consumer confusion and anxiety about maintaining safety during hospital stays. Conclusion Further research is required to address these issues to enable older adults to undertake effective falls prevention behaviours in hospital settings. Hospital policies and guidelines need to prioritise falls prevention education. Policies can be designed to emphasise tailored education, effective communication, and the importance of addressing ageism to enhance patient safety and well-being. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The study was funded by a Research Excellence Award to Anne-Marie Hill, a program of the Western Australian Future Health Research and Innovation Fund. Anne-Marie Hill is supported by a National Health and Medical Research Council (NHMRC) of Australia Investigator (EL2) award (GNT1174179) and the Royal Perth Hospital Research Foundation. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics approval for the study was obtained from the University of Western Australia, Human Research Ethics Committee (2022/ET000692). All participants provided written informed consent to participate. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained within the manuscript.