Falls prevention in hospitalised older adults with cognitive impairment: strategies and ethical implications

Falls are the most commonly reported patient safety incident in hospitals in the UK, and a major cause of patient harm. Older adults with cognitive impairment, such as dementia or delirium, are at particular risk of falls in acute settings due, for example, to attempting to mobilise without support, inability to communicate their needs or misjudging danger. Nurses have a central role in falls prevention, balancing patient safety with preserving individuals' dignity and autonomy to ensure that practice is consistent, compassionate and ethically sound. This article explores strategies for reducing the risk of falls in older adults with cognitive impairment in acute settings. The authors discuss patient safety interventions, including the use of enhanced observation and technological devices such as pressure-sensitive mats and bed-exit alarms, and consider the ethical implications of using such interventions. The authors also discuss the importance of multidisciplinary assessment and rehabilitation, as well as education for staff, patients and families, in effective falls prevention practice.