Informal Caregiver-Observed Fall Risk Indicators and Caregiver Responses to Prevent Falls Among Community-Dwelling Older People: A Systematic Review.

INTRODUCTION

Informal caregivers are uniquely positioned to recognize subtle changes that precede falls because of their continuous presence in older people's everyday environments. However, caregiver-observed indicators of escalating fall risk have not been systematically synthesized. This systematic review synthesizes the evidence on informal caregiver-observed fall risk indicators and caregiver responses to prevent falls among community-dwelling older people.

METHODS

A targeted synthesis of peer-reviewed literature was undertaken using six electronic databases (PubMed, CINAHL, Scopus, Web of Science, PsycINFO, and Embase) that were searched. Qualitative content analysis was used to synthesize the findings. A total of 16 studies were included in the review.

RESULTS

Caregivers recognized a broad range of observable indicators associated with increased fall risk, including: (1) mobility and gait changes; (2) cognitive and neurobehavioral changes; (3) functional decline and increasing dependence in activities of daily living; (4) physiological warning signs; (5) environmental hazards; and (6) behavioral risk indicators. The synthesis further revealed an observation-to-response pathway, whereby caregivers translated perceived fall-risk indicators into: (1) increased surveillance and protective monitoring; (2) providing mobility and functional assistance; (3) implementing environmental modifications; (4) promoting safety behaviors; and (5) seeking health care support through care coordination and professional consultation.

CONCLUSIONS

Informal caregivers detect early signs of fall risk and initiate preventive responses that may reduce fall risk among community-dwelling older people.

CLINICAL RELEVANCE: Nurses should systematically incorporate caregiver observations into routine fall-risk assessment and care planning to improve the early identification of escalating fall risk and support timely, individualized fall-prevention interventions. Health policies should recognize informal caregivers as essential partners in fall prevention by promoting standardized caregiver education, documentation of caregiver observations, and their integration into routine fall-risk assessment and community-based care.