Using a systems perspective to understand hospital falls among patients with dementia

•A systems approach can help to broaden our understanding of falls prevention amongst patients with dementia.•Hospital falls training programmes can incorporate systems thinking into the educational process.•Current falls interventions will benefit from the use of a systems approach. Falls are a frequent event among older adults with dementia during their hospital stay. This qualitative study explores the factors contributing to falls in this population using a systems perspective. Semi-structured interviews were conducted with 32 carers of patients with dementia and 20 hospital staff who worked on medical wards. Interview transcripts were analysed thematically using a systems framework. The themes generated from this falls research were factors related to the: patient (e.g. their physical health), carer (e.g. their ability to re-call a patient's past medical history), staff (e.g. teamwork), hospital policies (e.g. transfer of patients between wards), the hospital environment (e.g. lack of observation side rooms for infectious patients who are at risk of falls on some wards) and the use of hospital equipment (e.g. walking aid). We recommend that future hospital falls intervention programmes need to be supported by a credible systems approach aiming to improve patient outcomes in relation to falls prevention.