| Sumario: | Background Over half of older adults in long-term care (LTC) experience concern about falling (CaF), yet existing CaF measurement tools do not adequately capture concerns related to daily activities specific to LTC, limiting their usefulness for assessment and management. This study aimed to: (i) develop a co-designed LTC-specific scale by working directly with older residents, adapting relevant Iconographical Falls Efficacy Scale (IconFES) items and adding newly identified activities reflecting their daily lives and CaF (IconFES-LTC), and (ii) identify gaps in current CaF management practices in LTC. Methods Semi-structured interviews were conducted with 15 LTC residents (aged 60+ years) to identify daily activities associated with CaF and with 10 LTC staff members to explore resident experiences, barriers and facilitators to implementing a CaF scale, and gaps in current CaF management. Interviews were analysed using reflexive thematic analysis to identify patterns across resident and staff perspectives. The draft IconFES-LTC was pilot-tested with nine residents and further refined. Results The final IconFES-LTC comprises 20 items, including seven adapted from the original IconFES. Items reflect common activities of daily living, undertaken within and outside the facility. Interviews further identified key practice gaps, including the absence of a suitable CaF measure, low participation in exercise programmes, limited falls prevention knowledge and a lack of evidence-based programmes addressing CaF in LTC. Conclusion Co-designed with LTC residents and staff, the IconFES-LTC offers a context-specific approach to assessing CaF in LTC settings and may inform targeted fall-prevention strategies, with further psychometric validation required in larger, more diverse populations.
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