Introduction
Falling in patients, especially the elderly, is the most adverse complication reported in medical centers [4], which causes safety violations, increased hospital stay, and delayed recovery [5]. Clinical guidelines provide a systematic solution to reduce the risk of falls in hospitalized patients based on evidence-based practice [9]. To use these guidelines as a reliable tool for decision-making, their quality such as accuracy and methodological transparency should be ensured [12]. One essential step in localization of clinical guidelines is to evaluate their methodological quality [18]. In Iran, no study has been conducted to evaluate the quality of clinical guidelines for fall prevention using the Persian version of the Appraisal of Guidelines, Research and Evaluation (AGREE) reporting checklist. In the present study, we aim to evaluate the quality of clinical guidelines for preventing falls in the hospitalized elderly using the AGREE II checklist. 

Methods
In this study, a search was first conducted in databases publishing clinical guidelines such as GIN, NICE, NGC, SIGN, NZGG, RNAO, ACSQHC using the keywords Clinical guideline, falls, elderly, prevention, and hospital to find and select the clinical guidelines that meet the inclusion criteria by using a purposive sampling method. In case of disagreement in the selection of guidelines, a consensus was reached after further discussion. Finally, four clinical guidelines that met the inclusion criteria were selected. Then, the clinical guidelines were evaluated by 5 experts in the health system using the AGREE checklist. The AGREE II consists of 23 key items organized within 6 domains followed by 2 global rating items (Overall Assessment). Each of the criteria was evaluated using a seven-point Likert scale from 1 (strongly disagree) to 7 (strongly agree). The guidelines that obtained a standard score of 50% or more in all domains were given the title “highly recommended, ” and those that received a standard score of 50% or more in the overall assessment were given the title “recommended with modifications. ”

Results
Based on the results in Table 1, three clinical guidelines “RNAO, 2017”, “NICE, 2013” and “ACSQHC, 2009” were highly recommended, and have the ability to be localized in Iran and used in clinical practice.


The best guideline was “RNAO, 2017”, which received the highest score in most domains and in overall assessment. The “Post Fall Multidisciplinary Management Guidelines for Western Australian Health Care Settings” was recommended after making modifications. Since the first goal in a treatment center is to prevent harm to the elderly and endangering their safety, and the treatment team plays a key role in preventing falls in the elderly in the hospital, the use of current clinical guidelines is recommended. The domain of “clarity of presentation” obtained the highest overall score among the domains, indicating the attention of the editors of the guidelines to this area. The domain of “applicability” obtained the lowest overall score. 

Conclusion
The study clinical guidelines obtained the highest in the domain of “ clarity of presentation “ and the lowest score in the domain of “applicability”. This is consistent with the results of Majkusová et al. and Ng et al., who used the AGREE checklist [38, 39]. These guidelines received the highest score in the presentation clarity due to having specific recommendations and clearly stating different care and treatment options. On the other hand, due to less attention to barriers, facilitators, possible tools and resources for using the recommendations, and key indicators of monitoring of the implementation, obtained the lowest score in the field of “applicability”. 

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the ethics committee of Isfahan University of Medical Sciences (Code: IR. MUI. RESEARCH. REC. 1399. 425).  

Funding
This article was extracted from a master’s thesis in nursing funded by Isfahan University of Medical Sciences. 

Authors' contributions
Investigation, editing & review: Masa Soleimani and Maryam Shirazi; Resources, initial draft preparation, and visualization: Masa Soleimani; Supervision and project administration: Maryam Shirazi; Conceptualization, methodology, validation, and data analysis: All authors.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank Isfahan University of Medical Sciences for supporting this research.