Background <p>Falls are a leading cause of preventable harm among hospitalized older adults. In Korean integrated nursing care service (INCS) wards, patients receive nurse-led inpatient care without resident family caregivers; unlike usual wards where family caregivers or privately hired caregivers often remain at the bedside, older patients in INCS wards must independently initiate requests for assistance during daily activities. Evidence on participatory, practice-based fall-prevention education for this setting remains limited.</p> Methods <p>A quasi-experimental, nonequivalent control group pretest–posttest design was employed. Seventy patients aged ≥ 65 years in INCS wards of a tertiary hospital were allocated by ward to an experimental (<i>n</i> = 35) or comparison group (<i>n</i> = 35). The experimental group received APREAL (Active Participatory Real-world Application-based Learning)—intensive education on day 1 followed by daily review and hands-on practice over five days (10–15&#xa0;min/day)—while the comparison group received routine education. Fall-related knowledge, fall-prevention self-efficacy, and fall-prevention behaviors were measured at baseline and day 5. ANCOVA adjusting for baseline scores was the primary analysis; Bonferroni correction (α = 0.017) was applied. Ceiling effects and ward-level fall-incident rates were examined as supplementary analyses.</p> Results <p>ANCOVA revealed that the experimental group had significantly higher adjusted post-intervention scores than the comparison group for all outcomes: fall-related knowledge (F = 27.41, <i>p</i> &lt; .001, partial η² = 0.287), fall-prevention self-efficacy (F = 32.85, <i>p</i> &lt; .001, partial η² = 0.326), and fall-prevention behaviors (F = 93.14, <i>p</i> &lt; .001, partial η² = 0.578). All effects remained significant after Bonferroni correction. Ceiling effects were noted for knowledge and behavior scores in the experimental group. During the study period, the experimental ward had a numerically lower fall rate (0.0 falls per 1,000 patient-days) than the comparison ward (2.3 falls per 1,000 patient-days), though this exploratory comparison was not statistically powered.</p> Conclusions <p>APREAL was associated with significant improvements in fall-related knowledge, self-efficacy, and preventive behaviors among older inpatients in INCS wards. The two-cluster design, short follow-up, ceiling effects, and self-report measures warrant cautious interpretation. A multi-center cluster-randomized trial with objective fall-rate outcomes is warranted.</p> Trial registration <p>Clinical Research Information Service (CRIS), Republic of Korea, PRE20260625-001; submitted June 25, 2026. Retrospective registration pending.</p>