Effectiveness of a home-based cognitive behavioral program to manage concerns about falls in community-dwelling, frail older people: results of a randomized controlled trial

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Abstract

Background

Concerns about falls are common among older people. These concerns, also referred to as fear of falling, can have serious physical and psychosocial consequences, such as functional decline, increased risk of falls, activity restriction, and lower social participation. Although cognitive behavioral group programs to reduce concerns about falls are available, no home-based approaches for older people with health problems, who may not be able to attend such group programs are available yet. The aim of this study was to assess the effectiveness of a home-based cognitive behavioral program on concerns about falls, in frail, older people living in the community.

Methods

In a randomized controlled trial in the Netherlands, 389 people aged 70 years and older, in fair or poor perceived health, who reported at least some concerns about falls and related activity avoidance were allocated to a control ( n = 195) or intervention group ( n = 194). The intervention was a home-based, cognitive behavioral program consisting of seven sessions including three home visits and four telephone contacts. The program aims to instill adaptive and realistic views about fall risks via cognitive restructuring and to increase activity and safe behavior using goal setting and action planning and was facilitated by community nurses. Control group participants received usual care. Outcomes at 5 and 12 months follow-up were concerns about falls, activity avoidance due to concerns about falls, disability and falls.

Results

At 12 months, the intervention group showed significant lower levels of concerns about falls compared to the control group. Furthermore, significant reductions in activity avoidance, disability and indoor falls were identified in the intervention group compared with the control group. Effect sizes were small to medium. No significant difference in total number of falls was noted between the groups.

Conclusions

The home-based, cognitive behavioral program significantly reduces concerns about falls, related activity avoidance, disability and indoor falls in community-living, frail older people. The program may prolong independent living and provides an alternative for those people who are not able or willing to attend group programs.

Trial registration

ClinicalTrials.gov, NCT01358032. Registered 17 May 2011

Related collections

Most cited references 29

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Development and initial validation of the Falls Efficacy Scale-International (FES-I).

Lucy Yardley, Nina Beyer, Klaus Hauer … (2005)

There is a need for a measure of fear of falling that assesses both easy and difficult physical activities and social activities and is suitable for use in a range of languages and cultural contexts, permitting direct comparison between studies and populations in different countries and settings. To develop a modified version of the Falls Efficacy Scale to satisfy this need, and to establish its psychometric properties, reliability, and concurrent validity (i.e. that it demonstrates the expected relationship with age, falls history and falls risk factors). Cross-sectional survey. Community sample. 704 people aged between 60 and 95 years completed The Falls Efficacy Scale-International (FES-I) either in postal self-completion format or by structured interview. The FES-I had excellent internal and test-retest reliability (Cronbach's alpha=0.96, ICC=0.96). Factor analysis suggested a unitary underlying factor, with two dimensions assessing concern about less demanding physical activities mainly in the home, and concern about more demanding physical activities mainly outside the home. The FES-I had slightly better power than the original FES items to discriminate differences in concern about falling between groups differentiated by sex, age, occupation, falls in the past year, and falls risk factors (chronic illness, taking multiple or psychoactive medications, dizziness). The FES-I has close continuity with the best existing measure of fear of falling, excellent psychometric properties, and assesses concerns relating to basic and more demanding activities, both physical and social. Further research is required to confirm cross-cultural and predictive validity.

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The efficacy of psychological, educational, and behavioral treatment. Confirmation from meta-analysis.

M W Lipsey, D B Wilson (1993)

Conventional reviews of research on the efficacy of psychological, educational, and behavioral treatments often find considerable variation in outcome among studies and, as a consequence, fail to reach firm conclusions about the overall effectiveness of the interventions in question. In contrast meta-analytic reviews show a strong, dramatic pattern of positive overall effects that cannot readily be explained as artifacts of meta-analytic technique or generalized placebo effects. Moreover, the effects are not so small that they can be dismissed as lacking practical or clinical significance. Although meta-analysis has limitations, there are good reasons to believe that its results are more credible than those of conventional reviews and to conclude that well-developed psychological, educational, and behavioral treatment is generally efficacious.

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Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people.

Gertrudis I. J. M. Kempen, W Van der Pol, P A Stalenhoef … (2007)

Little is known about the prevalence rates and correlates of fear of falling and avoidance of activity due to fear of falling in the general population of community-living older people. To assess prevalence rates and study correlates of fear of falling and avoidance of activity due to fear of falling in this population. cross-sectional study in 4,031 community-living people aged > or =70 years. Fear of falling was reported by 54.3% and associated avoidance of activity by 379% of our population. Variables independently associated with fear of falling were: higher age (> or =80 years: odds ratio (OR) =1.79; 95% confidence interval (CI) =1.49-2.16), female gender (OR = 3.23; 95% CI = 2.76-3.79), poor perceived general health (OR = 6.93; 95% CI = 4.70-10.21) and multiple falls (OR = 5.72; 95% CI = 4.40-7.43). Higher age (> or =80 years: OR = 1.92; 95% CI = 1.59-2.32), poor perceived general health (OR = 11.91; 95% CI = 8.38-16.95) and multiple falls (OR = 4.64; 95% CI = 3.73-5.76) were also independently associated with avoidance of activity. Fear of falling and avoidance of activities due to fear of falling, were highly prevalent in our sample of community-living older people. Particularly, poor perceived general health showed a strong, independent association with both, fear of falling, and related avoidance of activity. Findings of our study may help health care professionals to identify people eligible for interventions aimed at reducing fear of falling and activity restriction.

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Author and article information

Contributors

Tanja A. C. Dorresteijn: +31 43 38 82289 , t.dorresteijn@maastrichtuniversity.nl

G. A. Rixt Zijlstra: r.zijlstra@maastrichtuniversity.nl

Antonius W. Ambergen: ton.ambergen@maastrichtuniversity.nl

Kim Delbaere: k.delbaere@neura.edu.au

Johan W. S. Vlaeyen: Johannes.Vlaeyen@ppw.kuleuven.be

Gertrudis I. J. M. Kempen: g.kempen@maastrichtuniversity.nl

Journal

Journal ID (nlm-ta): BMC Geriatr

Journal ID (iso-abbrev): BMC Geriatr

Title: BMC Geriatrics

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2318

Publication date (Electronic): 6 January 2016

Publication date PMC-release: 6 January 2016

Publication date Collection: 2016

Volume: 16

Electronic Location Identifier: 2

Affiliations

[ ]Department of Health Services Research – Focusing on Chronic Care and Ageing, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands

[ ]Department of Methodology and Statistics, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands

[ ]Neuroscience Research Australia, University of New South Wales, P.O. Box 1165, Randwick, NSW 2031 Australia

[ ]Research Group Health Psychology, University of Leuven, Tiensestraat 102, 3000 Leuven, Belgium

[ ]Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands

Article

Publisher ID: 177

DOI: 10.1186/s12877-015-0177-y

PMC ID: 4704266

PubMed ID: 26739339

SO-VID: 8a7f6669-5354-4a62-a9c1-9f41143b200d

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 18 August 2015

Date accepted : 17 December 2015

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100001826, Netherlands Organisation for Health Research and Development (NL);

Award ID: 120610001

Award Recipient : Gertrudis I. J. M. Kempen

Funded by: FundRef http://dx.doi.org/10.13039/501100003130, Fonds Wetenschappelijk Onderzoek (BE);

Custom metadata

ScienceOpen disciplines: Geriatric medicine

Keywords: fear of falling,cognitive behavioral therapy,accidental falls,activity of daily life,aged,randomized controlled trial

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ScienceOpen disciplines: Geriatric medicine

Keywords: fear of falling, cognitive behavioral therapy, accidental falls, activity of daily life, aged, randomized controlled trial

Effectiveness of a home-based cognitive behavioral program to manage concerns about falls in community-dwelling, frail older people: results of a randomized controlled trial

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Hearing Loss and Restoration

Most cited references 29

Development and initial validation of the Falls Efficacy Scale-International (FES-I).

The efficacy of psychological, educational, and behavioral treatment. Confirmation from meta-analysis.

Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people.

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