G. A. Rixt Zijlstra

Interventions to Reduce Fear of Falling in Community‐Living Older People: A Systematic Review

The objective was to assess which interventions effectively reduce fear of falling in community‐living older people. An extensive search for relevant literature comprised a database search of PubMed, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials; expert consultation; and manually searching reference lists from potentially relevant papers. Randomized, controlled trials that assessed fear of falling in community‐living older people were included. Two independent reviewers extracted data from full papers on study characteristics, methodological quality, outcomes, and process characteristics of the intervention. The search identified 599 abstracts, and 19 papers met the inclusion criteria. Seven of those papers were identified using expert consultation. Fifty‐five percent of all validity items and 39% of process characteristic items were fulfilled across the 19 trials. Twelve of the 19 papers were of higher methodological quality. In 11 of these trials, fear of falling was lower in the intervention group than in the control group. Interventions that showed effectiveness were fall‐related multifactorial programs (n=5), tai chi interventions (n=3), exercise interventions (n=2), and a hip protector intervention (n=1). Three of these interventions explicitly aimed to reduce fear of falling. Several interventions, including interventions not explicitly aimed at fear of falling, resulted in a reduction of fear of falling in community‐living older people. Limited but fairly consistent findings in trials of higher methodological quality showed that home‐based exercise and fall‐related multifactorial programs and community‐based tai chi delivered in group format have been effective in reducing fear of falling in community‐living older people.

Cross-cultural validation of the Falls Efficacy Scale International (FES-I) in older people: Results from Germany, the Netherlands and the UK were satisfactory

Purpose. To carry out a cross-cultural validation of the Falls Efficacy Scale International (FES-I), a 16-item modified version of the Falls Efficacy Scale that was developed to assess both easy and more complex physical and social activities, in a range of languages and different cultural contexts. Method. Data were collected in Germany (n = 94), The Netherlands (n = 193), and the UK (n = 178) in samples of older people living in the community. Four-week FES-I re-test data were collected in Germany and The Netherlands. Descriptive statistics and reliability estimates were computed as well as FES-I sum scores according to age, sex, falls history and fear of falling. Results. Mean inter-item correlations were all above 0.38 and internal reliability estimates were all 0.90 or above. The intra-class correlation coefficients in the German and the Dutch sample were 0.79 and 0.82, respectively. As expected, FES-I scores were associated with age, sex, falls history and fear of falling. In addition, the FES-I discriminated between sub-groups somewhat better than the original ten-item FES scale. Conclusions. The FES-I has been shown to have acceptable reliability and construct validity in different samples in different countries and may be used in cross-cultural rehabilitation research and clinical trials.

Effects of a Multicomponent Cognitive Behavioral Group Intervention on Fear of Falling and Activity Avoidance in Community-Dwelling Older Adults: Results of a Randomized Controlled Trial

OBJECTIVES: To evaluate the effects of a multicomponent cognitive behavioral intervention on fear of falling and activity avoidance in older adults.

Socio-demographic, health-related and psychosocial correlates of fear of falling and avoidance of activity in community-living older persons who avoid activity due to fear of falling

BackgroundFear of falling and avoidance of activity are common in old age and are suggested to be (public) health problems of equal importance to falls. Earlier studies of correlates of fear of falling and avoidance of activity did hardly differentiate between severe and mild levels of fear of falling and avoidance of activity which may be relevant from clinical point of view. Furthermore, most studies focused only on socio-demographics and/or health-related variables and hardly incorporated an extensive range of potential correlates of fear of falling including psychosocial variables. This study analyzes the univariate and multivariate associations between five socio-demographic, seven health-related and six psychosocial variables and levels of fear of falling and avoidance of activity in older persons who avoid activity due to fear of falling.MethodsCross-sectional study in 540 community-living older people aged ≥ 70 years with at least mild fear of falling and avoidance of activity. Chi-squares, t-tests and logistics regression analyses were performed to study the associations between the selected correlates and both outcomes.ResultsOld age, female sex, limitations in activity of daily living, impaired vision, poor perceived health, chronic morbidity, falls, low general self-efficacy, low mastery, loneliness, feelings of anxiety and symptoms of depression were identified as univariate correlates of severe fear of falling and avoidance of activity. Female sex, limitations in activity of daily living and one or more falls in the previous six months correlated independently with severe fear of falling. Higher age and limitations in activity of daily living correlated independently with severe avoidance of activity.ConclusionPsychosocial variables did not contribute independently to the difference between mild and severe fear of falling and to the difference between mild and severe avoidance of activity due to fear of falling. Although knowledge about the unique associations of specific variables with levels of severe fear of falling and avoidance of activity is of interest for theoretical reasons, knowledge of univariate association may also help to specify the concepts for developing interventions and programmes to reduce fear of falling and avoidance of activity in old age, particularly in their early stages of development.

Long-Term Effects of Three Multicomponent Exercise Interventions on Physical Performance and Fall-Related Psychological Outcomes in Community-Dwelling Older Adults: A Randomized Controlled Trial

To determine the long‐term effects of three strength and balance exercise interventions on physical performance, fall‐related psychological outcomes, and falls in older people.

Feelings of Anxiety and Symptoms of Depression in Community-Living Older Persons Who Avoid Activity for Fear of Falling

OBJECTIVES The objectives of this cross-sectional study were to assess the presence of feelings of anxiety and symptoms of depression among older persons who avoid activity for fear of falling and to assess whether feelings of anxiety and symptoms of depression are independently associated with the severity of fear of falling and fear-related activity avoidance. DESIGN This is a cross-sectional study. SETTING Data were collected at two urban areas south of The Netherlands. PARTICIPANTS Participants included 540 community-living people aged 70 years or older who reported fear of falling and associated activity avoidance. MEASUREMENTS Data were collected by means of self-administered questionnaires. RESULTS This study shows that 28.2% and 26.1% of the persons with severe fear of falling had feelings of anxiety and symptoms of depression, respectively. These rates were 28.5% and 22.6% for participants with severe fear-related activity avoidance. Multivariate analyses revealed that participants with severe fear of falling were more likely to have feelings of anxiety and symptoms of depression than those with mild fear of falling. Furthermore, persons who reported severe fear-related activity avoidance were more likely to have feelings of anxiety than mild avoiders. CONCLUSIONS Feelings of anxiety and symptoms of depression are common in persons with severe fear of falling and fear-related activity avoidance. Professional care providers should be alert to underlying anxiety disorders and depression in this category of older persons in the interests of providing optimum treatment.

Validity and sensitivity to change of the falls efficacy scales international to assess fear of falling in older adults with and without cognitive impairment.

Background: Measures of fear of falling have not yet been validated in patients with dementia, leaving a methodological gap that limits research in a population at high risk of falling and fall-related consequences. Objective: The objectives of this study are to determine: (1) the validity of the 7-item Short Falls Efficacy Scale International (Short FES-I) in geriatric patients with and without cognitive impairment, and (2) the sensitivity to change of the 10-item Falls Efficacy Scale (FES), the 16-item FES-I and the 7-item Short FES-I in geriatric patients with dementia. Methods: Cross-sectional data of community-dwelling older adults and geriatric rehabilitation patients (n = 284) collected during face-to-face interviews were used to determine construct and discriminant validity by testing for differences within variables related to fear of falling. Sensitivity to change was studied in an intervention study including patients with mild to moderate dementia (n = 130) as determined by standard response means (SRMs). Results: The Short FES-I showed excellent construct and discriminant validity in the total group and subsamples according to cognitive status. Sensitivity to change was adequate to good in the FES (range SRM: 0.18–0.77) and FES-I (range SRM: 0.21–0.74), with the Short FES-I showing the highest peak sensitivity to change (range SRM: 0.18–0.91). Conclusions: The Short FES-I is a valid measure to assess fear of falling in frail older adults with and without cognitive impairment, yet it may show floor effects in higher functioning older people. All scales, including the Short FES-I, were sensitive to detecting intervention-induced changes in concerns about falling in geriatric patients with dementia.

Mediating effects of psychosocial factors on concerns about falling and daily activity in a multicomponent cognitive behavioral group intervention

Objectives: Concerns about falling, or fear of falling, is highly common in old age and has adverse consequences. The development and understanding of interventions to reduce concerns about falling are therefore relevant. This study explored the mediating effects of psychosocial factors on trajectories of concerns about falling and daily activity in a multicomponent cognitive behavioral group intervention. Method: The study sample comprised 540 community-dwelling adults aged 70 years or older, with concerns about falling and associated activity avoidance, who participated in a randomized controlled trial evaluating this intervention. Control beliefs, self-efficacy beliefs, outcome expectations, and social interactions, as potential mediators, and concerns about falling and daily activity, as outcome variables, were assessed at baseline, and at two, eight, and 14 months. Data were analyzed with mixed-effects regression models. Results: Small to moderate statistically significant effects of the intervention on the potential mediators were found at nearly all follow-up assessments. Separate psychosocial factors showed modest mediating effects on the outcomes. When all mediators were taken into account simultaneously, 44–76% of the association between the intervention and the outcomes was explained. Conclusion: This study showed that the multicomponent cognitive behavioral intervention improved control beliefs, self-efficacy, outcome expectations, and social interactions. These variables mediated the association between the intervention and concerns about falling or daily activity in community-dwelling older adults. This knowledge may facilitate further improvement and development of interventions to reduce concerns about falling and to increase daily activity.

Effects of the Implementation of an Evidence-Based Program to Manage Concerns About Falls in Older Adults

PURPOSE OF THE STUDY Concerns about falls and related activity avoidance are common in older people. A multicomponent program reduced these concerns and increased daily activity among older people in a randomized controlled trial. This study explored whether the effects and acceptability of the program maintain after its implementation into home care organizations. DESIGN AND METHODS In a pretest-post-test study, the effects and acceptability of the 8-week cognitive behavioral program was evaluated in 125 community-living older adults. Data on concerns about falls, related avoidance behavior, falls, fall-related medical attention, feelings of loneliness and anxiety, and symptoms of depression were collected prior to the start of the program and at 2 and 4 months. RESULTS Pretest-post-test analyses showed significant improvements at 4 months for concerns about falls, activity avoidance, number of falls in the past 2 months, feelings of anxiety, and symptoms of depression. No significant differences were shown for daily activity, feelings of loneliness, and fall-related medical attention. IMPLICATIONS After implementation in home care organizations, the program reduced concerns about falls, avoidance behavior, and falls in community-living older adults. These findings are highly consistent with the outcomes of a previously performed randomized controlled trial, indicating that the program can be successfully implemented in practice. Further dissemination of the program is recommended to reduce concerns about falls and related activity avoidance in community-living older people.

Older people's preferences regarding programme formats for managing concerns about falls

Objective: to explore the preferences of community-dwelling older persons regarding different programme formats for managing concerns about falls. Subjects and design: cross-sectional study of 5,755 community-dwelling people aged ≥70 years in the Netherlands. Methods: a questionnaire assessed peoples willingness to participate per programme format (n = 6), i.e. a programme at home, via telephone, via home visits and telephone consultations, via television or via Internet. Results: of the 2,498 responders, 62.7% indicated no interest in any of the formats. The willingness to participate per programme format varied between 21.5 (at home) and 9.4% (via Internet). Among people interested in at least one of the formats (n = 931), higher levels of fall-related concerns were associated with increased preference for a programme with home visits. Poor perceived health and age ≥80 years were associated with less preference for a group programme. Higher educated people were more in favour of a programme via Internet compared with their lower educated counterparts. Conclusion: the majority of community-dwelling older people are not likely to participate in any of the six proposed programme formats for managing concerns about falls. However, when diverse formats of effective programmes will be made available, uptake and adherence may be increased since programme preferences are associated to specific population characteristics.