J. C. M. van Haastregt

Cost-effectiveness of an intervention to reduce fear of falling

OBJECTIVES The aim of this study was to assess whether a multicomponent cognitive behavioral group intervention is preferable to usual care in terms of (healthcare) costs and effects on fear of falling and activity avoidance. METHODS This economic evaluation was embedded in a randomized controlled trial among 540 community-living adults in the Netherlands, aged 70 years and older who reported fear of falling and fear-induced activity avoidance. The participants allocated to the intervention group received a multicomponent cognitive behavioral group intervention consisting of eight weekly sessions and a booster session. The sessions were aimed at instilling realistic views of falls, reducing fall risk, and increasing activity and safe behavior. Participants in the control group received usual care. Cost outcome measures were healthcare costs, and patient and family costs. Clinical outcomes were fear of falling and activity avoidance. All outcomes were assessed at baseline and at 2, 8, and 14 months by means of registration forms, self-administered questionnaires, and interviews by telephone. RESULTS Participants were randomly allocated to intervention (n = 280) and control groups (n = 260). Costs for the intervention program were on average €276 per person. Total costs per person were comparable (€4,925 in intervention group and €4,828 in control group). Furthermore, favorable effects of the program were observed for fear of falling and activity avoidance. CONCLUSIONS This study showed that the intervention program is preferable to usual care in terms of costs and effects. The program had comparable costs and significantly reduced fear of falling and associated activity avoidance among older community-living persons.

Het meten van angst om te vallen met de Falls Efficacy Scale-International (FES-I). Achtergrond en psychometrische kenmerken

The assessment of fear of falling with the Falls Efficacy Scale-International (FES-I). Development and psychometric properties in Dutch elderly. Fear of falling is common in older persons. Different methods have been developed to assess fear of falling. The most well-know measure is the 10-item Falls Efficacy Scale (FES). However, the FES items (a) focus on low functioning older persons and particularly on in-home activities, (b) do not comprise social activities, and (c) were developed from a US perspective so that translation in European languages is hampered. To solve these issues, the 16-item Falls Efficacy Scale-International (FES-I) was recently developed within the Prevention of Falls Network Europe (ProFaNE). In this article, the Dutch version of the FES-I is presented and the psychometric properties in 213 Dutch persons aged 70 years of age and over are described. The FES-I showed to be unidimensional and internally consistent; the Cronbach alpha coefficient was 0.96. The 4 week test-retest intra-class correlation coefficient was 0.82. The associations of the FES-I sumscores with age, gender, falls history and overall fear of falling was as expected, indicating construct validity. In addition, the FES-I discriminated in the same extent as the original 10-item FES scale. We conclude that the FES-I showed acceptable reliability and construct validity and may be useful in cross-national research. Future studies should focus on the sensitivity to change of FES-I.Tijdschr Gerontol Geriatr 2007; 38: 204-212SamenvattingAngst om te vallen komt frequent voor bij ouderen. In het verleden zijn hiervoor verschillende meetmethoden ontwikkeld. Een bekend en veelgebruikt instrument om angst om te vallen bij ouderen te meten is de Falls Efficacy Scale (FES). De FES blijkt echter (a) met name gericht te zijn op slechter functionerende ouderen en op activiteiten binnenshuis en minder geschikt te zijn voor ouderen uit de algemene populatie, (b) geen betrekking te hebben op sociale activiteiten die verband kunnen houden met valangst, en (c) te zijn ontwikkeld vanuit Amerikaans perspectief waardoor een eenduidige vertaling in verschillende Europese talen wordt bemoeilijkt. Binnen het Prevention of Falls Network Europe (ProFaNE) is de 16-item Falls Efficacy Scale-International (FES-I) ontwikkeld om tegemoet te komen aan deze bezwaren. In dit artikel wordt de Nederlandse versie van de FES-I gepresenteerd en wordt verslag gedaan van de psychometrische kwaliteiten van de FES-I in een Nederlandse steekproef van 213 ouderen van 70 jaar en ouder. De FES-I blijkt unidimensioneel en intern consistent te zijn; de test-hertest betrouwbaarheid is goed. De samenhang met leeftijd, geslacht, valincidenten en bezorgdheid om te vallen wordt zoals verwacht aangetroffen. Het discriminerend vermogen van de FES-I is vergelijkbaar met de oorspronkelijke FES. Geconcludeerd kan worden dat de FES-I een betrouwbaar en valide instrument is om angst om te vallen bij ouderen vast te stellen. Toekomstig onderzoek zal moeten uitwijzen of de FES-I ook gevoeliger is dan de FES voor het vaststellen van veranderingen in angst om te vallen.

Zicht op Evenwicht Landelijke implementatie van een cursus gericht op het verminderen van angst om te vallen bij zelfstandig wonende ouderen

BACKGROUND The Dutch version of A Matter of Balance (AMB-NL) is a cognitive behavioral group program to reduce fear of falling and related activity avoidance in community-living older persons. This paper presents the strategy for implementation of AMB-NL in Dutch homecare organizations and the outcomes of this implementation. The aim was to implement AMB-NL in at least 50 % of 64 homecare organizations in The Netherlands in 2009 and 2010. METHODS The implementation strategy was based on the four phases of the Replicating Effective Interventions: pre-conditions, pre-implementation, implementation, and maintenance and evolution. RESULTS After preparing the implementation activities, such as identifying implementation barriers, consulting stakeholders, preparing the materials involved in the implementation, and training the facilitators of the program (n = 53), AMB-NL was implemented in 16 of the 64 homecare organizations (25 %). Another five homecare organizations indicated that they would shortly include AMB-NL in their care program. These organizations conducted the intervention 19 times to a total of 178 participants. After the implementation phase another 16 facilitators were trained, and program materials were successfully disseminated. CONCLUSION The implementation of AMB-NL was well performed. The targeted aim is not fully reached within the two-year timeframe, but the program is well received by participants, trainers and homecare organizations. Further implementation and maintenance of AMB-NL in primary health care is recommended.