Aged, Concerns About Falling
Conditions
Keywords
Fear of falling, Cognitive behavioral therapy, Randomized controlled trial, Frailty, Accidental Falls
Brief summary
The main objectives of this study are: 1. an effect evaluation of an in-home multicomponent cognitive behavioural program on concerns about falling and related avoidance of activity (primary outcomes), as well as disability, fall incidents (secondary outcomes) and several additional outcomes in frail community-dwelling older people, 2. a process evaluation of the feasibility of the program, with the following main outcomes: population reached, performance according to protocol, exposure and engagement, opinion on the program of participants and facilitators, perceived benefit or achievement, and experienced barriers and potential solutions, and 3. an economical evaluation on the impact of the program on healthcare utilization and related costs.
Interventions
BEHAVIORALan in-home cognitive behavioral program
The in-home cognitive behavioral program aims to learn older persons, living in the community, how to deal with concerns about falling and to increase physical, social and functional activity. The principles of cognitive restructuring are used for shifting maladaptive in adaptive attitudes with respect to falling as well as increasing self efficacy beliefs and feelings of control. The following themes are discussed during the program: concerns about falling, thoughts about falling, physical exercise, assert oneself, overcome personal barriers, recognizing fall-ty habits and managing concerns about falling. Duration of the program is 10 weeks with 7 individual sessions (3 home visits (60, 60 and 75 minutes, respectively) & 4 telephone contacts (35 minutes each). The program is facilitated by trained nurses qualified in the field of geriatrics and working for home care agencies.
Sponsors
ZonMw: The Netherlands Organisation for Health Research and Development
Maastricht University Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
70 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Aged 70 years or over * At least some concerns about falling * At least some associated avoidance of activity * Fair or poor perceived general health * Living independently in the community * Written informed consent
Exclusion criteria
* Cognitive impairment (a score of less than 4 on the Abbreviated Mental Test 4) * Language or hearing problems that impede completing an interview by telephone * Sight problems that impede completing the intervention * Confinement to bed * Waiting for nursing home admission * Permanent use of a wheelchair
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| concerns about falling | baseline, 5 months and 12 months | Falls Efficacy Scale International (FES-I) |
| avoidance of activities due concerns about falling | baseline, 5 months and 12 months | Falls Efficacy Scale International Avoidance Behaviour (FES-IAB) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| catastrophic beliefs about falling | baseline, 5 months and 12 months | Catastrophic beliefs about falling (CAFS) |
| perceived consequences of falling | baseline, 5 months and 12 months | CoF - loss of functional independence subscale and damage to identity subscale |
| perceived control over falling | baseline, 5 months and 12 months | Perceived control over falling (PCOF) |
| mastery | baseline, 5 months and 12 months | Personal Mastery Scale |
| disability | baseline, 5 months and 12 months | Groningen Activity Restriction Scale (GARS) |
| symptoms of depression | baseline, 5 months and 12 months | Subscale of the Hospital Anxiety and Depression Scale (HADS-D) |
| social support interactions | baseline, 5 months and 12 months | Social support interactions (SSL 12-I) |
| health-related quality of life | baseline, 5 months and 12 months | SF-12 Health Survey |
| feelings of anxiety | baseline, 5 months and 12 months | Subscale of the Hospital Anxiety and Depression Scale (HADS-A) |
| number of falls | continuous registration during the course of the trial for a period of 1 year | Fall calendar |
Countries
Netherlands
Outcome results
None listed