Fear of Falling
Conditions
Keywords
Older adults, Assisted living, Cognitive behavioral therapy, Exercise, Fall prevention, Mobility, Gait
Brief summary
Aktiv Gegen Sturzangst (AGES) is a multicomponent group intervention combining cognitive behavioral therapy and structured exercise to address fear of falling in older adults receiving services from assisted living facilities. This single-arm, non-randomized pilot study evaluated the feasibility of implementing AGES in three assisted living facilities in Switzerland and the feasibility of study procedures and outcome measures for a future controlled trial. Nineteen older adults participated in eight weekly group sessions delivered by trained course leaders. Feasibility outcomes included recruitment, retention, course-leader deployment, protocol adherence, completion of clinical outcome measures, and feasibility of contactless LiDAR-based gait assessment.
Detailed description
AGES was developed as an adaptation of multicomponent approaches to fear of falling for use in German-speaking Swiss assisted living facilities. The intervention consisted of eight weekly group sessions of approximately 60 minutes combining cognitive behavioral therapy-based discussion and reflection with structured balance, strength, mobility, and flexibility exercises. Sessions were delivered by trained facility-based course leaders. The pilot primarily assessed the feasibility of recruitment and retention, course-leader training and deployment, intervention delivery, completion of proposed outcome measures, and LiDAR-based gait assessment. Clinical measures included the Falls Efficacy Scale-International (FES-I), World Health Organization-5 Well-Being Index (WHO-5), and Timed Up and Go test (TUG). The study was exploratory and was not designed or powered to establish intervention effectiveness.
Interventions
BEHAVIORALMulticomponent fear of falling intervention
Eight weekly group sessions delivered by trained course leaders. Sessions included cognitive behavioral therapy-based discussion and reflection addressing emotions, automatic thoughts, safety behaviors, assumptions, goal setting, and self-management, combined with structured exercises performed in seated or supported-standing positions where appropriate.
Sponsors
Eric Lenouvel
Age-Stiftung
Public Health Switzerland
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
NONE
Masking description
No masking was used. Participants, course leaders, and investigators were aware that all participants received the AGES intervention.
Intervention model description
Single-group, non-randomized pilot study in which all participants received the AGES intervention. No comparator or control group was included.
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Age 65 years or older * Receiving some level of care or services through a participating assisted living facility * Identified by facility staff as potentially experiencing fear of falling or expressing interest in a fall-prevention program * Able to participate safely in group sessions
Exclusion criteria
* Moderate to severe neurocognitive disorder * Unstable psychiatric illness, including an acute depressive episode or substance use disorder * Physical limitations precluding safe participation in group sessions, including blindness, severe frailty, wheelchair dependence, or requirement for full mobility assistance
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Course-leader deployment | During the 8-week intervention period | Number and proportion of trained course leaders who subsequently delivered an AGES intervention group |
| Participant retention | Baseline to approximately 8 weeks | Number and proportion of enrolled participants retained through completion of the intervention |
| Completion of clinical outcome measures | Baseline and approximately 8 weeks | Number and proportion of participants providing paired FES-I, WHO-5 and TUG assessments |
| Protocol adherence | Through approximately 8 weeks | Number of delivering course leaders reporting delivery according to the standardized intervention manual without major deviations |
| Feasibility of LiDAR gait assessment | At approximately Week 8, toward the end of the 8-week intervention period | Proportion of participants in whom LiDAR measurement could be acquired and proportion of acquired measurements yielding usable processed gait data |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Falls Efficacy Scale-International (FES-I) | Baseline and approximately 8 weeks | The Falls Efficacy Scale-International (FES-I) is a 16-item questionnaire assessing concern about falling during physical and social activities. Each item is scored from 1 (not at all concerned) to 4 (very concerned), giving a total score ranging from 16 to 64. Higher scores indicate greater concern about falling and therefore a worse outcome. |
| World Health Organization-5 Well-Being Index (WHO-5) | Baseline and approximately 8 weeks | The World Health Organization-5 Well-Being Index (WHO-5) is a 5-item questionnaire assessing subjective psychological well-being over the previous two weeks. Each item is scored from 0 (at no time) to 5 (all of the time), giving a total raw score ranging from 0 to 25. Higher scores indicate greater psychological well-being and therefore a better outcome. |
| Timed Up and Go (TUG) Test | Baseline and approximately 8 weeks | The Timed Up and Go (TUG) test assesses functional mobility. Participants are timed, in seconds, while standing up from a chair, walking 3 meters, turning, walking back, and sitting down. The outcome is the time required to complete the test. Lower times indicate better functional mobility, whereas higher times indicate worse mobility. |
Countries
Switzerland
Contacts
STUDY_DIRECTORStefan Kloeppel, MD
Department of Old Age Psychiatry and Psychotherapy, University Hospital of Psychiatry (UPZ), Bern
Outcome results
None listed