Effect of a program of multifactorial fall prevention on health-related quality of life, functional ability, fear of falling and psychological well-being. A randomized controlled trial

Vind, Ane Bonnerup; Andersen, Hanne Elkjær; Pedersen, Kirsten Damgaard; Joergensen, Torben; Schwarz, Peter

doi:10.1007/bf03324804

Cited by 24 publications

(23 citation statements)

References 25 publications

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“…8 In a subsequent trial, a geriatric outpatient-based multifactorial intervention study found no such benefit. 24 More recently, a Cochrane review of exercise (three-dimensional exercise, such as t'ai chi and yoga, balance training or strength and resistance training) for reducing fear of falling in older people living in the community found that exercise 'probably' reduces fear of falling to a limited extent immediately after intervention, with inadequate evidence of an effect in the longer term. 25 The authors called for further evidence, with priority being given to the establishment of core outcomes, including fear of falling, in all trials of exercise intervention in community-dwelling elders.…”

Section: Falls and Fear Of Fallingmentioning

confidence: 99%

“…Numeric rating scales for pain and fear of falling when walking As summary measures of pain and fear of falling, participants were asked to rate these constructs on a 11-point scale, ranging from 0 (no concern/no pain) to 10 (as bad as it could be); a similar approach has been used in a number of studies as summarised by Scheffer et al The close relationship between fear of falling and falls 6,[8][9][10][11][12][13][14][15][16]23,24,26,27,29,58,59 means that measurements of falls and their adverse consequences are vital. Falls research is often hampered by poor definitions and hence difficult interpretation of falls outcome data.…”

Section: Secondary Outcome Measuresmentioning

confidence: 99%

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Cognitive–behavioural therapy-based intervention to reduce fear of falling in older people: therapy development and randomised controlled trial – the Strategies for Increasing Independence, Confidence and Energy (STRIDE) study

Parry

Bamford

Deary

et al. 2016

Health Technol Assess

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BackgroundFalls cause fear, anxiety and loss of confidence, resulting in activity avoidance, social isolation and increasing frailty. The umbrella term for these problems is ‘fear of falling’, seen in up to 85% of older adults who fall. Evidence of effectiveness of physical and psychological interventions is limited, with no previous studies examining the role of an individually delivered cognitive–behavioural therapy (CBT) approach.ObjectivesPrimary objective To develop and then determine the effectiveness of a new CBT intervention (CBTi) delivered by health-care assistants (HCAs) plus usual care compared with usual care alone in reducing fear of falling.Secondary objectives To measure the impact of the intervention on falls, injuries, functional abilities, anxiety/depression, quality of life, social participation and loneliness; investigate the acceptability of the intervention for patients, family members and professionals and factors that promote or inhibit its implementation; and measure the costs and benefits of the intervention.DesignPhase I CBTi development.Phase II Parallel-group patient randomised controlled trial (RCT) of the new CBTi plus usual care compared with usual care alone.SettingMultidisciplinary falls services.ParticipantsConsecutive community-dwelling older adults, both sexes, aged ≥ 60 years, with excessive or undue fear of falling per Falls Efficacy Scale–International (FES-I) score of > 23.InterventionsPhase I Development of the CBTi. The CBTi was developed following patient interviews and taught to HCAs to maximise the potential for uptake and generalisability to a UK NHS setting.Phase II RCT. The CBTi was delivered by HCAs weekly for 8 weeks, with a 6-month booster session plus usual care.Main outcome measuresThese were assessed at baseline, 8 weeks, 6 months and 12 months.Primary outcome measure Fear of falling measured by change in FES-I scores at 12 months.Secondary outcome measures These comprised falls, injuries, anxiety/depression [Hospital Anxiety and Depression Scale (HADS)], quality of life, social participation, loneliness and measures of physical function. There were process and health-economic evaluations alongside the trial.ResultsFour hundred and fifteen patients were recruited, with 210 patients randomised to CBTi group and 205 to the control group. There were significant reductions in mean FES-I [–4.02; 95% confidence interval (CI) –5.95 to –2.1], single-item numerical fear of falling scale (–1.42; 95% CI –1.87 to 1.07) and HADS (–1; 95% CI –1.6 to –0.3) scores at 12 months in the CBTi group compared with the usual care group. There were no differences in the other secondary outcome measures. Most patients found the CBTi acceptable. Factors affecting the delivery of the CBTi as part of routine practice were identified. There was no evidence that the intervention was cost-effective.ConclusionsOur new CBTi delivered by HCAs significantly improved fear of falling and depression scores in older adults who were attending falls services. There was no impact on other measures.Further workFurther work should focus on a joint CBTi and physical training approach to fear of falling, more rational targeting of CBTi, the possibility of mixed group and individual CBTi, and the cost-effectiveness of provision of CBTi by non-specialists.Trial registrationCurrent Controlled Trials ISRCTN78396615.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 56. See the NIHR Journals Library website for further project information.

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Section: Falls and Fear Of Fallingmentioning

confidence: 99%

Section: Secondary Outcome Measuresmentioning

confidence: 99%

Cognitive–behavioural therapy-based intervention to reduce fear of falling in older people: therapy development and randomised controlled trial – the Strategies for Increasing Independence, Confidence and Energy (STRIDE) study

Parry

Bamford

Deary

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

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“…77 However, fall-prevention programs, which usually incorporate an exercise component, have not shown a beneficial effect on depression rating scale scores. 78,79 Although clinically significant depressive symptoms are common in community-dwelling fallers, they tend to be less frequent in clinical trials of fall-prevention programs; this may represent a selection bias in individuals presenting to and participating in these programs or studies. Thus, the apparent lack of benefit of fall-prevention programs on depression may be due to the paucity of clinically depressed persons in the studies that have examined this question.…”

Section: Depression Fear Of Falling Falls Prevention and Exercisementioning

confidence: 99%

The Complex Interplay of Depression and Falls in Older Adults: A Clinical Review

Iaboni

Flint

2013

The American Journal of Geriatric Psychiatry

212

178

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Depression and falls have a significant bidirectional relationship. Excessive fear of falling, which is frequently associated with depression, also increases the risk of falls. Both depression and fear of falling are associated with impairment of gait and balance, an association that is mediated through cognitive, sensory, and motor pathways. The management of depression in fall-prone individuals is challenging, since antidepressant medications can increase the risk of falls, selective serotonin reuptake inhibitors may increase the risk of fragility fractures, and data are lacking about the effect of fall rehabilitation programs on clinically significant depression. Based on the current state of knowledge, exercise (particularly Tai Chi) and cognitive-behavioral therapy should be considered for the first-line treatment of mild depression in older fallers. Antidepressant medications are indicated to treat moderate to severe depression in fall-prone individuals, but with appropriate precautions including low starting dose and slow dose titration, use of psychotropic monotherapy whenever possible, and monitoring for orthostatic hypotension and hyponatremia. To date, there have been no recommendations for osteoporosis monitoring and treatment in individuals prescribed antidepressant medications, beyond the usual clinical guidelines. However, treatment of the older depressed person who is at risk of falls provides the opportunity to inquire about his or her adherence with osteoporosis and fracture-prevention guidelines. KeywordsAntidepressants; depression; falls; fear of falling; fractures One-third of community-dwelling seniors fall each year, with half of these individuals falling more than once. Ten percent of all falls result in a major injury, which can lead to institutionalization and death. 1 Falls often result in a fear of further falls, leading to fearrelated restriction of activities: this activity restriction has been associated with subsequent impairment in balance, mobility, and disability. 2,3 Send correspondence and reprint requests to Alastair

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“…This will facilitate the building of evidence specific for frail older persons and provide research results of easier and quicker implementation to the clinical setting. For example, several trials have already been increasingly implementing multidomain interventions against major geriatric conditions (including physical disability (Opasich et al, 2010;van Hout et al, 2010), Alzheimer's disease (Gillette Guyonnet et al, 2008;Nourhashemi et al, 2010), and falls (Vind et al, 2010)), often adopting standardly-tailored designs (Van Ness et al, 2010). In this context, about one year ago, we started at the Centre Hospitalier Universitaire de Toulouse (Toulouse, France), a novel and innovative clinical setting aimed at evaluating frail non-disabled older persons living in the community.…”

Section: Interventions To Delay Age-related Decline and Frailtymentioning

confidence: 99%

The stress of aging

Cesari

Vellas

Gambassi

2013

Experimental Gerontology

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Effect of a program of multifactorial fall prevention on health-related quality of life, functional ability, fear of falling and psychological well-being. A randomized controlled trial

Abstract: This program of multifactorial fall prevention may have an effect on the physical function item of health-related quality of life in favor of the intervention group, but none on other measures of health-related quality of life, daily function, fear of falling or psychological well-being.

Cited by 24 publications

References 25 publications

Cognitive–behavioural therapy-based intervention to reduce fear of falling in older people: therapy development and randomised controlled trial – the Strategies for Increasing Independence, Confidence and Energy (STRIDE) study

Cognitive–behavioural therapy-based intervention to reduce fear of falling in older people: therapy development and randomised controlled trial – the Strategies for Increasing Independence, Confidence and Energy (STRIDE) study

The Complex Interplay of Depression and Falls in Older Adults: A Clinical Review

The stress of aging

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