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Overcoming the fear of falling

Date: 02 August 2016

New research, published in Health Technology Assessment has found that cognitive behavioural therapy can help reduce fear of falling in older people.

Many older people, including those who have never fallen, find themselves fearful of falling. With up to 85 percent of older people who have had a fall finding themselves fearful of falling again. This loss of confidence often leads to activity avoidance, social isolation and frailty.

Usual care is provided by falls services made up of occupational therapists, physiotherapists and nurses who provide exercise and safety advice. Talking treatments like cognitive behavioural therapy (CBT) may help people to overcome this fear, but little research has been done in this area.

Researchers, led by Dr Steve Parry of the University of Newcastle upon Tyne, have developed a new CBT intervention to help. The researchers wanted to find out how effective this form of therapy is at helping to reduce fear, but also how well received it was and if it was cost-effective.

The form of CBT they developed was delivered by non-specialist Health Care Assistants, rather than specialist staff. It took into account health conditions, relationships and social factors that were discovered by assessment interviews.

After the intervention had been developed, 415 adults aged over 60 who had a fear of falling were recruited to the study. One group received usual care and another group received usual care plus the CBT intervention delivered by Healthcare Assistants. Eight weekly sessions were given in the home with a refresher at six months.

The research team found that people who had received CBT in addition to usual care showed a significant reduction in fear and depression after one year. The results also indicated that whilst levels of fear had fallen, other factors such as social participation, loneliness and measures of physical function remained the same. Whilst Healthcare Assistants effectively facilitated the sessions and they were well received, the intervention was not found to be cost-effective.

“Past research hasn’t considered the role of CBT in helping with fear of falling” commented Dr Parry. “Our research has shown that it is highly effective at helping many people and restoring their confidence. However, where there are other health factors, more help may be needed to combat issues like loneliness and quality of life.”

Read the full report in the NIHR Journals Library.