Exposure Therapy for Fear of Falling in Older Adults
|Fear of Falling||Behavioral: Activity, Balance, Learning, and Exposure Behavioral: Fall prevention education||Phase 2|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Treatment
|Official Title:||Exposure Therapy for Fear of Falling in Older Adults|
- Fear of falling [ Time Frame: 2 months (primary) ]Fear of Falling will be measured using the Falls Efficacy Scale - International (FES-I), a version of the most widely used measure of falls self-efficacy. Assessments are performed at baseline, 1 month, 2 months (end of intervention - primary outcome point). We will also collect data at 5 months (3 month follow-up) and 8 months (6 month follow-up).
- Activity avoidance [ Time Frame: 2 months (primary) ]Activity avoidance will be assessed using a modified version of the Activity Card Sort, a set of photographs of older adults engaged in various activities that is used in rehabilitation settings. Assessments are performed at baseline, 1 month, 2 months (end of intervention - primary outcome point), 5 months (3 month follow-up), and 8 months (6 month follow-up).
- Physical activity - self-report [ Time Frame: 2 months (primary) ]Self-reported physical activity will be assessed with the Physical Activities Scale for the Elderly (PASE).
- Physical activity [ Time Frame: 2 months ]Accelerometers will also be used to measure physical activity. Patients in the study will wear an Actigraph battery-operated activity monitor worn around the waist to measure physical activity continuously during waking hours. Assessment will occur before and after the intervention.
- Physical Performance [ Time Frame: 2 months (primary) ]Physical performance will be measured using the Short Physical Performance Battery (SPPB), which includes measured of balance, walking, and lower body strength.
- Quality of Life [ Time Frame: 2 months (primary) ]Quality of life will be measured with the Quality of Life Inventory (QOLI).
- Depressive and Anxiety symptoms [ Time Frame: 2 months (primary) ]Depressive and anxiety symptoms will be assessed with the Hospital Anxiety and Depression Scale (HADS), a 14-item self-report measure with subscales assessing depressive and anxiety symptoms that does not include somatic items such as fatigue that can be associated with aging or medical conditions rather than psychiatric disorders.
- Agoraphobic Avoidance [ Time Frame: 2 months (primary) ]Agoraphobic avoidance will be measured using the 5-item agoraphobia subscale of the Fear Questionaire (FQ).
- Post Traumatic Stress Disorder Symptoms [ Time Frame: 2 months (primary) ]Post Traumatic Stress Disorder (PTSD) symptoms will be measured with the 6-item abbreviated form of the PTSD Checklist (PCL).
- Fear of Falling [ Time Frame: 2 months (primary) ]Fear of falling will be measured using the Falling Questionaire, a 15-item survey assessing attitudes towards falling.
- Avoidance [ Time Frame: 2 months (primary) ]Avoidance of activities will be measured using the Fear of Falling Avoidance-Behavior Questionaire (FFABQ), a 14-item measure to assess avoidance behaviors.
- Falls [ Time Frame: 2 months (primary) ]Recorded on fall diaries provided to investigators throughout the 2-month intervention and 6-month follow-up period.
|Study Start Date:||August 2010|
|Study Completion Date:||August 2013|
|Primary Completion Date:||August 2013 (Final data collection date for primary outcome measure)|
Active Comparator: Education about falls
In-person education about falls with a health educator.
Behavioral: Fall prevention education
In-home, individual sessions with a health educator regarding fall prevention
Experimental: Activity, Balance, Learning, and Exposure
Intervention combining medication review, exercise, home safety evaluation, and exposure therapy.
Behavioral: Activity, Balance, Learning, and Exposure
An in-home intervention that integrates exposure therapy with cognitive restructuring, exercise, and a home safety evaluation.
Approximately 7-14% of older adults living independently in the community, including more than 5% of those who have never experienced a fall, experience moderate to severe fear of falling. Fear of falling leads to decreased physical activity, disability, loss of independence, depression, anxiety, reduced social engagement, and poor quality of life. It is also a major independent risk factor for falls.
Interventions targeting fear of falling, typically delivered in groups and incorporating cognitive restructuring, education, and exercise, have been shown to increase fall-related self-efficacy. Avoidance is resistant to treatment, however, and more than one-third of patients enrolled in these interventions drop out. Factors associated with attrition include high levels of fear and avoidance, indicating that the individuals most in need of such programs are those most likely to withdraw prematurely. These data suggest that avoidance should be targeted in treatment, and that interventions should be designed to reach very fearful individuals who are most likely to drop out of traditional fear of falling programs.
Participation in this study will last up to 8 months. Participants will be randomly assigned to receive either the ABLE intervention or an education control condition. The control condition will consist of in-person education about falls to control for the time and attention provided in the ABLE arm.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01609322
|United States, California|
|University of California San Diego|
|San Diego, California, United States, 92103|
|Principal Investigator:||Julie Wetherell, PhD||UCSD|