Interventions to Reduce Fear of Falling in Community-Living Older People: A Systematic Review

G. A. Rixt Zijlstra, MSc; Jolanda C. M. van Haastregt, PhD; Erik van Rossum, PhD; Jacques Th. M. van Eijk, PhD; Lucy Yardley, PhD; Gertrudis I. J. M. Kempen, PhD

Disclosures

J Am Geriatr Soc. 2007;55(4):603-615. 

In This Article

Abstract and Introduction

Abstract

The objective was to assess which interventions effectively reduce fear of falling in community-living older people. An extensive search for relevant literature comprised a database search of PubMed, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials; expert consultation; and manually searching reference lists from potentially relevant papers. Randomized, controlled trials that assessed fear of falling in community-living older people were included. Two independent reviewers extracted data from full papers on study characteristics, methodological quality, outcomes, and process characteristics of the intervention. The search identified 599 abstracts, and 19 papers met the inclusion criteria. Seven of those papers were identified using expert consultation. Fifty-five percent of all validity items and 39% of process characteristic items were fulfilled across the 19 trials. Twelve of the 19 papers were of higher methodological quality. In 11 of these trials, fear of falling was lower in the intervention group than in the control group. Interventions that showed effectiveness were fall-related multifactorial programs (n=5), tai chi interventions (n=3), exercise interventions (n=2), and a hip protector intervention (n=1). Three of these interventions explicitly aimed to reduce fear of falling. Several interventions, including interventions not explicitly aimed at fear of falling, resulted in a reduction of fear of falling in community-living older people. Limited but fairly consistent findings in trials of higher methodological quality showed that home-based exercise and fall-related multifactorial programs and community-based tai chi delivered in group format have been effective in reducing fear of falling in community-living older people.

Introduction

Approximately half of the community-living older population experiences fear of falling.[1,2,3,4] Because of a lack of studies that allow conclusions regarding causality in the research field of fear of falling, little evidence is available on what causes this fear. The experience of a recent fall is a known cause for the development of fear of falling, but fear of falling is also prevalent in nonfallers.[5] Therefore, it is plausible that factors related to the process of aging, such as physical frailty, contribute to the development of fear of falling as well. Several studies have indicated that people who are afraid of falling appear to enter a debilitating spiral of loss of confidence, restriction of physical activities and social participation, physical frailty, falls, and loss of independence.[4,5,6,7,8,9,10] In addition to the adverse consequences of fear of falling for those suffering from it, there are consequences for the public expenditure, because healthcare utilization increases.[9] It is therefore important to reduce fear of falling by reversing the downward spiral by intervening in factors in the spiral, such as increasing physical functioning,[10] or in predictors of those factors, such as improved medication use.[5]

In the past decade, a substantial number of studies have assessed the effectiveness of interventions on fear of falling. In these studies, interventions explicitly aimed and interventions not explicitly aimed at reducing fear of falling were evaluated, but an overview of these studies is lacking. Insight into which kind of interventions effectively reduce or prevent an increase in fear of falling in older people and whether these interventions were conducted according to protocol is essential for implementation and future research. Therefore, a systematic review was conducted to assess the methodological quality of trials evaluating interventions that could reduce fear of falling in community-living older people, the kind of interventions that effectively reduce fear of falling in this population, and the extent to which process characteristics of these interventions are described. Because well-conducted, randomized, controlled trials are considered the most appropriate studies to assess the effectiveness of interventions,[11] only randomized, controlled trials were included.

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