Physical Therapists May Ease Fear of Falling in the Elderly

LOS ANGELES — A combination of physical therapy and cognitive-behavioral therapy (CBT) can reduce the severe fear of falls in older adults and make them less likely to avoid activities because of fear, new research suggests.

Fear of falling is commonplace in older adults, said study author Julie Loebach Wetherell, PhD, associate psychiatry professor in residence at the University of California, San Diego.

Approximately 10% of older adults living independently in the community, including more than 5% of those who have never fallen, experience moderate to severe fear of falling and avoid multiple activities as a result.

"There are effective programs to help people avoid falls, but the people who are most afraid won't go to those," Dr. Wetherell told Medscape Medical News. "For some people, the fear is really excessive — they have a lot of fear, but they don't have reason to be afraid."

The findings were presented here at the American Association for Geriatric Psychiatry (AAGP) 2013 Annual Meeting.

Preventing Social Isolation

The study examined 40 individuals older than 65 years with a severe fear of falling who had a score of >27 on the Falls Efficacy Scale-International (FES-I) but who did not have a high risk of falling.

Participants were split into 2 groups and were treated for 8 sessions.

One group received falls education, and the other received a combination of an exercise program and exposure-based CBT.

Investigators found that the therapy had significant effects on fear (F = 5.45, P = .01) and avoidance (F = 4.08, P = .02), and that it did not have an effect on the other variables. The CBT and exercise therapy did not increase the number of falls.

The therapists were rated on their ability to perform exposure therapy; 11 out of 12 of them were rated 4/5 or 5/5.

"The most important thing was we reduced fear but increased participation in valued activities," Dr. Wetherell explained. "People might say, 'I'm not going to go to church because I might fall getting into the pews.' The fear keeps them from doing the activities they enjoy and keeps them from getting out."

Clinically Meaningful?

Dr. Wetherell added that she was surprised by how well the CBT worked with the geriatric patients and that she was impressed with the point of view of the physical therapists doing the therapy.

"Physical therapists see the world in a different but complementary way. We were able to see real effects in the participants, so this was a very rewarding study to do," Dr. Wetherell said.

Commenting on the study for Medscape Medical News, Susan Friedman, MD, MPH, associate professor of medicine at the University of Rochester School of Medicine and Dentistry in New York, said a varied approach is necessary to treat the falling phobia.

"As with many syndromes in older adults, the causes are often multifactorial, so using a multifaceted approach certainly has merit," said Dr. Friedman, who was not involved in the research.

However, she cautioned that the study was small, "so it is hard to know whether the higher incidence of falls would translate into an outcome that is clinically meaningful."

The investigators plan to continue the study, training home healthcare physical therapists to do the work with their patients.

"We want to take the study into the real world," she said.

Dr. Wetherell and Dr. Friedman report no relevant financial relationships.

American Association for Geriatric Psychiatry (AAGP) 2013 Annual Meeting. Abstract NR 37. Presented March 15, 2013.