Effects of a Multicomponent Cognitive Behavioral Group Intervention on Fear of Falling and Activity Avoidance in Community-Dwelling Older Adults: Results of a Randomized Controlled Trial

OBJECTIVES: To evaluate the effects of a multicomponent cognitive behavioral intervention on fear of falling and activity avoidance in older adults.
DESIGN: Randomized controlled trial.
SETTING: Community-dwelling adults in the Netherlands.
PARTICIPANTS: Five hundred forty adults aged 70 and older who reported fear of falling and fear-induced activity avoidance (280 intervention, 260 control).
INTERVENTION: A multicomponent cognitive behavioral group intervention consisting of eight weekly sessions and a booster session. The sessions were aimed at instilling adaptive and realistic views on falls, reducing fall risk, and increasing activity and safe behavior.
MEASUREMENTS: Data on fear of falling, activity avoidance, concerns about falling, perceived control over falling, and daily activity were collected at baseline and at 2, 8, and 14 months.
RESULTS: At 2 months, there were significant between-group differences in fear of falling (odds ratio (OR)=0.11; P <.001), activity avoidance (OR=0.26; P <.001), concerns about falling (adjusted mean difference=−1.51; P =.02), and daily activity (adjusted mean difference=0.95; P =.01). At 8 months, there were significant between-group differences in all outcomes and at 14 months in fear of falling ( P =.001), perceived control over falling ( P =.001), and recurrent fallers ( P =.02) but not in activity avoidance ( P =.07), concerns about falling ( P =.07), daily activity ( P =.24), or fallers ( P =.08).
CONCLUSION: This multicomponent cognitive behavioral intervention showed positive and durable effects on fear of falling and associated activity avoidance in community-dwelling older adults. Future research should focus on improving intervention uptake and adherence, reaching frailer populations, and determining potential intervention effects on functional outcomes.