Department of Health Care and Nursing Science, Faculty of Health, Medicine and Life Sciences, CAPHRI-School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
J Am Geriatr Soc. 2009 Nov;57(11):2020-8. doi: 10.1111/j.1532-5415.2009.02489.x. Epub 2009 Sep 28.
To evaluate the effects of a multicomponent cognitive behavioral intervention on fear of falling and activity avoidance in older adults.
Randomized controlled trial.
Community-dwelling adults in the Netherlands.
Five hundred forty adults aged 70 and older who reported fear of falling and fear-induced activity avoidance (280 intervention, 260 control).
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.
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.
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).
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.
评估多组分认知行为干预对老年人跌倒恐惧和活动回避的影响。
随机对照试验。
荷兰社区居住的成年人。
540 名年龄在 70 岁及以上、报告有跌倒恐惧和因恐惧而回避活动的成年人（280 名干预组，260 名对照组）。
多组分认知行为小组干预，包括 8 次每周的课程和一次强化课程。这些课程旨在灌输对跌倒的适应性和现实性看法，降低跌倒风险，并增加活动和安全行为。
在基线和 2、8 和 14 个月时收集跌倒恐惧、活动回避、对跌倒的担忧、对跌倒的控制感和日常活动的数据。
在 2 个月时，两组间在跌倒恐惧（优势比（OR）=0.11；P<.001）、活动回避（OR=0.26；P<.001）、对跌倒的担忧（调整后的平均差异=-1.51；P=.02）和日常活动（调整后的平均差异=0.95；P=.01）方面有显著的组间差异。在 8 个月时，所有结局均有显著的组间差异，在 14 个月时，跌倒恐惧（P=.001）、对跌倒的控制感（P=.001）和复发性跌倒者（P=.02）有显著的组间差异，但活动回避（P=.07）、对跌倒的担忧（P=.07）、日常活动（P=.24）或跌倒者（P=.08）没有显著的组间差异。
这种多组分认知行为干预对社区居住的老年人的跌倒恐惧和相关的活动回避有积极和持久的影响。未来的研究应侧重于提高干预的参与度和依从性，覆盖到更脆弱的人群，并确定潜在的干预对功能结果的影响。
