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.