Alongside the several Cochrane reviews of ways to prevent falls in older people, a new review of the effects of cognitive behavioural therapy on their fear of falling was added in November 2023. Here's lead author, Eric Lenouvel from the University Hospital of Psychiatry in Bern Switzerland, to tell us more.
Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. Alongside the several Cochrane reviews of ways to prevent falls in older people, a new review of the effects of cognitive behavioural therapy on their fear of falling was added in November 2023. Here's lead author, Eric Lenouvel from the University Hospital of Psychiatry in Bern Switzerland, to tell us more.
Eric: Fear of falling, or FoF, is a lasting concern about falling that makes an older person avoid activities that they remain capable of performing. It's common and may occur even if the person has not experienced a previous fall. The main approaches to treat FoF are exercise and cognitive behavioural therapy, CBT for short.
Exercise interventions are planned, structured, repetitive, and purposeful physical activities to improve or maintain components of physical fitness that also target related health outcomes such as prevention of falls. While CBT is a talking therapy that helps change dysfunctional thoughts and behaviour and, when used with and without exercise, might reduce FoF; for example by reducing catastrophic thoughts related to falls and modifying dysfunctional behaviour. Many interventions combine CBT and exercise and our review looks at the effects of these combined interventions and of CBT when used alone and found small benefits.
We aimed to assess the effects on FoF in older people living in the community. We searched several electronic databases and consulted experts who may have done studies and found 12 relevant studies. We were able to use 11 of these in statistical analyses, with a total of nearly 2400 people, who had a mean age varying from 73 to 83 years. The therapy (CBT or dummy treatment) was given at a frequency that ranged from three times per week to once per month, over a period of eight to 48 weeks. Added up, the treatments lasted between six and 156 hours and most interventions were given in groups of five to ten participants, but one study had group sizes of up to 25.
In regard to the results, we found that CBT with and without exercise interventions probably reduces fear of falling in older people living in the community by a small amount once treatment has ended, with these small effect improvements being sustained during the first six months after treatment has finished, and probably lasting beyond six months.
One of the main reasons why the effect sizes are so small, is that most studies in this review did not disentangle what we call maladaptive and non-maladaptive processes. For example, in a comment on the recent World Fall Guidelines, it was noted that concerns that arise from a realistic and appropriate appraisal of one's risk of falling could be well treated by just using structured exercise and balance training programs. However, if the concerns indicate maladaptive processes, it becomes essential to suggest psychological interventions, such as CBT, along with the exercise.
We rated our certainty of the evidence as moderate and, improving on this, will require more studies, which are more similar in how they treat and measure fear of falling. We'd also like to see more research that includes older people living in assisted living facilities and nursing homes and special populations with different diseases or comorbidities, and which considers gender-specific issues with respect to therapy initiation or treatment effects.
Mike: To read more about the current research and to watch for the first update of this new review if new research becomes available, you can find it online. Just go to Cochrane Library dot com and search 'CBT and fear of falling' to see a link to it.