Fear of falling in older adults living in the community: a review of multicomponent interventions to inform proportionate care
Ho Ki Chiu, Emma Menzies-GowBackground
Fear of falling among older adults can trigger physical deconditioning because of activity avoidance and is associated with an increased risk of recurrent falls.
Aims
This study aimed to determine whether multicomponent interventions combining physical activity with psychologically informed components reduce fear of falling more than interventions without psychological components in community-dwelling adults aged ≥65 years.
Methods:
A literature search for empirical studies focused on interventions to treat fear of falling in community-dwelling adults >65 years was conducted on Ovid SP, Embase, PubMed and CINAHL. The search yielded six randomised-controlled trials and one pre-post study. Studies were critically appraised using the Critical Appraisal Skills Programme analysis tools and findings were synthesised narratively and organised into themes.
Findings:
Seven empirical studies were identified, encompassing six multicomponent programmes. Each programme combined physical exercise with psychologically informed strategies. The analysis of the studies found significant reductions in fear of falling in patients undergoing the programme. One trial found no additional benefit from combining cognitive behavioural therapy with tai chi compared with tai chi alone.
Conclusions:
Multicomponent programmes involving physical and psychological component are associated with reductions in fear of falling, although implementation may be constrained by resources. A two-tier approach may support proportionate care, with lower-resource interventions offered initially and escalation to Otago exercise combined with formal cognitive behavioural therapy for individuals identified as having severe fear of falling following assessment.
Implications for practice
Community nurses should assess fear of falling alongside physical fall risks and provide individualised interventions. A stepped approach combining exercise and psychologically informed strategies may support proportionate fear of falling management.