Summary of the Study
Objectives
The primary objective of the intervention "A Matter of Balance" was to reduce fear of falling. The secondary aim was to increase physical, social and functional activity. Three hypotheses were tested:
- Fear of falling will decrease in intervention subjects as compared to control subjects.
- Self-efficacy and a sense of control regarding risk of falling will increase in intervention subjects as compared to control subjects.
- Physical and social activity will increase in interventions subjects as compared to control subjects.
The intervention was designed with the aim of implementing and experimentally evaluating the efficacy of this 8-session group intervention in 20 senior housing projects randomly assigned to either receive the group intervention or to serve as controls and dissemination of the program to a broader community of users.
Recruitment and Eligibility of Participants
Recruitment of participants was done through public or publicly subsidized senior housing sites in the greater Boston area. Eligibility criteria included age > 60 years; absence of any major physical or health condition that would interfere with participation in the intervention; English-speaking; and self-reported restriction in activity due to fear of falling.
Description of Intervention Program
The intervention was a group program consisting of eight two-hour sessions scheduled twice a week for four weeks. The techniques used in these group sessions were videotape, lecture, group discussion, mutual problem solving, role playing, exercise training, assertiveness training, home assignments, and behavioral contracting. These early session focused on attempting to change attitudes and self-efficacy prior to attempting changes in actual behavior. This "cognitive restructuring" involved instilling beliefs such as greater perceived control, greater confidence and realistic assessment of failures through use of a documentary-style video presenting older adults expressing fears about falling contrasted to others expressing positive attitudes.
Subsequent program content involved varying activities included training exercises on how to shift to more positive cognitions. The cognitive restructuring component was reinforced by didactive material regarding incidence of falls, risks of falling, skill training in falls prevention and what to do if one falls. The benefits of exercise to improve strength and balance were emphasized. Strength training exercises were included in 6 of the 8 sessions. Assertiveness techniques were also taught in the context of encouraging discussion with health care providers and family about concerns about falling.
The final stage of the intervention was to focus on individual behavior change by correcting home hazards, enforcing the importance of regular physical exercise and trying to get participants to resume a formerly restricted activity.
Figure 1: Study Design
Enrollment into the Fear of Falling study consisted of 434 randomized subjects who expressed concerns about falling and resulting limitation of daily activities. Subjects were recruited from senior housing complexes in the Greater Boston area and started on an 8 session, bi-weekly group intervention.
Results
Recruitment was completed by the end of Year 04. Enrollment and retention rates exceeded original targets. As of the completion of the enrollment period, 434 subjects had been recruited into Fear of Falling intervention. Of those, 399 completed the 6 week follow-up and 343 completed the 6 month follow-up. Eighty percent completed the 12 month follow-up. Nine percent of subjects are non-white and 90% are female.
Major Findings
Immediate effects:
- reduced fear of falling
- increased confidence in managing falls
- increased level of intended activity
- increase mobility control
Long-term effects:
- reduced fear of falling
- increased confidence to manage falls
- increased mobility range
- enhanced social behavior
It was also found that maintenance of program effects would likely be enhanced with one or more booster sessions about three months after the program. There was no increase in falls for participants.
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