title: Effects of the implementation of an evidence-based program to manage concerns about falls in older adults.
abstract: OBJECTIVE
  Concerns about falls and related activity avoidance are common in older people. A multicomponent program reduced these concerns and increased daily activity among older people in a randomized controlled trial. This study explored whether the effects and acceptability of the program maintain after its implementation into home care organizations.
  
  
  METHODS
  In a pretest-post-test study, the effects and acceptability of the 8-week cognitive behavioral program was evaluated in 125 community-living older adults. Data on concerns about falls, related avoidance behavior, falls, fall-related medical attention, feelings of loneliness and anxiety, and symptoms of depression were collected prior to the start of the program and at 2 and 4 months.
  
  
  RESULTS
  Pretest-post-test analyses showed significant improvements at 4 months for concerns about falls, activity avoidance, number of falls in the past 2 months, feelings of anxiety, and symptoms of depression. No significant differences were shown for daily activity, feelings of loneliness, and fall-related medical attention.
  
  
  CONCLUSIONS
  After implementation in home care organizations, the program reduced concerns about falls, avoidance behavior, and falls in community-living older adults. These findings are highly consistent with the outcomes of a previously performed randomized controlled trial, indicating that the program can be successfully implemented in practice. Further dissemination of the program is recommended to reduce concerns about falls and related activity avoidance in community-living older people.
authors.affiliation: *Address correspondence to G. A. R. Zijlstra, Maastricht University, Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, P.O. Box 616, 6200 MD Maastricht, The Netherlands. E-mail: r.zijlstra@maastrichtuniversity.nl.
authors.forename: G A Rixt
authors.initials: GA
authors.lastname: Zijlstra
authors.forename: Jolanda C M
authors.initials: JC
authors.lastname: van Haastregt
authors.forename: Monique F M T
authors.initials: MF
authors.lastname: Du Moulin
authors.forename: Martha C
authors.initials: MC
authors.lastname: de Jonge
authors.forename: Agnes
authors.initials: A
authors.lastname: van der Poel
authors.forename: Gertrudis I J M
authors.initials: GI
authors.lastname: Kempen
mesh_terms: D000058:Accidental Falls; D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000523:psychology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000523:psychology; D055317:Evidence-Based Practice; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D010342:Patient Acceptance of Health Care; D020377:Self Efficacy
keywords: Accidental falls; Evaluation; Fear of falling; Home care services; Intervention; Nursing