title: Effectiveness of a home-based cognitive behavioral program to manage concerns about falls in community-dwelling, frail older people: results of a randomized controlled trial.
abstract: BACKGROUND
  Concerns about falls are common among older people. These concerns, also referred to as fear of falling, can have serious physical and psychosocial consequences, such as functional decline, increased risk of falls, activity restriction, and lower social participation. Although cognitive behavioral group programs to reduce concerns about falls are available, no home-based approaches for older people with health problems, who may not be able to attend such group programs are available yet. The aim of this study was to assess the effectiveness of a home-based cognitive behavioral program on concerns about falls, in frail, older people living in the community.
  
  
  METHODS
  In a randomized controlled trial in the Netherlands, 389 people aged 70 years and older, in fair or poor perceived health, who reported at least some concerns about falls and related activity avoidance were allocated to a control (n = 195) or intervention group (n = 194). The intervention was a home-based, cognitive behavioral program consisting of seven sessions including three home visits and four telephone contacts. The program aims to instill adaptive and realistic views about fall risks via cognitive restructuring and to increase activity and safe behavior using goal setting and action planning and was facilitated by community nurses. Control group participants received usual care. Outcomes at 5 and 12 months follow-up were concerns about falls, activity avoidance due to concerns about falls, disability and falls.
  
  
  RESULTS
  At 12 months, the intervention group showed significant lower levels of concerns about falls compared to the control group. Furthermore, significant reductions in activity avoidance, disability and indoor falls were identified in the intervention group compared with the control group. Effect sizes were small to medium. No significant difference in total number of falls was noted between the groups.
  
  
  CONCLUSIONS
  The home-based, cognitive behavioral program significantly reduces concerns about falls, related activity avoidance, disability and indoor falls in community-living, frail older people. The program may prolong independent living and provides an alternative for those people who are not able or willing to attend group programs.
  
  
  BACKGROUND
  ClinicalTrials.gov, NCT01358032. Registered 17 May 2011.
authors.affiliation: Department of Health Services Research - Focusing on Chronic Care and Ageing, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. t.dorresteijn@maastrichtuniversity.nl.
authors.forename: Tanja A C
authors.initials: TA
authors.lastname: Dorresteijn
authors.affiliation: Department of Health Services Research - Focusing on Chronic Care and Ageing, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. r.zijlstra@maastrichtuniversity.nl.
authors.forename: G A Rixt
authors.initials: GA
authors.lastname: Zijlstra
authors.affiliation: Department of Methodology and Statistics, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. ton.ambergen@maastrichtuniversity.nl.
authors.forename: Antonius W
authors.initials: AW
authors.lastname: Ambergen
authors.affiliation: Neuroscience Research Australia, University of New South Wales, P.O. Box 1165, Randwick, NSW, 2031, Australia. k.delbaere@neura.edu.au.
authors.forename: Kim
authors.initials: K
authors.lastname: Delbaere
authors.affiliation: Research Group Health Psychology, University of Leuven, Tiensestraat 102, 3000, Leuven, Belgium. Johannes.Vlaeyen@ppw.kuleuven.be.|Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. Johannes.Vlaeyen@ppw.kuleuven.be.
authors.forename: Johan W S
authors.initials: JW
authors.lastname: Vlaeyen
authors.affiliation: Department of Health Services Research - Focusing on Chronic Care and Ageing, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. g.kempen@maastrichtuniversity.nl.
authors.forename: Gertrudis I J M
authors.initials: GI
authors.lastname: Kempen
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005239:Fear / Q000523:psychology; D005260:Female; D016330:Frail Elderly / Q000523:psychology*; D015577:Geriatric Assessment / Q000379:methods; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D057187:Independent Living / Q000523:psychology*; D008297:Male; D016743:Mental Competency; D009426:Netherlands; D015397:Program Evaluation; D040242:Risk Reduction Behavior