Research investigating the impacts of cognitive behavioural therapy and balance programs on fear of falling, funded by Mindgardens.
Falls and fear of falling affect many older people and can impose limitations upon daily activities. Over one third of community dwelling older people fall each year with about 15% of falls being injurious. However, two thirds of older people express a fear of falling during common daily activities, making it more common than falls itself. Fear of falling has been associated with needless restriction in physical and social activities, and subsequent deterioration of health and wellbeing.
Previous research has suggested that fear of falling can be reduced through cognitive behavioural therapy (CBT) and balance exercise programs. However, these face-to-face treatments are resource intensive and not readily accessible to people. Furthermore, the effects of these treatments on fear of falling are small and often do not last beyond the duration of the program.
By utilising technology and providing tailored physical activity guidance we are aiming to reduce a fear of falling in an accessible, efficient and lasting way.
A thee-arm randomised clinical trial will be conducted in 189 community-dwelling older adults with a substantial concern of falling. Participants will be randomly allocated into one of three groups in order to test whether a self-managed CBT intervention, alone or in combination with a graded balance activity program, can reduce concerns about falling in older adults when compared to usual care.
We are collaborating with the Black Dog institute to provide a home-based cognitive behavioural therapy program that addresses a fear of falling. We will also be utilising our cutting-edge balance program StandingTall to provide a graded balance program.
A cutting-edge research study on the effectiveness of a multifaceted program including balance exercise, brain training and cognitive behavioural therapy towards reducing falls.
For our next research study, called “StandingTall-Plus”, we have added a cutting-edge brain training program to our original StandingTall program. The main goal is to help people think faster on their feet during daily activities. We are also collaborating with the Black Dog Institute to offer online cognitive behavioural therapy to address depressive thoughts and low mood.
Falls in older people are often caused by a concomitant decline across three domains: mobility, cognition and affect; or in other words, across moving – thinking – feeling domains. The aim of this trial is to test a program that is individually tailored to various physical, cognitive and affective aspects (as opposed to medical pathologies) by taking a multifactorial profile approach to fall prevention. The use of technology will ensure that is easily accessible to do in the home and engaging to continue over a long period.
A randomised controlled trial will be conducted in 518 community-dwelling older adults at high-risk of falls. All participants will be assessed using a comprehensive test battery of known falls risk factors across physical, cognitive and affective domains. This will then be used to offer each participant a fully tailored program that is suited to their abilities and circumstances. Our primary aim is to reduce the number of falls over a 12-month follow-up period when compared to a health promotion program.
We hypothesise that our program will improve balance, cognitive function and mood, increase physical activity levels and reduce falls in older people, when compared to a health promotion program. This trial addresses a key gap in the understanding of falls interventions and application of personalized medicine and will provide direct evidence about the cost and effectiveness of a tailored multifaceted “best-bet” solution.
An unsupervised, home-based balance exercise program delivered through a tablet computer to prevent falls in older adults.
StandingTall is an engaging balance training program that is designed specifically for use by older people. It was developed using the latest insights in geriatric and translational neuroscience, and employs mobile (tablet) technology to deliver an effective method for improving balance and reducing fall risk. StandingTall includes: effective, individually-tailored exercise prescription to improve balance ability and reduce fall risk in older people; and behavioural change techniques to enhance exercise uptake and long-term adherence, with optimal usability for older people to use independently at home. By combining technology with research in fall prevention, StandingTall provides a radically new solution to support older adults to stay independent for longer and lower healthcare-related costs caused by falls.
The StandingTall team, led by Professor Kim Delbaere, has worked with over 1500 community-dwelling older people since 2015, implementing a home-based balance exercise program delivered through a tablet computer.
A conclusive randomised controlled trial in 503 individuals aged 70+ over 2 years showed a 16% lower falls rate, and a 20% lower rate of injurious falls over 2-years in the intervention group compared to controls. Particularly encouraging were the unprecedented adherence rates. 80% of participants continued to use the program for 6 months, 68% for 1 year and 52% remained to engage with the program for 2 years. Participant response to the program was highly positive, and feedback received is being used to further improve future versions of the program.
The first StandingTall trial has paved the way for future research projects, furthering our understanding of healthy ageing and reducing the risk of falls across the community. A follow-on study, StandingTall-Plus, which added a brain training element, is now at its tail end. We are also testing StandingTall with a psychological program aimed at improving confidence in daily activities that involve balance in our Own Your Balance study. We have had the opportunity to use StandingTall in other research areas including Aboriginal and Māori communities, Parkinson’s Disease, Cardiovascular Health, home and residential aged care, and within a multinational implementation study across select health districts in New South Wales, Victoria, and Northern England.
We are now working with collaborators to redevelop StandingTall to improve our user experience and include a larger range of exercise activities.
StandingTall, is currently being trialled in one of our research projects recruiting new participants. If you are interested in finding out more or wish to express interest, please visit this website.
You can find updates about the program’s progress and fall prevention information on the StandingTall website.
If you would like to read the full results published in the British Medical Journal, you can access the paper at the following website: https://doi.org/10.1136/bmj.n740
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CARLY CHAPLIN Research Assistant : firstname.lastname@example.org
LILLIAN MILES Research Assistant