Exposure Therapy for Fear of Falling in Older Adults

NCT ID: NCT01609322

Last Updated: 2013-12-23

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

40 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-08-31

Study Completion Date

2013-08-31

Brief Summary

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This project aims to test the efficacy of an in-home intervention, "Activity, Balance, Learning, and Exposure" (ABLE), which integrates exposure therapy with cognitive restructuring, exercise, and home safety evaluation for older adults with excessive fear of falling. The intervention will be conducted by a licensed physical therapist. A control intervention will be conducted by a health educator. The specific aims of the study are to test the feasibility, acceptability, tolerability, and safety of the ABLE intervention.

Detailed Description

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Approximately 7-14% of older adults living independently in the community, including more than 5% of those who have never experienced a fall, experience moderate to severe fear of falling. Fear of falling leads to decreased physical activity, disability, loss of independence, depression, anxiety, reduced social engagement, and poor quality of life. It is also a major independent risk factor for falls.

Interventions targeting fear of falling, typically delivered in groups and incorporating cognitive restructuring, education, and exercise, have been shown to increase fall-related self-efficacy. Avoidance is resistant to treatment, however, and more than one-third of patients enrolled in these interventions drop out. Factors associated with attrition include high levels of fear and avoidance, indicating that the individuals most in need of such programs are those most likely to withdraw prematurely. These data suggest that avoidance should be targeted in treatment, and that interventions should be designed to reach very fearful individuals who are most likely to drop out of traditional fear of falling programs.

Participation in this study will last up to 8 months. Participants will be randomly assigned to receive either the ABLE intervention or an education control condition. The control condition will consist of in-person education about falls to control for the time and attention provided in the ABLE arm.

Conditions

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Fear of Falling

Keywords

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fear of falling agoraphobia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Education about falls

In-person education about falls with a health educator.

Group Type ACTIVE_COMPARATOR

Fall prevention education

Intervention Type BEHAVIORAL

In-home, individual sessions with a health educator regarding fall prevention

Activity, Balance, Learning, and Exposure

Intervention combining medication review, exercise, home safety evaluation, and exposure therapy.

Group Type EXPERIMENTAL

Activity, Balance, Learning, and Exposure

Intervention Type BEHAVIORAL

An in-home intervention that integrates exposure therapy with cognitive restructuring, exercise, and a home safety evaluation.

Interventions

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Activity, Balance, Learning, and Exposure

An in-home intervention that integrates exposure therapy with cognitive restructuring, exercise, and a home safety evaluation.

Intervention Type BEHAVIORAL

Fall prevention education

In-home, individual sessions with a health educator regarding fall prevention

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

1. Age 65 years old or older.
2. Severe fear as measured by a brief FES-I score \> or = 13.
3. Low to moderate actual risk of falls as set out in Lamb et al. (2008).
4. Distress or functional impairment due to fear of falling.
5. Approval from the patient's primary health care provider.

Exclusion Criteria

1. Medical condition that would interfere with the safe conduct of the intervention or compromise study participation.
2. Bedbound, wheelchair-dependent, paralyzed in the lower extremities, or requiring the assistance of another person to transfer, walk, or perform intervention exercises within the home.
3. Dementia or cognitive impairment as measured by a score above 10 on the Blessed Orientation Memory Test.
4. Corrected visual acuity \< 20/60.
5. Current participation in psychotherapy or professional rehabilitation services (PT, OT) or in the process of being referred or evaluated for such services. Patients who develop a need for such services during their participation will complete an assessment prior to commencing the outside therapy but will be allowed to continue in the study.
6. Active suicidal ideation
7. Lifetime diagnosis of bipolar I or II disorder or any psychotic disorder.
8. Alcohol or other substance abuse or dependence within six months.
9. Psychosocial factors that would compromise study participation (e.g. homelessness, no telephone).
10. History of osteoporotic fracture.
11. Experiencing 3 or more falls in the past year.
12. Body Mass Index of 17.0 or under.
13. Significant orthostasis, defined as a 20 point or greater difference between seated and standing blood pressure, either systolic or diastolic.
Minimum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute of Mental Health (NIMH)

NIH

Sponsor Role collaborator

University of California, San Diego

OTHER

Sponsor Role lead

Responsible Party

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Julie Wetherell

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Julie Wetherell, PhD

Role: PRINCIPAL_INVESTIGATOR

UCSD

Locations

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University of California San Diego

San Diego, California, United States

Site Status

Countries

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United States

References

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Wetherell JL, Bower ES, Johnson K, Chang DG, Ward SR, Petkus AJ. Integrated Exposure Therapy and Exercise Reduces Fear of Falling and Avoidance in Older Adults: A Randomized Pilot Study. Am J Geriatr Psychiatry. 2018 Aug;26(8):849-859. doi: 10.1016/j.jagp.2018.04.001. Epub 2018 Apr 12.

Reference Type DERIVED
PMID: 29754811 (View on PubMed)

Other Identifiers

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R34MH086668

Identifier Type: NIH

Identifier Source: secondary_id

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R34MH086668

Identifier Type: NIH

Identifier Source: org_study_id

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