Mr. Tai-Wa LIU is a Senior Lecturer at the Open University of Hong Kong. In this blog, he shares a recent Age and Ageing publication looking at the effectiveness of cognitive behavioral therapy in reducing fear of falling and improving balance among older people.
Whenever you are afraid of losing balance in doing something, it means you might have fear of falling. For example, a baby first tries to stand on its own, or a kid learns cycling. We all have had this fear of falling, especially in situations where we might get hurt or be embarrassed in public. This fear is normal and self-protective in nature, but the reality is that older people with excessive levels of this fear could lead to restricted activity of daily living, limited social participation and physical deconditioning. Eventually, it could lead to increased fall risks and form the vicious cycle of “fear of falling and actual falls”.
For some reasons, such as deteriorated physical ability or previous fall experiences, fear of falling is common among older people. The origin of this excessive level of fear is believed to be psychological and stems from the impaired balance confidence and over-pessimistic view regarding the consequences of falls. Conventionally, physiotherapists adopt physical interventions to improve the balance ability of older people in turn to build up their balance confidence.
In the recent two decades, researchers advocated the use of psychological intervention, such as the cognitive behavioral therapy (CBT), as an alternative to work against the fear of falling. While physical interventions aim at improving the sense of mastery of balance to reduce fear of falling, CBT focuses on identifying and modifying balance and fall related maladaptive thoughts and behaviors. Several clinical trials have demonstrated the effects of using CBT alone or combined with exercise therapy.
To synthesize the previous findings, we performed a systematic review and meta-analysis to evaluate the effects of CBT in reducing fear of falling and improving balance among older people. Encouragingly, we found that with the elements of cognitive restructuring, personal goal setting and promotion of physical activities, CBT could reduce fear of falling with immediate and retention effects up to 12 months and enhance balance at six months post intervention among older people.
Our findings revealed that a talking therapy, CBT, is effective and is a feasible way to reduce fear of falling and improve balance among older people. This may allow clinicians considering a mix use of talking and exercise therapy to achieve better therapeutic outcomes.
Read Cognitive behavioural therapy for fear of falling and balance among older people: a systematic review and meta-analysis in Age and Ageing.