Clinical question
How effective and safe is cognitive behavioural therapy (CBT) for reducing fear of falling in older people living in the community?
Bottom line
Compared with sham treatment or treatment as usual, CBT with and without exercise interventions probably reduces fear of falling in older people living in the community immediately after the intervention (moderate-certainty evidence). Improvements may be sustained up to 6 months after the intervention (very-low-certainty evidence) and probably are sustained beyond 6 months (moderate-certainty evidence).
Caveat
The effect sizes were small and potentially not clinically relevant. This may be a result of the underlying cause of the fear. If the concerns reflect a realistic and appropriate appraisal of one’s risk of falling, these people could well be treated using structured exercise and balance training programmes. However, if the concerns are indicative of maladaptive processes, it becomes essential to suggest psychological interventions such as CBT, along with exercise, to overcome the fear.
Context
Fear of falling is a lasting concern about falling that leads to an individual avoiding activities that they remain capable of performing. It is a common condition among older adults and may occur independently of previous falls. CBT, a talking therapy that helps change dysfunctional thoughts and behaviour, with or without exercise, may reduce fear of falling. For example, it may reduce catastrophic thoughts related to falls and modify dysfunctional behaviour.
Cochrane Systematic Review
Lenouvel E, et al. Cognitive behavioural therapy (CBT) with and without exercise to reduce fear of falling in older people living in the community. Cochrane Database Syst Rev 2023;11:CD014666. This review contains 12 trials with a total of 3197 participants.
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