Exposure Therapy for Fear of Falling in Older Adults

针对老年人跌倒恐惧的暴露疗法

• 批准号: 8080299
• 负责人: Julie L Wetherell
• 金额: $ 26.77万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2013-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8080299
• 关键词: Address; Anxiety; Anxiety Disorders; Behavior Therapy; Cognitive; Cognitive Therapy; Communities; Competence; Data; Data Collection; Drops; Education; Elderly; Elements; Enrollment; Equilibrium; Evaluation; Exercise; Feasibility Studies; Fright; Funding; Goals; Health Services Research; Home environment; Individual; Intervention; Knowledge; Learning; Left; Life; Measurement; Mental Depression; Outcome; Participant; Patients; Pharmaceutical Preparations; Physical activity; Procedures; Public Health; Quality of life; Randomized; Research; Research Project Grants; Resistance; Risk Factors; Safety; Self Efficacy; Testing; Training; clinical practice; data management; design; disability; experience; fall risk; falls; fear of falling; functional disability; patient safety; programs; public health relevance; social

DESCRIPTION (provided by applicant): Approximately 7-14% of older adults living independently in the community, including more than 5% of those who have never fallen, experience moderate to severe fear of falling (FF) and avoid multiple activities as a result. At least 3% avoid leaving their homes or yards due to fear. Excessive FF 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 FF, typically delivered in groups and incorporating cognitive restructuring, education, and exercise, increase fall-related self-efficacy. Avoidance is resistant to treatment, however, and almost 40% of patients enrolled in these interventions drop out. Factors associated with attrition include high levels of FF, 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 those with severe fear and avoidance who are most likely to drop out of traditional FF programs. Yet despite the similarities between FF and anxiety disorders, and the fact that the most effective behavioral treatment for most anxiety disorders is exposure therapy, no FF interventions to date have incorporated an exposure component. Overall, the existing research suggests the need for an intervention that combines exposure therapy with other elements that have proven effective for reducing FF. Such an intervention must also be sensitive to issues of patient safety. The proposed project aims to develop an in-home, physical therapist-delivered intervention, "Activity, Balance, Learning, and Exposure" (ABLE), that integrates exposure therapy and cognitive restructuring with exercise, education about fall risks, a home safety evaluation, and a medication review for older adults with excessive and disabling FF. After developing and pilot testing this new intervention with 20 older adults with FF, we propose to conduct a feasibility study in which 40 patients are randomly assigned to ABLE or an education control condition. By developing and testing a new intervention to address a prevalent geriatric anxiety condition with potentially devastating public health consequences, this line of research has the promise to fill a major gap in knowledge and clinical practice. PUBLIC HEALTH RELEVANCE: Excessive fear of falling (FF) leads to decreased physical activity, disability, loss of independence, depression, anxiety, reduced social engagement, poor quality of life, and increased fall risk in older adults. Yet despite the similarities between FF and anxiety disorders, and the fact that the most effective behavioral treatment for most anxiety disorders is exposure therapy, no FF interventions to date have incorporated an exposure component. This R34 application proposes to develop an in-home, physical therapist-delivered intervention integrating exposure therapy and cognitive restructuring with exercise, education about fall risks, a home safety evaluation, and a medication review for older adults with excessive and disabling fear of falling.

描述（由申请人提供）：大约7-14％的老年人在社区中独立居住，其中包括从未跌倒的人中有5％以上，经历了中度至严重的恐惧（FF）（FF），因此避免了多次活动。至少有3％的人避免由于恐惧而离开家或院子。过度的FF导致体育锻炼，残疾，独立性丧失，抑郁，焦虑，社交参与度减少和生活质量差。它也是跌倒的主要独立风险因素。针对FF的干预措施通常分组进行，并纳入认知重组，教育和运动，并提高与跌倒有关的自我效能。但是，避免对治疗有抵抗力，几乎40％的患者参加了这些干预措施。与流失相关的因素包括高水平的FF，表明最需要此类程序的个人是最有可能过早撤回的个人。这些数据表明，应避免在治疗中避免，并且应设计干预措施来吸引那些最有可能退出传统FF计划的严重恐惧和回避的人。然而，尽管FF和焦虑症之间有相似之处，而大多数焦虑症最有效的行为治疗方法是暴露疗法，但迄今为止，尚无FF干预措施纳入了暴露成分。总体而言，现有的研究表明，需要进行干预，将暴露疗法与其他事实证明有效减少FF有效的元素相结合。这种干预也必须对患者安全问题敏感。拟议的项目旨在开发一个由纳入物理治疗师提供的干预措施，“活动，平衡，学习和暴露”（ABL），将暴露疗法和认知重组与运动，有关跌倒风险的教育，家庭安全评估以及对老年人过度和失业FF的药物审查的教育进行整合。在与20名患有FF的老年人进行了新的干预测试和试点测试之后，我们建议进行一项可行性研究，其中40名患者被随机分配到ABLE或教育控制条件。通过开发和测试新的干预措施，以解决具有潜在毁灭性公共卫生后果的普遍的老年焦虑症状，这一研究有望填补知识和临床实践的重大空白。 公共卫生相关性：过度害怕跌倒（FF）导致体育锻炼，残疾，独立性丧失，抑郁，焦虑，社交参与度减少，生活质量差以及老年人的跌倒风险增加。然而，尽管FF和焦虑症之间有相似之处，而大多数焦虑症最有效的行为治疗方法是暴露疗法，但迄今为止，尚无FF干预措施纳入了暴露成分。该R34的应用建议开发出纳入物理治疗师的干预措施，将暴露疗法和认知重组与运动，有关秋季风险的教育，家庭安全评估以及对过度且残疾的恐惧跌倒的老年人进行药物审查。