Exposure Therapy for Fear of Falling in Older Adults

描述（由申请人提供）：大约7-14%的独立生活在社区的老年人，包括超过5%从未跌倒过的老年人，经历中度至重度的跌倒恐惧（FF），并因此避免多种活动。至少3%的人由于害怕而避免离开他们的家或院子。过度的FF会导致身体活动减少、残疾、独立性丧失、抑郁、焦虑、社会参与减少和生活质量下降。这也是导致跌倒的一个主要独立风险因素。针对FF的干预措施，通常以小组为单位，结合认知重组、教育和锻炼，可以提高跌倒相关的自我效能感。然而，回避对治疗有抵抗性，几乎40%参加这些干预措施的患者退出。与人员流失相关的因素包括高水平的FF，这表明最需要此类计划的个人是最有可能过早退出的人。这些数据表明，在治疗中应该有针对性地回避，干预措施应该针对那些有严重恐惧和回避的人，他们最有可能退出传统的FF项目。然而，尽管FF和焦虑症有相似之处，而且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，FF干预措施还没有纳入暴露成分。总的来说，现有的研究表明，需要将暴露疗法与其他已被证明对减少FF有效的因素结合起来进行干预。这种干预还必须对患者安全问题敏感。拟议的项目旨在开发一种由物理治疗师提供的家庭干预措施“活动、平衡、学习和暴露”（ABLE），该干预措施将暴露疗法和认知重构与运动、跌倒风险教育、家庭安全评估以及患有过度和致残FF的老年人的药物审查结合起来。在对20名患有FF的老年人进行开发和试点测试后，我们建议进行一项可行性研究，其中40名患者随机分配到ABLE或教育控制条件。通过开发和测试一种新的干预措施来解决一种普遍存在的老年焦虑症，这种焦虑症可能会对公共卫生造成破坏性影响，这一研究方向有望填补知识和临床实践方面的重大空白。

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.