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‘Zicht op Evenwicht’: een effectieve interventie om bezorgdheid om te vallen en gerelateerd vermijdingsgedrag bij ouderen te verminderen

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Tijdschrift voor Gerontologie en Geriatrie

“A Matter of Balance - Netherlands”: an effective intervention to reduce concerns about falls and related avoidance of activity in older people

Concerns about falls and related avoidance behavior are common among older people and may lead to decreased quality of life, decreased physical and psychosocial functioning, and premature admission to a nursing home. In a randomized controlled trial among 540 community-dwelling older people we studied the feasibility and effects of a cognitive behavioral program on concerns about falls, related avoidance of activity, and falls. Data of the process evaluation obtained from participants in the intervention group (n= 280) and the trainers (n= 6) showed that the program was considered as feasible by the trainers, and positively judged by participants and trainers. Furthermore, participants experienced benefits from attending the program (61% still reported benefits one year after the program). Prior to the start of the program 26% of the participants of the intervention dropped out, yet, among the participants who started the program completion was high (84%). The effect evaluation showed positive outcomes for concerns about falls, related avoidance of activity, and daily activity at 2 months (after the program) when comparing the intervention group with the control group (n= 260). Long-term effects were also shown for, amongst others, concerns about falls and recurrent falls. Following these positive results the cognitive behavioral group program is currently made available to geriatric care settings nationwide in the Netherlands.

Samenvatting

Valangst en gerelateerd vermijdingsgedrag komen veel voor bij ouderen en kunnen leiden tot een verminderde kwaliteit van leven, verminderd fysiek en psychosociaal functioneren en vervroegde opname in een verpleeghuis. In een gerandomiseerd onderzoek onder 540 zelfstandig wonende ouderen met valangst en gerelateerd vermijdingsgedrag zijn de uitvoerbaarheid en effecten van een cognitief gedragsmatige groepscursus geëvalueerd. De procesgegevens van de interventiegroep (n= 280) en de cursusleiders (n= 6) wees uit dat de cursus goed uitvoerbaar is, positief beoordeeld wordt en dat deelnemers baat hebben bij de cursus (61% rapporteert deze baat tot een jaar na de cursus). Wel meldde 26% van de interventiegroep zich voor de start van de cursus af voor deelname, maar deelnemers die met de cursus begonnen maakten deze doorgaans af (84%). De effectevaluatie liet positieve uitkomsten zien voor de interventiegroep vergeleken met de controle groep (n= 260); na de cursus werd minder bezorgdheid om te vallen en gerelateerd vermijdingsgedrag gerapporteerd en meer dagelijkse activiteit. Ook op de lange termijn waren positieve effecten zichtbaar, onder andere voor bezorgdheid om te vallen en herhaalde valincidenten. Op basis van deze succesvolle resultaten is de implementatie van de cognitief gedragsmatige groepscursus “Zicht op Evenwicht” in de Nederlandse gezondheidszorg gestart.

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Literatuur

  1. van Haastregt JC, Zijlstra GA, van Rossum E, van Eijk JT, de Witte LP, Kempen GI. Feasibility of a cognitive behavioural group intervention to reduce fear of falling and associated avoidance of activity in community-living older people: a process evaluation. BMC Health Serv Res 2007;7:156.

    Article  PubMed  Google Scholar 

  2. Zijlstra GA. Managing concerns about falls. Fear of falling and avoidance of activity in older people. Maastricht: Maastricht University, 2007.

    Google Scholar 

  3. Zijlstra GA, van Haastregt JC, Ambergen T, van Rossum E, van Eijk JT, Tennstedt SL, et al. Effects of a multicomponent cognitive behavioral group intervention on fear of falling and activity avoidance in community-dwelling older adults: results of a randomized controlled trial. JAm Geriatr Soc 2009;57(11):2020–8.

    Article  Google Scholar 

  4. Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 2006;35 Suppl 2:ii37-ii41.

    Article  PubMed  Google Scholar 

  5. Richtlijn Preventie van valincidenten bij ouderen. Alphen aan den Rijn: Van Zuiden Communications, 2004.

  6. Gillespie LD, RobertsonMC, GillespieWJ, Lamb SE, Gates S, Cumming RG, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2009(2):CD007146.

  7. Zijlstra GA, van Haastregt JC, van Eijk JT, van Rossum E, Stalenhoef PA, Kempen GI. Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people. Age Ageing 2007;36(3):304–9.

    Article  PubMed  CAS  Google Scholar 

  8. Scheffer AC, SchuurmansMJ, van Dijk N, van der Hooft T, de Rooij SE. Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing 2008;37(1):19–24.

    Article  PubMed  Google Scholar 

  9. Yardley L, Smith H. A prospective study of the relationship between feared consequences of falling and avoidance of activity in communityliving older people. Gerontologist 2002;42(1):17–23.

    Article  PubMed  Google Scholar 

  10. Delbaere K, Close JC, Brodaty H, Sachdev P, Lord SR. Determinants of disparities between perceived and physiological risk of falling among elderly people: cohort study. BMJ 2010;341:c4165.

    PubMed  Google Scholar 

  11. Mendes de Leon CF, Seeman TE, Baker DI, Richardson ED, Tinetti ME. Self-efficacy, physical decline, and change in functioning in community-living elders: a prospective study. J Gerontol B Psychol Sci Soc Sci. 1996;51(4):S183–90.

    Article  Google Scholar 

  12. LachmanME, Howland J, Tennstedt S, Jette A, Assmann S, Peterson EW. Fear of falling and activity restriction: the survey of activities and fear of falling in the elderly (SAFE). J Gerontol B Psychol Sci Soc Sci 1998;53(1):P43–50.

    Article  PubMed  CAS  Google Scholar 

  13. Delbaere K, Crombez G, Vanderstraeten G,Willems T, Cambier D. Fear-related avoidance of activities, falls and physical frailty. A prospective community-based cohort study. Age Ageing 2004;33(4):368–73.

    Article  PubMed  Google Scholar 

  14. Cumming RG, Salkeld G, Thomas M, Szonyi G. Prospective study of the impact of fear of falling on activities of daily living, SF-36 scores, and nursing home admission. J Gerontol A Biol Sci Med Sci 2000;55(5):M299–305.

    Article  PubMed  CAS  Google Scholar 

  15. Zijlstra GA, van Haastregt JC, van Rossum E, van Eijk JT, Yardley L, Kempen GI. Interventions to reduce fear of falling in communityliving older people: a systematic review. JAm Geriatr Soc 2007;55(4):603–15.

    Article  Google Scholar 

  16. Bula CJ, Monod S, Hoskovec C, Rochat S. Interventions aiming at balance confidence improvement in older adults: an updated review. Gerontology 2011;57(3):276–86.

    Article  PubMed  Google Scholar 

  17. Tennstedt S, Howland J, Lachman M, Peterson E, Kasten L, Jette A. A randomized, controlled trial of a group intervention to reduce fear of falling and associated activity restriction in older adults. J Gerontol B Psychol Sci Soc Sci 1998;53(6):P384–92.

    Article  PubMed  CAS  Google Scholar 

  18. Zijlstra GA, van Haastregt JC, van Eijk JT, Kempen GI. Evaluating an intervention to reduce fear of falling and associated activity restriction in elderly persons: design of a randomised controlled trial [ISRCTN43792817]. BMC Public Health 2005;5(1):26.

    Article  PubMed  Google Scholar 

  19. Zijlstra GA, Tennstedt SL, van Haastregt JC, van Eijk JT, Kempen GI. Reducing fear of falling and avoidance of activity in elderly persons: the development of a Dutch version of an American intervention. Patient Educ Couns 2006;62(2):220–7.

    Article  PubMed  Google Scholar 

  20. Tinetti ME, Richman D, Powell L. Falls efficacy as a measure of fear of falling. J Gerontol 1990;45(6):P239–43.

    PubMed  CAS  Google Scholar 

  21. Hill KD, Schwarz JA, Kalogeropoulos AJ, Gibson SJ. Fear of falling revisited. Arch Phys Med Rehabil 1996;77(10):1025–9.

    Article  PubMed  CAS  Google Scholar 

  22. Lawrence RH, Tennstedt SL, Kasten LE, Shih J, Howland J, Jette AM. Intensity and correlates of fear of falling and hurting oneself in the next year: baseline findings from a Roybal Center fear of falling intervention. J Aging Health 1998;10(3):267–86.

    Article  PubMed  CAS  Google Scholar 

  23. Schuling J, de Haan R, Limburg M, Groenier KH. The Frenchay Activities Index. Assessment of functional status in stroke patients. Stroke 1993;24(8):1173–7.

    Article  PubMed  CAS  Google Scholar 

  24. Cohen J. A power primer. Psychol Bull 1992;112(1):155–9.

    Article  PubMed  CAS  Google Scholar 

  25. Twisk JW. Missing data in longitudinal studies. Applied longitudinal data analysis for epidemiology: a practical guide. Cambridge: Cambridge University press, 2003.

    Google Scholar 

  26. Zijlstra GA, van Haastregt JC, van Eijk JT, de Witte LP, Ambergen T, Kempen GI. Mediating effects of psychosocial factors on concerns about falling and daily activity in a multicomponent cognitive behavioral group intervention. Aging Ment Health 2010; 4:1–10.

    Article  Google Scholar 

  27. Yardley L, Bishop FL, Beyer N, Hauer K, Kempen GI, Piot-Ziegler C, et al. Older People’s Views of Falls-Prevention Interventions in Six European Countries. Gerontologist 2006;46(5):650–60.

    Article  PubMed  Google Scholar 

  28. Dorresteijn TA, Zijlstra GA, Delbaere K, van Rossum E, Vlaeyen JW, Kempen GI. Evaluating an in-home multicomponent cognitive behavioural programme to manage concerns about falls and associated activity avoidance in frail community-dwelling older people: Design of a randomised control trial [NCT01358032]. BMC Health Serv Res 2011;11:228.

    Article  PubMed  Google Scholar 

  29. Kempen GI, Meier AJ, Bouwens SF, van Deursen J, Verhey FR. [The psychometric properties of the Dutch version of the Telephone Interview Cognitive Status (TICS)]. Tijdschr Gerontol Geriatr 2007;38(1):38–45.

    Article  PubMed  CAS  Google Scholar 

  30. Stewart AL, Hays RD,Ware JE, Jr. TheMOS short-form general health survey. Reliability and validity in a patient population. Med Care 1988;26(7):724–35.

    Article  PubMed  CAS  Google Scholar 

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Dankwoord

De auteurs zijn de deelnemers en verpleegkundigen van “GroeneKruisDomicura” in Maastricht en “Zorggroep Meander” in Heerlen zeer erkentelijk voor hun participatie in het onderzoek. Onze dank gaat tevens uit naar het Centrum voor Data en Informatiemanagement, Vonca Schaffers en andere betrokkenen bij dit project (o.a. prof. dr. J.Th.M. van Eijk, dr. E. van Rossum, dr. S.L. Tennstedt, dr. T. Ambergen, dr. P. Stalenhoef, prof. dr. L.P. deWitte). Dit onderzoek is gefinancierd door ZonMw (project 014-91-052).

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Authors and Affiliations

  1. Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, Maastricht, The Netherlands

    G. A. R. Zijlstra, J. C. M. van Haastregt & G. I. J. M. Kempen

  2. CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands

    G. A. R. Zijlstra, J. C. M. van Haastregt & G. I. J. M. Kempen

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  1. G. A. R. Zijlstra
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  2. J. C. M. van Haastregt
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  3. G. I. J. M. Kempen
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Tijdschr Gerontol Geriatr 2012; 43: 164-175

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Hoogleraar Sociale Gerontologie

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Zijlstra, G.A.R., van Haastregt, J.C.M. & Kempen, G.I.J.M. ‘Zicht op Evenwicht’: een effectieve interventie om bezorgdheid om te vallen en gerelateerd vermijdingsgedrag bij ouderen te verminderen. TIJDSCHR. GERONTOLOGIE GER. 43, 164–174 (2012). https://doi.org/10.1007/s12439-012-0026-9

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