At least one-third of older adults experience a fall annually, with falls in this age group costing the NHS £4.6 million per-day (Age UK, 2010). Despite clinicians directing considerable effort towards addressing physical risk-factors (such as strength and mobility), incidences of falls continue to rise (Shankur et al., 2017). This has led to increased interest in attempts to identify and target alternative risk-factors for falls. One such risk factor is fear of falling. Fear of falling is reported by up to 50% of older adults (Scheffer et al., 2008). It is associated with an increased risk of falling, as well as other debilitating changes including social isolation, depression and diminished quality of life (Hadjistavropoulos et al., 2011). Current clinical interventions typically target fear of falling indirectly, through exercise and balance training. However, these strategies are relatively ineffective. Researchers have instead identified the importance of directly targeting fear of falling using psychological strategies (Kumar et al., 2016). Despite this, there is currently no routine practice to directly address fear of falling within clinical settings. The proposed project seeks to address this gap. Research conducted by the Primary Supervisor during his recent ESRC SWDTP Fellowship has identified specific mechanisms through which fear of falling can reduce safety in older adults. The proposed project will co-create a novel psychological intervention which directly targets these specific fear-related risk-factors, with the aim of enhancing balance safety and overall quality of life in older adults. This process will begin with the student shadowing fall-prevention services to learn how fear of falling is currently clinically managed. Next, falls-prevention service providers (physiotherapists, occupational therapists, geriatricians and psychiatrists) and service users (older adults fearful of falling) will be interviewed about their experiences of managing fear of falling. This will help identify gaps, barriers and limitations in how fear of falling is currently managed, and ensure that the resulting intervention can be integrated into clinical practice. Next, an expert panel of UK clinicians will be consulted (e-Delphi approach) to establish consensus on important components of a psychological falls-prevention intervention. These findings will inform the development of the novel psychological intervention – which will be co-created with older adults. This intervention will then be piloted in a sample of older adults who are fearful of falling, and evaluated using a mixed-method approach. This project will provide novel insight into how to translate psychological theory and techniques to falls-prevention settings, and represents the first-step in developing routine practice for directly targeting fear of falling. This project will be a collaboration with the Falls-Prevention Service within University College London Hospitals NHS Trust.
