Clinical Management of Concerns About Falling: Gaps, Barriers and Future Directions

Background and Aim:
Concerns (or “fears”) about falling are common in older adults and people with clinical balance disorders. Experimental and epidemiological evidence indicates that these concerns can disrupt balance and increase fall risk. Although various evidence-based guidelines exist to address concerns about falling (e.g., World Falls Guidelines), anecdotal evidence suggests limited uptake in clinical practice. This programme of research aimed to (i) identify gaps and barriers in the clinical management of concerns about falling, and (ii) identify practical, evidence-based intervention strategies that can be implemented alongside usual care.

Methods:
A scoping review was conducted to identify psychologically informed techniques currently used to address concerns about falling. This was followed by a mixed-methods survey examining currently management practice, completed 114 falls-prevention healthcare professionals. Finally, semi-structured interviews were conducted with 30 falls-prevention healthcare professionals to explore experiences of managing concerns about falling, including barriers and facilitators to implementation, and perspectives on feasible and acceptable clinical approaches.

Results:
The scoping review revealed a wide range of psychological techniques/interventions, the most common being cognitive behavioural therapy, followed by exposure therapy and motivational interviewing. However, many interventions were time and resource intensive (mean total dose = 5 hours 50 minutes), limiting their feasibility into clinical practice. Survey findings identified low rates of adoption of the evidence-based recommendations from the World Falls Guidelines, particularly within hospital settings. Interview data underscored systemic barriers to implementation, including time constraints, limited training, competing priorities, and low awareness of the importance of concerns about falling.

Conclusions:
This research highlights a critical mismatch between best-practice recommendations and what is feasible in clinical practice. Findings point to the need for time-efficient, evidence-based strategies to address concerns about falling which can be integrated alongside current clinical practice. We present recommendations on how this can be clinically achieved, based on the present findings.