Evaluation of a dedicated 'Concerns about Falling' clinic

Up to 50% of people aged 60 and over have concerns about falling; concern about falling is a clear predictor of future falls in older adults.  Addressing patients’ concerns about falling is a crucial component of falls assessment and management.  The World Falls Guidelines 2022 recommend evaluation of concerns, management with cognitive behavioural therapy (CBT) and consideration of specialist referral.  The NICE Falls Guideline 2025 recommends exploration of concerns plus CBT interventions for patients who are not helped by strength and balance exercises.

Previously, patients with Concerns about Falling referred to WTWA hospitals, MFT were managed through either a Comprehensive Geriatric Assessment Clinic or Falls and Balance Clinic, with Geriatrician-led MDT (Consultant Nurse, Frailty Nurse, Occupational Therapy, Physiotherapy, Audiology and Podiatry) assessment and management.  Whilst some Occupational Therapists / Physiotherapists are competent to provide low-level psychological interventions (mindfulness, breathing exercises, visualisation etc.) this is not always sufficient to meet the needs of patients with more psychologically complex presentations.  As Concerns about Falling typically result from an interplay between physical and psychological factors, failure to address deeper psychological needs can reduce the effectiveness of other interventions offered such as strength and balance exercises.

We present the outcomes from an ongoing pilot of a dedicated CaF Clinic run by a dual-trained Frailty ANP / Psychotherapeutic Counsellor.  Patients are seen for 50-minute clinic appointments based on a ‘single session therapy’ model (assessment and brief intervention plus referral for ongoing talk therapy if required), using a pluralistic approach (predominantly psychodynamic / CBT, with a focus on trauma).  These clinics are provided as part of the broader MDT falls and balance service, adding a vital clinical resource to strengthen our specialist assessment and intervention.