Evaluating the effectiveness of an in-home self-management intervention to prevent psychological distress in frail older people living in the community
Angst om te vallen komt bij ongeveer de helft van de zelfstandig wonende ouderen voor. Ruim één derde van hen vermijdt dagelijkse bezigheden door deze bezorgdheid. De cursus ‘Thuis in Balans’ leert kwetsbare ouderen realistisch omgaan met deze bezorgdheid en activiteiten (weer) veilig te ondernemen. De ouderen kregen tijdens huisbezoeken en telefoongesprekken individuele begeleiding van een getrainde verpleegkundige van de thuiszorg. De bezorgdheid en het vermijdingsgedrag van de deelnemende ouderen verminderde ten opzichte van de controlegroep. Dit effect hield stand tot 12 maanden na de cursus. De overgrote meerderheid van de deelnemende ouderen beoordeelde de cursus als goed en zou deze ook aanbevelend aan anderen. Er zijn geen verschillen in zorggebruik tussen beide groepen. De positieve resultaten hebben geleid tot een aansluitend implementatieproject. Het Trimbos instituut biedt de cursus nu aan onder de naam Zicht op Evenwicht – Thuis.
Samenvatting van de aanvraag
Anxious and depressed mood are common in frail, older persons. Falls and fall-related complications are common in old age as well. Highly frequent complications of falls are fear of falling, avoidance behavior and catastrophizing about falls, which are associated with adverse psychological outcomes such as anxious and depressed mood. Next to falls, it is also important to reduce the psychological complications of falls in frail older persons. A cognitive-behavioral group approach has shown to reduce fear of falling, avoidance of activities, catastrophizing about falls as well as symptoms of anxiety and depression. However, previous research has also shown that a very large amount (up to 46%) of particularly frail older persons is not reached by group approaches mainly due to health problems. Tailoring the intervention to personal abilities and needs as part of an easy accessible in-home version may substantially improve exposure to and effectiveness of intervention programs in frail elderly. The effectiveness and feasibility of such interventions in this area of research are unknown. Hence, we propose to study: 1) the effectiveness of an in-home self-management intervention to reduce fear of falling, avoidance behavior, catastrophizing about falls in order to prevent anxious and depressed mood in frail elderly living in the community; 2) the feasibility of this intervention; and 3) the impact of the intervention on care utilization and cost. A two group randomized controlled trial will be performed: one group (N=155) will receive the intervention; the other group (N=155) will receive care as usual. The cognitive-behavioral intervention comprises 7 sessions (5 telephone sessions and 2 home visits) and will be facilitated by regular public health nurses. The contents and format of the intervention are based on previous experiences with cognitive-behavioral group approaches and empirical evidence on the effectiveness of cognitive-behavioral telephone-based interventions. An important element is that strengthening of cognitions to reduce psychological distress should not be general or abstract, but focused on the experience of successfully dealing with overcoming specific (fear-related) problems in daily life (‘exposure in vivo’). Effects on fear of falling, avoidance behavior, catastrophizing about falls, anxious and depressed mood are in this study independently measured by telephone interviews before randomization, directly after the intervention, and at 12-months follow-up. The feasibility of the intervention is studied by a process evaluation comprising checklists and semi-structured interviews with facilitators and a selection of intervention participants. Furthermore, the effects of the intervention with respect to care utilization and cost are analyzed in detail. The study takes 48 months and results in (a) protocols for identifying the target population and intake procedure for eligible participants, an intervention booklet for participants and a training and intervention protocol for facilitators and (b) a PhD-thesis comprising 5 international articles.