Mediating effects of psychosocial factors on concerns about falling and daily activity in a multicomponent cognitive behavioral group intervention

Abstract

Objectives: Concerns about falling, or fear of falling, is highly common in old age and has adverse consequences. The development and understanding of interventions to reduce concerns about falling are therefore relevant. This study explored the mediating effects of psychosocial factors on trajectories of concerns about falling and daily activity in a multicomponent cognitive behavioral group intervention.

Method: The study sample comprised 540 community-dwelling adults aged 70 years or older, with concerns about falling and associated activity avoidance, who participated in a randomized controlled trial evaluating this intervention. Control beliefs, self-efficacy beliefs, outcome expectations, and social interactions, as potential mediators, and concerns about falling and daily activity, as outcome variables, were assessed at baseline, and at two, eight, and 14 months. Data were analyzed with mixed-effects regression models.

Results: Small to moderate statistically significant effects of the intervention on the potential mediators were found at nearly all follow-up assessments. Separate psychosocial factors showed modest mediating effects on the outcomes. When all mediators were taken into account simultaneously, 44–76% of the association between the intervention and the outcomes was explained.

Conclusion: This study showed that the multicomponent cognitive behavioral intervention improved control beliefs, self-efficacy, outcome expectations, and social interactions. These variables mediated the association between the intervention and concerns about falling or daily activity in community-dwelling older adults. This knowledge may facilitate further improvement and development of interventions to reduce concerns about falling and to increase daily activity.

Keywords:

• psychosocial functioning
• randomized controlled trial
• mediating effects
• accidental falls
• fear of falling

Acknowledgments

This study was funded by ZonMw – The Netherlands Organization for Health Research and Development (grant no. 014-91-052), the School for Public Health and Primary Care (CAPHRI), and the Faculty of Health, Medicine and Life Sciences of the Maastricht University. We gratefully acknowledge participants and facilitators for their involvement in our study. The Centre for Data and Information Management (MEMIC) and Vonca Schaffers are acknowledged for assistance in the data collection and Dr J.W.R. Twisk for statistical advice.