Cognitive behavioural therapy for fear of falling avoidance behaviour in older adults: a scoping review of multicomponent and standalone interventions

Background Fear of falling avoidance behaviour (FFAB) represents a distinctive health concern associated with fear of falling (FoF). It is important to consider both physical and psychological dimensions in older adults due to their bidirectional impact on FFAB and FoF; therefore, interventions for FFAB need to consider them too.Purpose This scoping review aimed to examine the literature on Cognitive Behavioural Therapy (CBT) interventions for FFAB in older adults and to identify assessment methods and CBT approaches.Methods Following the Joanna Briggs Institute methodology and PRISMA guidelines, comprehensive search was conducted in MEDLINE, Embase, Scopus, APA PsycInfo, CINAHL, Papers First, and ProQuest Dissertations & Theses without data restriction. Studies involving individuals aged 60 and older with FoF and reporting CBT-based interventions were included. Two reviewers independently screened studies and extracted data.Results Eight articles met the eligibility criteria; five randomised controlled trials (RCTs) and three one-group pre-post-test studies. Six assessment tools for FFAB were identified, among which the Survey of Activities and Fear of Falling in the Elderly (SAFFE) and the Fear of Falling Avoidance Behaviour Questionnaire (FFABQ) were validated. Intervention strategies included three original CBT protocols, with two being modified in multiple formats. The combination of CBT with exercise was commonly observed.Conclusion CBT is increasingly explored as a treatment option for FFAB in older adults. However, current evaluation practices lack integration of both psychosocial and physiological assessments. More diverse and targeted research is needed to optimise CBT interventions across ageing populations.