A cognitive-behavioral and exercise intervention to reduce fear of falling in older adults in assisted living facilities: a pilot study

Abstract Background Fear of falling (FoF) is common in assisted living facilities (ALFs) and contributes to reduced mobility and well-being. Cognitive Behavioral Therapy (CBT) and exercise interventions are effective, but no culturally adapted programs exist for German-speaking ALFs. Objectives To assess the feasibility of implementing a combined Cognitive Behavioral Therapy and exercise intervention, Aktiv Gegen Sturzangst (AGES), in ALFs and to evaluate the feasibility of the proposed study procedures and outcome measures for a future controlled trial. Methods A single-arm, non-randomized pilot study was conducted in three ALFs with 19 participants (mean age 84 years). AGES comprised eight weekly group sessions delivered by trained course leaders. Feasibility was assessed through recruitment, retention, course-leader deployment, indirect indicators of acceptability, leader-reported protocol adherence, outcome completion, and LiDAR-based gait assessment. Clinical outcomes included the Falls Efficacy Scale–International (FES-I), World Health Organization-5 Well-Being Index (WHO-5), and Timed Up and Go test (TUG). Results All 19 participants remained in the study, and paired clinical outcome data were available for 18 participants (94.7%). Twelve course leaders were trained, of whom four delivered the three intervention groups. Course leaders reported no major deviations from the intervention protocol, although adherence was not independently verified. Mean FES-I scores decreased from 27.28 (SD 6.27) to 25.67 (SD 8.04), median WHO-5 scores increased from 17.5 (IQR 15.0–20.25) to 19.5 (IQR 15.75–22.25), and mean TUG time decreased from 14.68 (SD 5.15) to 13.40 s (SD 3.97). These changes are descriptive and do not establish intervention effectiveness. LiDAR measurements were obtained in 18 of 19 participants (94.7%); usable processed data were obtained for 13 of the 18 assessed participants (72.2%), with processing limited by interference from walking aids. Conclusion AGES could be delivered in three assisted living facilities with no participant withdrawals. However, progression to a definitive trial requires modifications to course-leader deployment, direct assessment of participant and staff acceptability, independent fidelity assessment, and gait measurement for participants using walking-aids. The clinical outcome estimates should be interpreted descriptively and not as evidence of effectiveness. Trial registration Feasibility of Aktiv Gegen Sturzangst (AGES) in Assisted Living Facilities, Identifier: NCT07787819. Retrospectively registered on 26.08.2026.