Analysis And Intervention Research On The Fear Of Falling Over The Elderly With Hypertension Based On Cognitive Behavior

Objective:Based on the theory of cognitive behavior,to understand the current situation of the fear of falling in elderly hypertensive patients in the community-dwelling,and to implement the Activity,Balance,Learning,Exposure(ABLE)intervention programs for them,such as individualized health education,exercise and emotional management,in order to reduce the occurrence of fall injuries in elderly hypertensive patients in the community-dwelling and the experience on fear of falling.Methods:1.Questionnaire survey(single-item fear of falling assessment,Berg balance scale,etc.)and semi-structured interview were used to investigate the fear of falling in elderly hypertensive patients,and the current situation and management needs of fear of falling in elderly patients in the community-dwelling were analyzed.2.ABLE intervention was conducted for the elderly hypertensive patients with fear of falling.We selected 96 patients who had established healthy records in the community and randomly divided them into two groups.The experimental group implemented the ABLE program(including changes in patients’ negative cognition of falls,emotional management,exercise and other multi-dimensional guidance).The control group implemented conventional intervention in community.After 12-week intervention,fall efficacy,balance,mobility,occurrence of falls,and depression between the two groups of patients were compared.Results:1.270 patients were surveyed and 144(53.3%)elderly hypertensive patients in the community-dwelling had fear of falling.Regression analysis showed that age,depression,balance ability,mobility and frailty were independent risk factors for fear of falling(P<0.05).In addition,the interview results showed that the fear of falling affects elderly hypertensive patients,causing them to develop mal-adaptive cognition and adopt active or negative strategies.The topics covered were:(1)experience of dynamic changes;(2)heart in fear of falling;(3)selection of coping strategies.2.After 12 weeks of intervention,93 of 96 elderly hypertensive patients with fear of falling were entered to randomized control trial finally.One person of the intervention group and three persons of the control group dropped out.There was no significant difference in general information and scores of each scale between the two groups of patients(P>0.05),and they were comparable.After 12-week of intervention,compared with the control group,the intervention group’s fall efficacy and balance scores were significantly improved,and the difference was statistically significant(P=0.015,P=0.017).There were no statistically significant differences in TUGT time,blood pressure,frequency of falls and depression between the two groups(P > 0.05).Conclusions:53.3% of elderly hypertensive patients in the community-dwelling have fear of falling.Age,frailty,depression,balance,and mobility ability are independent risk factors for the fear of falling in elderly hypertensive patients living in the community-dwelling.Fear of falling can make elderly hypertensive patients develop mal-adaptive cognition and adopt active or negative strategies.ABLE intervention program is beneficial to improve the fall efficacy,alleviate the fear of falling,and enhance the balance ability of elderly hypertensive patients in the community-dwelling.