Award Date

12-15-2025

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Interdisciplinary Programs

First Committee Member

Merrill Landers

Second Committee Member

James Navalta

Third Committee Member

Kai-Yu Ho

Fourth Committee Member

Nirmala Lekhak

Number of Pages

199

Abstract

Introduction: Fear of falling (FoF) and associated avoidance behavior represent critical health concerns for older adults, with profound impacts on physical functioning, independence, psychosocial well-being, and healthcare utilization. Although fear of falling avoidance behavior (FFAB) is increasingly recognized as a distinct construct and clinically meaningful construct, intervention research remains limited due to fragmented assessment methodologies and incomplete integration of cognitive-behavioral and physical approaches. This dissertation addresses these gaps through two interrelated projects (1) a scoping review of the evidence base, assessment methods, and intervention strategies for Cognitive Behavioral Therapy (CBT) targeting FFAB in older adults; and (2) a randomized controlled trial (RCT) evaluating the feasibility, safety, and efficacy of a novel multicomponent CBT-exercise intervention for community-dwelling older adults with FoF.

Methods: The scoping review systematically identified, appraised, and synthesized studies of CBT interventions for FFAB among older adults, following the JBI and PRISMA-ScR guidelines. Eligible articles were screened and data on assessment tools, intervention content, and outcomes were extracted. The RCT randomly assigned participants to one of four groups: the new integrated CBT-exercise program, the Matter of Balance (MoB; CBT-based), the Otago Exercise program, or the Control group. Primary outcomes included changes in FoF (Falls Efficacy Scale-International), FFAB (Fear of Falling Avoidance Behavior Questionnaire), physical function, and psychosocial endpoints. Feasibility, adherence, and safety were also evaluated.

Results: The scoping review revealed substantial variability in assessment and intervention methods across CBT studies, yet highlighted the promise of integrated CBT and exercise interventions for addressing both functional and psychological domains. In the RCT, the new multicomponent intervention produced statistically and clinically significant improvements in FoF, avoidance behavior, and all measured physical function domains—substantially surpassing the effects of single-component or limited multicomponent interventions. The intervention demonstrated high feasibility (87.5% attendance, 93.8% completion), safety, and acceptability. Findings support the critical role of adequate exercise dosing and the synergistic effect of embodied cognitive restructuring, wherein direct behavioral activation reinforces cognitive changes to comprehensively mitigate fear-avoidance cycles.

Conclusion: This dissertation advances the field by: (1) clarifying the scope and methodological gaps in FFAB intervention research; (2) providing robust evidence that synergistic integration of CBT with adequate, evidence-based exercise is superior to single-component approaches for reducing FoF and FFAB in older adults; and (3) outlining clear guidance for intervention development, assessment, and scalable implementation. Findings have direct implications for clinicians, researchers, and policymakers seeking to translate evidence into effective, sustainable FoF interventions that improve the lives and independence of older adults.

Keywords

Cognitive behavioral therapy; Falling; Fear of falling; Fear of falling avoidance behavior; Multicomponent intervention

Disciplines

Medicine and Health Sciences | Physical Therapy | Physiotherapy

File Format

PDF

File Size

3500 KB

Degree Grantor

University of Nevada, Las Vegas

Language

English

Rights

IN COPYRIGHT. For more information about this rights statement, please visit http://rightsstatements.org/vocab/InC/1.0/

Download


Share

COinS