Developing a psychological framework to manage and reduce falls in older adults

At least one-third of adults aged 65 years and above experience a fall annually, with falls in this age group costing the NHS £4.6 million per-day (Age UK, 2010). A clear relationship exists between fall-related anxiety (or, 'fear of falling') and increased falls (Hadjistavropoulos et al., 2011; Young & Williams, 2015). However, the specific mechanisms through which fall-related anxiety increases the likelihood that an older adult will fall remain unknown. As such, developing interventions to reduce anxiety-related risk factors remains difficult.

The work conducted during my PhD identified numerous (potentially inter-related) mechanisms through which fall-related anxiety can alter balance and gait, and subsequently reduce safety while walking. However, before this work can be translated to clinical practice, it is first necessary to integrate the independent findings within a unified conceptual framework. Doing so will help clinical practitioners identify not only how fall-related anxiety can reduce safety, but also the specific processes which underpin this relationship. Such framework will thus allow for the emergence of interventions which target these processes.

The first aim of this Fellowship is to therefore consolidate the experimental work from my PhD, through the development of a theoretical framework to account for the specific ways in which fall-related anxiety can increase the likelihood of a fall occurring. This framework will be developed while at the University of Exeter (ranked 10th in the world for human movement science related subjects). I will work with (and be mentored by) Prof. Mark Wilson to develop this framework; as he is an internationally renowned psychologist within the area of motor control and anxiety.

Once this framework has been developed, the second aim relates to its refinement and dissemination. I will present the framework, through public lectures, to researchers and applied practitioners at numerous academic and clinical institutions around the country; in addition to disseminating the work at national and international conferences, and during numerous public engagement events (including a symposium that I will organise, and deliver, in collaboration with Europe's leading falls-prevention network). This will allow me to both publicise the work, and acquire feedback from experts in several disciplines, allowing for further refinement. Such activities will also maximise the likelihood that this work is integrated within both clinical and research practice, thus significantly increasing its potential impact. I will also submit this work for peer review in an internationally renowned journal, and publicise it further via my association with popular public-interest online media outlets (e.g., Age UK, Psychology Today, etc.).

Finally, with the support of Prof. Wilson and his clinical colleagues within the areas of ageing and rehabilitation (Profs. Sallie Lamb and Vicki Goodwin) and clinical psychology (Prof. Ed Watkins), I will use this framework to develop a novel intervention to target fall-related anxiety. This intervention will also be developed with the aid of a Patient Public Involvement group consisting of relevant stakeholders (older adults who have fallen, or are at a risk of falling, their family, healthcare providers, etc.). Once this intervention has been finalised, I will work with the University of Exeter's dedicated NHS Research Support Service to develop grant proposals for research to test the feasibility of the intervention. These funding proposals will be submitted to both the Medical Research Council and the National Institute of Health Research. The diverse range of expertise based at University of Exeter (e.g., clinical and theoretical psychologists, clinicians working in falls-prevention/elderly care, a Clinical Trials Unit, etc.) will be paramount in developing expertise in how to best incorporate experimental research findings into applied practice and policy.