Feasibility of Aktiv Gegen Sturzangst (AGES) in Assisted Living Facilities (AGES)

A Cognitive-Behavioral and Exercise Intervention to Reduce Fear of Falling in Older Adults in Assisted Living Facilities: A Pilot Study

Aktiv Gegen Sturzangst (AGES) is a multicomponent group intervention combining cognitive behavioral therapy and structured exercise to address fear of falling in older adults receiving services from assisted living facilities. This single-arm, non-randomized pilot study evaluated the feasibility of implementing AGES in three assisted living facilities in Switzerland and the feasibility of study procedures and outcome measures for a future controlled trial. Nineteen older adults participated in eight weekly group sessions delivered by trained course leaders. Feasibility outcomes included recruitment, retention, course-leader deployment, protocol adherence, completion of clinical outcome measures, and feasibility of contactless LiDAR-based gait assessment.

Study Overview

• Status: Completed
• Conditions: Fear of Falling
• Intervention / Treatment: Behavioral: Multicomponent fear of falling intervention

Detailed Description

AGES was developed as an adaptation of multicomponent approaches to fear of falling for use in German-speaking Swiss assisted living facilities. The intervention consisted of eight weekly group sessions of approximately 60 minutes combining cognitive behavioral therapy-based discussion and reflection with structured balance, strength, mobility, and flexibility exercises. Sessions were delivered by trained facility-based course leaders. The pilot primarily assessed the feasibility of recruitment and retention, course-leader training and deployment, intervention delivery, completion of proposed outcome measures, and LiDAR-based gait assessment. Clinical measures included the Falls Efficacy Scale-International (FES-I), World Health Organization-5 Well-Being Index (WHO-5), and Timed Up and Go test (TUG). The study was exploratory and was not designed or powered to establish intervention effectiveness.

• Study Type: Interventional
• Enrollment (Actual): 19
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Switzerland
  • Canton of Bern
    • Bern, Canton of Bern, Switzerland, 3013
      • Domicil Spitalackerpark
    • Biel/Bienne, Canton of Bern, Switzerland, 2504
      • Alterswohnheim Büttenberg Biel
  • Canton of Fribourg
    • Murten/Morat, Canton of Fribourg, Switzerland, 3280
      • Senevita Résidence Beaulieu Murten

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Age 65 years or older
• Receiving some level of care or services through a participating assisted living facility
• Identified by facility staff as potentially experiencing fear of falling or expressing interest in a fall-prevention program
• Able to participate safely in group sessions

Exclusion Criteria:

• Moderate to severe neurocognitive disorder
• Unstable psychiatric illness, including an acute depressive episode or substance use disorder
• Physical limitations precluding safe participation in group sessions, including blindness, severe frailty, wheelchair dependence, or requirement for full mobility assistance

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: AGES Intervention; Participants received the AGES intervention, consisting of eight weekly approximately 60-minute group sessions combining cognitive behavioral therapy-based components with structured physical exercises targeting balance, strength, mobility, and flexibility.

Behavioral: Multicomponent fear of falling intervention; Eight weekly group sessions delivered by trained course leaders. Sessions included cognitive behavioral therapy-based discussion and reflection addressing emotions, automatic thoughts, safety behaviors, assumptions, goal setting, and self-management, combined with structured exercises performed in seated or supported-standing positions where appropriate.; Other Names: Aktiv Gegen Sturzangst (AGES)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Course-leader deployment	Number and proportion of trained course leaders who subsequently delivered an AGES intervention group	During the 8-week intervention period
Participant retention	Number and proportion of enrolled participants retained through completion of the intervention	Baseline to approximately 8 weeks
Completion of clinical outcome measures	Number and proportion of participants providing paired FES-I, WHO-5 and TUG assessments	Baseline and approximately 8 weeks
Protocol adherence	Number of delivering course leaders reporting delivery according to the standardized intervention manual without major deviations	Through approximately 8 weeks
Feasibility of LiDAR gait assessment	Proportion of participants in whom LiDAR measurement could be acquired and proportion of acquired measurements yielding usable processed gait data	At approximately Week 8, toward the end of the 8-week intervention period

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Falls Efficacy Scale-International (FES-I)	The Falls Efficacy Scale-International (FES-I) is a 16-item questionnaire assessing concern about falling during physical and social activities. Each item is scored from 1 (not at all concerned) to 4 (very concerned), giving a total score ranging from 16 to 64. Higher scores indicate greater concern about falling and therefore a worse outcome.	Baseline and approximately 8 weeks
World Health Organization-5 Well-Being Index (WHO-5)	The World Health Organization-5 Well-Being Index (WHO-5) is a 5-item questionnaire assessing subjective psychological well-being over the previous two weeks. Each item is scored from 0 (at no time) to 5 (all of the time), giving a total raw score ranging from 0 to 25. Higher scores indicate greater psychological well-being and therefore a better outcome.	Baseline and approximately 8 weeks
Timed Up and Go (TUG) Test	The Timed Up and Go (TUG) test assesses functional mobility. Participants are timed, in seconds, while standing up from a chair, walking 3 meters, turning, walking back, and sitting down. The outcome is the time required to complete the test. Lower times indicate better functional mobility, whereas higher times indicate worse mobility.	Baseline and approximately 8 weeks

Collaborators and Investigators

• Sponsor: Eric Lenouvel
• Collaborators: Age-Stiftung; Public Health Switzerland
• Investigators: Study Director: Stefan Kloeppel, MD, Department of Old Age Psychiatry and Psychotherapy, University Hospital of Psychiatry (UPZ), Bern

Publications and helpful links

General Publications

• Lenouvel E, Ullrich P, Siemens W, Dallmeier D, Denkinger M, Kienle G, Zijlstra GAR, Hauer K, Kloppel S. Cognitive behavioural therapy (CBT) with and without exercise to reduce fear of falling in older people living in the community. Cochrane Database Syst Rev. 2023 Nov 15;11(11):CD014666. doi: 10.1002/14651858.CD014666.pub2.
• Lenouvel E, Novak L, Biedermann A, Kressig RW, Kloppel S. Preventive treatment options for fear of falling within the Swiss healthcare system : A position paper. Z Gerontol Geriatr. 2022 Nov;55(7):597-602. doi: 10.1007/s00391-021-01957-w. Epub 2021 Sep 29.

Helpful Links

• Age-Stiftung project page for Aktiv Gegen Sturzangst (AGES), including project description and documentation

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2022
• Primary Completion (Actual): December 31, 2022
• Study Completion (Actual): December 31, 2022

Study Registration Dates

• First Submitted: August 19, 2026
• First Submitted That Met QC Criteria: August 22, 2026
• First Posted (Actual): August 26, 2026

Study Record Updates

• Last Update Posted (Actual): August 26, 2026
• Last Update Submitted That Met QC Criteria: August 22, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Keywords: Exercise; Gait; Cognitive behavioral therapy; Older adults; Mobility; Fall prevention; Assisted living
• Additional Relevant MeSH Terms: Behavior; Motor Activity
• Other Study ID Numbers: AGES-2021; 849 - Age-Stiftung Project ID (Other Identifier: Age-Stiftung)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: De-identified individual participant data underlying the results reported in the primary publication may be made available to qualified researchers upon reasonable request, subject to institutional approval, ethical and data-protection requirements, and assessment of the risk of participant re-identification.
• IPD Sharing Time Frame: Beginning 6 months after publication of the primary study results and available for 5 years thereafter.
• IPD Sharing Access Criteria: Requests will be considered from qualified researchers submitting a scientifically sound proposal. Access will be subject to review by the study investigators and, where required, the responsible institution or ethics body. Data will be shared only where compatible with participant consent, applicable data-protection requirements, and an acceptable risk of re-identification. A data-use agreement may be required.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No