1. Introduction
Since with the improvement of health, preventive care, and living conditions, life expectancy increases and the rate of births and deaths decreases, the rate of aged population is growing. With aging, due to the gradual decline in the function of various body organs, many changes are made in the health status of the person, and thus the risk of falling, mobility limitation, and reduced daily performance increase. Falling is one of the most common problems in old age and is the result of a complex interaction between biological, economic, environmental and behavioral factors. It leads to dependency, reduced self-efficacy, depression, and reduced quality of life and imposes costs on the individual, family and society. Therefore, in designing interventions to create an active aging, special attention should be paid to its barriers including the fear of falling. Family members and caregivers should also be involved in nursing interventions and health education to reduce the fear of falling in the elderly. Various methods and programs have been used to prevent and reduce falls, but no study has been done on involving patients and their families in the implementation of interventions, decision making, and creation of preventive behaviors. The present study aims to investigate the effect of collaborative care model on fear of fall and its frequency in the elderly.

2. Materials and Methods
This is a quasi-experimental study. The study population consists of the elderly aged over 60 years covered by comprehensive health services centers in Isfahan, Iran in 2019. Using a convenience sampling method, 72 older adults (and their families) with a history of falling, adequate cognition, the presence of their caregivers or family members and not participating in other studies were selected for the study. Those who did not want to cooperate, did not attend meetings, lost consciousness, or died were excluded from the study. The intervention group participated in a collaborative care program (motivation, preparation, involvement, and evaluation) for 12 weeks, while the control group participated in two 60-minute educational sessions. Data collection was performed in three stages before, immediately and 3 months later by completing a demographic form and the Falls Efficacy Scale International (FES-I).
In the first session of intervention, explanations were given about what is the study process, how, why, by whom, where and when. In this step, an educational needs assessment was performed by examining and recognizing patients’ problems through recording history and conducting interview. This phase was lasted for 2 hours during the first week. The stages of collaborative care training program included: (a) Motivation: At this stage, the fall and its types, fear of falling and its causes, prevalence and complications were discussed with the elderly. Their attitude were different; (b) Preparation: The training group was divided into four groups of 9 for training and scheduling the training program. Participants were also explained about the nature (training and follow-up sessions), duration (45-60 minutes), and purpose of the visits; (c) Involvement: It was done with the aim of continuing the care program and involving the participants; to make sure they perform and follow up what they learned in the previous stage, to solve problems and use experiences, and to give behavior feedback to them and inform them of the extent of their participation and agreement; (d) Evaluation: The previous learning level of participants and their attitude were measured in this stage. Data were analyzed in SPSS v. 21 software using Chi-square, Mann-Whitney U, independent t-test and repeated measures ANOVA.

3. Results
The Mean±SD age of participants was 71.34±7.47 years. The majority of them had a chronic disease, such that only 19.4% in the training group and 21.9% in the control group had no any chronic disease. Moreover, the majority of participants were taking medications such that only 22.6% in the training group and 15.6% in the control group had no medication use. Most of them in two groups had lower than high school education (84.4% in the training group). In the training group, 59.4% were women and 40.6% were men, while in the control group, 50% were women and 50% were men. Most falls in both groups occurred in different locations and were not at the same place. There was no significant difference in time of falling between the two groups. It occurred at different times (37% in the training group and 27.3% in the control group). The Mean±SD number of falls in the past 6 months was 1.59±0.24 in the training group and 1.38±0.28 in the control group. The studied groups were homogeneous in terms of the underlying factors which did not act as confounding variables (Table 1).






Independent t-test results showed that the mean scores of fear of falling before the intervention were not significantly different between the two groups (P>0.05), but immediately and 3 months after the intervention, the mean scores in the training group were significantly lower than in the control group (P<0.05). Independent t-test results showed significantly higher changes in the post-test and follow-up scores than the changes in the pretest scores in the training group compared to the control group (P<0.05).
Results of repeated measures ANOVA showed that the mean scores of fear of falling in the training group were significantly different between the three evaluation times (P<0.05). LSD post hoc test results showed that in the training group, the mean post-test score of fear of falling was significantly lower than the mean pretest score, and the mean follow-up score was lower than the mean post-test score (P<0.001). Results of repeated measures ANOVA showed that the mean scores of fear of falling were not significantly different between the three evaluation times in the control group (P>0.05). Moreover, Chi-square test results showed that the frequency of falls 3 months after the intervention in the control group was slightly higher than in the training group.


4. Discussion and Conclusion
Based on the components of collaborative care model, one of which is the involvement of patients and their families in making decisions and how to implement interventions, this study by establishing an effective, interactive and continuous relationship between team members during the care and treatment process according to the culture and family and individual conditions, collaborative care training program was provided to the elderly and lead to reduced fear of falling in them. Hence, it can be concluded that the collaborative care model reduces the fear of falls in the elderly. Therefore, it is recommended to use this simple and cost-effective program to teach patients and their families how to prevent falls and reduce the fear of falls in the elderly. Some of the limitations of the present study was the short intervention period, financial problems to solve some environmental problems, and lack of cooperation of some samples to participate in training sessions.

Ethical Considerations
Compliance with ethical guidelines
This study obtained ethical approval from the Ethics Committee of Isfahan University of Medical Sciences (Code: IR.MUI.RESEARCH.RES.1398.046). All ethical principles are considered in this article. The participants were informed about the purpose of the research and its implementation stages. They were also assured about the confidentiality of their information. They were free to leave the study whenever they wished, and if desired, the research results would be available to them.

Funding
This study was extracted from a Msc. thesis of first author at the Department of Geriatrics and Community Health Nursing and Management, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan.

Authors' contributions
Conceptualization, methodology, software, validation, formal analysis, investigation, resources, data curation, writing – original draft preparation: Elham Sadat Mirlohi; Writing – review & editing, visualization, supervision: All Authors; Project administration, funding acquisition: Elham Sadat Mirlohi and Mahrokh Keshvari.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors would like to thank the Comprehensive Health Centers of Isfahan, the general physician, and the elderly who participated in the study for their cooperation.

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