tai chi and fall reductions in older adults

Tai Chi and Fall Reductions Tai Chi and Fall Reductions in Older Adultsin Older Adults

Fuzhong Li, PhDOregon Research InstituteEugene, OR 97403www.ori.orgE-mail: [email protected]

Shanghai

BackgroundBackgroundWhat is Tai Chi?

– Originated as a style of martial arts – Consists of a series of individual forms

linked together to flow smoothly from one form to another

– Linked to the classic Chinese philosophy of “yin” and “yang”

– The dynamic relationship between Yin and Yang underpins all movements of Tai Chi to create a continuous reciprocity of yin states and yang states.

Describe the growing body of research assessing health benefits of Tai Chi

Falls Among Older Adults

Tai Chi and falls prevention

From Research to Community Practice: A case study

About This Talk

Mental and Physical Health

• Improving mental health, positive affect, life satisfaction; reduced levels of depression negative affect, and psychological distress, and overall sense of well-being (Kutner et al., 1997; Li et al., 2001).

• Improving movement/exercise self-efficacy and arthritis self-efficacy, and domain-specific physical self-esteem (Hartman et al., 2000;

Li et al., 2001; Li et al., 2002).

Research on Tai Chi

Musculoskeletal Conditions

• Improving muscular strength – knee extensors, force control (Christou et al., 2003; Wolfson et al., 1996)

• Improving tension, fatigue, pain and stiffness in joints, range of motion in patients with osteoarthritis (Hartman et al., 2000; Song et al., 2003)

• Improving symptom management and health-related quality of life in patients with Fibromyalgia (Taggart et al., 2003)

Research on Tai Chi

Musculoskeletal Conditions

• Retarding bone loss in older women (Chan et al., 2004)

• Lumbar spine, proximal femur (DXA), distal tibia (pQCT)

• a general bone loss in all measured skeletal sites (0.1-1.8%) but with a slow rate for those in Tai Chi

• a significant 2.6- to 3.6 fold retardation of bone loss in distal tibia

Research on Tai Chi

Cardiovascular and Respiratory Function

• Better cardiorespiratory function (heart rates, energy cost; VO2 Max) in long-term Tai Chi practitioners (Chao et al., 2002; Lai et al., 1993; Lan et al., 1996)

• Enhanced cardiac function for patients who had coronary artery bypass surgery (Lan et al., 1999)

Research on Tai Chi

Hypertension

• Reducing systolic and diastolic blood pressure (Wolf et al., 1996; Young et al., 1999)

• -7.0 mm Hg in systolic, -2.4 mm Hg in diastolic

• Reducing blood pressure in patients recovering from acute myocardial infraction (Channer et al., 1996)

Research on Tai Chi

Quality of Sleep

• Improving overall quality of sleep with respect to sleep-onset latency, sleep duration, sleep efficiency, sleep disturbances, and daytime sleepiness (Li et al., 2004)

• sleep-onset latency of about 18 minutes less per night

• sleep duration of about 48 minutes more per night

Research on Tai Chi

Neurological Disease

• Increased walking speed and hamstring flexibility in patients with multiple sclerosis after a 8-week Tai Chi program (Husted et al., 1999).

• Improving physical performance in older adults with Parkinson’s Disease (Li et al., 2007).

Research on Tai Chi

Immune Function

• Improving the antibody response to influenza vaccine in older adults (Yang et al., 2007).

Research on Tai Chi

The Problem• More than one in three people age 65 years or older falls each year. The risk of falling -- and fall-related problems -- rises with age.

• Among older adults, falls are the leading cause of injury deaths

• In 2005, 15,800 people 65 and older died from injuries related to unintentional falls; about 1.8 million people 65 and older were treated in emergency departments for nonfatal injuries from falls, and more than 433,000 of these patients were hospitalized.

Tai Chi and Falls Prevention

http://www.cdc.gov/ncipc/factsheets/adultfalls.htm

Outcomes of Falls• 20%-30% suffer moderate to severe injuries (e.g., bruises, hip fractures, or head traumas)

• Falls are the most common cause of traumatic brain injuries (or TBI).

• Most fractures among older adults are caused by falls.

• Many people who fall, even those who are not injured, develop a fea4r of falling activity restrictions reduced mobility increased actual risk of falling

• In 2000, direct medical costs totaled $0.2 billion ($179 million) for fatal falls and $19 billon for nonfatal fall injuries (Stevens et al., 2006)



Who Is at Risk?• Men are more likely to die from a fall

• Women are 67% more likely than men to have a nonfatal fall injury

• Rates of fall-related fractures among older adults are more than twice as high for women as for men.

• The risk of being seriously injured in a fall increases with age

• Nearly 85% of deaths from falls in 2004 were among people 75 and older

• White women have significantly higher rates of fall-related fractures than black women



How Can Older Adults Prevent Falls• Ask doctor or pharmacist to review medicines – reducing side effects and interactions

• Have eyes checked at lest once a year

• Improve the lighting in home

• Reduce hazards in home that can lead to falls



• Exercise Regularly; Exercise programs like Tai Chi that increase strength and improve balance are especially good

How Can Older Adults Prevent Falls• Exercise Regularly; Exercise programs like Tai Chi that increase strength and improve balance are especially good • CDC Compendium (2008)



• Designed for public health practitioners and community-based organizations, to help them address the problem of falls among older adults. • Describes 14 scientifically tested and proven interventions, and provides relevant details about these interventions for organizations who want to implement fall prevention programs.

Balance Control

• Improving balance – static, dynamic, functional (Jacobson et al., 1997; Li et al., 2005; Schaller, 1996)

Research on Tai Chi and Falls Prevention

Fall Reductions

• Reducing risk of multiple falls • 40% - 55% (Barnett et al., 2003; Li et al., 2005; Wolf et al., 1996)

• Frequency of falls - fewer falls (38 vs. 73), lower proportions of falls (28 vs. 44%), injurious falls (7 vs. 18%) (Li et al., 2005)


Reductions in Fear of Falling

• Reducing fear of falling (Wolf et al., 1996; Li et al., 2005)

• ADLs/IADLs, mobility, and social activity


Translating and Disseminating Evidence-based Falls Prevention

Programs into Community

From Research to Practice

Li et al (2008). Journal of Physical Activity & HealthLi et al (2008). American Journal of Public Health

• Randomized controlled trials have shown the efficacy of Tai Chi in reducing frequency of falls and risks of falling in older adults

• However, there is little evidence for whether scientifically validated falls prevention programs can be translated and disseminated to reach broader community-based senior service providers

RATIONALE

To evaluate Tai Chi – Moving for Better Balance, an evidence-based falls prevention program developed for use in community-based organizations such as senior centers

OBJECTIVE OF THIS RESEARCH

REACH:% of individuals who responded to the program promotion divided by the number of eligible individuals qualified per study criteria

Questions

ADOPTION: % of local community senior centers approached that agreed to participate and implement the program

IMPLEMENTATION: the extent to which providers/instructors successfully implemented key elements of the program

EFFECTIVENESS: change in measures of physical performance and qualify-of-life

Questions

MAINTENANCE: at the setting level: the center’s: (1) willingness to consider Tai Chi as part of a center’s programs, and (2) continuation of the program upon completion of the intervention. At the participant level: the extent to which participants continued their Tai Chi practice during the 12-weeks following class termination

The Program

• 8 Forms – Tai Chi: Moving for Better Balance

• Program package: Implementation plan, teaching manual and user’s guide

• Training Schedule – a 6—minutes group-based practice session implemented on a twice per week in-class schedule, supplemented by a 30-minutes weekly home-based exercise session.

Class Instructor

• Average 8.5 years of teaching experience (range: 0 – 15)

• Mean age – 59 (range: 56 – 82 years old)

• Three master level (mean = 15 years training); 2 novel (2 years of training; 0 years of teaching)

REACH:87% (by study criteria); 45% by client attendance

Dissemination Outcome

ADOPTION: Six senior activity centers from five communities: 100% adoption

IMPLEMENTATION: 75% completed; >85% class attendance; average 32 min. of home practice

Effectiveness: Improved physical performance and quality-of life measures (a) Functional Reach test; (b) Up and Go test; (c) time to rise from a chair (chair stands), (d) the 50-foot speed walk, and SF-12.

Maintenances: Five centers continued; 87% participants continued

Dissemination Outcome

ImpactAdopted by the State of Oregon: being implemented in four counties; three more starting this year

The evidence-based Tai Chi program is practical to disseminate and can be effectively implemented and maintained in community settings.

Conclusion

Questions?

Thank You

tai chi and fall reductions in older adults

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