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Tai Chi and Fall Reductions in Older Adults. Fuzhong Li, PhD Oregon Research Institute Eugene, OR 97403 www.ori.org E-mail: [email protected] Shanghai. Background. What is Tai Chi? Originated as a style of martial arts

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Tai Chi and Fall Reductions in Older Adults

Fuzhong Li, PhD

Oregon Research Institute

Eugene, OR 97403

www.ori.org

E-mail: [email protected]

background
Background

What 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.
slide7

About This Talk

[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

slide8

Research on Tai Chi

  • 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).
slide9

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)
slide10

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
slide11

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)
slide12

Research on Tai Chi

  • Hypertension
  • Reducing systolic and diastolicblood 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)
slide13

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
slide14

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).
slide15

Research on Tai Chi

  • Immune Function
  • Improving the antibody response to influenza vaccine in older adults (Yang et al., 2007).
slide16

Tai Chi and Falls Prevention

  • 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.

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

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Tai Chi and Falls Prevention

  • 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)

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

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Tai Chi and Falls Prevention

  • 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

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

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Tai Chi and Falls Prevention

  • 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

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

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Tai Chi and Falls Prevention

  • 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.

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

slide21

Research on

Tai Chi and Falls Prevention

  • Balance Control
    • Improving balance – static, dynamic, functional (Jacobson et al., 1997; Li et al., 2005; Schaller, 1996)
slide22

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)
slide24

Research on

Tai Chi and Falls Prevention

  • Reductions in Fear of Falling
    • Reducing fear of falling (Wolf et al., 1996; Li et al., 2005)
      • ADLs/IADLs, mobility, and social activity
slide25

From Research to Practice

Translating and Disseminating

Evidence-based Falls Prevention

Programs into Community

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

Li et al (2008). American Journal of Public Health

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RATIONALE

  • 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
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OBJECTIVE OF THIS RESEARCH

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

slide28

Questions

REACH: % of individuals who responded to

the program promotion divided by the number

of eligible individuals qualified per study criteria

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

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Questions

EFFECTIVENESS: change in measures of

physical performance and qualify-of-life

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

slide31

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.
slide32

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)
slide33

Dissemination Outcome

REACH: 87% (by study criteria);

45% by client attendance

ADOPTION: Six senior activity centers

from five communities: 100% adoption

IMPLEMENTATION: 75% completed;

>85% class attendance; average 32 min.

of home practice

slide34

Dissemination Outcome

  • Effectiveness: Improved physical
  • performance and quality-of life measures
  • 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

Impact

Adopted by the State of Oregon: being

implemented in four counties; three more

starting this year

slide35

Conclusion

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

slide36

Questions?

Thank You

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