Tai Chi and Fall Reductions in Older Adults

1. Tai Chi and Fall Reductions in Older Adults Fuzhong Li, PhD Oregon Research Institute Eugene, OR 97403 www.ori.org E-mail: fuzhongl@ori.org

2. Shanghai

6. 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.

7. 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

8. 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).

9. 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)

10. 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

11. 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)

12. 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)

13. 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

14. 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).

15. Research on Tai Chi • Immune Function • Improving the antibody response to influenza vaccine in older adults (Yang et al., 2007).

16. 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

17. 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

18. 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

19. 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

20. 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

21. Research on Tai Chi and Falls Prevention • Balance Control • Improving balance – static, dynamic, functional (Jacobson et al., 1997; Li et al., 2005; Schaller, 1996)

22. 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)

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

31. 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.

32. 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)

33. 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

34. 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

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

36. Questions? Thank You