Falls among the elderly has been linked to the risk of different diseases and mortality. Falls among the elderly have become a public health concern due to the high mortality rates and medical costs linked to resulting injuries. While many preventive techniques have been put in place in clinical settings such as the use of support rails and grip socks, the risk of falls outside the clinical settings is still high. Different researchers have considered Tai Chi exercises as a possible solution for preventing falls among the elderly based on its effectiveness in promoting muscle strength, stability, posture, and flexibility. This capstone project examines the benefits and effectiveness of using Tai Chi in preventing falls among the elderly based on evidence obtained by different researchers.
Keywords: Falls, elderly, Tai Chi, muscle strength, fall prevention
Capstone Project: Effects of Tai Chi Promotion in Muscle Strength and Fall Prevention in Older Population Greater Than 65 Years Old
Falls can lead to reduced functionality or disabilities, high medical costs, or even death among the elderly. The adverse physiological and psychological effects that linked to falls are usually heightened among the elderly because of their reduce motor skills functionality, fear of falling, loss of balance, and drowsiness resulting from treatment plans used for preexisting conditions, among other factors. Numerous preventive measures have been put in place to reduce the risks of falls among the elderly. Tai Chi, a martial art practice originating from China, has been considered one of the possible options for promoting mental and physical health among the elderly due to its ability to promote people’s posture and balance through weight-shifting exercises. Different research studies have examined the effectiveness of Tai Chi in reducing the risks of falls among the elderly.
Falls have been a leading cause of mortality and fatal injuries among the elderly, which in turn generate enormous personal and economic costs associated with medical bill and care of older patients that have suffered from fatal falls. According to the Centers for Disease Control and Prevention, the mortality rate linked to falls among the elderly increased by 31% from 2007 to 2016, with the number of deaths being higher among individuals aged 85 years and above. In 2016, 29,668 individuals aged 65 years and above died due to falls (Burns & Kakara, 2018). Falls have been linked to more than 2.8 million injuries that have been managed in emergency rooms, more than 800,000 cases of hospitalizations, and high medical bills. In 2015, $50 billion was used to cater for the medical bills linked to falls, with Medicare and Medicaid shouldering 75% of the total costs. The amount is expected to increase to $67.7 billion by the end of 2020 (Burns & Kakara, 2018; National Council on Aging, 2019). The high rates of falls, the morbidity and mortality associated with injuries incurred by the elderly after a fall necessitate the need to find effective preventive measures for falls.
The phenomenon of interest linked to this capstone project is based on the need to prevent falls among the elderly based on the effects that they can have on the well-being of the elderly. Over 800,000 patients are hospitalized annually due to falls (Burns & Kakara, 2018). Most of the elderly patients who had suffered fatal falls are hospitalized because of hip fractures and head injuries. Fractures can also occur in other areas such as wrists, arms, and ankles. Head injuries can be fatal especially if the elderly patient was on blood thinning medication or had other preexisting conditions (Hefny, Abbas, & Abu-Zidan, 2016). Aside from physical effects of falls, some of the psychological effects of falls that most elderly patients face include post-traumatic stress disorder (PTSD), which can invoke fear and feelings of helplessness, reduced balance confidence and involvement in physical activity, anxiety, and avoidant behavior (Payette, Belanger, Leveille, & Grenier, 2016). These physical and psychological effects of falls can interfere with the lives of the elderly and their ability to perform their daily activities.
Based on the clinical problem of falls among the elderly identified, there is a need to research methods that can be used to prevent or reduce the risks of falls among this population as a way of promoting their overall health. Conducting research studies on prevention of falls is essential in reducing the rates of falls and overall costs of healthcare linked to falls among the elderly (Burns & Kakara, 2018). The existence of both detrimental physical and psychological health concerns related to falls among the elderly also makes this research necessary in promoting better care of elderly patients at risk of falls. The PICOT question that will be used in the capstone project will be; in older patients aged 65 years and above (P), is the use of Tai Chi in promoting muscle strength and fall prevention (I) more effective when compared to the absence of this intervention (C) in preventing risks of falls (O)? The purpose of this capstone project will be to assist nurses in becoming more familiar with the practice of Tai Chi and its possible effects in promoting muscle strength among the elderly.
The project was conducted through a systematic review approach that involved examining literature from different research articles on prevention of falls using Tai Chi. The literature search methods used relied on the PICOT question developed, dividing it into keywords and phrases that were used to search for useful peer-reviewed articles on Tai Chi and fall prevention. The databases used to find appropriate research articles included CIHAHL, Cochrane, and PubMed. These databases were selected because they contain peer-reviewed studies that were conducted and published by qualified professionals in the health field (Melnyk & Fineout-Overholt, 2015). The research studies included in the capstone project were based on inclusion criteria that focused on the use of Tai Chi among the elderly for fall prevention and ensuring that the studies were published within the past five years.
The research articles examined proved that the use of Tai Chi can be effective in reducing the risks of falls or fatal injuries from falls among the elderly due to increased muscle strength, balance, and coordination. In one of the systematic reviews included in the capstone project, the use of Tai Chi among the elderly was linked to a significant reduction in fall risks regardless of the duration of training sessions or style used. The study showed that the risk of falls fell significantly by the 24th week of training (Hu, et al., 2016). Individuals who participated in Tai Chi exercises in different studies showed better visual and proprioceptive functions and experienced increased knee extensor and flexor muscle strength. They also had experienced improved balance and posture (Stevens, Voukelatos, & Ehrenreich, 2014; Konig, et al., 2014). These physiological benefits of Tai Chi among the elderly suggest that utilization of Tai Chi exercises could reduce the risks of falls among the elderly considerably.
Aside from the direct link between the use of Tai Chi for muscle strength and prevention of falls, the studies obtained showed that Tai Chi exercises have additional indirect benefits. In an evidence map study that examined the role of Tai Chi in improving the health of the elderly by reducing falls, the researchers found out that Tai Chi was effective in supporting the management of hypertension, cognitive performance, depression, chronic pain, osteoarthritis, and chronic obstructive pulmonary disease (COPD) (Solloway, et al., 2016). Most of these conditions affect the elderly and their management reduces the risks of falls significantly among affected individuals. The use of Tai Chi has also be linked to reduced fear of falling among the elderly based on its posture improvement capabilities (Hosseini, et al., 2018). Reduction in the fear of falling and the use of Tai Chi promotes the psychological health of the elderly. The application of Tai Chi in diverse clinical areas that range from management of physical and psychological problems affecting the elderly to the treatment of comorbid conditions proves that Tai Chi can be effective in preventing falls.
The researchers’ association of Tai Chi and reduced falls can be used to draw recommendations on the practices that the elderly can participate in to reduce their risks of falls. For instance, since one of the studies linked engagement in Tai Chi for approximately 24 weeks with reduced risks of falls, it would be helpful if older adults enrolled in these programs are trained for more than 24 weeks to improve their health (Hu, et al., 2016). Additionally, since muscles need to be trained regularly for effective results, ensuring that older patients participate in Tai Chi continuously could ensure that they retain their muscle strength and stability. Older adults could also be educated on the benefits of Tai Chi in managing other conditions like chronic pain, COPD, osteoarthritis, and hypertension through the breathing exercises and slow muscle movements to promote their willingness to engage in Tai Chi (Hosseini, et al., 2018). These recommendations would promote engagement of the elderly in Tai Chi. The capstone project and the recommendations would also improve nurses understanding of the benefits of Tai Chi and support patients overall well-being.
Falls can lead to numerous complications among the elderly, due to their advanced age, the existence of other conditions, osteoporosis that might increase their risks of fracturing their bones, and overall fragility. Based on the evidence obtained from the research articles, using Tai Chi for muscle strength training can be effective in reducing the risks of falls. The research articles used in the capstone project illustrate the benefits of Tai Chi in improving the physical and psychological health of the elderly. Nurses’ understanding of Tai Chi techniques and its benefits could promote its utilization in healthcare facilities and its acceptance by the elderly. Utilization of the recommendations suggested could reduce the annual rate of falls among the elderly.
Burns, E., & Kakara, R. (2018). Deaths from Falls Among Persons Aged ≥65 Years — United States, 2007–2016. Morbidity and Mortality Weekly Report, 67(18), 509-514. Retrieved from https://www.cdc.gov/mmwr/volumes/67/wr/mm6718a1.htm.
Hefny, A. F., Abbas, A. K., & Abu-Zidan, F. M. (2016). Geriatric fall-related injuries. African Health Sciences, 16(2), 554-559. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4994555/.
Hosseini, L., Kargozar, E., Sharifi, F., Negarandeh, R., Memari, A.-H., & Navab, E. (2018). Tai Chi Chuan can improve balance and reduce fear of falling in community-dwelling older adults: a randomized control trial. Journal of Exercise Rehabilitation, 14(6), 1024-1031. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6323335/.
Hu, Y. N., Chung, Y.-J., Yu, H.-K., Chen, Y.-C., Tsai, C.-T., & Hu, G.-C. (2016). Effect of Tai Chi Exercise on Fall Prevention in Older Adults: Systematic Review and Meta-analysis of Randomized Controlled Trials. International Journal of Gerontology, 10(3), 131-136. Retrieved from https://www.sciencedirect.com/science/article/pii/S1873959816300746.
Konig, P. R., Galarza, E., Goulart, N. B., Lanferdini, F. J., Tiggerman, C. L., & Dias, C. P. (2014). Effects of Tai Chi Chuan on the elderly balance: a semi-experimental study. Revista Brasileira de Geriatria e Gerontologia, 17(2). Retrieved from https://www.scielo.br/scielo.php?script=sci_arttext&pid=S1809-98232014000200373.
Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice. Lippincott Williams & Wilkins.
National Council on Aging. (2019). Falls Prevention Facts. Retrieved from National Council on Aging: https://www.ncoa.org/news/resources-for-reporters/get-the-facts/falls-prevention-facts/#:~:text=According%20to%20the%20U.S.%20Centers,adult%20dies%20from%20a%20fall.
Payette, M.-C., Belanger, C., Leveille, V., & Grenier, S. (2016). Fall-Related Psychological Concerns and Anxiety among Community-Dwelling Older Adults: Systematic Review and Meta-Analysis. PLOS|ONE, 11(4), e0152848. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4820267/.
Solloway, M. R., Taylor, S. L., Shekelle, P. G., Miake-Lye, I. M., Beroes, J. M., Shanman, R. M., & Hempel, S. (2016). An evidence map of the effect of Tai Chi on health outcomes. BMC Systematic Reviews, Retrieved from https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-016-0300-y.
Stevens, J. A., Voukelatos, A., & Ehrenreich, H. (2014). Preventing falls with Tai Ji Quan: A public health perspective. Journal of Sport and Health Science, 3(1), 21-26. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4701043/.