The statistics about falls in older adults are eye-opening. The Center for Disease Control and Prevention (CDC)’s STEADI program make it clear that fall prevention in aging adults is critically important:
- One in four older adults reported a fall
- One out of five of these falls causes a serious injury (head trauma or a fracture)
- The severity of the injuries is compounded if the senior takes certain medications, such as blood thinners.
- More than 3 million seniors who experience non-fatal falls are treated in emergency departments each year
- Medicare costs for fall-related injuries amount to more than $31 billion per year
- Hospital costs account for 2/3 of the total Medicare costs
- Finally, falls can be fatal an older adult dies from a fall every 20 minutes
Even falls that don’t result in injury can have a detrimental impact on a person’s psyche. For example, the fear of falling may result in a decrease in physical activity. This can lead to a weakened state and increase the chance of falling. In fact, falling once has been found to double the risk of falling again.
Risk factors for falls in aging adults
With age, individuals may develop more risk factors that can lead to a fall. During the normal maturing process, people have decreased muscle strength, slow reflexes and balance reactions, and can develop a fear of falling.
Balance and gait are also impacted by neurological conditions, such as Parkinson’s disease or stroke and complications related to visual disturbances, diabetes, and unstable blood pressure.
Advanced age also often leads to an increased number of prescription medications. According to a study in the Journal of Age and Aging, people taking 4 or more prescription medications have an increased risk of falling.
Since most falls are caused by a combination of factors, the greater the number of risk factors one has, the greater the chance of falling.
Fall prevention, in the form of patient education, screening, assessments, exercise and physical therapy is more important than ever. But what do we know about interventions that work?
A 2010 systematic review of the evidence for the U.S. Preventive Services Task Force (USPSTF)found that exercise, physical therapy, and Vitamin D had evidence to support efficacy in fall prevention.
The exercise examined in the USPSTF included general exercise (walking, cycling, etc.), resistance training, and “some type of gait, balance, or functional training.” They did not specifically address the effectiveness of other types of exercise, such as Tai Chi.
What is Tai Chi?
In brief, the ancient Chinese practice of Tai Chi is a soft martial art. The name when translated approximates “supreme, ultimate harmony.”
Tai Chi is based on the principles of yin and yang. Its ultimate purpose is to enhance life and balance. Yin represents the parasympathetic nervous system (rest and digest). Yang represents the sympathetic nervous system (fight or flight).
Tai Chi involves soft, slow movements in opposite directions (yin and yang) to increase strength and improve flexibility and concentration. It also improves balance and gait.
But does Tai Chi prevent falls
A 2017 meta-analysis (a systematic review of research papers) examined the impact of Tai Chi on the risk of falls. It was published in the Journal of the American Geriatric Society. The study found that the practice of tai chi reduced the rate of falls by 43% over the short term (less than 12 months). It also reduced the rate of injury-related falls by 50%. The studies reviewed were not felt to be high quality so more studies were recommended.
Tai Chi was also shown to be effective in reducing falls in people with Parkinson’s disease and stroke in a 2018 meta-analysis published in the journal Clinical Rehabilitation. Another 2018 meta-analysis published found that “Tai Chi exercise might have a significant impact in improving balance efficiency and reducing fall rate.” And, yet another 2018 meta-analysis found that Tai Chi “may be beneficial for stroke survivors with respect to gait ability in the short term. The authors also issued a call for better studies, specifically large, long-term randomized control trials to confirm their conclusion.
All of these studies suggest that Tai Chi can improve balance and reduce falls in aging adults. Further, the studies did not find any adverse effects of the practice. Given the benefits and non-existent risks, I believe that aging adults should take the time to learn and routinely practice the discipline of Tai Chi.
How does it work?
To achieve balance, the following principles are employed:
- Upright posture
- Coordinated breathing
- Weight shifting
- Slow, fluid, rounded movements
The slow, smooth, and continuous movements of Tai Chi help to strengthen internal muscles that support and strengthen the spine. In addition to its physical benefits, this form of gentle resistance can calm the mind.
As noted above, it may help to reduce falls, including those related to blood pressure drops from sudden movements that lead to significant blood pressure drop. This is particularly true in those who take medication that can cause variations in blood pressure.
Tai Chi practitioners are mindful of the importance of transferring weight with each step. This assists mobility, coordination, and balance And, it places emphasis on upright and supple posture to further strengthen muscles.
That said; Tai Chi—which can best be described as a moving form of meditation—is extremely low-impact, placing minimal stress on joints and muscles.
Basic Tai Chi forms
To better illustrate this gentle practice, basic Tai Chi forms might include:
Seated Cloud Hands (minute 11:50): This seated exercise requires raised hands, followed by the right-hand scooping down and then rising to land in front of the left-hand. As the right rises in front of the left, the left-hand drops down and rests above the thigh, palm facing down. The exercise is then duplicated beginning with the left-hand.
Standing Tai Chi Circling Hands: This standing exercise starts in a neutral position holding the aforementioned pretend ball. The ball is brought inwards toward the abdomen, then up, pushed down, and away.
Seated Tai Chi Circling Hands: This seated exercise can be done with or without back support, depending on comfort. The head is lifted skyward; patients are asked to pretend they are holding a ball and to bring it into their stomach, then to bring the ball up and push it away and down. The movement is then reversed.
The bottom line
By incorporating Tai Chi into an exercise program, aging adults can take advantage of the many benefits of an ancient Chinese practice that at its core promotes strength, flexibility, and balance—both physically and psychologically. All of these are key components of any fall prevention strategy.
First published May 15, 2017. Medically reviewed and updated 2/1/20.
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