The statistics are eye-opening. According to the Center for Disease Control and Prevention (CDC), millions of Americans, age 65 or older, with 1 of 5 fall-related injuries account for 800,000 hospitalizations each year and 74 deaths a day. Injuries resulting from a fall are among the 20 most expensive medical conditions, with the cost of treating fall injuries increasing with age. To compound the issue, falling once doubles the risk of falling again.
As the landscape of health insurance continues to shift—including Medicare’s increasing emphasis on health outcomes and quality—fall prevention, in the form of patient education, screening, assessments, and physical therapy is more important than ever. In fact, physical therapy can be an effective management tool against fall risks, an intervention protocol that is supported by the U.S. Preventive Task Force, the American Geriatrics Society, and the National Council on Aging.
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 the National Institutes of Health, 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 number of risk factors one has, the greater the chance of falling.
According to the CDC, one out of five falls causes a serious injury, such as a broken bone or head trauma. The severity of such an injury can be compounded if the injured takes certain medications, such as blood thinners. Falls that don’t result in injury can have a detrimental impact on a person’s psyche. The fear of falling may result in a decrease in activity, which can lead to a weakened state and increased chance of falling.
The benefits of Tai Chi
While any number of “traditional” physical therapy exercises can help to improve balance and prevent falls, there exists meaningful evidence that the discipline of Tai Chi may reduce the risk of falling in older adults.
In brief, the ancient Chinese practice of Tai Chi is a soft martial art, that when translated approximates “supreme, ultimate harmony.” With the ultimate purpose to enhance life and balance, Tai Chi is based on the principles of yin and yang, with yin representing the parasympathetic nervous system (rest and digest) and yang 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 can also restore self-confidence in those who have fallen in the past and fear a repeat performance.
Studies have shown that the incorporation of Tai Chi to an elders’ exercise program can be beneficial. A systematic review and meta-analysis of seven randomized controlled trials involving 1,088 older adults published in the March 2015 issue of the Archives of Gerontology and Geriatrics concluded that Tai Chi practice was “beneficial to improve the balance control ability and flexibility of older adults, which may be the reason of preventing falls.”
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, helping to reduce falls resulting from sudden movements that lead to significant blood pressure drop, particularly 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 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.
To better illustrate this gentle practice, basic Tai Chi forms might include:
Seated Cloud Hands: 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.
Tai Chi Circling: 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.
Standing Tai Chi Circling: 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.
By incorporating Tai Chi into an exercise program, members of the geriatric population 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.