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Thread: Fall prevention

  1. #16
    Join Date
    Jan 1970
    Fremont, CA, U.S.A.

    Prevent Falls Among Older Adults at High Risk of Falling

    Another paper on Fall Prevention. Another study implementing Tai Ji Quan: Moving for Better Balance® (TJQMBB).

    I only copied until the abstract & conclusions - you'll have to follow the link for the entire paper.

    One more note - this is why I always objected to JAMA (the now-defunct Journal of Asian Martial Arts) being referred to as JAMA. Anyone in the know about academic journals reads 'JAMA' and they think Journal of the American Medical Association, which is far more prestigious.

    Effectiveness of a Therapeutic Tai Ji Quan Intervention vs a Multimodal Exercise Intervention to Prevent Falls Among Older Adults at High Risk of Falling
    A Randomized Clinical Trial
    Fuzhong Li, PhD1,2; Peter Harmer, PhD, MPH3; Kathleen Fitzgerald, MD4; et al Elizabeth Eckstrom, MD, MPH5; Laura Akers, PhD1; Li-Shan Chou, PhD6; Dawna Pidgeon, PT7; Jan Voit, PT8; Kerri Winters-Stone, PhD9
    Author Affiliations Article Information
    JAMA Intern Med. 2018;178(10):1301-1310. doi:10.1001/jamainternmed.2018.3915

    Key Points
    Question Is a fall prevention–specific tai ji quan intervention clinically more effective in reducing falls among older adults at high risk of falling than a stretching intervention (control) or a standard multimodal exercise intervention?

    Findings In a randomized clinical trial involving 670 adults 70 years or older with a history of falls or impaired mobility, the therapeutic tai ji quan intervention effectively reduced falls by 58% compared with the stretching exercise (control intervention) and by 31% compared with a multimodal exercise intervention.

    Meaning For older adults at high risk of falling, a therapeutically tailored tai ji quan intervention was more effective than stretching or multimodal exercises in reducing the incidence of falls.


    Importance Falls in older adults are a serious public health problem associated with irreversible health consequences and responsible for a substantial economic burden on health care systems. However, identifying optimal choices from among evidence-based fall prevention interventions is challenging as few comparative data for effectiveness are available.

    Objective To determine the effectiveness of a therapeutically tailored tai ji quan intervention, Tai Ji Quan: Moving for Better Balance (TJQMBB), developed on the classic concept of tai ji (also known as tai chi), and a multimodal exercise (MME) program relative to stretching exercise in reducing falls among older adults at high risk of falling.

    Design, Setting, and Participants A single-blind, 3-arm, parallel design, randomized clinical trial (February 20, 2015, to January 30, 2018), in 7 urban and suburban cities in Oregon. From 1147 community-dwelling adults 70 years or older screened for eligibility, 670 who had fallen in the preceding year or had impaired mobility consented and were enrolled. All analyses used intention-to-treat assignment.

    Interventions One of 3 exercise interventions: two 60-minute classes weekly for 24 weeks of TJQMBB, entailing modified forms and therapeutic movement exercises; MME, integrating balance, aerobics, strength, and flexibility activities; or stretching exercises.

    Main Outcomes and Measures The primary measure at 6 months was incidence of falls.

    Results Among 670 participants randomized, mean (SD) age was 77.7 (5.6) years, 436 (65%) were women, 617 (92.1%) were white, 31 (4.6%) were African American. During the trial, there were 152 falls (85 individuals) in the TJQMBB group, 218 (112 individuals) in the MME group, and 363 (127 individuals) in the stretching exercise group. At 6 months, the incidence rate ratio (IRR) was significantly lower in the TJQMBB (IRR, 0.42; 95% CI, 0.31-0.56; P < .001) and MME groups (IRR, 0.60; 95% CI, 0.45-0.80; P = .001) compared with the stretching group. Falls were reduced by 31% for the TJQMBB group compared with the MME group (IRR, 0.69; 95% CI, 0.52-0.94; P = .01).

    Conclusions and Relevance Among community-dwelling older adults at high risk for falls, a therapeutically tailored tai ji quan balance training intervention was more effective than conventional exercise approaches for reducing the incidence of falls.
    Gene Ching
    Author of Shaolin Trips
    Support our forum by getting your gear at MartialArtSmart

  2. #17
    Join Date
    Jan 1970
    Fremont, CA, U.S.A.

    Pensioners can cut the risk of falls by a fifth by practicising Tai Chi

    Usually I'd dig up the original study paper, but I'm a bit pressed this morning, so if anyone wants to search it out, please be my guest.

    Pensioners cut risk of falling by almost a fifth if they take up Tai Chi, Oxford University study finds

    Tai Chi was found to reduce falls by 19 per cent CREDIT: TIM PLATT

    Laura Donnelly, health editor
    31 JANUARY 2019 • 9:05PM

    Pensioners can cut the risk of falls by a fifth by practicising Tai Chi and other exercise programmes, research suggests.

    A study involving Oxford University found that elderly people enrolled in fitness classes to improve their strength were far less likely to end up suffering potentially deadly injuries.

    The research, which examined 108 trials, with 23,407 participants, found that classes which aim to improve balance and functional exercise cut the risk of falls by 23 per cent.

    The average age of those in the study was 76 years old, with three quarters of participants female.

    The trials involved pensioners living independently at home as well as those in retirement villages, or in sheltered accommodation.

    The review found that exercise programmes carried out in group classes or done at home prescribed by a physiotherapist were effective. Exercises were mostly done while standing as this better enhances balance and the ability to do daily activities such as standing up from a low chair or climbing stairs.

    On average, those taking part in all exercise programmes had 23 per cent fewer falls than those who did not, while Tai Chi was found to reduce the rate of falls by 19 per cent.

    Experts said it was less clear whether exercises like dancing and walking, which do not focus on balance, could cut the risk of falls.

    The Cochrane Review was carried out by Oxford University and Sydney University.

    Author, Professor Cathie Sherrington from The University of Sydney, Institute for Musculoskeletal Health said: “This evidence helps build an even stronger picture that exercise can help prevent older people having falls. It also illustrates which types of exercise can be beneficial. It is well known that keeping active promotes good health but this review pinpoints which types of exercise are more likely to be effective for preventing falls.”
    Gene Ching
    Author of Shaolin Trips
    Support our forum by getting your gear at MartialArtSmart

  3. #18
    Join Date
    Jan 1970
    Fremont, CA, U.S.A.

    NPR coverage

    There's an audio file.

    Simple Ways To Prevent Falls In Older Adults
    July 14, 20198:21 AM ET
    Heard on Weekend Edition Sunday

    Many falls among the elderly are preventable. Ways to help include reducing certain medications, getting vision checked and using walking aides.
    Tomas Rodriguez/Getty Images/Picture Press RM

    As we age, the risk of falling increases and becomes increasingly perilous. A fall can be a real health setback for a frail, elderly person. And, more older adults are dying from falls today than 20 years ago. A recent study showed that more than 25,000 U.S. adults age 75 or above died from a fall in 2016, up from more than 8,600 deaths in 2000, and the rate of fatal falls for this age group roughly doubled.

    But the risk of falling can be minimized, says Dr. Elizabeth Eckstrom, professor and chief of geriatrics at Oregon Health & Science University. "A lot of older adults and a lot of physicians think that falling is inevitable as you age, but in reality it's not."

    NPR's Lulu Garcia-Navarro and Luisa Torres spoke to Eckstrom about the most common causes of falling among seniors and the best ways to prevent them.

    This interview combines two separate conversations with Eckstrom and has been edited for clarity and length.

    Are seniors falling more than they used to? Or are there more seniors? Does something else explain this increase?

    I think it might be a little bit of both. There are so many more seniors, and there's probably better reporting than there used to be. There's more awareness about falls as older adults and doctors are starting to think about it a little bit more. I think our older adults are starting to [be more active], and that also is going to put you at risk for falling. I always tell people to please not be sedentary to prevent falls. That's the worst thing you can do. You've got to be out and active, but being out and doing things does allow you to put yourself in a position where you could fall.

    Also, I think one of the biggest problems for falls is that so many older adults are on risky medications. Those sleeping pills, pain pills, a lot of the drugs that older adults have been prescribed for years and years have markedly increased risk for falling. And if we could get everybody off of those pills, it would be so helpful.

    How do pain pills increase the risk of falls?

    Pain pills have similar side effects [compared to] sleeping pills. They can make you dizzy. They can make you confused. They can make you lethargic. They can cause you to not be as sharp so that you're not paying attention to curbs or uneven sidewalks.

    Are there any other drugs that seniors should be aware of?

    Yeah, absolutely. There are a lot of drugs that fall into a class called anticholinergics. It's the class that has cold medications in it, like Sudafed PE, [and] drugs to help control bladder problems, like Detrol. All of those drugs are in that very dangerous anticholinergic class, [which] increases your risk for falling.

    The other thing that a lot of older people take is blood pressure pills. Managing blood pressure is a little tricky [because] you don't want your blood pressure to be too high, because that increases your risk for heart attacks and strokes. But if you take too many blood pressure pills, it makes your blood pressure too low, and you get dizzy and you fall.

    A study from the Centers for Disease Control and Prevention found that physicians routinely failed to perform basic interventions to help prevent falls. Why do you think that is, and how could doctors help?

    Most primary care doctors have no more than 15 minutes with a patient, and they're managing their diabetes, congestive heart failure, their asthma — all of those other medical conditions. And [they] don't recognize the importance of fall prevention in that milieu. It takes a lot of work to help an older adult reduce their risk for falling. You've got to talk about the glasses; you've got to make sure they're wearing the right shoes; you've got to make sure they're using a gait aid [like a cane or a walker] if they need one — and all of those things take time.

    The CDC has also done a beautiful job of putting together a fall prevention package in an initiative called STEADI (Stopping Elderly Accidents, Deaths & Injuries). You can go to their website and find all sorts of useful information to help both clinical teams, older adults and families to reduce risk for falling.

    Can you remind us why falling is so dangerous for older adults?

    About a third of older adults who fall actually have some form of injury, and a lot of those are hip fractures and head injuries. And those can be fatal, of course. A vitally important thing is fear of falling, and many older adults who fall curtail their activities because they're afraid they're going to fall again. And, again, that's kind of the worst thing you can do because now you're losing mobility, you're getting weaker and you're not moving around as much.

    What are some of the interventions you've used that can help seniors?

    You can do so many things. First of all, I tell everybody you've got to do some balance training. Tai chi is probably the best exercise to prevent falls, but whatever works for you. And, interestingly, just walking does not reduce your risk for falling. So a lot of doctors will say, "Just get out and walk 20 minutes every day, and that'll keep you safe. That'll help you stay healthy." Walking is great for your heart; it's great for your brain; it's great for lots of it. But in order to really reduce your risk for falls, you've got to do something specific to balance.

    What makes tai chi a good exercise to prevent falls? And why isn't walking a good alternative?

    Walking is kind of just keeping you in one plane moving forward, and it's not doing any kind of postural training. What tai chi does is it gives you an increased area of postural stability, [which is] kind of your being able to remain upright in space. When you do tai chi, you do stepping moves to the front, to the side; you move your arms out, you reach, you bend. And basically that increases the size of your postural stability so that you can catch yourself and not have the fall. You can be a little bit off kilter and right yourself.

    Do you have any more advice on how seniors can prevent falls?

    For most people, it's not just one bad thing. It's not just your balance, or it's not just your vision, or it's not just one pill that you're taking. If somebody wants to reduce their risk of falls, they should really think about all of the various ways: making sure you're wearing the right shoes, using a walker if you need it, getting off those risky medications. It's really important to tend to all of those little details to really get your fall risk as low as possible. I encourage people to just work on that really, really hard. It's worth the trouble.

    Francesca Paris and Ed McNulty produced and edited this story for broadcast.

    July 15, 2019
    A previous Web version of this story stated that Sudafed is an anticholinergic. It is not, but the more commonly available Sudafed PE is.
    Gene Ching
    Author of Shaolin Trips
    Support our forum by getting your gear at MartialArtSmart

  4. #19
    an old but interesting clip on the stages of walking, development
    and aspects defining gait.

    A good contrast to understand what might change as a person ages,
    and explain why the practice of taiji among other practices might be
    a good way to either correct or retain good qualities of movement
    well into ones old age

    Last edited by windwalker; 07-27-2019 at 06:36 AM.

  5. #20
    Join Date
    Jan 1970
    Fremont, CA, U.S.A.

    Tai Chi: Postural Balance & Dementia

    Randomised Controlled Trial Of The Effect Of Tai Chi On Postural Balance Of People With Dementia

    Authors Nyman SR, Ingram W, Sanders J, Thomas PW, Thomas S, Vassallo M, Raftery J, Bibi I, Barrado-Martín Y

    Received 28 August 2019

    Accepted for publication 26 September 2019

    Published 19 November 2019 Volume 2019:14 Pages 2017—2029


    Checked for plagiarism Yes

    Review by Single-blind

    Peer reviewers approved by Dr Nicola Ludin

    Peer reviewer comments 3

    Editor who approved publication: Dr Richard Walker

    Article has an altmetric score of 28

    Video abstract presented by Samuel R Nyman.

    Views: 436

    Samuel R Nyman,1 Wendy Ingram,2 Jeanette Sanders,2 Peter W Thomas,3 Sarah Thomas,3 Michael Vassallo,4 James Raftery,5 Iram Bibi,1 Yolanda Barrado-Martín1

    1Department of Psychology and Ageing & Dementia Research Centre, Faculty of Science and Technology, Bournemouth University, Poole House, Talbot Campus, Poole, Dorset BH12 5BB, UK; 2Peninsula Clinical Trials Unit, Peninsula Medical School, University of Plymouth, Plymouth, Devon PL4 8AA, UK; 3Bournemouth University Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Royal London House, Lansdowne Campus, Bournemouth, Dorset BH1 3LT, UK; 4Centre of Postgraduate Medical Research and Education, Faculty of Health and Social Sciences, Bournemouth University, Royal London House, Lansdowne Campus, Bournemouth, Dorset BH1 3LT, UK; 5Faculty of Medicine, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK

    Correspondence: Samuel R Nyman
    Department of Medical Science and Public Health, Faculty of Health and Social Sciences, Bournemouth University, Poole House, Talbot Campus, Poole, Dorset BH12 5BB, UK
    Tel +44 1202 968179

    Purpose: To investigate the effect of Tai Chi exercise on postural balance among people with dementia (PWD) and the feasibility of a definitive trial on falls prevention.
    Patients and methods: Dyads, comprising community-dwelling PWD and their informal carer (N=85), were randomised to usual care (n=43) or usual care plus weekly Tai Chi classes and home practice for 20 weeks (n=42). The primary outcome was the timed up and go test. All outcomes for PWD and their carers were assessed six months post-baseline, except for falls, which were collected prospectively over the six-month follow-up period.
    Results: For PWD, there was no significant difference at follow-up on the timed up and go test (mean difference [MD] = 0.82, 95% confidence interval [CI] = −2.17, 3.81). At follow-up, PWD in the Tai Chi group had significantly higher quality of life (MD = 0.051, 95% CI = 0.002, 0.100, standardised effect size [ES] = 0.51) and a significantly lower rate of falls (rate ratio = 0.35, 95% CI =0.15, 0.81), which was no longer significant when an outlier was removed. Carers in the Tai Chi group at follow-up were significantly worse on the timed up and go test (MD = 1.83, 95% CI = 0.12, 3.53, ES = 0.61). The remaining secondary outcomes were not significant. No serious adverse events were related to participation in Tai Chi.
    Conclusion: With refinement, this Tai Chi intervention has potential to reduce the incidence of falls and improve quality of life among community-dwelling PWD [Trial registration: NCT02864056].
    Tai Chi as medicine
    Fall prevention
    Gene Ching
    Author of Shaolin Trips
    Support our forum by getting your gear at MartialArtSmart

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