How Tai Chi Can Help Conquer Fear of Falling as We Age
Researchers explore the power of exercise to help seniors overcome apprehension and stay active
Fear of falling causes many older people to shun physical activity, which perversely increases their risk of falls. WSJ health reporter Melanie Evans joins Tanya Rivero to discuss. Photo: Tamar Searles/La Paz County Health Department
Melanie Evans
May 23, 2016 1:10 p.m. ET
The odds of a bone-shattering fall increase with age, as muscles grow weak and vision fades.
Yet seniors who fear falling are at higher risk of falling, research shows, even if they have never taken a spill before. Those most fearful of falling may decide to avoid risk by avoiding activity—and then grow weaker and more likely to fall as a result.
“It can become this vicious cycle,” said Susan Friedman, a geriatrician at the University of Rochester Medical Center who studies falls and hip fractures among the elderly. Bad falls send about 250,000 seniors to the hospital each year for hip fractures that can leave them depressed and increasingly frail, even after extensive physical therapy.
Research on fall prevention suggests the slow and meditative exercise of tai chi, with its disciplined focus on balance, may help lessen apprehension.
In Arizona, the state’s Healthy Aging Program launched tai chi classes in January across Arizona’s four counties with the largest number of falls among residents 55 years of age or older. When Laura Rhodes, 85 years old, joined a class four weeks ago, she wasn’t able to stand through the hour-long session.
Ms. Rhodes fractured her pelvis three years ago. She embraced exercise to recover, but didn’t enjoy it. Then, while visiting her daughter last year, she stopped exercising. She grew weak and her daughter became worried, Ms. Rhodes says. “I knew I had to do something, because I was getting to where I could hardly do anything.”
She returned home and joined tai chi at the local senior center. She enjoys it and says she has seen early benefits. Instructors described the discipline during the first class and introduced easy warm-up and cool-down routines.
The warm-up includes a slow, deliberate walk. Instructors demonstrate exercises that combine multiple gentle movements and then have students repeat the motions, said Lee Ann Anderson, an instructor and the prevention education and outreach manager for the La Paz County Department of Health.
Seniors are encouraged to do only what they can. In a recent class, students raised the arms to shoulder height, then tucked in the chin as they pulled arms to the chest. Students don’t move on until they feel they have mastered each exercise. “They are usually not shy at all about that,” Ms. Anderson said.
Exercise is one of the best ways to prevent falls, and research suggests it could moderately reduce fear of falling, according to a 2014 review of multiple studies on fear of falling and various exercises, including tai chi, to improve strength, coordination, balance and walking; it also found more research is needed to understand how long benefits last. Another study found tai chi was more effective than other exercises, though the benefit faded over time.
Ms. Rhodes finished a recent class standing up through almost every exercise. “The worst thing I can think of right now is fracturing something and being in a hospital bed the rest of my life,” she said. She says her neighborhood is deserted in the summer as seasonal residents leave, and she worries no one will be nearby to help if she should fall on a hot summer day. ”When it’s 110, 112 degrees, it won’t take long,” she says.
Fear of falling becomes a serious problem when seniors do less to avoid falls. Seniors are likely to eliminate social events before errands, leaving themselves isolated, said Helen Lach, a St. Louis University nursing professor who studies fear of falling. They then do even less, and grow even more frail. “There’s a point when you get older when you just can’t get away with that,” Ms. Lach said. “If you don’t exercise, it will start to catch up with you.”
Psychology researchers are focusing on cognitive behavioral techniques, which encourage discussion, to help identify fear and find ways to think differently about it. Screening tools and studies tease out how fearful a senior might be—from worried to phobic—and what are the best ways to allay concerns.
A small French study tested the use of virtual reality exposure therapy, which is commonly studied as an antidote to fear of flying or public speaking. “It shows some promise,” said Skip Rizzo, a psychologist and director of medical virtual reality at the University of Southern California Institute for Creative Technology, who wasn’t involved in the research. The area is ripe for study, Dr. Rizzo said. “We recognize this is a significant problem that leads to disability and chronic progression into loss of functional independence.”
Ann Moore realized she was avoiding nature walks and museum visits because she was afraid of falling. She participated in a cognitive behavioral therapy program last year to discuss fears and coping strategies and now enjoys going on outings in Phoenix. PHOTO: ELIZA HAWS/CHANDLER SENIOR CENTER
Ann Moore, 78, said she avoided guided nature walks and visits to museums in Phoenix because she worried about the uneven trails, museum parking ramps and stairs. But she didn’t fully recognize how much fear was holding her back until she joined an eight-week course designed to tackle the anxiety, she said.
“I really thought I was living a nice, full life,” said Ms. Moore, who volunteers at the senior center and serves on the Chandler, Ariz., mayor’s committee for the aging. Instructors challenged her to closely consider her choices, and Ms. Moore said she was surprised when she realized how many activities she shunned.
The course, which she took a year ago, is run by A.T. Still University, which trains future physical therapists, physician assistants and other health professionals. Cognitive behavioral techniques used in the course teach seniors to reconsider their fear and think differently about how to respond to anxiety.
The courses, developed at Boston University’s Roybal Center, have expanded to dozens of locations in hospitals, retirement communities and churches, said Jeffrey Alexander, an associate professor at A.T. Still University who trains instructors in the program and has evaluated its results. The course, called A Matter of Balance: Managing Concerns About Falls, is free to seniors.
Ms. Moore and other students used journals to record potential fall risks at home and at frequent haunts. During class, they shared fears and discussed strategies that could minimize risks. Instructors demonstrated how to get up after a fall and taught students exercises to improve balance.
Since taking the course, Ms. Moore has visited the Phoenix Art Museum and the Arizona Capitol Museum. One evening, she joined a guided tour in the Usery Mountain Regional Park in nearby Mesa. She felt confident navigating a dark trail with a flashlight, she said, and she enjoyed seeing owls, geckos and other nocturnal animals. “There are all sorts of little creatures that come out at night,” she said.
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