Supplement

Reducing the Risk of Falls and the Fear of Falling

Falls in the elderly are a serious public health issue. they are the leading cause of injury death in persons 65 years or older and one-third of older adults fall every year. More than 350,000 seniors were hospitalized in 2000 for injuries related to falls. Falls are more common in nursing homes than in the community, perhaps because of the greater frailty of institutionalized elders. Non-modifiable risk factors for falls include increasing age, female sex, previous falls, and concurrent physical limitations or conditions. Possibly modifiable risk factors include gait or balance problems and lower body weakness. Interventions that would reduce the risk of falls in the elderly would be of interest—especially if such interventions were safe, relatively low cost, and acceptable to the elderly population at risk (see Table 1 and Table 2 for tips on reducing the risk of falls and fear of falling).1,2

An increasing body of evidence suggests that an exercise program based on the ancient Chinese martial arts, tai chi, may be very useful in reducing the risk of falling in the elderly. Tai chi (also known as taiji or taijiquan) reportedly was invented by a hermit monk living 3,000 years ago in China. He established what has been called the 13 basic postures. By moving in all directions, these postures were thought to represent all of the cardinal directions and the basic elements, ending with the centering of the energy in the earth. Many different types of tai chi have been developed from these basic moves. The most common form practiced in today is the Yang short form. It consists of 24 interconnected movements/postures that are designed to slowly take a person through a series of turns, balance shifts, and changes in distribution of weight from foot to foot while in a slightly crouched stance. These are done in a relaxed, meditative state using slow, controlled breathing. Each person practices as much of the movements as they can at her own pace. In China, it used to be very common for large groups of even very elderly persons to practice these movements each morning in the parks for about 30-45 minutes.3

Given the description of the technique, it should be apparent how such an intervention could aid in fall prevention. The crouched stance increases lower body strength, and the movement from foot to foot while turning slowly addresses balance and stance issues. Patients could be expected to increase their awareness of the position of their body in space and to have a greater sense of self-confidence about their ability to maintain their balance.

How will elderly patients accept this unusual form of exercise? Subjects in the studies tolerated the procedure well and seemed to continue to practice even after formal instruction ended—at least for a while. Group classes are likely the best forum for patients to learn and continue to practice this type of exercise. For those who have elderly patients or family members at risk, find a class at a local senior center, nursing home, hospital, or community center that is taught by an instructor used to teaching seniors. This low-cost and potentially very helpful intervention could be life-saving.

References

1. Centers for Disease Control. National Center for Injury Prevention and Control. Falls among older adults: A summary of research findings. Available at: www.cdc.gov/ncipc/duip/SummaryOfFalls.htm. Accessed July 12, 2003.

2. Centers for Disease Control. National Center for Injury Prevention and Control. Falls and hip fractures among older adults. Available at: www.cdc.gov/ncipc/factsheets/falls.htm. Accessed July 12, 2003.

3. Novey DW. Clinician’s Complete Reference to Complementary & Alternative Medicine. St. Louis, MO: Mosby; 2000.