A systematic review of the effectiveness of Tai Chi on fall reduction among the elderly

doi:10.1016/j.archger.2008.02.018

Archives of Gerontology and Geriatrics

Volume 48, Issue 3, May–June 2009, Pages 325-331

https://doi.org/10.1016/j.archger.2008.02.018 Get rights and content

Abstract

Falls among the elderly is a major public health concern. There has been recent extensive research on the effects of Tai Chi in fall prevention among the elderly. As such, we undertook a systematic review to look for evidence on the effect of this intervention. There were seven randomized controlled trials, which met our objective and inclusion criteria. Our review has shown that Tai Chi has the potential to reduce falls or risk of falls among the elderly, provided that they are relatively young and non-frail. Further review is needed to look into the non-English studies, which assess the effectiveness of Tai Chi on fall reduction.

Introduction

Falls among the elderly is a major public health concern (Verhagen et al., 2004, Voermans et al., 2007). It has been reported that falls occurred in more than one third of the elderly aged 65 years and older annually (Blake et al., 1988, Tinetti et al., 1988). These have contributed to morbidity resulting from injuries, nursing home admissions, high medical costs, and deterioration of cognitive functions and even mortality. There is also the concern about the reduction in the quality of life subsequent to fall(s) among the elderly (Tinetti and Williams, 1997, Voermans et al., 2007). As life expectancy increases, the problem of falls among the elderly will become more pertinent (Voermans et al., 2007).

Mobility impairment involving balance, leg extension strength and gait, has been identified as a major risk factor of falls among the elderly (Graafmans et al., 1996). Of note, Tai Chi is an ancient form of exercise, which has been reported to be beneficial in enhancing balance control (Wolf et al., 1996, Wolf et al., 2003a). An earlier systematic review has reported limited evidence of its effects in preventing falls in view of paucity of randomized controlled trials (Verhagen et al., 2004). There has been recent extensive research on the effects of Tai Chi in fall prevention among the elderly. As such, we performed a recent systematic review to look for conclusive evidence on the effect of this exercise intervention.

The objective of this review was to assess the effect of Tai Chi in reducing falls among the elderly.

All randomized controlled trials were eligible. These studies should examine the effect of Tai Chi on fall prevention compared to other forms of intervention or no intervention. The population was adults aged 60 and over. The primary outcome measure was occurrence of one or more falls.

Section snippets

Search strategy

We performed an exploratory search for the relevant search terms. The population, intervention and outcome categories were filled with alternative terms considering the terminology and spelling variations. These included elderly, aged or old for population; Tai Chi or Tai Ji for intervention and falls for outcome.

The following databases were searched: Medline (1950–2007), Embase (1980–2007), Cochrane Library, Web of Science and CAB Direct. A combination of MeSH terms and natural language terms

Results

Table 3 and Fig. 1 showed the results of the studies. In Studies 3–6, there were less fallers among the Tai Chi group compared to the control group. However, only Study 4 reported that the difference in number of fallers was statistically significant (p = 0.01), while Studies 5 and 6 reported that there was no statistical difference. While Study 3 did not report whether there was any difference between the 2 groups, we found a statistical significant difference (p < 0.05) from our own computation

Main findings of the review

There were almost equal numbers of studies which showed that Tai Chi was effective in fall reduction and which found no evidence of effectiveness of Tai Chi on fall reduction in the study sample. However, it was worth noting that the studies which supported the effectiveness of Tai Chi in reducing falls were generally of higher quality (all three studies 1, 4 and 6 have adequately addressed at least 70% of the methodological criteria) compared with those which did not find any evidence of

Conclusions

Our review has shown that Tai Chi has the potential to reduce falls or fall risk among the elderly, provided that they are relatively young and non-frail. It is important to ensure the compliance rates are kept high for the intervention to be effective. It is important to note the different factors which might affect the effectiveness of Tai Chi in reducing falls among the elderly. Further review may be required to look into the non-English studies which assess the effectiveness of Tai Chi on

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A systematic review of the effectiveness of Tai Chi on fall reduction among the elderly

Abstract

Introduction

Section snippets

Search strategy

Results

Main findings of the review

Conclusions

Arch. Phys. Med. Rehabil.

Falls by elderly people at home: prevalence and associated factors

Age Ageing

Falls in the elderly: a prospective study of risk factors and risk profiles

Am. J. Epidemiol.

Tai chi: improving functional balance and predicting subsequent falls in older persons

Med. Sci. Sports Exerc.

Tai chi and fall reductions in older adults: a randomized controlled trial

J. Gerontol. A: Biol. Sci. Med. Sci.

The guidelines manual (Appendix C)

Methodology Checklist: Randomised Controlled Studies

A randomised trial of exercise programs among older individuals living in two long-term care facilities: the FALLsFREE program

J. Am. Geriatr. Soc.

Falls, injuries due to falls, and the risk of admission due to a nursing home

N. Engl. J. Med.