The effect of a falls prevention program in elderly people in primary health care. What does Tai Chi practice provide?
e201906032
Keywords:
Accidental falls, Health of the Elderly, Accident prevention, Tai Chi, Primary Health CareAbstract
Background: Falls in the elderly are a major health problem. There are multiple experiences of intervention in primary care. Aim: To evaluate the impact of a multifactorial intervention in the prevention of falls in elderly people. To compare the differential effect of the practice of Tai Chi.
Methods: Non-randomized before-after quasi-experimental design in an urban health center between the years 2014-2017. The study population was those over 65 years old with a high risk of falls. The intervention consisted of an individual assessment of risk factors: sensory problems, balance, orthostatic hypotension, treatments (psychotropic drugs, hypotensive drugs), barriers, technical aids. It was intervened in its correction. Tai Chi group participation is proposed. The dependent variables (baseline and year measurements) were Barthel, Unipodal Station Test (TEU), number of falls per year, Anxiety/Depression Goldberg Scale (EADG), number of medical consultations per year, walking aids, Daily Dose Defined of analgesics (DDD)/ year. The before-after analysis was performed using the Chi2 and T Student statistics for paired samples.
Results: A total of 93 patients participated with an average age of 76±06,65, 84.9% women. Falls/year baseline 1.65±0.24; no significant differences between groups with or without Tai Chi in any baseline variable. At one year, average reduction of falls/year 0.53 (IC95% 0,07-0,99) (p=0.023), EADG anxiety 1.4±0.33 points (p<0.0001), EAGD depression 0.73±0.26 points (p=0.007). 44 patients practiced Tai Chi; finding: reduction of 1.88 (IC95% 0.90-2.80) points (p<0.0001) in EADG anxiety and 0.86 points (IC95% 0.12-1.60) (p=0.024) in EADG depression; 30.9% of patients abandoned technical aids (p<0.0001); 11% started psychotropic drugs. 49 patients did not practice Tai Chi; of them: EADG anxiety reduction of 1,020 points (IC95% 0.07-1.96) (p=0.035); 41.2% of patients initiated psychotropic drugs (p=0.001); none of the patients abandoned technical aids and 14.3% started them (p<0.001).
Conclusions: The intervention reduced the number of falls, anxiety, the use of psychotropic drugs, depression, and the use of walking aids, with differential benefit of Tai Chi in these last three aspects.
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References
Akyol AD. Falls in the elderly: What can be done?. Int Nurs Rev.2007;54:191-6.
. Ganz DA, Bao Y, Shekelle PG, Rubenstein LZ. Will my patient fall?. JAMA. 2007;297:77-86.
National Institute for Health and Care Excellence (NICE). Falls: assessment and prevention of falls in older people. London (UK): National Institute for Health and Care Excellence (NICE); 2013 Jun. 33 p. (Clinical guideline; no. 161).
WHO. WHO global report on falls prevention in older age. Geneva Switzerland: World Health Organization; 2007.[Acceso 12/09/2018]; Disponible en: http://www.who.int/ageing/projects/falls_prevention_ older_age/en/.
Terra L, Vitorelli LK, Inácio M, Mendes A, Silva JV, Mónica Ribeiro M. Evaluación del riesgo de caídas en las personas mayores: ¿cómo hacerlo? Gerokomos. 2014;25(1):13-6.
Documento de consenso sobre prevención de fragilidad y caídas en la persona mayor. Estrategia de promoción de la Salud y prevención en el SNS. Madrid: Ministerio de Sanidad, Servicios Sociales e Igualdad. 2014.
Gómez Pavón J, Martín Lesende I, Batzán Cortés JJ, Regato Pajares P, Fomiga Pérez F, Segura Benedito A et al. Primera Conferencia Nacional de Prevención y Promoción de la Salud en la Práctica Clínica en España. Madrid, 15-16 de junio de 2007. Rev Esp Geriatr Gerontol. 2007;42 (Supl 2):15-56.
Kiel DP. Falls in older persons. Risk factors and patient evaluation. UpToDate; 2014 [Acceso 23-4-2018]. Disponible en: http://www.uptodate.com.
Kwan E, Straus SE. Assessment and management of falls in older people. CMAJ.2014;186(6):E610-21.
Lavedán A, Jürschik, P, Botigué T, Nuin C, Viladrosa M. Prevalencia y factores asociados a caídas en adultos mayores que viven en la comunidad. Aten Primaria.2015;47(6):367-75.
Gillespie L, Robertson M, Gillespie W, Sherrington C, Gates S, Clemson L, et al. Intervenciones para la prevención de caídas en las personas de edad avanzada que residen en la comunidad. Cochrane Database Syst Rev. 2013;9:CD007146.
Pujiula M, Quesada M, Avellana E, Ramos R, Cubí R, y Grupo APOC ABS SALT. Resultados finales de un estudio de intervención multifactorial y comunitario para la prevención de caídas en ancianos. Aten Primaria. 2010; 42, (4): 211-7.
Pérula LA, Varas-Fabra F, Rodríguez V, Ruiz-Moral R, Fernández JA, González J, et al. EPICA Study Collaborative Group. Effectiveness of a multifactorial intervention program to reduce falls incidence among community-living older adults: a randomized controlled trial. Arch Phys Med Rehabil. 2012;93(10):1677-84.
Goodwin VA, Abbott RA, Whear R, Bethel A, Ukoumunne OC, Thompson-Coon J, et al. Multiple component interventions for preventing falls and fall-related injuries among older people: systematic review and meta-analysis. BMC Geriatr. 2014;14:15.
de Hoyos MC, Gorroñogoitia A, Martin I, Baena JM, López-Torres J, Magán P, et al. Actividades preventivas en los mayores. Aten Primaria. 2018;50(Supl 1):109-24.
Cuella M, Garrido M. Prevención, detección y evaluación de las caídas en ancianos. AMF 2017;13(3):146-52.
Campbell AJ, Robertson MC. Rethinking individual and com¬munity fall prevention strategies: a meta-regression comparing single and multifactorial interventions. Age Ageing. 2007; 36:656-62.
Hackney ME, Wolf SL. Impact of Tai Chi Chu´an practice on balance and mobility in older adults: An integrative review of 20 years of research. J Geriatr Phys Ther. 2014;37:127-35.
Lelard T, Doutrellot PL, David P, Ahmaidi S. Effects of a 12-week Taichi Chuan program versus a balance training program on postural control and walking ability in older people. Arch Phys Med Rehabil 2010; 91(1):9-13.
Voukelatos A, Cumming RG, Lord SR, Rissel C. A randomized controlled trial of tai chi for the prevention of falls: the central Sydney tai chi trial. J Am Geriatr Soc. 2007;55(8):1185–91.
Peter M. Wayne, PhD, et al. The Effects of Tai Chi on Bone Mineral Density in Postmenopausal Women: A Systematic Review. Arch Phys Med Rehabil. 2007;88(5): 673-80.
Hu YN, Chung YH, Yu HK, Chen Y Ch, Tsai Ch-T, Hu G-Ch. Effect of Tai Chi Exercise on Fall Prevention in older Adults: Systematic Review and Meta-analysis of Randomized Controlled Trials. Int J Gerontol. 2016;10:131-36.
MacIaszek J, Osinski W. Effect of Tai Chi on body balance: randomized controlled trial in elderly men with dizziness. Am J Chin Med.2012; 40(2): 245– 53.
Chen EW, Fu ASN, Chan KM, Tsang WWN. The effects of Tai Chi on the balance control of elderly persons with visual impairment: a randomised clinical trial. Age Ageing. 2012;41(2):254–9.
Kwok JC, Hui-Chan CW, Tsang W W.Effects of aging and Tai Chi on finger-pointing toward stationary and moving visualtargets. Arch Phys Med Rehabil.. 2010;91(1):149–55.
Taylor-Piliae RE, Haskell WL, Waters CM, Froelicher ES. Change in perceived psychosocial status following a 12-week Tai Chi Exercise programme. J Adv Nurs. 2006; 54(3): 313-29.
Lan Ch, Chen SY, Lai JS, Wong AMK. Tai Chi in Medicine and Health Promotion. Evid Based Complement Alternat Med. 2013;2013:502131.
Wang C, Bannuru R, Ramel J, Kupelnick B, Scott T, Schmid H. Tai Chi on psychological well-being: systematic review and metaánalysis. BMC Complementary and Alternative Medicine.2010;10:23. [Acceso 07/09/2018];Disponible en http://www.biomedcentral.com/1472-6882/10/23.
Windle G, Hughes D, Linck P, Russell I, Woods B. Is exercise effective in promoting mental well-being in older age?. A systematic review. Aging Ment Health.2010. 14(6): 652-69.
Li F, Harmer P, Glasgow R, Mack KA, Sleet D, Fischer J et al. Translation of an Effective Tai Chi Intervention Into a Commnity-Based Falls-Prevention Program. Am J Public Health. 2008;98(7):1195-8.
Valero B, Franquelo P, González F, de León J, Quijada JL. La práctica del Tai Chi previene las caídas en el Anciano Institucionalizado: un ensayo clínico. Rev Clín Med Fam. 2010;3(1):34-8.
Ministerio de Sanidad, Servicios Sociales e Igualdad. Actividad física para la salud y reducción del sedentarismo. Recomendaciones para la población. Estrategia de Promoción de la Salud y Prevención en el SNS. Ministerio de Sanidad: Madrid, 2015.
Church J, Goodall S, Norman R, Haas M. An economic evaluation of community and residential aged care falls prevention strategies in NSW. N S W Public Health Bull. 2011;22:60-8.
Carande-Kulis V, Stevens JA, Florence CS, Beattie BL, Arias I. A cost-benefit analysis of three older adult fall prevention interventions. J Safety Res. 2015; 52:65-70.
Li F, Harmer P, Fitzgerald K. Implementing an evidence-based fall prevention intervention in community senior centers. Am J Public Health. 2016;106:2016-31.
Lu X, Hui-Chan CW, Tsang WW. Tai Chi, arterial compliance, and muscle strength in older adults. Eur J Prev Cardiol.2012;4:613–9.
Lomas-Vega R, Obrero-Gaitán E, Molina-Ortega FJ, Del-Pino-Casado R. Tai Chi for Risk of Falls. A Meta-analysis. Am Geriatr Soc. 2017;65(9):2013-43.
Cuenca del Moral R, Muñoz Cobos F, Xia Ye SY, Ramírez Aliaga M, Vallejo Cañete V, Pérez Vidal L. Impacto de una intervención multifactorial en personas mayores con riesgo de caídas. Efecto diferencial de la práctica del Tai Chi. Med Fam (And). 2012;1:17-27.
Calero MJ, López-Cala G, Ortega AR, Cruz-Lendínez AJ. Prevención de caídas en el adulto mayor: revisión de nuevos conceptos basada en la evidencia Eur J Investig Health Psychol Educa. 2016;6(2):71-82.
Hurvitz EA, Richardson JK, Werner RA, Ruhl AM, Dixon MR. Unipedal stance testing as an indicator of fall risk among older outpatients. Arch Phys Med Rehabil. 2000;81:587-91.
Goldberg D, Bridges K, Duncan-Jones P, et al. Detecting anxiety and depression in general medical settings. Br Med J.1988; 97: 897-9.
López-Benavente Y, Arnau-Sánchez J, Ros-Sánchez Tania, Lidón-Cerezuela MB, Serrano-Noguera A, Medina-Abellán MD. Difficulties and motivations for physical exercise in women older tan 65 years. A qualitative study. Rev Latino-Am Enfermagem.2018;26:e2989. [Acceso 10/10/2018]; Disponible en: http://dx.doi.org/10.1590/1518-8345.2392.2989.
Jahnke R, Larkey L, Rogers C, Etnier J, Lin F. A Comprehesive Review of Health benefits of Qigong and Tai Chi. Am J Health Promot.2010;24(6):e1-e25.
Logghe IHJ, Zeeuwe PEM, Verhagen AP, Wijnen-Sponselee R, Willemsem SP, Bierma-Zeinstra S. Lack of effect of Tai Chi chuan in preventing falls in elderly people living at home: a randomized clinical trial. J Am Geriatr Soc.2009;57(1):70-5.
Woo J, Hong A, Lau E, Lynn H. A randomised controlled trial of tai chi and resistance exercise on bone health, muscle strength and balance in community living elderly people. Age Ageing.2007;36:262-8.
Roges CE, Larkey LK, Keller C. A review of clinical trials of tai chi and qigong in older adults. West J Nurs Res.2009;31:245-79.
Wang Ch, Schmid CH, Hibberd PL, Kalish R, Roubenoff R, Rones R et al. Tai Chi is effective in treating Knee osteoarthritis: a randomized controlled trial. Arthritis Rheum.2009; 61(11): 1545 – 53.
Chou K, Lee PWH, Yu ECS, Macfarlane D, Cheng YH, Chang SSC, Chi I. Effect of tai chi on depressive symptoms amongst Chinese older patients with depressive disorders: A randomised clinical trial. Int J Geriatr Psych.2004;19:1105-7.
Chan AW, Lee A, Suen LK, Tam WW. Effectiveness of a Tai Chi Qigong program in promoting health-related quality of life and perceived social support in chronic obstructive pulmonary disease clients. Qua Life Res.2010; 19(5):653-64.
Lee LYK, Lee DTF, Woo J. Effect of tai on state self-steem and health related quality of life in older chinese residential care home residents. J Clin Nurs.2007;16:1580-2.
Fong SM, Ng GY. The effects on sensorimotor performance and balance with Tai Chi training. Arch Phys Med Rehabil. 2006;87:82–7.
Mao DW, Li JX, Hong Y. The duration and plantar pressure distribution during one-leg stance in Tai Chi exercise. Clin Biomech.2006;21(6):640–5.
Letts L, Moreland J, Richardson J, Coman L, Edwards M, Martin Ginis K et al. The physical environment as a fall risk factor in older adults: systematic review and meta-analysis of cross-sectional and cohort studies. Aust Occup Ther J.2010;57:51-64.
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Copyright (c) 2019 Francisca Muñoz Cobos, Enrique Alarcón Pariente, Adriana Gaspar Solanas, Marina Méndez Ramos, Alberto Canalejo Echeverría, Mª Luz Burgos Varo
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