Sharjah United Arab Emirates. Falls in elderly people can lead to serious health problems.
Tai Chi and Fall Risk | | AHC Media - Continuing Medical Education Publishing
There is limited knowledge about the prevalence of falls, risk factors and causes of falls in the United Arab Emirates. To assess the prevalence of falls among older adults aged 60 years and above and to determine the risk factors associated with falls. This cross-sectional study was conducted using an anonymous, item questionnaire which was developed in English and Arabic to be delivered as a semi-structured interview. The pre-piloted questionnaire was distributed to families with at least one elderly person. Participants were Arabs ; Almost half of the participants ; The results indicate that female and 70 years and above old participants are more likely to experience falls than males and younger counterparts respectively.
A larger proportion of elderly participants not taking medications did not experience falls, while those on medications fallers were less than non-fallers. However as the number of medications increased to and more than 8 the number of those experiencing falls was significantly higher than non-fallers. Falls are prevalent among the elderly population studied and efforts should be made to decrease the incidence of falls, identify those at risk and increase awareness about falls and their health consequences among the elderly and the general public.
Forty percent of traumatic injuries-related hospitalizations are due to falls.
Falls Prevention in Older Age
Frequent falls in the elderly population can lead to serious health consequences and efforts to reduce their incidence are necessary. Risk factors for falls that have been identified include history of falling, use of assistive devices, environmental hazards such as poor lightening, and various health conditions including muscle weakness, vertigo, gait and balance impairments, visual and hearing disorders, cognitive and sensory impairments, orthostatic hypotension, diabetes mellitus and osteoporosis.
While some risk factors cannot be changed, many are modifiable. Many falls result from interactions among multiple risk factors, and the risk of falling increases linearly with the number of risk factors. Hence, the aim of this study was to assess the prevalence of falls in the past two years among older adults who are aged 60 years and above and to determine the risk factors associated with falls. Ethical approval for the study was obtained from the Ethical Committee of the Medical Campus at the University of Sharjah.
The study participants completed the questionnaire without providing any identification information. Participants were assured of confidentiality and anonymity of the responses provided and written informed consent was obtained. The inclusion criterion was elderly persons aged 60 years and above. A total of families with at least one elderly from Dubai and Sharjah-UAE were approached to participate in the survey. The surveys were distributed by hand and were collected over the study period of three months September-November, This cross-sectional study was conducted using an anonymous questionnaire to be delivered as a semi-structured interview.
The questionnaire consists of 4 sections and 20 questions and was designed by the researchers in both English and Arabic to collect specific data about the problem of falls in the elderly. The questionnaire was pre-piloted by distributing it to 5 elderly persons who were interviewed face-to-face to check face validity of the questionnaire.
Recommendations from the pilot study were considered to develop the final version of the questionnaire; however the participants were not included in the actual study. The first section of the questionnaire collects the socio-demographic characteristics of the participants. The second section is completed by participants who have experienced a fall and assesses the number, consequences and causes of falls and whether the participants visited a hospital for the fall.
The third section discusses the health status of the participants, medications used and the number of medications. The fourth section includes questions to be answered by all participants concerning preventive strategies. A total of participants completed the questionnaire giving a response rate of Table 1 shows the demographics of participants. The majority of participants were females ; More than half of the participants were in the age group of years age ; About half ; Table 2 shows the number of falls within the last two years in the elderly population studied.
Falls in the elderly: assessment of prevalence and risk factors
About two thirds , More than half ; None of the participants suffered intracranial bleeding during the study period. The number of falls in the elderly who experienced falls in the past two years and their causes and health consequence. Other causes of falls are shown in Table 2. Falls were more common in females, patients 75 years and above, illiterate respondents and those using assistive devices. The risk factors as related to the health status of the participant, the medications used and the number of medications on the prevalence of falls are shown in Table 4.
The majority 29, Among participants who take 5- 8 medications per day a total of 54 On the other hand, only 16 Participants taking beta-blockers comprised The most common health condition reported by respondents was hypertension and about 88 Nevertheless, there was a significant association between other co-morbid health conditions and the increased risk of falls; for example, of those ; Respondents taking calcium comprised only The majority ; Falls in older individuals are common and may lead to serious health problems.
They can be associated with various risk factors including intrinsic and extrinsic factors. Several studies assessed the prevalence of falls in older adults, and the related fall risk factors. Therefore, in the present study we aimed to assess the prevalence of falls in the past two years among older adults aged 60 years and above and to determine the risk factors associated with falls.
In the present study, the prevalence of falls in older adults was Numerous studies identified environmental hazards like poor lighting, and a variety of health conditions, such as muscle weakness, vertigo or gait and balance impairment, visual and hearing disorders, cognitive and sensory impairment, orthostatic hypotension, diabetes, and osteoporosis as risk factors of falls. A primary finding of this study is that females are more likely to experience falls than males, and with advancing age, the prevalence of falls increases. This is consistent with earlier observations that females and advanced age age above 75 years were associated with a greater prevalence of falls.
Among other risk factors, sarcopenia defined as loss of skeletal muscle mass that occurs with aging has also been associated with a higher incidence of falls in females. In the present study, illiterate elderly suffered more falls and the incidence of falls seems to decrease as the education level increase. Moreover, elderly people who use assistive devices such as canes are more exposed to falls. Such an influence of educational level on falls may be due to elderly people with low level of education perceive and worry less about their health status.
Hence, they have fewer tendencies to engage in health recovery and are less aware of the preventive strategies and advice given by the healthcare professionals; therefore they are at increased risk of falls. Several studies reported a strong relationship between the use of three or more medications and risk of falls.
Sedation and postural hypotension by antidepressants and beta-blockers and the hypoglycemic effect of insulin also significantly contribute to the incidence of falls in the elderly. While statistical analysis controlled for heterogeneity, some of these details may affect clinical adaptation.
A comprehensive review also a meta-analysis of fall prevention associated with a different exercise intervention Step Training Program revealed results similar to those found with tai chi. Interestingly, medication review and vitamin D supplementation emerged as most cost-effective for older adults in residential facilities in this same study.
Results of a Chinese meta-analysis, including 18 studies of tai chi and fall prevention, suggested that the impact of tai chi on fall prevention is more robust with exercise frequency.
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Additionally, this group noted a variation in response to different types of tai chi and mentions a likelihood that the Yang style of tai chi may be more effective than the Sun style. More studies documenting specific style of tai chi are recommended. The variability in the types of control groups among the studies, in the frequency of tai chi practice from one to three times weekly , and unclear documentation of the type or style of tai chi make generalizability of results of this meta-analysis difficult.
All of these factors may very well prove to be essential in understanding the effect of tai chi for any individual. Future studies paying particular attention to these details are needed. Talking with older adults about fall prevention and recommending specific interventions is a vital component of medical care of the aging population.
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Prevention of falls often requires a multipronged approach; the integrative provider is on solid ground reviewing both environmental and personal interventions with patients. Noting the positive results from tai chi studies, combined with an understanding of the limitations of these studies, can help shape a fall prevention strategy that suits each individual according to unique needs and circumstances. Developing such a plan with a focus on the positives may help with acceptance and buy-in. As future studies with more rigid criteria and results emerge, these recommendations and interventions can be adjusted accordingly, with the goal of helping our patients maintain a healthy lifestyle throughout the age continuum.
Although suggestive evidence points to best results from practice of the Yang style of tai chi several times weekly, many patients will find a specific choice of tai chi style and frequency, limited by practical considerations such as community availability and scheduling. Even with specific questions remaining, the potential benefits from tai chi are clear. In the aging population and those at risk of significant health consequences from falls, waiting for results of more definitive studies may prove to be too late.
With no identified adverse effects from tai chi and clear potentially devastating adverse health consequences from falls, promoting tai chi should be adopted as part of an overall strategy for fall prevention. Clinical Briefs in Primary Care. Hatcher report no financial relationships relevant to this field of study. Reprints Share. Tai Chi and Fall Prevention in the Elderly.
Keywords Exercise. The analysis showed high-quality evidence for medium protective effect for rate of falls in the short-term and a weaker protective effect over the long-term after 12 months. When looking at falls causing injury, there is low-quality evidence of a medium protective effect in the short term and even less of an effect in the long term. There is moderate-quality evidence that tai chi practice does not affect time to first fall. Report Abusive Comment. Randomized placebo-controlled trial of brisk walking in the prevention of postmenopausal osteoporosis.
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What is a Fall?
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