Community-based interventions to reduce falls among older adults inTaiwan – long time follow-up randomised controlled study

Hui-Chi Huang,, Chieh-Yu Liu, Yu-Tai Huang, W George Kernohan

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Aims. The aim of the study was to examine the effects of different interventions that are used to prevent falls. These wereeducation, Tai Chi Chuan and education plus Tai Chi Chuan; the study involved a five-month implantation period and a oneyearfollow-up period.Background. With advancing years, a fall can be very serious and an increased number of falls/re-falls among older adults hasbeen noted. Hence, both education about risk factors and balance exercise programs such as Tai Chi Chuan may help to preventfalls.Design. This study adopted a randomised case-controlled design with a two-by-two factorial approach. It included threeintervention groups and one control group in a community-based program.Methods. Cluster-randomised sampling was used and four villages in Taiwan City were selected. Three interventions groupsand one control group were involved over five-months from late July 2000–January 2001 and each participant was followed upone year later (n = 163).Results. The intervention involving education plus Tai Chi Chuan resulted in a statistically significant reduction in falls and therisk factors of falls over the five-month intervention. After one-year follow-up, participants receiving any one of the interventionsshowed a reduction in falls compared with the control group.Conclusions. Tai Chi Chuan was able to improve gait balance significantly. Education may also help participants to preventfalls-by eliminating related risk factors present in their environment. However, it was found that at the one-year follow-up, anyone of the three interventions had reduced falls significantly.Relevance to clinical practice. The prevention of falls among older adults seems to needs multiple interventions. Education plusTai Chi Chuan has both an immediately and a long-term effect and it is possible that a shorter intervention period using thisapproach would also be successful.
LanguageEnglish
Pages959-968
JournalJournal of Clinical Nursing
Volume19
DOIs
Publication statusPublished - 12 Mar 2010

Fingerprint

Tai Ji
Education
Control Groups
Taiwan
Gait

Keywords

  • community
  • education
  • falls
  • older people
  • risk assessment
  • Tai Chi Chuan

Cite this

@article{de7b438f5d234f989ea677ebd5f6a64f,
title = "Community-based interventions to reduce falls among older adults inTaiwan – long time follow-up randomised controlled study",
abstract = "Aims. The aim of the study was to examine the effects of different interventions that are used to prevent falls. These wereeducation, Tai Chi Chuan and education plus Tai Chi Chuan; the study involved a five-month implantation period and a oneyearfollow-up period.Background. With advancing years, a fall can be very serious and an increased number of falls/re-falls among older adults hasbeen noted. Hence, both education about risk factors and balance exercise programs such as Tai Chi Chuan may help to preventfalls.Design. This study adopted a randomised case-controlled design with a two-by-two factorial approach. It included threeintervention groups and one control group in a community-based program.Methods. Cluster-randomised sampling was used and four villages in Taiwan City were selected. Three interventions groupsand one control group were involved over five-months from late July 2000–January 2001 and each participant was followed upone year later (n = 163).Results. The intervention involving education plus Tai Chi Chuan resulted in a statistically significant reduction in falls and therisk factors of falls over the five-month intervention. After one-year follow-up, participants receiving any one of the interventionsshowed a reduction in falls compared with the control group.Conclusions. Tai Chi Chuan was able to improve gait balance significantly. Education may also help participants to preventfalls-by eliminating related risk factors present in their environment. However, it was found that at the one-year follow-up, anyone of the three interventions had reduced falls significantly.Relevance to clinical practice. The prevention of falls among older adults seems to needs multiple interventions. Education plusTai Chi Chuan has both an immediately and a long-term effect and it is possible that a shorter intervention period using thisapproach would also be successful.",
keywords = "community, education, falls, older people, risk assessment, Tai Chi Chuan",
author = "Hui-Chi Huang, and Chieh-Yu Liu and Yu-Tai Huang and Kernohan, {W George}",
note = "Accepted for publication: 10 January 2009 Reference text: References Arai T, Obuchi S, Inaba S, Nagasawa N, Shiba Y, Watanabe S, Kimura K & Kojima M (2007) The effects of short-term exercise intervention on falls self-efficacy and the relationship between changes in physical function and falls self-efficacy in Japanese older people: a randomised controlled trial. American Journal of Physical Medicine & Rehabilitation 86, 133–141. Brouwer B, Musselman K & Culham E (2004) Physical function and health status among seniors with and without a fear of falling. Gerontology 50, 135–141. Buchner DM (1997) Preserving mobility in older adults. Western Journal Medicine 167, 258–364. Buchner DM, Cress ME, deLateur BJ, Esselman PC & Margherita AJ (1997) The effect of strength and endurance training on gait, balance, fall risk and health services use in community-living older adults. Journals of Gerontology Series A-Biological Sciences and Medical 52, M218–M224. Chang JT, Morton SC, Rubenstein LZ, Mojica WA, Suttorp MJ, Roth EA & Shekelle PG (2004) Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. British Medicine Journal 328, 680– 686. Chen Tony H-H, Chiu Y-H, Luh D-L, Yen M-F,Wu H-M, Chen L-S, Yeh Y-P, Liou H-H, Liao C-S, Lai H-C, Chiang C-P, Peng H-L, Tseng C-D, Yen M-S, Hsu W-C, Chen C-H & Taiwan Community- Based Integrated Screening Group (2004) Community-based multiple screening model: design, implementation and analysis of 42,387 participants Taiwan community-based integrated screening group. Cancer 100, 1734–1743. Chiu Y-H, Chen L-S, Chan C-C, Liou D-M, Wu S-C, Kuo H-S, Chang H-J & Chen Tony H-H (2006) Health information system for community-based multiple screening in Keelung, Taiwan (KCIS No. 3). International Journal of Medical Informatics 75, 369–383. Cohen J (1988) Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Erlbaum, Hillsdale, pp. 19–65. Cumming RG, Thomas M, Szonyi G, Salkeld G, O’Neill E, Westbury C & Frampton G (1999) Home visits by an occupational therapist for assessment and modification of environmental hazards: a randomised trial of falls prevention. Journal of the American Geriatrics Society 47, 1397–1402. Department of Health & Human Services (2008) Preventing Falls: How to Develop Community-Based Fall Prevention Programs for Older Adults. National Centre for Injury Prevention and Control, Atlanta, GA. Feder G, Cryer C & Donovan S (2000) Guidelines for the prevention of falls in people over 65. British Medical Journal 321, 1007–1011. Friedman SM, Munoz B, West SK, Rubin GS & Fried LP (2002) Falls and fear of falling: which come first? A longitudinal prediction model suggests strategies for primary and secondary prevention. Journal of the American Geriatrics Society 50, 1329–1335. Gill TM, Williams CS & Tinetti ME (2000) Environmental hazards and the risk of nonsyncopal falls in the homes of community-living older persons. Medical Care 38, 1174–1183. Hartrick G (2000) Developing health-promoting practice with families: one pedagogical experience. Journal of Advanced Nursing 31, 27–34. Huang H-C (2004) A checklist for assessing the risk of falls among the elderly. Journal of Nursing Research 12, 131–142. Huang H-C, Gau M-L, Lin W-C & Kernohan G (2003) Assessing risk of falling in older adults. Public Health Nursing 20, 399–411. Huang H-C, Lin W-C & Lin J-D (2008) Development of a fall-risk checklist using the Delphi technique. Journal of Clinical Nursing 17, 2275–2283. Kannus P, Niemi S, Palvanen M & Parkkari J (2000) Continuously increasing number and incidence of fall-induced, fracture-associated, spinal cord injuries in elderly persons. Archived of Internal Medicine 160, 2145–2149. Kannus P, Sievanen H, Palvanen M, Jarvinen T & Parkkari J (2005) Prevention of falls and consequent injuries in elderly people. Lancet 366, 1885–1893. Katz IR, Rupnow M, Kozma C & Schneider L (2004) Risperidone and falls in ambulatory nursing home residents with dementia and psychosis or agitation: secondary analysis of a double-blind placebo-controlled trial. American Journal of Geriatric Psychiatry 12, 499–508. Mihay LM, Boggs KM, Breck AJ, Dokke EL & NaThalang GC (2006) The effect of Tai Chi Chuan inspired exercise compared to strength training a pilot study of elderly retired community dwellers. Physical & Occupational Therapy in Geriatrics 24, 13–26. Moreland J, Richardson J, Chan DH, O’Neill J, Bellissimo A, Grum RM & Shanks L (2003) Evidence-based guidelines for the secondary prevention of falls in older adults. Journal of Gerontology 49, 93–116. Parker MJ, Gillespie WJ & Gillespie LD (2006) Effectiveness of hip protectors for preventing hip fractures in elderly people: systematic review. British Medical Journal 332, 571–574. Polit DF & Beck CT (2004) Nursing Research: Principles and Methods, 7th edn. Linnicott Willians & Wilkins, Philadelphia, PA. Shigematsu R, Chang ML, Yabushita N, Sakai T, NakagaichiM, Nho H & Tanaka K (2000) Dance-based aerobic exercise may improve indices of falling risk in older women. Age and Ageing 31, 261–266. Taylor JA (2002) The Vanderbilt fall prevention program for longterm care: eight years of field experience with nursing home staff. Journal of the American Medical Directors Association 3, 180– 185. Taylor-Piliae RE, Haskell WL, Waters CM & Froelicher ES (2006) Change in perceived psychosocial status following a 12-week Tai Chi Chuan exercise program. Journal of Advanced Nursing 54, 313–329. Tinetti ME & Williams CS (1998) The effect of falls and fall injuries on functioning in community-dwelling older persons. Journal of Gerontology 53, 112–119. Tinetti ME, Mendes de Loen CF, Doucette JT & Baker DI (1994) Fear of falling and fall-related efficacy in relationship to functioning among community-living elders. Journal of Gerontology 49, M140–M147. Tinetti ME, Baker DI, Gottschalk M, Williams CS, Pollack D, Garrett P, Gill TM, Marottoli RA & Acampora D (2000) Homebased multicomponent rehabilitation program for older persons after hip fracture: a randomised trial. Architechiar Physical Medical Rehabilitation 80, 916–922. Wolf SL, Kutner NG, Green RC & McNeely E (1993) The Atlanta FICSIT study: two exercise interventions to reduce frailty in elders. Journal of American Geriatrics Society 41, 329–332.",
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Community-based interventions to reduce falls among older adults inTaiwan – long time follow-up randomised controlled study. / Huang, Hui-Chi; Liu, Chieh-Yu; Huang, Yu-Tai; Kernohan, W George.

In: Journal of Clinical Nursing, Vol. 19, 12.03.2010, p. 959-968.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Community-based interventions to reduce falls among older adults inTaiwan – long time follow-up randomised controlled study

AU - Huang,, Hui-Chi

AU - Liu, Chieh-Yu

AU - Huang, Yu-Tai

AU - Kernohan, W George

N1 - Accepted for publication: 10 January 2009 Reference text: References Arai T, Obuchi S, Inaba S, Nagasawa N, Shiba Y, Watanabe S, Kimura K & Kojima M (2007) The effects of short-term exercise intervention on falls self-efficacy and the relationship between changes in physical function and falls self-efficacy in Japanese older people: a randomised controlled trial. American Journal of Physical Medicine & Rehabilitation 86, 133–141. Brouwer B, Musselman K & Culham E (2004) Physical function and health status among seniors with and without a fear of falling. Gerontology 50, 135–141. Buchner DM (1997) Preserving mobility in older adults. Western Journal Medicine 167, 258–364. Buchner DM, Cress ME, deLateur BJ, Esselman PC & Margherita AJ (1997) The effect of strength and endurance training on gait, balance, fall risk and health services use in community-living older adults. Journals of Gerontology Series A-Biological Sciences and Medical 52, M218–M224. Chang JT, Morton SC, Rubenstein LZ, Mojica WA, Suttorp MJ, Roth EA & Shekelle PG (2004) Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. British Medicine Journal 328, 680– 686. Chen Tony H-H, Chiu Y-H, Luh D-L, Yen M-F,Wu H-M, Chen L-S, Yeh Y-P, Liou H-H, Liao C-S, Lai H-C, Chiang C-P, Peng H-L, Tseng C-D, Yen M-S, Hsu W-C, Chen C-H & Taiwan Community- Based Integrated Screening Group (2004) Community-based multiple screening model: design, implementation and analysis of 42,387 participants Taiwan community-based integrated screening group. Cancer 100, 1734–1743. Chiu Y-H, Chen L-S, Chan C-C, Liou D-M, Wu S-C, Kuo H-S, Chang H-J & Chen Tony H-H (2006) Health information system for community-based multiple screening in Keelung, Taiwan (KCIS No. 3). International Journal of Medical Informatics 75, 369–383. Cohen J (1988) Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Erlbaum, Hillsdale, pp. 19–65. Cumming RG, Thomas M, Szonyi G, Salkeld G, O’Neill E, Westbury C & Frampton G (1999) Home visits by an occupational therapist for assessment and modification of environmental hazards: a randomised trial of falls prevention. Journal of the American Geriatrics Society 47, 1397–1402. Department of Health & Human Services (2008) Preventing Falls: How to Develop Community-Based Fall Prevention Programs for Older Adults. National Centre for Injury Prevention and Control, Atlanta, GA. Feder G, Cryer C & Donovan S (2000) Guidelines for the prevention of falls in people over 65. British Medical Journal 321, 1007–1011. Friedman SM, Munoz B, West SK, Rubin GS & Fried LP (2002) Falls and fear of falling: which come first? A longitudinal prediction model suggests strategies for primary and secondary prevention. Journal of the American Geriatrics Society 50, 1329–1335. Gill TM, Williams CS & Tinetti ME (2000) Environmental hazards and the risk of nonsyncopal falls in the homes of community-living older persons. Medical Care 38, 1174–1183. Hartrick G (2000) Developing health-promoting practice with families: one pedagogical experience. Journal of Advanced Nursing 31, 27–34. Huang H-C (2004) A checklist for assessing the risk of falls among the elderly. Journal of Nursing Research 12, 131–142. Huang H-C, Gau M-L, Lin W-C & Kernohan G (2003) Assessing risk of falling in older adults. Public Health Nursing 20, 399–411. Huang H-C, Lin W-C & Lin J-D (2008) Development of a fall-risk checklist using the Delphi technique. Journal of Clinical Nursing 17, 2275–2283. Kannus P, Niemi S, Palvanen M & Parkkari J (2000) Continuously increasing number and incidence of fall-induced, fracture-associated, spinal cord injuries in elderly persons. Archived of Internal Medicine 160, 2145–2149. Kannus P, Sievanen H, Palvanen M, Jarvinen T & Parkkari J (2005) Prevention of falls and consequent injuries in elderly people. Lancet 366, 1885–1893. Katz IR, Rupnow M, Kozma C & Schneider L (2004) Risperidone and falls in ambulatory nursing home residents with dementia and psychosis or agitation: secondary analysis of a double-blind placebo-controlled trial. American Journal of Geriatric Psychiatry 12, 499–508. Mihay LM, Boggs KM, Breck AJ, Dokke EL & NaThalang GC (2006) The effect of Tai Chi Chuan inspired exercise compared to strength training a pilot study of elderly retired community dwellers. Physical & Occupational Therapy in Geriatrics 24, 13–26. Moreland J, Richardson J, Chan DH, O’Neill J, Bellissimo A, Grum RM & Shanks L (2003) Evidence-based guidelines for the secondary prevention of falls in older adults. Journal of Gerontology 49, 93–116. Parker MJ, Gillespie WJ & Gillespie LD (2006) Effectiveness of hip protectors for preventing hip fractures in elderly people: systematic review. British Medical Journal 332, 571–574. Polit DF & Beck CT (2004) Nursing Research: Principles and Methods, 7th edn. Linnicott Willians & Wilkins, Philadelphia, PA. Shigematsu R, Chang ML, Yabushita N, Sakai T, NakagaichiM, Nho H & Tanaka K (2000) Dance-based aerobic exercise may improve indices of falling risk in older women. Age and Ageing 31, 261–266. Taylor JA (2002) The Vanderbilt fall prevention program for longterm care: eight years of field experience with nursing home staff. Journal of the American Medical Directors Association 3, 180– 185. Taylor-Piliae RE, Haskell WL, Waters CM & Froelicher ES (2006) Change in perceived psychosocial status following a 12-week Tai Chi Chuan exercise program. Journal of Advanced Nursing 54, 313–329. Tinetti ME & Williams CS (1998) The effect of falls and fall injuries on functioning in community-dwelling older persons. Journal of Gerontology 53, 112–119. Tinetti ME, Mendes de Loen CF, Doucette JT & Baker DI (1994) Fear of falling and fall-related efficacy in relationship to functioning among community-living elders. Journal of Gerontology 49, M140–M147. Tinetti ME, Baker DI, Gottschalk M, Williams CS, Pollack D, Garrett P, Gill TM, Marottoli RA & Acampora D (2000) Homebased multicomponent rehabilitation program for older persons after hip fracture: a randomised trial. Architechiar Physical Medical Rehabilitation 80, 916–922. Wolf SL, Kutner NG, Green RC & McNeely E (1993) The Atlanta FICSIT study: two exercise interventions to reduce frailty in elders. Journal of American Geriatrics Society 41, 329–332.

PY - 2010/3/12

Y1 - 2010/3/12

N2 - Aims. The aim of the study was to examine the effects of different interventions that are used to prevent falls. These wereeducation, Tai Chi Chuan and education plus Tai Chi Chuan; the study involved a five-month implantation period and a oneyearfollow-up period.Background. With advancing years, a fall can be very serious and an increased number of falls/re-falls among older adults hasbeen noted. Hence, both education about risk factors and balance exercise programs such as Tai Chi Chuan may help to preventfalls.Design. This study adopted a randomised case-controlled design with a two-by-two factorial approach. It included threeintervention groups and one control group in a community-based program.Methods. Cluster-randomised sampling was used and four villages in Taiwan City were selected. Three interventions groupsand one control group were involved over five-months from late July 2000–January 2001 and each participant was followed upone year later (n = 163).Results. The intervention involving education plus Tai Chi Chuan resulted in a statistically significant reduction in falls and therisk factors of falls over the five-month intervention. After one-year follow-up, participants receiving any one of the interventionsshowed a reduction in falls compared with the control group.Conclusions. Tai Chi Chuan was able to improve gait balance significantly. Education may also help participants to preventfalls-by eliminating related risk factors present in their environment. However, it was found that at the one-year follow-up, anyone of the three interventions had reduced falls significantly.Relevance to clinical practice. The prevention of falls among older adults seems to needs multiple interventions. Education plusTai Chi Chuan has both an immediately and a long-term effect and it is possible that a shorter intervention period using thisapproach would also be successful.

AB - Aims. The aim of the study was to examine the effects of different interventions that are used to prevent falls. These wereeducation, Tai Chi Chuan and education plus Tai Chi Chuan; the study involved a five-month implantation period and a oneyearfollow-up period.Background. With advancing years, a fall can be very serious and an increased number of falls/re-falls among older adults hasbeen noted. Hence, both education about risk factors and balance exercise programs such as Tai Chi Chuan may help to preventfalls.Design. This study adopted a randomised case-controlled design with a two-by-two factorial approach. It included threeintervention groups and one control group in a community-based program.Methods. Cluster-randomised sampling was used and four villages in Taiwan City were selected. Three interventions groupsand one control group were involved over five-months from late July 2000–January 2001 and each participant was followed upone year later (n = 163).Results. The intervention involving education plus Tai Chi Chuan resulted in a statistically significant reduction in falls and therisk factors of falls over the five-month intervention. After one-year follow-up, participants receiving any one of the interventionsshowed a reduction in falls compared with the control group.Conclusions. Tai Chi Chuan was able to improve gait balance significantly. Education may also help participants to preventfalls-by eliminating related risk factors present in their environment. However, it was found that at the one-year follow-up, anyone of the three interventions had reduced falls significantly.Relevance to clinical practice. The prevention of falls among older adults seems to needs multiple interventions. Education plusTai Chi Chuan has both an immediately and a long-term effect and it is possible that a shorter intervention period using thisapproach would also be successful.

KW - community

KW - education

KW - falls

KW - older people

KW - risk assessment

KW - Tai Chi Chuan

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UR - http://www3.interscience.wiley.com/cgi-bin/fulltext/123320511/PDFSTART

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JO - Journal of Clinical Nursing

T2 - Journal of Clinical Nursing

JF - Journal of Clinical Nursing

SN - 0962-1067

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