Reducing the Fear of Falling through Cognitive-Behavioural Strategies and Intense Tai Chi Exercise among Community-Dwelling Elderly Adults: A Randomised Controlled Trial

Tuesday, 13 July 2010

Tzu-Ting Huang, PhD, RN
School of Nursing, Chang Gung University, Tao-Yuan, Taiwan

Learning Objective 1: The learner will be able to know how to develope a Tai-Chi and cognitive behavioral combination intervention to reduce fear of falling among elderly.

Learning Objective 2: The learner will be able to know Tai Chi and cognitive behavioral strategies is effective for reducing fear of falling among community-dwelling elderly.

Background: Fear of falling ranks as the top fear of community-dwelling older persons. The prevalence of this fear ranges from 29% to 77%, indicating the importance of developing effective strategies to reduce fear of falling among elderly adults.
Objective: To examine the effectiveness of cognitive-behavioural strategies with/without intense Tai Chi exercise in reducing fear of falling among community-dwelling elderly adults.
Design: A prospective, randomised control trial.
Setting: Participants’ homes in a rural area of northeastern Taiwan.
Participants: Population-based sample of 186 community-dwelling older adults (≥60 years old) were randomly assigned to one of three groups: comparison group, cognitive-behavioural intervention, or cognitive-behavioural intervention with intense Tai Chi exercise.  
Methods: Data were collected from January to December 2007. Participants were assessed at baseline for demographic data, falls-related history, and fear of falling. Data on these variables plus falls, mobility, social support behaviour and satisfaction, and quality of life were also collected at 2 and 5 months after interventions. Fear of falling was assessed using the Geriatric Fear of Falling Measure and Falling Efficacy Scale.
Results: Participants in the three groups differed significantly in both measures of fear of falling (F=20.89, p<.001; F=6.09, p<.001), mobility (F=30.33, p<.001), social support behaviour and satisfaction (F=3.32, p<.05 and F=6.35, p<.001, respectively), and quality of life (F=16.66, p<.001). In addition, participants who received the cognitive-behavioural intervention with Tai Chi had significantly lower fear of falling scores (p<.0.001), and higher mobility (p<.001), social support satisfaction (p<.01) and quality of life (p<.001) than the cognitive-behavioural alone and comparison groups at 5 months. The three groups did not differ significantly in falls.
Conclusions: The results of this trial suggest that the cognitive-behavioural intervention with Tai Chi exercise helped community-dwelling elderly adults to enhance their mobility, manage their fear of falling, and increase their quality of life.