Answer

Benefits of Tai Chi for Falls Prevention among Elderly Patients

Introduction of the Problem of Interest

Focus on quality care is a vital strategy for ensuring that healthcare organizations remain relevant in the medical field that keeps on changing. Currently, healthcare organizations assess and monitor the value of their performance on the basis of the quality and safety of the patient care they provide. Patient outcomes can be used to measure healthcare quality in various ways. Falls and falls with patient injury are among the most critical nursing-sensitive quality indicators that can markedly influence patient and family contentment with nursing care (Heslop & Lu, 2014). Falls have impacted care in various aspects especially when they lead to patient injury. For instance, a patient who suffers from musculoskeletal injury such as bone fracture will have to stay in the hospital for long at an increased cost of care.

Advanced age is the sole cause of many causes of falls experienced by patients (Staggs et al. 2015). An older person is treated in the emergency room for a fall every eleven seconds while an older person dies from a fall every nineteen minutes (National Council on Aging, 2017a). Therefore, it is significant to critically analyze the benefits of motion exercises such as Tai Chi in preventing falls among individuals with advanced ages. According to the Centers for Disease Control and Prevention (2016), twenty-nine million older Americans experienced falls resulting to seven million injuries and there are more than twenty-seven thousand fall deaths among older adults every year. There is an urgent need to reduce the high prevalence of falls that disproportionately affects the elderly.  The central argument in this research paper is that Tai Chi exercise leads to improved mobility and stability among both male and female elderly patients, and this reduces prevalence of falls among this population in geriatric wards.

Operational Definitions

The following are the operation definitions of the key terms used in this paper;

Quality: a measure of adherence to patient falls risk assessment and management policies, and the satisfaction of the elderly patients and their families with nursing care.

Falls: Individual experiences of unintentionally, and suddenly moving the human body from a higher level to lower levels due to the gravitational pull.

Advanced age: older ages at and beyond 65 years of life

Tai Chi: a noncompetitive form of stretching and physical exercise that involves a series of slow, repetitive, and gentle body movements performed during deep breathing.

Geriatric wards: A healthcare organization unit where elderly patients aged 65 years and above are accommodated during their period of hospitalization.

The pathophysiology of falls among the elderly patients can be attributed to the ageing process that makes them vulnerable to experience accidental injuries. The ageing process is associated with sensory, cognitive, and physical degenerative changes that make elderly people more vulnerable to experiencing falls compared to the rest of the population (World Health Organization, 2016). For instance, old age leads to reduced muscular strength, low visual acuity and hearing, poor body stability, and low mobility. Therefore, elderly patients might fail to see obstacles on their way leading to slides that result to harmful falls. Once they experience falls, the elderly patients often suffer from injuries that might compromise their state of health and activities for daily living. Falls can to hip and non-spine fractures that might take long to heal among the elderly (Ambrose et al. 2015). The elderly patients would not be able to perform daily activities for living such as bathing in the bathroom once their hips get broken in the process of experiencing falls.

Tai Chi is a suitable mobility exercise that can be a significant solution to the high prevalence of falls among elderly patients. This type of exercise involves slow motion of the body in specific directions while taking deep breaths. Tai Chi reduces falls by improving postural stability through footwork, both psychological and physiological functioning, and increased energy flow throughout the body (Nyman & Skelton, 2017). The motion exercise will get the elderly individuals engaged in the physical activities that reduce their stress levels and this improves their psychological functioning. In this manner, they will have improved reaction time to circumstances that might challenge their positions during movement or at rest.

Therefore, Advanced Practice Registered Nurses (APRNs) have a critical preventive role in solving the problem of falls among elderly patients. APRNs have excellent knowledge and expertise on falls and they can assess the risk of the elderly patients for experiencing falls during admission. Tools such as questionnaires assessing level of confusion, administered drugs, and cognitive impairment are effective for assessing a patients risk for experiencing falls during hospitalization (Milos et al. 2014). APRNs working in geriatric ward spend most of their time with the patients during bedside care. Therefore, they can use such questionnaires to assess the risk factors of their patients for experiencing falls and refer them to the Tai Chi stability, endurance, and strength training exercise.

The professional impetus for this research was the need to alleviate the suffering experienced by elderly patients due to falls that distracts their nursing care process. Some falls involving hip and skull fractures are medical emergencies that must be addressed before the usual care is continued. Tai Chi is a form of exercises that is currently accepted in the healthcare sector for improving the health of elderly individuals and limiting their chances of falling (World Health Organization, 2016). Therefore, the search for strategies for improving the care process for the elderly informed the research topic on reducing falls using Tai Chi.

Background and Significance

Older adults face a multitude of health challenges and unintentional fall is one of them. Falls pose a threat to the normal health of older people because fall-related injuries can cause disabilities that limit their independence. Falls are quite prevalent among older people in healthcare settings and this is a critical challenge to public health due to the associated high healthcare costs and poor patient outcomes. Fall is a prevalent public health issue in the geriatric community served in long-term care facilities, and it results to detrimental psychological and physical consequences (Howcroft et al. 2013). Individuals can get injured and experience psychological distress after a fall due to the disabilities associated with falls injuries. Unintentional falls are very costly to older people because their fractures take longer to heal in case injuries occur during the fall. Older people who have experienced lower limb fractures have long-term disabilities and high risk for future falls (Sherrington et al. 2016). The bone fractures resulting from fall-related injuries cause debilitating pain, loss of independence due to disability, and premature death.

One-fourth of older Americans aged 65 and above falls every year (National Council on Aging, 2017a). The non-fatal and fatal injuries related to falls threaten both independence and safety of seniors leading to enormous financial costs. In the United States, 2.8 million fall-related injuries are treated in emergency room yearly resulting to 800,000 hospitalizations and over 27,00deaths while the total cost of $34 billion was recorded in 2013 for fall injuries among older adults (National Council on Aging, 2017a). Therefore falls results to high rates of hospitalization rates of older adults and increased death rates. The high expenditure on the management of fall injuries can be reduced when the factors leading to falls in older adults are properly addressed. The occurrence of falls is influenced by the complex interaction between cognitive and physical health factors such as gait and mobility. Visual impairment is a critical cognitive factor that reduces the perception of elderly patients of their environment. These factors are amenable to prevention by implementation of evidence-based practices for reduction of the prevalence of falls among older patients. Resources should be targeted towards effective strategies that will help the older adults to gain body stability and improve their mobility.

Tai Chi is a form of body training that has been associated with the Chinese culture from time immemorial. However, Tai Chi has grown in popularity due to its mind-body multicomponent training that integrates flexibility, balance, and neuromuscular coordination training (Wayne et al. 2015). These improvements in physical and cognitive can be beneficial to older adults with increased risks for experiencing falls.

Lastly, falls and fall-related injuries are significant to this research because of their health and financial impacts on older adults, their families, and the society at large. The findings of this research on the benefits of Tai Chi for preventing falls among older adults will inform policymakers in healthcare to implement the exercise program to improve the health of older adults. Healthcare providers will be able to employ Tai Chi trainers to guide older adults through the exercise for health and fitness.

Review of Literature

The completion of this literature review was critical to assess the body of evidence addressing the research question on falls prevention. The literature review process involves research question formulation, searching knowledge base, managing the search results; synthesize literature, and writing the assessment (Garson & Lillvik, 2016). These activities were integrated into this literature review process. The benefit of Tai Chi in preventing falls among the elderly was selected as the research topic before searching the literature.

The PubMed, Cochrane, Medline, and CINAHL were the databases that provided helpful articles for analysis in the literature review. The key terms for the searches were falls, Tai Chi, older adults, and fall injuries. These key terms were combined in search strategies such as Tai Chi and falls prevention, Tai Chi and older adults, and Tai Chi for falls prevention. The sources that were used were 3 systematic reviews, 3 randomized controlled trials, and 1 cross-sectional study. These sources were elementary in analyzing the argument that Tai Chi significantly contributes to the prevention of falls and fall-related injuries among older adults. The following themes were identified from the body of literature that has been analyzed below in the following subsections.

Tai Chi Prevents Falls by Improving Cognitive Function of Older Adults

Sungkarat, S., Boripuntakul, S., Chattipakorn, N., Watcharasaksilp, K., & Lord, S. R. (2017). Effects of tai chi on cognition and fall risk in older adults with mild cognitive impairment: a randomized controlled trial. Journal of the American Geriatrics Society, 65(4), 721-727.

This is a randomized controlled trial based in Chiang Mai, Thailand with the objective of investigating the effectiveness of home-based Tai Chi exercise in reducing physiologic fall risk and improving cognition in older people with mild cognitive impairment. The participants were 60 and above years old adults with confirmed amnestic mild cognitive impairment. 12 weeks home-based and 3 weeks center-based Tai Chi exercises were the interventions for the two groups. Sungkarat et al. found out that the Tai Chi group had better Logic Memory (LM), falls risk assessment parameter scores, muscular strength, postural sway, and reaction time. This study is relevant to the research topic on falls prevention because it supports Tai Chi as a strategy for improving cognitive function among older adults.

Nyman, S. R., & Skelton, D. A. (2017). The case for Tai Chi in the repertoire of strategies to prevent falls among older people. Perspectives in public health, 137(2), 85.

Nyman and Skelton explored the benefits of Tai Chi in preventing falls among older adults in this PubMed scientific review. They organized their expert opinion discussion into six themes that discuss Tai Chi from various aspects. The first section focus on the effectiveness of Tai Chi on adults as compared to other strategies for preventing falls. They noted that Tai Chi more effectively increases self-efficacy of older adults and prevents them from experiencing falls compared to physiotherapy. However, Tai Chi is only effective for older adults who are not frail. In the second theme, Tai Chi is acknowledged as cost-effective falls prevention strategy with $500 dollars net benefit per $1 dollar investment. The effectiveness of Tai Chi is coupled with the high adherence rates of trainees because it is perceived as a normal activity performed by the general population. However, Nyman and Skelton advised that older adults have diverse interests and a range of falls prevention interventions should be presented to them. Lastly, they noted Tai Chi as an effective strategy for individuals with dementia because it involves gentle, slow, and repetitive motions. Therefore, this study supports the use of Tai Chi to prevent falls among adults with cognitive impairment as noted by Sungkarat et al.

Wayne, P. M., Hausdorff, J. M., Lough, M., Gow, B. J., Lipsitz, L., Novak, V., & Manor, B. (2015). Tai chi training may reduce dual task gait variability, a potential mediator of fall risk, in healthy older adults: cross-sectional and randomized trial studies. Frontiers in human neuroscience, 9, 332.

This research is a combination of cross-sectional and randomized controlled trial studies. Wayne et al. also found out the benefits of Tai Chi in improving the cognition of older adults at risk for experiencing falls. A cross-sectional study was conducted to compare the gait of Tai Chi experts and Tai Chi naïve individuals. They observed increased gait speed after long-term Tai Chi training in both groups with increased neuromuscular coordination, flexibility, focused mental attention, and increased body awareness.

Tai Chi Prevents Falls by Improving Physical Function of Older Adults

Gleeson, M., Sherrington, C., & Keay, L. (2014). Exercise and physical training improve physical function in older adults with visual impairments but their effect on falls is unclear: a systematic review. Journal of physiotherapy, 60(3), 130-135.

Gleeson et al. completed this systematic review of four randomized controlled trials to investigate how physical training and exercise in older people with uncorrectable visual impairment. Out of the four trials, one used Tai Chi as the sole exercise while the others used group multimodal exercise incorporating both balance and strength training for improving physical function. The studies show that both balance training and Tai Chi are effective in improving physical function in older adults living with uncorrectable visual impairments. This systematic review adds to the knowledge of falls by elaborating the risks visual impairment pose to older adults that increase their chances of falling and supporting Tai Chi for alleviating this risk. The current research adds a new concept that relates Tai Chi to both physical and cognitive function of older adults.

Taylor-Piliae, R. E., Hoke, T. M., Hepworth, J. T., Latt, L. D., Najafi, B., & Coull, B. M. (2014). Effect of Tai Chi on physical function, fall rates and quality of life among older stroke survivors. Archives of physical medicine and rehabilitation, 95(5), 816-824.

This single-blind, randomized controlled trial was completed by Taylor-Piliae et al. to examine the consequences of a 12-week Tai Chi program on the quality of life and physical function of older stroke survivors. The research was conducted in a general community setting with a total of 145 older stroke survivors aged 50 years and above recruited as the study participants. Tai Chi participants had two-thirds fewer numbers of falls compared to their counterparts in the usual care and the general strength training. Both Tai Chi and strength training led to an improvement in aerobic endurance.

Risks, Timeliness, and Cost-Effectiveness of Tai Chi in Preventing Falls in Older Adults

Wayne, P. M., Berkowitz, D. L., Litrownik, D. E., Buring, J. E., & Yeh, G. Y. (2014). What do we really know about the safety of tai chi?: A systematic review of adverse event reports in randomized trials. Archives of physical medicine and rehabilitation, 95(12), 2470-2483.

In this systematic review, Wayne et al. explored the severity and frequency of adverse events reported in Tai Chi. 153 randomized controlled trials were systematically reviewed and the results indicated that Tai Chi is unlikely to cause serious adverse events. Wayne et al. noted minor musculoskeletal adverse events such as back and knee pain as the main effects of Tai Chi. This study adds to the knowledge about the safety level of Tai Chi as an exercise for preventing falls among older adults.

Hu, Y. N., Chung, Y. J., Yu, H. K., Chen, Y. C., Tsai, C. T., & Hu, G. C. (2016). Effect of Tai Chi Exercise on Fall Prevention in Older Adults: Systematic Review and Meta-analysis of Randomized Controlled Trials. International Journal of Gerontology, 10(3), 131-136.

Hu et al. also completed a systematic review to analyze the effects of Tai Chi on preventing falls in older adults. They searched databases such as the Medline, Embase, and PubMed to retrieve ten trials that showed significant reduction in falls rate among older adults training in Tai Chi. The impact of Tai Chi in reducing risk for experiencing falls was significant after the 24^th week of training older adults. At this time, there was marked improvements in the neural, muscular, and skeletal functions of the body. This time limit is also supported by Nyman & Skelton (2017) who noted that Tai Chi reduces fall risks after six months of training and Tai Chi has $500 dollars net benefit for every $1 dollar invested. Therefore, Tai Chi is a cost-effective program that can reduce the prevalence of falls in older adults.

Thematic Discussion of Literature

Tai Chi Prevents Falls by Improving Cognitive Function of Older Adults

Sungkarat et al. (2017) found out in their randomized controlled trial the benefits of Tai Chi to improve the cognitive function of individuals at risk for experiencing falls. The study was conducted in Chiang Mai, Thailand where 66 adults aged 60 years and older with mild cognitive impairment were included. The Tai Chi group had better cognitive tests than the control group with significant improvements in reaction time, knee extension strength, and lower limb proprioception. Therefore, Tai Chi is beneficial to older adults with mild cognitive impairment.

Wayne et al.  (2015) added to this body of knowledge in their cross-sectional study by assessing the mechanisms through which Tai Chi improves cognitive function of older adults. They noted that the motor-cognition coordination during Tai Chi training led to focused mental attention, multitasking, imagery, and heightened body awareness. Nyman & Skelton (2017) also analyzed the cognitive benefits of Tai Chi among elderly patients. Tai Chi uses gentle, slow, and repetitive body movements making it suitable for patients living with dementia (Nyman & Skelton, 2017). Dementia is a medical condition characterized by impaired memory and cognitive dysfunctions. Therefore, the repetitive motions in Tai Chi would improve the memory of the trainees.

Tai Chi Prevents Falls by Improving Physical Function of Older Adults

Taylor-Piliae et al. (2014) explored the effects of Tai Chi on physical function, quality of life, and fall rates among older adults in a randomized controlled trial. The participants were stroke survivors aged 50 years and above in the general community. The interventions that were implemented after the randomizations were Yang style Tai Chi, strength exercises, and usual care for 12 weeks. They observed in the results that the number of falls for Tai Chi, strength exercise, and usual care groups were 5, 14, and 15, respectively. The findings indicated that Tai Chi is almost three times more effective in improving the physical functioning of older adults and preventing falls in this population.

Additionally, Tai Chi has been shown to be effective in improving physical functioning in older people living with various cognitive impairments. Gleeson et al. (2014) found out that individuals with visual impairments have high risk for falling due to the poor detection of environmental hazards along their way of movement. Tai Chi training led to improved strength of the knee joint extensors and flexors, vestibular sensitivity, and visual acuity in older individuals with visual impairment (Gleeson et al. 2014). However, Nyman & Skelton (2017) gave a controversial opinion about the effectiveness of Tai Chi in improving physical function of older adults. They noted that Tai Chi does not prevent falls when used with frailer older adults who use seated and more static movements (Nyman & Skelton, 2017).

Risks Associated with Using Tai Chi to Prevent Falls in Older Adults

Wayne et al. (2014) evaluated the safety of Tai Chi in preventing falls among older adults. They analyzed 153 eligible randomized controlled trials to systematically assess the quality and frequency of adverse events reported during Tai Chi. They noted that the adverse events related to Tai Chi were minor musculoskeletal complaints such as back and knee pain. A systematic review is the highest level of evidence in the hierarchy of evidence. Therefore, these findings by Wayne et al. (2014) provide strong evidence that Tai Chi is a safe motion exercise that can benefit the older adults in preventing falls. However, Gleeson et al. (2014) noted the risks associated with Tai Chi in older adults. In their systematic review, Gleeson et al. (2014) found out that Tai Chi improves physical ability of individuals making them more vulnerable to environmental hazards as they become more mobile. Therefore, Tai Chi should be complemented with other strategies such as patient education and effective use of visual assistive devices.

Timeliness and Cost-Effectiveness of Tai Chi in Preventing Falls in Older Adults

Healthcare administrators and policymakers should know the cost of implementing a falls prevention strategy so that they can consider it in their programs. Nyman & Skelton (2017) are experts in healthcare who evaluated the effectiveness of Tai Chi in preventing falls in comparison to physiotherapy. Tai Chi has the largest return of investment of all the falls prevention strategy with a net benefit of more than $500 dollars for every $1 dollar invested (Nyman & Skelton, 2017). The effectiveness of Tai Chi is attributed to the high adherence rates to this exercise because older adults view it as a normal activity for wellness. Literature has also focused on the timeliness of Tai Chi in preventing falls among older adults. Tai Chi improves functional balance of the trainees after six months of intervention (Nyman & Skelton, 2017). The functional balance improves because Tai Chi increases reaction time to challenging circumstances and leads to better postural stability.

Hu et al. (2016) established the significant protective role of Tai Chi in preventing falls among older adults in a systematic review. Tai Chi training appears to be protective in falls prevention at the 24^th week of the vigorous exercise (Hu et al. 2016). This finding is in tandem with the assertion made by Nyman & Skelton (2017) that Tai Chi is effective in preventing falls after six months of the intervention, an equivalent of 24 weeks. Therefore, policymakers can focus on designing Tai Chi training programs to be covered within at least six months for every group of older adults.

Synthesis and Summary of Review of Literature

In a nutshell, this literature review has revealed the significance of Tai Chai in preventing falls in older adults by improving both cognitive and physical function. The first theme identified in the review of literature was the benefits of Tai Chi in improvement of cognition. Tai Chi is a motor-cognitive interaction exercise that improves the cognitive function of older adults by its gentle, slow, and repetitive movements. This benefit in cognition improvement makes Tai Chi a suitable strategy for preventing falls among individuals suffering from cognitive impairments such as dementia (Nyman & Skelton, 2017). On the other hand, the significance of Tai Chi in improving physical function among older adults cannot be understated. This second theme focused on the relationship between Tai Chi and improvements in physical function.

Tai Chi improves physical function such as knee joint reflexes, postural sway, stability, and vestibular sensitivity (Gleeson et al. 2014). However, the improvement in cognitive and physical functions might be accompanied with minor musculoskeletal risks such as back and knee pain that have been discussed in the third theme. These minor risks are outweighed by the benefits of Tai Chi that has been shown to be effective in preventing falls among older adults. Timeliness and cost-effectiveness of Tai Chi is the fourth theme in this review of literature. A healthcare organization can receive a net benefit of $500 dollars for every $1dollar invested into the Tai Chi program for falls prevention among elderly patients (Nyman & Skelton, 2017). The benefits of Tai Chi in improving cognitive and physical health are particularly significant after six weeks of training. Therefore, healthcare policymakers can engage in long-term Tai Chi programs to prevent falls among older patients.

A few gaps exist in the current knowledge about the benefits of Tai Chi on improving the physical and cognitive function of older adults to prevent falls. First, there is inconsistent and poor reporting of adverse events related to Tai Chi and this limits the knowledge about the safety of Tai Chi (Wayne et al. 2014). Exercises used for health fitness usually have sets, repetitions, and different styles. However, there is no optimal style, frequency, and duration of Tai Chi training that has been documented for older adults to prevent falls (Hu et al. 2016). Therefore, future studies should focus on filling these gaps identified in the current review of literature. First, future researchers should develop tools for reporting and monitoring adverse events that occur during Tai Chi training, Secondly, the future studies should focus on determining the optimal frequency and Tai Chi style that can revive the cognitive and physical function of older adults.

Related Socio-economic, Political, Cultural, and Health Literacy Issues of the Health Problem

There are related socioeconomic, political, cultural, and health literacy issues on using Tai Chi for preventing falls among older adults. The socioeconomic issues can be analyzed from the aspects of social interactions and financial issues related to practicing Tai Chi for fall prevention among older adults. One of the social effects of falls is that the older adults might fear experiencing falls and this might reduce their level of activity in social interactions and leisure time (Chiu et al. 2014). The ultimate effect would be social isolation because the older adults will fail to move out and interact with friends due to fear of falling. However, group-based Tai Chi leads to both social interaction and health (Robins et al. 2016). Older adults are able to meet and make friends with each other during the falls prevention exercises. Economically, falls are very costly because the total cost of fall-related injuries in 2013 alone was $34 billion (National Council on Aging, 2017a). Healthcare stakeholders channel resources to emergency rooms and wards where the older adults receive care after getting fall-related injuries. Older adults will have to miss work in case they suffer from fractures during falls and their families will have to spend money in paying for the care and buying pain medications. However, Tai Chi is a cost-effective strategy for preventing falls with $500 dollars net benefit when $1 dollar is invested (Nyman & Skelton, 2017). This high return on investment makes the implementation of Tai Chi program practicable in most healthcare settings.

The concepts of equity, fairness, and the rights of citizens are important political factors influencing falls in older adults. These political issues provides favorable environment for the elderly population to prevent them from experiencing falls. There have been a series of movements to reform the American society since the inception of the U.S. to promote equal treatment of every individual (Gordon & Reynolds, 2017). The elderly populations are also beneficiaries of these reformations that ensure proper retirement, housing, and pension schemes. In federal courts, equity is an independent arm of the general law (Morley, 2017). The equity ensures that the elderly are empowered and this limits their chances of experiencing falls because they can get good housing and healthcare through programs such as Medicare and Medicaid. Also, the citizens are free in the U.S. political context to practice exercises such as Tai Chi without any restrictions by the law.

However, the implementers of Tai Chi for fall prevention in older adults might experience some challenges on the cultural context of the exercise and falls. Fall prevention strategies and exercise should be culturally appropriate because program participation and adherence are remarkably influenced by cultural values of the end users (Jang et al. 2016). Even though Tai Chi is widely associated with the Chinese culture, healthcare providers should educate the older adults on the significance of this exercise as a normal activity for health and fitness. This makes health literacy an important issue in falls prevention program using Tai Chi. Health literacy is defined as the social and cognitive skills which influence the ability and motivation of a person to access, understand, and utilize information to maintain and promote good health (Ballinger & Brooks, 2014). The significance of health literacy in falls prevention using Tai Chi cannot be understated. However, there is still low knowledge of falls prevention interventions among older adults despite the importance of health literacy in preventing falls (Ballinger & Brooks, 2014). There is an association between health literacy and adherence whereby low levels of health literacy leads to poor adherence to falls prevention interventions (Heerman et al. 2014). Therefore, it would be important to educate older adults about falls prevention and Tai Chi to improve their adherence during the implementation of the program in various clinical settings.

Related Spiritual and Ethical as well as Family and Community Issues

As a falls prevention strategy, ethical and spiritual issues should be considered by healthcare providers implementing the Tai Chi program. It is an ethical requirement that all interventions in healthcare facilities should be made considering the autonomy of the patient. Therefore, the older adults practicing Tai Chi would have the right to voluntarily participate in the program and no one should coerce them to participate in the Tai Chi training for falls prevention (Chan et al. 2017). In this manner, the older adults will have a right to either refuse or accept the program after giving their written informed consent. Spirituality might also influence an individual’s motivation to participate in falls prevention among older adults using activities such as Tai Chi. Involvement with religious activities increases with increasing age of an individual while religion has positive effect on health (Jones et al. 2016). There is a connection between religious activity and Tai Chi program for falls prevention. Individuals expecting religious components in Tai Chi program find significant satisfaction when the program contains elements such as prayer sessions (Jones et al. 2016). Therefore, it is important to consider spirituality of participants when designing Tai Chi programs for falls prevention.

On the other hand, family is a basic unity of the community that influences occurrence of falls among the elderly. Smaller family sizes and exclusion from families put older adults in more marginalized and isolated conditions that make them more vulnerable to experiencing falls (Yekkalam, 2012). Family members support one another towards meeting the social, financial, and emotional needs. Older adults can also garner adequate support from the community to participate in Tai Chi programs for falls prevention. The elderly individuals can use community spaces such as seniors’ community centers to discuss their unique conditions with local trained exercise facilitators and disseminate information about the training programs (National Council on Aging, 2017b). Therefore, community resources can be quite permissive to the successful implementation of Tai Chi exercise.

Conceptual Model and Theoretical Framework

Fall prevention using Tai Chi can be explored from the perspective of health promotion of the elderly adults. The older adults should have appropriate health-seeking behavior in order to effectively participate in the Tai Chi program. Therefore, the particulars of this study will be informed by Nola Pender’s Health Promotion Model of 1996 to provide both the conceptual model and the theoretical framework of the research. This model has five elements; nursing, person, health, environment, and the concept (Pender, 2012). Nursing is defined in this Health Promotion model as the part of interpersonal environment that exerts influence on and interacts with people to encourage their wellness and their specific health potentials.

A person is an individual with growing bio-psycho-social components that achieve equilibrium between stability and change and have the capacity for self-regulation of behaviors and reflective self-awareness (Pender, 2012). Under the health component of this model, each person has a specific health potential and self-efficacy improves health behavior making individuals to progressively transform overtime towards their optimal health potential. On the other hand, the environment is a critical multifaceted component that includes socio-cultural factors and situational influences such as aesthetic features that have indirect or direct influence on one’s health behavior. The key concept in this theoretical framework on Health Promotion is health-promoting behaviors that will enable the older adults to adhere to the program.

The Health Promotion Model has four major assumptions. First, Pender assumed that individuals always seek to actively self-regulate their behaviors (Petiprin, 2016). This assertion is an assumption because some people in the society might lack information about the health-seeking behaviors that they need to adopt. The second assumption posits that individuals are composed of bio-psycho-social complexity that interacts with the environment for transformation. However, the third assumption includes healthcare professionals such as nurses as part of the interpersonal environment of individuals influencing their health-promoting behaviors throughout the lifespan (Petiprin, 2016). It is an assumption that healthcare professionals influence health-promoting behaviors of all individuals because effective patient education is required for such an influence to be experienced. Lastly, Pender assumed that self-initiated change of the environment-person interaction is critical to the modification of health-promoting behavior.

Nola Pender’s Health Promoting Model has been applied in various research activities to provide a theoretical framework. Dehdari et al. (2014) conducted a pertinent research on health promotion using Pender’s Health Promotion Theoretical Framework. The aim of this study was to investigate the effectiveness of a nutrition educational intervention based on the Pender’s Health Promotion Model in enhancing the frequency and nutritional intake of breakfast among female Iranian students (Dehdari et al. 2014). Self-administered questionnaires were used to collect information from the participants who completed a 3-day breakfast consumption record. After the health promotion program, the experimental group had significantly higher levels of perceived benefits, frequency and intakes of micronutrients and macronutrients of breakfast consumption, and perceived self-efficacy. Dehdari et al. used these findings to conclude that the concepts of Pender’s Health Promotion Model can be used to design effective health promotion strategies.

Hosseini et al. (2013) also noted the significance of Pender’s Health Promotion Model in their systematic review of the health-promoting lifestyles of various nursing students in 14 studies. The model was used to assess health-promoting behaviors such as spiritual growth, interpersonal relationship, nutrition, and physical activity. Physical activity was the lowest achieved health-promoting behavior, and Hosseini et al. (2013) suggested the use of Pender’s Health Promotion Model in health promotion programs to increase physical activity. This assertion is relevant to the current study that focuses on increasing participation of older adults in Tai Chi, a form of physical activity, to prevent falls.

Theoretical Framework Applied

People have the capacity to live with optimal health depending on the level of their health-promoting behavior. The phenomenon of using Tai Chi for preventing falls among older adults fits into this Nola Pender’s Health Promotion theoretical framework. The three factors influencing health-promoting behavior in Pender’s model are individual’s experiences and characteristics, knowledge and feelings about a particular behavior, and behavior of the desired health promotion (Appendix: de Oliveira et al. 2016, p.4391). First, Tai Chi is a type of exercise that is an important health-promoting behavior among adults. Exercise is a health-promoting behavior due to its advantages in improving cognitive and physical functions among the elderly and preventing lifestyle diseases such as diabetes, cardiovascular disease, obesity, and hypertension. Therefore, the phenomenon can be explored from the perspective of improving adherence to Tai Chi exercise as a health-promoting behavior in older adults.

In her health promotion model, Nola noted the nursing practice to influence and encourage well-being and unique health potentials. Nurses participating in this research can encourage wellness by assessing older adults for risks of falling and referring them to the Tai Chi programs to prevent falls among elderly patients. However, the person, the elderly patient at risk of experiencing a fall, will have the capacity for self-regulation of health-promoting behaviors.

Thorough patient education will be important to assist the older adults to make informed decisions to self-regulate their health-seeking behaviors by joining Tai Chi programs to improve their physical and cognitive function. Therefore, the Pender’s model informs the Tai Chi solution by first seeking to enhance health-promoting behaviors among the older adults. In this manner, the older adults will be willing to participate in the Tai Chi and this will improve their adherence to the program. The model can be applied in the recruitment stage to educate the participants about Tai Chi to enable them have adequate knowledge about the benefits of Tai Chi in improving their physical and cognitive health.

APRN Role in Assessment of the Problem

Nurse Practitioners have a role in assessing patients’ risk for experiencing falls among the older population. The APRNs will complete the assessments on a sample of 50 older adults in the Geriatric Ward. The NPs will use structured questionnaires to identify the risks patients might have for experiencing falls so that they can be referred to the Tai Chi program. Advanced Practice Nurses should have geriatric assessment skills as well as assertive and communication skills to provide quality care to older adults (Goldberg et al. 2014). The assessment skills will enable them to identify the risks older adults have for experiencing falls. Also, communication and assertive skills are critical to coordinate usual nursing care with Tai Chai program in aspects such as interacting with the Tai Chi trainers and experts.

The proper geriatric assessment will have significant implications for the health of older adults. Older adults at risk of falling will receive timely intervention by participating in the Tai Chi program to improve their physical and cognitive function (Hu et al. 2016). The older patients will have improvements in their stability, mobility, and neuromuscular coordination leading to better cognition and social stamina. Therefore, the overall health of the geriatric patients will improve because they will avoid bone fractures and long hospital stays associated with falls.

Proposed Interventions to Address the Problem

Tai Chi is the proposed solution to address the high prevalence of falls in older adults. The American Academy of Orthopedic Surgeons developed guidelines supporting exercise for preventing falls. The advice of the doctor should be sought before beginning the exercise program that focuses on stability and strength building (American Academy of Orthopedic Surgeons, 2012). Therefore, all participants in the Tai Chi program will have to undergo initial assessment from the physician to determine their health and fitness status to avoid complications that might develop during the program. For example, it will be necessary to take caution for individuals with hypertension and cardiovascular disease who might pass out during the training.

After clearance from the physician, the participants will be recruited to perform Tai Chi trainings under the guidance of a Tai Chi expert who will instruct the group during the program. The trainees will attend the Tai Chi trainings once daily for six weeks. The nurses will assist to collect data by entering the records of the performance of the older adults in their specific data sheets. Outcomes such as muscle strength, stability, and flexibility will be recorded over the 6-month training program.

Outcomes, Timelines, and Evaluation

The expected outcomes in this project are reduction in falls rate and improved cognitive and physical function among the older adults. The participants will report a reduction in fear of falling that increases their confidence in moving across various clinical and community settings. This improvement in mobility will also increase their social interactions and helps them to avoid social isolation and loneliness. As such, there will be no reports on mental conditions such as depression that are mainly contributed by social isolation. These outcomes were achieved after 6 months as indicated in the timeline in figure 1 below.

Figure 1: Timeline of Activities

Older adults in the Geriatric Unit will be assessed for the risk of experiencing falls in the first two weeks and recruited into the Tai Chi training program. The participants will receive thorough training from weeks 3 to 5 before the project evaluation is completed in the sixth week.

The elements of evaluation are the adherence rate to the Tai Chi program and prevalence of falls post-intervention. Adherence to the program can be used as a measure for determine its effectiveness and accounting for confounding variables that might contribute to the reduction in falls rate. The organization will have to partner with the community to obtain community spaces such as centers for seniors where the older adults can be trained on Tai Chi. Additionally, collaboration will be essential among the healthcare professionals and the Tai Chi experts to ensure that the older adults are continuously assessed for any health complications during the training.

Conclusion and Recommendations for Clinical Practice

In conclusion, Tai Chi is an indispensable strategy for preventing falls in older adults across all healthcare settings. The central argument in this paper was that Tai Chi exercise leads to improved mobility and stability among both male and female elderly patients, and this reduces prevalence of falls among this population in geriatric wards. The various sections of this paper reveal how Tai Chi improves mobility leading to falls prevention. The operational definition of advanced age is 65 years of age and above. Literature provides rich background on the consequences of falls such as financial costs, hospital admissions, and reduced quality of life. Several research and scientific articles have been analyzed in the review of literature to identify the current level of knowledge about using Tai Chi for fall prevention among older adults. According to the main themes that emerged from the literature review, Tai Chi is a safe and cost-effective exercise that is guaranteed for improving physical and cognitive function in older adults. However, there are still low health literacy levels about the health benefits of exercise. Integration of spiritual beliefs into Tai Chi program was identified as a potential strategy for satisfying older adults who have high rates of attendance of religious activities.

Nola Pender’s Health Promotion Model was identified as a suitable theoretic framework for designing the program. The Tai Chi program can be designed to educate older adults to develop health-promoting behaviors such as exercise that will increase adherence. It will be critical for APRNs to develop geriatric assessment skills to give accurate information about the condition of patients before and after registration to the Tai Chi exercise. The timeline of this program is expected to last for 6 months of thorough Tai Chi training with the expected outcomes of reduced falls rate, increased physical and cognitive function. Based on these outcomes, healthcare professionals should allocate resources for Tai Chi and recruit their older patients for Tai Chi training to reduce falls risk. Future research and clinical projects can use the evidence provided by this study to focus on the perceptions of older adults about Tai Chi and how this affects adherence to the program.