Falls among older adults have become a serious public health problem because they result in inevitable injuries, increase hospital admissions, threaten independence, and reduce quality of life. Falls, however, are preventable and can be reduced through exercise. There are currently a number of effective exercise-based fall interventions recommended by the Centers for Disease Control and Prevention (CDC) that can be used to address the problem of falls in older adults. However, there is little informed information on best practices in terms of comparative efficacy and cost effectiveness among the recommended intervention programs. This lack of information hinders policy makers, public health practitioners, health planners, aging service providers, and others in making decisions on how to effectively invest funds to implement the "best" evidence-based fall prevention programs. This project is intended to narrow this knowledge gap. Our long-term goal is to create an effective, low-cost, scalable community-based Tai Chi program to help public health practitioners and community-based organizations address the problem of falls among older adults and to help older adults maintain their health and independence in the community, thereby reducing the drain on health care spending. The overall objective of this proposal is to conduct a comparative efficacy and cost-effectiveness study of an evidence-based fall prevention program-Tai Chi: Moving for Better Balance (TCMBB). Specifically, research in this proposal will address the following two questions of parallel importance: will TCMBB be more effective compared to a CDC-recommended Strength Training program? If so, will the TCMBB be more cost effective in terms of cost per fall prevented and quality adjusted life year gained? These questions will be addressed by conducting a randomized controlled trial aimed at testing the efficacy of TCMBB and Strength Training programs relative to a Stretching control on reducing fall rate and improving balance and physical functioning. It will also evaluate whether TCMBB, compared to Strength Training, will be more cost-effective, relative to the Stretching program. The study will also address the sustainability of the effects of TCMBB intervention on the proposed outcomes. At the conclusion of the study, we will have bridged an important research-to-practice gap on the cost effectiveness of different fall prevention programs and expanded our knowledge regarding how to best invest funds for intervention programs to address the pressing problems of falls in older adults and to meet Healthy People 2020 goals for improving the health, function, and life independence of community- dwelling older adults.
In the United States, at least one in every three adults aged 65 and older falls each year and fall-related injuries are a significant cause of premature mortality, disability, loss of independence, and early admission to nursing homes. Falls are also costly to health care systems. Although there are currently a number of evidence-based, exercise-related fall prevention programs recommended by the Centers for Disease Control and Prevention, little information is available to inform decision makers, policy makers, and health planners about the costs of these programs. This study will determine whether Tai Chi: Moving for Better Balance, one of the most commonly recommended and adopted exercise-based programs in the U.S., can be both efficacious and cost effective. If successful, this project will ill an important knowledge gap in the fall prevention field and satisfy an increasing community service need for efficacious, cost-effective, and community-based fall prevention programs.