While the causes for falls among older individuals are multifactorial, their consequences extend well beyond physical trauma and its associated costs. Falls augment the fear of falling, which, in turn, encroaches upon the freedom to voluntarily engage in activities of daily living and the enjoyment of life. As a result of health-related changes in quality of life, older people in transition toward frailty may lose their enthusiasm to participate in previously enjoyable activities while also compromising important socialization behaviors. During the FICSIT trials (1990-1994), the investigators provided a 15 week program of mild Tai Chi (TC), an exercise form practiced by Chinese elders for centuries. All subjects came to one site to participate. TC reduced the rate of falls by 47.5% compared to a control group or a group undergoing computerized balance training after adjusting for significant risk factors, such as fear of falling, falls within the past year, and trouble falling asleep (Wolf, Barnhart, Kutner et al., 1996). Concomitant improvements were also noted among TC practitioners in cardiovascular status after a 12 minute walk and in select quality of life measures. Many study participants were relatively active. However, in view of these findings and the far-reaching effects that falls may have upon costs for medical care, independent functioning, and health-related quality of life, justification can now be made for pursuing a more intense TC intervention (three times a week for 48 weeks in one year) within the congregate living facilities of people 70 years of age or older. The purpose of this clinical trial, for at-risk volunteer subjects who have fallen at least once in the previous year and are in transitional phase toward frailty, is to examine the effect of intense TC training (N=150) on time to onset of falls or multiple falls compared to a group receiving an education intervention (N=150) once a week for 48 weeks in one year. Subjects will be recruited from 20 congregate living facilities in the greater Atlanta area with 15 participants per site. Facilities will be randomized in pairs by similarity in socioeconomic factors, functional capabilities of residents and minority representation. The investigators also plan to determine if TC improves function as measured by single limb stance, reach, body turning, and bending as well as health-related quality of life as measured by falls efficacy and sickness impact profile. In an effort to examine how TC may cause improvements in movement capabilities, a subset from each group (N=25 per group) will be examined for changes in biomechanical aspects of movement and strength. Evaluators will be blinded to the interventions, and all subjects will receive evaluations every four months over two years to ascertain the persistence of improvements.
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