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Tai chi, an ancient Chinese martial art, may improve senior citizens’ strength and help them avoid falls, South Korean researchers find. Regular exercise is very important as we get older because when we get to 65 we start losing muscle strength at a rate of up to two percent per year. It is effective in fall prevention for older people because of improvements in strength and balance.

The researchers tested tai chi in older adults. The slow, gentle, and continuous movements help them develop stronger muscles, better balance control, concentration, and psychological well-being.

They found benefits including:

• Stronger knees and ankles
• Better balance and flexibility
• Improved walking
• More confidence in the ability to avoid falls

The tai chi students had fewer falls than others who didn’t take the class. Their study appears in the Journal of Advanced Nursing.

Tai chi uses slow, fluid body movements. It’s not a jarring form of exercise. Health experts want everyone to get enough exercise. That includes older adults.

Every year, about 30% of people aged 65 and older and living on their own fall. Some of the risk factors that lead to falls in seniors include imbalance, muscle weakness, and lack of flexibility — all of which can be modified.

Seniors who fall and are seriously injured may take a long time to recover. Meanwhile, they may be sidelined from their normal routine. That can lead to physical decline and depression.

The tai chi students had stronger knees and ankles than their peers. They also improved in flexibility and walking. The tai chi group had fewer falls during the study.

This is not to say that taking Tai Chi will definitely help you prevent falls but it may and it’s good for your body.

Getting in and out of the bathtub or shower may be a dangerous task for many older adults. A study suggests a third of adults over age 60 have difficulty climbing in and out of the bathtub or shower, and more than 70 percent of those with shower stalls use unsafe features such as the glass door or towel bar for support.

“For older adults, losing the ability to bathe is associated with having falls, fracturing bones, and even being admitted to a nursing home. It is important that we take steps to help to prevent bathing disability before it occurs,” says researcher Susan L. Murphy, ScD, OTR, an occupational therapist at the University of Michigan Medical School’s division of geriatric medicine.

In the study, published in the Journal of the American Geriatrics Society, researchers videotaped 89 independently bathing adults over 60 as they demonstrated (fully clothed) how they normally get in and out of the shower or tub. The average age was 82 years, and most of the study participants were women.

Researchers examined their movement and noted if the participants had difficulty negotiating the environment or used things like grab bars, towel bars, shower curtains, glass doors, tub seats, or other parts of the tub to assist themselves.

The results showed that a third of the older adults had difficulty getting in or out of the bath. The most common problem was falling or difficulty positioning themselves onto a tub seat or into the bathtub.

About 30 percent of the participants hit the sides of the tub or the bath seat with their legs during the transfer.

Nineteen percent of the participants using a tub used unsafe features, and 70 percent of those with shower stalls used unsafe features.

The biggest problem was using sliding glass doors in shower stalls for stability or balance. More than three-fourths of older adults who had shower stalls used the sliding glass door for assistance.

“This is extremely unsafe because shower doors were not designed to support a person’s weight,” says Murphy. “This problem could be easily remedied by educating older adults not to use the door as a support or possibly replacing it with a shower curtain, which was used only rarely by older adults in this study.”

The second most commonly used unsafe feature was the towel bar, which was used by about half of the participants.

“While bathrooms in senior housing facilities are designed to be safe, we have found that older adults often do not know the difference between a grab bar and a towel bar. They also have unsafe strategies of getting into and out of their shower or tub,” says Murphy. “We think the results from this study demonstrate the need for health care professionals to become involved in helping to prevent bathing disability, instead of just treating people in the hospital after they have had a fall in the bathroom.”

In 2004, the most recent year statistics are available, almost 15,000 people 65 and older died from falls and about 1.9 million were treated for injuries in emergency rooms, said Judy Stevens, an epidemiologist with the Centers for Disease Control and Prevention.

“I think the magnitude of the problem is something that people don’t recognize,” Stevens said. “It really is a serious issue for older adults.”

Making sure that people over the age of 65 know how to avoid falling or being injured by a fall is the goal of a campaign launched this month by the National Athletic Trainers’ Association and American Academy of Orthopaedic Surgeons.

The organizations say in addition to exercise, older people can make their homes safer by installing night lights, bathroom grab bars and slip- resistant floors.

“If we continue to exercise, especially strength training, we decrease the loss of bone density. Just by working on strength training, you’re working your muscles to keep strong,” said Joe Scott, a NATA member who is outpatient orthopedic team leader for Southcoast Hospitals Group in New Bedford, Mass.
Scott said that as people get older, they’re less active so they lose strength. Also, sight and balance problems can creep in.

Stevens also said it’s a good idea for older people to have a doctor review their medicines each year to look for things like drug interactions that could lead to dizziness.

Experts say certain exercises — yoga, tai chi, and trying to balance on one leg with your eyes closed — can help improve balance.

If a younger person slips, they’ll usually catch themselves, but older people often have less strength and slower reaction times, experts say.

Injuries from falls in the elderly can include broken wrists, elbows, arms and hips, said Dr. Jay Mabrey, chief of orthopedics at Baylor University Medical Center in Dallas.

Tai chi, an ancient Chinese martial art, may improve senior citizens’ strength and help them avoid falls, South Korean researchers find. Regular exercise is very important as we get older because when we get to 65 we start losing muscle strength at a rate of up to two percent per year. It is effective in fall prevention for older people because of improvements in strength and balance.

The researchers tested tai chi in older adults. The slow, gentle, and continuous movements help them develop stronger muscles, better balance control, concentration, and psychological well-being.

They found benefits including:

•  Stronger knees and ankles
• Better balance and flexibility
• Improved walking
• More confidence in the ability to avoid falls

The tai chi students had fewer falls than others who didn’t take the class. Their study appears in the Journal of Advanced Nursing.

Tai chi uses slow, fluid body movements. It’s not a jarring form of exercise. Health experts want everyone to get enough exercise. That includes older adults.

Every year, about 30% of people aged 65 and older and living on their own fall. Some of the risk factors that lead to falls in seniors include imbalance, muscle weakness, and lack of flexibility — all of which can be modified.

Seniors who fall and are seriously injured may take a long time to recover. Meanwhile, they may be sidelined from their normal routine. That can lead to physical decline and depression.

The tai chi students had stronger knees and ankles than their peers. They also improved in flexibility and walking. The tai chi group had fewer falls during the study.

This is not to say that taking Tai Chi will definitely help you prevent falls but it may and it’s good for your body.

Getting in and out of the bathtub or shower may be a dangerous task for many older adults. A study suggests a third of adults over age 60 have difficulty climbing in and out of the bathtub or shower, and more than 70 percent of those with shower stalls use unsafe features such as the glass door or towel bar for support.

“For older adults, losing the ability to bathe is associated with having falls, fracturing bones, and even being admitted to a nursing home. It is important that we take steps to help to prevent bathing disability before it occurs,” says researcher Susan L. Murphy, ScD, OTR, an occupational therapist at the University of Michigan Medical School’s division of geriatric medicine.

In the study, published in the Journal of the American Geriatrics Society, researchers videotaped 89 independently bathing adults over 60 as they demonstrated (fully clothed) how they normally get in and out of the shower or tub. The average age was 82 years, and most of the study participants were women.

Researchers examined their movement and noted if the participants had difficulty negotiating the environment or used things like grab bars, towel bars, shower curtains, glass doors, tub seats, or other parts of the tub to assist themselves.

The results showed that a third of the older adults had difficulty getting in or out of the bath. The most common problem was falling or difficulty positioning themselves onto a tub seat or into the bathtub.

About 30 percent of the participants hit the sides of the tub or the bath seat with their legs during the transfer.

Nineteen percent of the participants using a tub used unsafe features, and 70 percent of those with shower stalls used unsafe features.

The biggest problem was using sliding glass doors in shower stalls for stability or balance. More than three-fourths of older adults who had shower stalls used the sliding glass door for assistance.

“This is extremely unsafe because shower doors were not designed to support a person’s weight,” says Murphy. “This problem could be easily remedied by educating older adults not to use the door as a support or possibly replacing it with a shower curtain, which was used only rarely by older adults in this study.”

The second most commonly used unsafe feature was the towel bar, which was used by about half of the participants.

“While bathrooms in senior housing facilities are designed to be safe, we have found that older adults often do not know the difference between a grab bar and a towel bar. They also have unsafe strategies of getting into and out of their shower or tub,” says Murphy. “We think the results from this study demonstrate the need for health care professionals to become involved in helping to prevent bathing disability, instead of just treating people in the hospital after they have had a fall in the bathroom.”

One of the most useful tools for a healthcare provider is to have a great deal of information about the symptoms and general habits of the child. Consider keeping a symptom diary of daily habits and routines for a two week period prior to a medical appointment. You should take care to note when your child voids during the day and night, when accidents occur (time of day or night), the amount of urine voided, drinking patterns (does your child drink a lot of fluids in the later afternoon/evening? Does your child get up to drink something during the night?), what your child drinks (sugary fluids, caffeinated, etc.), when constipation occurs, if fecal soiling occurs, the nature of the urinary stream (is the urinary stream is strong and constant? Is there continuous dribbling?), if there are recurrent infections, and the number of wet versus dry nights. Any and all of this information can help a healthcare provider determine the cause of the problem and the appropriate treatment.

At the time of the appointment, you should be prepared to supply such information as well as questions related to medical history, medication, and family medical history. In addition to helping you find options to help cure bedwetting it is also important that you see a healthcare provider to rule out any other more serious problems that may cause bed wetting as a side effect.

Treatment Options

A variety of options are available to end bedwetting. Effective treatment for bed wetting has also been show to greatly improve the self-esteem of the child. Treatment options may vary based on the severity of the problem, the age of the child, the impact on the family. Both pharmacological and behavioral treatment options exist. To better combat the problem a combination of treatments may be used if necessary.

The most important aspect of all treatment options is the child’s involvement in treatment and motivation to dedicate the time and energy necessary. For this reason, some younger children may not be motivated and ready for treatment. This should be considered and if necessary treatment postponed until the child is ready.
It is also important for parents to be motivated and supportive of the child.

Behavioral Treatments Include:

Withholding Fluids: Limiting a child’s intake of fluids in the late afternoon and evening before bedtime, thereby causing a decreased amount of urine at night, may be a helpful first step to reduce wet nights.

Urotherapy : This behavioral treatment option implements a regular schedule of voiding during the day with voiding occurring every 2-3 hours.

Wakening: This treatment option involves the parent either randomly waking the child during the night or at schedule times once the child is asleep in order to urinate. If choosing this option, it is very important that the child be fully awake and aware. Otherwise the process encourages urinating while sleeping. This option also requires a high level of parental involvement to wake the child in the middle of the night and put them back to bed.

Reward System: While the child cannot control nocturnal enuresis, this option involves positive reinforcement of behavior the child can control, such as voiding before bed and at regular times during the day, as well as helping clean sheets and strip the bed. Rewards in some cases have consisted of sticker charts for positive behavior with a prize when a certain number of stickers have been won. Punishments for wet nights or rewards for dry nights are NOT appropriate as the child has no control over these.

In any case, until they are able to overcome this it is best to use underpads in bed in order to keep the urine from getting to the mattress.

Bed wetting, is the involuntary voiding of urine during sleep, with a severity of at least 3 times a week in children over the age of 5. A mentally handicapped child is generally expected to become dry at night when he or she reaches the mental age of four. It is estimated that more than 5 million children in the US experience nocturnal enuresis.

One of the most difficult aspects of bed wetting is its effect on children and their families. The greatest impact is on the child’s self-esteem. Bedwetting is often a source of great embarrassment for the child causing him or her to refrain from certain age-appropriate activities such as a sleep-over for fear of a bedwetting accident. Bed wetting can have an effect on school performance and later sexual activity as a result of the low self-esteem bedwetting can cause. Often parents become frustrated with continued bedwetting as it is a drain of time, energy, and money with constant cleaning and bed changing. Sometimes bedwetting can be a source of embarrassment for the parents who may view the problem as a result of bad parenting or a mischievous child, neither of which are true. It is crucial to remember that bedwetting happens to MILLIONS of children and that bed wetting is not the fault of the child or the parent.

Ages 1-2: The child has a conscious sensation of the bladder filling with urine.

Ages 2-3: The ability to urinate or to voluntarily stop urinating develops and children begin to learn the etiquette surrounding urination.

Ages 3-4: Most children by the age of the 4 have achieved urinary control and are dry both day and night.

Causes

Many causes of nocturnal enuresis (bed wetting) exist. Bedwetting is not a result of laziness or disobedience on the behalf of the child. Bedwetting is caused by many factors.

Bedwetting has been found to be genetically linked. One study has shown that a child of two bedwetting parents has a 77% chance of becoming a bedwetter. When one parent wet the bed as a child, his son or daughter was found to have a 44% chance of becoming a bedwetter. While little scientific support exists, many hold the “deep-sleep” theory which blames the exceptionally deep sleep some children experience as the cause of wetting the bed. Because a child is so deep in sleep, his brain and body ignore the signals of a full bladder.

Another cause cited for primary bed wetting is a “smaller” bladder. This does not mean, however, that the physical size of the bladder is smaller for bedwetting children than for their peers. Instead it means that their Functional Bladder Capacity (FBC) -the amount of urine the bladder will hold until sending a signal to the brain indicating it is time to urinate- is a smaller volume than that of their peers.

Another cause of bedwetting has to do with ADH or anti-diuretic hormone. ADH is a signaling hormone which tells the kidney to decrease the amount of urine produced. Normally the body produces more ADH at night causing the kidneys to produce less urine. Decreased urine production at night allows an individual to sleep through the night without having to urinate. Some people do not produce more of this hormone at night, as they are supposed to, and therefore produce a large amount of urine at night. In similar cases, the body produces ADH but the kidneys do not respond and continue to produce the same amount of urine.

Each year, 35-40% of older adults fall at least once. The best preventative measure is to take steps to improve bathroom safety to help avoid a fall, but you should also plan for a fall in the event that it occurs. Falling down is not just the result of getting older; it can be caused by a variety of circumstances.
Knowing how to help reduce injury, and to have a plan in place in advance when a fall occurs will help the older adult cope.

•  Improve Your Body Balance with Exercise - lack of exercise leads to weakness in the body
• Increase Your Home’s Accessibility and Safety - install grab bars and shower and toilet safety products
• Watch Out for Medication Side Effects - many medicines can cause diziness or fatigue
• Have Vision Checked Regularly - have regular eye exams to keep eyeglass perscriptions current

The bathroom can often be the most dangerous room in your home. Use our checklist to make sure you’ve done all you can to provide a safe bathroom for yourself and the older adults you love.

• Have you installed high quality grab bars in the bath tub and shower?
• Are you careful not to use towel racks or wall-mounted soapdishes as grab bars?
• Do you use a non-slip mat or have adhesive safety strips installed in bathtubs and showers?
• Do you promptly wipe up excess water from the bathroom floor?
• Do you have a non-skid bath mat for every bathroom?
• Do you use cleaning supplies that don’t leave a slippery residue behind?
• Do you use nightlights to help light hallways and bathrooms during the night?
• Are medications, including vitamins, prescription drugs and over-the-counter drugs clearly labeled and properly stored?
• Are all bathrooms in your home protected by ground fault circuit interrupters (GFCIs) and tested monthly to ensure they operate properly?
• Are small electrical appliances such as hair dryers, curling irons, and razors always kept away from water and unplugged when not in use?