Tai Chi Therapy Incorporated in Activities of Daily Living in the Elderly to Improve Quality of Life

1. Introduction

An elderly person is defined by the World Health Organization (2013) as a human being of above the age of sixty-five years. The population of the elderly people is on an increase across the globe and it has become a common phenomenon in the advanced age countries. According to the United Nations programme on Aging (2012), an advanced age country consists of countries that 7% of its population consists of people with more than 65 years. Currently, there are several countries that can be grouped as advance aged countries such as France whose population of the people above 65 years is at 16 percent, Britain 16 percent, Germany 19 percent, Italy 20 percent and Japan at 21 percent. The world's population of the older people is on a rapid raise based on the United Nations reports. For instance, in 1991, the population of aged people was 332,000,000, however, by the year 2000 this number had increased by approximately 100,000,000 to 426,000,000 people it is projected that by 2030, this number will have doubled (Department of Household registration, 2012). The current global situation is based on two major factors that include people living longer than in the past and the other factor is related to the "baby boomer" generation. The life expectancy for the aged people has increased both in the developing and developing countries based on the medical advances and public health. Moreover, the "baby boomer" generation will be responsible for the doubling the old age group in the United States by 2030. The Tai chi exercise is a Chinese ancient martial art that involves maintenance of various postures and controlled and slow movements. The movements in this exercise involve postural control, coordinated arm movements, weight shifting, the extension the knees and hips, flexion, and trunk rotation. The Tai Chi exercise is beneficial in reducing falls, muscle strength, improving balance and reducing high blood pressure.

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2. Integration/Synthesis of the Evidence

Mechanism of Tai chi

Various studies have indicated that the Tai Chi exercise assists in normalizing the neurotransmitter levels such as the ameliorate PD symptoms, dopamine in the ganglia-motor cortex feedback loop and the cortex-basal through bypassing the faulty circuit. The Tai Chi exercises allow faster reactions during the response to postural challenges, moreover, it promotes the development of new neural pathways through daily repetitive of a practice this therapy. Recent evidence reveals that Tai Chi is significant in the improvement of neuromuscular control pathways that play an important role in postural control, the exercise also elicits responses in somatosensory and the improvement of anticipatory postural adjustments.

The National Parkinson Foundation of The United States recommends the use of Tai Chi as a complementary therapy due to its various beneficial effects. Despite the recommendations for the Tai Chi therapy incorporation in the activities of the daily living of the elderly to improve quality of life, little empirical evidence is available in this area. Previous studies were done to examine the impacts of the Tai Chi Therapy focused primarily on its effectiveness in PD individuals, improvement of aerobic capacity, psychosocial wellbeing in older adults, prevention of fall in healthy/ frail elderly individuals and improving balance in this age group. Despite the attempt by various studies to examine the Tai Chi Therapy, little is known on the effects of its incorporation in the activities of the daily living in the elderly with an aim of improving the quality of life. Therefore, this study aims at reviewing the current evidence of the Tai Chi Therapy on the daily activities of the elderly persons in the recent seven years.

Quality of life of the elderly

The quality of life is one of the great concern since the 1970s in both the nursing and the medical professions. Moreover, it is rooted in the disciplines and cultures in geography, nursing, medicine, philosophy, psychology, sociology, and economics. The concept of quality of life is complex and multi-dimensional, therefore, it is important to implement and design appropriate health promotion programs based on the elderly people perceptions of their quality of life. There are several definitions of quality of life. For instance, the World Health Organization defines the quality of life as an individual' perception of his or her life in terms of the value and culture systems which he or she lives and in relation to their concerns, standards, expectations, and goals.

The quality of life consists of both objective and subjective elements. For instance, Dickinson, et al., (2011) emphasized on the four dimensions of the quality of life that include the subjectivity that refers to self-esteem and life satisfaction, while objectivity that focuses on the socio-economic status, functional status or the general health. Chau, Wong & Woo (2013) presents eight dimensions of the quality of life as the cultural factors, social integration, purposeful activity, the quality of the environment, the socio-economic status, mental and physical well-being, expressed satisfaction, and personal autonomy. However, Chau, Wong & Woo (2013) are of the view that quality of life is composed of a collection of interacting subjective and objective dimensions that might change over time in response to experiences, health events, and life. The health-related definition of quality of life as defined by the Centers for Disease Control and Prevention, CDC as a group or persons perceived mental and physical health over time.

The health-related quality of life is defined by Guo, Qiu, & Liu (2014) as an individual's perception of satisfaction based on the domains that are valued in life. The argument is that the relationship between the quality of life and the physical activities may be underlined by psychological construct, moreover, life satisfaction is directly affected by the experience in the participation in activities.

Various studies have indicated that a perfect quality of life of the elderly is associated with the living environment, youthfulness, material circumstances, happiness, independence, psychological well-being, health, social contacts and the family. Chan & Leung (2012) identified that therapies, activities, connectedness, sense of identity and self and the ethos of care had an impact on the perceptions of the elderly on the quality of life. The selection of care priorities is an important element of the quality of life of the elderly and the care environment. Therefore, the combination of factors such as participation and development of new friendships and enhancement of psychological well-being might offer the improvement of the quality of life through the use of Tai Chi Therapy.

Chan & Leung (2012) view that the health-related quality of life as a multidimensional construct, for instance, the four domains represent the personal satisfaction in life, they include social, emotional, cognitive and physical domains. Moreover, it is influenced by other factors like illness, place of residence, educational level, gender, age and physical activities (Chan & Leung, 2012). Therefore, the health-related quality of life is difficult to measure objectively based on the self-perceived quality (Chan & Leung, 2012). Similarly, the health-related quality of life includes valued and perceived health qualities such as the satisfaction with the social activities, maintenance of good intellectual functions, emotional and the sense of well-being or comfort (Guo, Qiu, & Liu, 2014).

The judgment of the above scholars on health and social relationships as the most significant aspects of the quality of life is of particular relevance to this study. Guo, Qiu, & Liu (2014) identified fives aspects of quality of life such as control that consists of (being in a position of making your own decisions and having independence); security (health and emotional support, feeling sufficient, having sufficient finance, feeing secure and safe); enjoyment (having communal and personal activities, feeling a sense of satisfaction, joy and feeling pleasure); role (feeling valued and having a purpose); and attachment (championship and affection, friendship, feeling of love).

Debates about Tai Chi

Some empirical studies present evidence that the Tai Chi Therapy is not significantly related to the general improvement of the elderly population health status. Moreover, for instance, some of them have revealed that there is no significant change in the older population fall episodes or fear for falling Ho RT, Au Yeung FS, et al., (2012). Chau, P. H., Wong, M., & Woo, J. (2013), presented evidence that there is no difference between flexibility and balance of the Tai Chi participants.

It could be possible that the therapy in the study was not of high intensity that could lead to improved flexibility or balance and strengths. However, the studies had limitations, for instance, subjects with chronic diseases were excluded, and hence the subjects considered by Chau, P. H., Wong, M., & Woo, J. (2013) study were in good health. Moreover, there was the inclusion of other factors that influence the control group; for example, the participants could have altered their lifestyles accordingly as they had been given health promotional information, and participated separately in health education programs at the health center.

The benefits of the Tai Chi therapy

Some studies have indicated that Tai Chi therapy has positive effects in the improvement of the general health status and psychological function (Chen, Fu, Chan & Tsang, 2012; Chen, Zhou & Cartwright, 2011; Field, Diego, Delgado and Medina, 2013). There is empirical evidence Tai Chi therapy provides physiological benefits in the elderly population as studies have indicated that musculoskeletal functions are enhanced by the Tai Chi therapy through muscle strengthening, flexibility and balance (Kohler, Kressig, Schindler and Granacher, 2012). The benefits of Tai Chi therapy includes a reduced fear of falling, decrease in the risks of falls and improvement in the posture control capacity. There are benefits related to lower back pain and arthritis through practicing Tai Chi. The respiratory function and the cardiovascular function are also affected by Tai Chi therapy as they play an important role in lowering blood pressure (Guan and Koceja, 2011; Nomura et al., 2011; Yeh et al., 2011).

Further, the Tai Chi exercise is of great significance in the control of symptoms such as abnormal blood pressure, pulmonary function and a heart rate in the elderly people suffering from chronic diseases (Lam et al., 2012). Moreover, Tai Chi therapy is beneficial in the muscle strengthening and flexibility as it is a gentle and slow exercise (Wong et al., 2011). Some studies report on the benefits of the use of the Tai Chi therapy in enhancing psychological health such as increasing the social functioning, improving positive mood states, lessening mood disturbances and reduction of anxiety and depression (Lam et al., 2012).

3. Critique of the Evidence

The overall quality of the evidence is impressive how there is a need for further study in order to unearth the fundamental effects of Tai Chi on the quality of life of the elderly. For instance, the impact of Tai Chi on the elderly on the elderly people have been explored in particular. Several studies are in support of the nation that the Tai Chi Therapy has positive effects on the health of the elderly people, however, they fail to report on any effects of their quality of life (Chen, Fu, Chan & Tsang, 2012; Chen, Zhou &...