Falls and concomitant injuries are common problems among large groups of the elderly population, leading to immobility and mortality. These problems are even more pronounced among people suffering from dementia. This thesis targets fall risk factors for people with dementia in institutions. The overall aim of this thesis was to investigate risk factors for falls, predisposing as well as related to circumstances surrounding falls, and to do this as efficiently as possible. In a prospective cohort study including residents of residential care facilities with and without dementia, the fall rate was higher for those with dementia, the crude incidence rate ratio (IRR) was 2.55 (95% CI 1.60–4.08) and the adjusted IRR was 3.79 (95% CI 1.95–7.36). In the group of people suffering from dementia, including 103 residents, a total of 197 falls resulted in 11 fractures during the 6-months follow-up period. From the same baseline measurements 26% and 55%, respectively, of the variation in falls could be explained in the group of residents with and without dementia. Fall predictors significantly and independently associated with an increased risk of falls in the group of people suffering from dementia were the category “man walking with an aid” and the use of more than four drugs. In a prospective cohort study, including 204 patients in a psychogeriatric ward, a total of 244 falls resulted in 14 fractures. Fall predictors significantly and independently associated with an increased risk of falls were male sex, failure to copy a design, use of clomethiazole, and walking difficulties. Treatment with statins was associated with a reduced risk of falls. With these fall predictors in the negative binomial regression (Nbreg) model, 48% of the variation in falls was explained. The data from the psychogeriatric ward were also analysed with the use of partial least squares regression (PLS) and regression tree to be compared with the results of the Nbreg analysis. PLS and regression tree are techniques based on combinations of variables. They both showed similar patterns, that a combination of a more severe level of dementia, behavioral complications and medication related to these complications is associated with an increased fall rate. Thirty-two percent and 38%, respectively, of the variation in fall rate were explained in the PLS and regression tree analysis. The circumstances surrounding the falls in the psychogeriatric ward were analysed. It was found that the fall rate was equally high during the night and the day. A large proportion of the falls was sustained in the patients’ own room and a small proportion of the falls was witnessed by the staff. This pattern was even more pronounced during the night. The proportion of diurnal rhythm disturbances and activity disturbances was higher for falls at night than for falls during the day. Circumstances associated with an increased risk of falls, as shown by a short time to first fall, were anxiety, darkness, not wearing any shoes and, for women, urinary tract infection. The proportion of urinary tract infection was also higher in connection to falls sustained by women than to falls sustained by men. This thesis confirms that people suffering from dementia are prone to fall. Walking difficulties, male sex and impaired visual perception are factors that should be considered in the work of reducing falls among people suffering from dementia. Furthermore, falls at night, behavioral complications and medication related to these complications should also be considered in this work, especially as the dementia disease progresses. A larger portion of the variation of the outcome variable was explained by the Nbreg model than the regression tree and PLS. However, these statistical methods, based on combinations of variables, gave a complementary perspective on how the fall predictors were related to falls.

The number of old people is growing and will increase future demands on healthcare services for old people. Hip fracture is one of the diagnoses that increases with age and it has become a major problem, both for those suffering a fracture and for society due to the large numbers involved, the morbidity with complications such as falls, functional decline, and the high mortality rate among those affected. The main purposes of this thesis were, to study the impact of previous hip fractures on their life among the very old, to study in-patient falls, fall-related injuries and fall-risk factors, and to evaluate a multidisciplinary, multi-factorial intervention program designed to reduce in-patient falls and to enhance functional performance among old people who have sustained a femoral neck fracture. The impact of a hip fracture was examined in a cross-sectional population-based study, among the very old (Umeå 85+). After adjustment for potential covariates, participants with a history of hip fracture were found to be more dependent in the performance of Personal/Primary Activities of Daily Living (P-ADL) (p=0.024), walked less independently (p=0.040) and used a wheelchair more frequently (p=0.017). Most of the participants with earlier hip fractures who had moved to institutional care or begun using mobility aids, as compared to before the fracture, had started to do so permanently in connection with the fracture incident. In-patient falls, fall-related injuries and fall-risk factors were studied in 97 participants, aged 70 or more, treated for a femoral neck fracture. There were 60 postoperative falls occurring among 26/97 participants (27%). Thirty-two percent of the falls resulted in injuries, 25 % were minor, and 7 % were serious. Delirium after day seven, (Hazard Rate Ratio (HRR) with a 95% Confidence Interval (CI)), 4.62 (1.30-16.37), male sex 3.92 (1.58-9.73), and sleeping disturbances 3.49 (1.24-9.86), were associated with in-patient falls. Forty-five percent of the participants were delirious on the day they fell. The effects of a multidisciplinary, multi-factorial intervention program on in-hospital falls and injuries as well as the short- and long-term effects on living conditions, walking ability and performance of activities of daily living were evaluated in a randomised controlled trial among 199 participants with femoral neck fracture, aged ≥70 years. Participants were randomised to care in a geriatric ward (intervention, n=102) or to conventional postoperative routines (control, n=97). The intervention consisted of staff education, individualized care planning and rehabilitation, systematic assessment and treatment of fall-risk factors, active prevention, and detection and treatment of postoperative complications and an intervention follow up at four-months. The staff worked in teams to apply comprehensive geriatric assessment, management and rehabilitation. Twelve participants fell a total 18 times in the intervention group compared to 26 participants suffering a total 60 falls in the control group. Only one participant with dementia fell in the intervention group compared to 11 participants with dementia in the control group. The fall incidence rate was 6.29/1000 days vs. 16.28/1000 for the intervention and control groups respectively. The Incidence Rate Ratio (IRR) was 0.38 (95% CI: 0.20-0.76, p=0.006) for the total sample and 0.07 (95% CI: 0.01-0.57, p=0.013) among participants with dementia. No new fractures were incurred in the intervention group but there were four in the control group. In addition, despite shorter hospitalization, significantly more people from the intervention group had regained independence in P-ADL performance at the four- and twelve-month follow ups, Odds Ratios (OR), with 95% CI, were 2.51 (1.00-6.30) and 3.49 (1.31-9.23) respectively. More participants in the intervention group had also regained the ability to walk independently without walking aids indoors, at the end of the study period, 3.01 (1.18-7.61). In conclusion, hip fracture among the very old seems to be associated with poorer P-ADL performance and poorer mobility. Falls and injuries are common during in-patient rehabilitation after a femoral neck fracture, delirium and sleep disturbances and male gender are factors associated with in-patient falls. Having a team apply comprehensive geriatric assessments and rehabilitation, including the prevention, detection and treatment of fall-risk factors, can successfully prevent in-patient falls and fall-related injuries, even among participants with dementia, and can also enhance the performance of Activities of Daily Living (ADL) and mobility after a hip fracture, in both short- and long-term perspectives.

The very old, aged 80 years and over, is the fastest growing age group today, and the demands for healthcare and services will be even higher in the future. It is, therefore, of great importance to advance our knowledge about this group. The main purpose of this thesis was to describe living conditions and health, with a special focus on physical ability, falls and morale, in women and men in three different age groups of very old people in northern Sweden. Half the population aged 85, and the total population aged 90 and ≥95 (-103) in the municipality of Umeå were selected for participation (n=348) in this population-based cross-sectional study, entitled the Umeå 85+ Study. Structured interviews and assessments were performed with the participants in their homes, and data were also collected from next-of-kins, caregivers and medical charts. Cognition was screened for using the Mini-Mental State Examination (MMSE), depressive symptoms using the Geriatric Depression Scale-15 (GDS-15), and nutritional status using the Mini Nutritional Assessment (MNA). Activities of Daily Living (ADL) were assessed using the Staircase of ADL (including the Katz Index of ADL) and morale using the Philadelphia Geriatric Center Morale Scale (PGCMS). Participants also rated their own health and answered a questionnaire about symptoms. Physical ability was assessed using a gait speed test over 2.4 meters (8 feet), three consecutive chair stands, and the Berg Balance Scale (BBS). A follow-up study for falls was performed during a period of six months with fall calendars and telephone calls. The very old people in this northern population have more depression, hypertension and hip fractures, as well as a higher consumption of drugs than comparable, more southern populations. In general, younger participants had lower rates of diagnoses and prescribed drugs, were less dependent in ADL and other functional variables than older participants, and men had lower rates of diagnoses and reported symptoms than women. However, there were no age or sex differences in self-rated health or morale, which were both rated as good by the majority of the participants. There was a wide range of physical ability among these very old people, especially in women, where an age-related decline was seen. The results also demonstrate that men had greater physical ability than women. The BBS had no floor or ceiling effects in the present sample. In contrast, a large proportion was unable to perform the gait speed and chair stands test, resulting in a floor effect for the timed performances, especially in women. Falling is a major public health problem in very old people. From the results of the present study, it could be predicted that every seventh participant and every third of the people who did fall would suffer a fracture over a period of one year. The independent explanatory risk factors for time to first fall in this sample of very old people were dependency in personal (P-) ADL but not bedridden, thyroid disorders, treatment with Selective Serotonin Reuptake Inhibitors (SSRIs) and occurrence of fall/s in the preceding year. These factors should all be considered in fall prevention programmes. The morale of very old people was found in this study to be rather high, with similar scores among age groups and sexes. The most important factors for high morale were the absence of depressive symptoms, living in ordinary housing, having previously had a stroke and yet still living in ordinary housing, not feeling lonely and having few symptoms. The PGCMS seems applicable in the evaluation of morale in very old people. In conclusion, there were wide variations in health status and physical ability in this northern population of very old people. Women had poorer health and physical ability than men. Falls and fractures were common and serious health problems. Morale seemed to be high, despite the fact that a large proportion of the participants suffered from many diseases and functional decline.

Impairments in balance, mobility, and lower-limb strength are common in the growing population of older people and can lead to dramatic consequences for the individual, such as dependency in activities of daily living, admission to nursing home, falls, and fractures. The main purposes of this thesis were, among older people in residential care facilities, to validate a fall-risk assessment tool and to evaluate a high-intensity functional weight-bearing exercise pro-gramme regarding its applicability as well as its effect on physical functions and falls. The prediction accuracy of the Downton fall risk index within 3, 6 and 12 months was evaluated among 78 residents, aged 65 years or more, at one residential care facility. The participants were assessed as having either a low or high fall risk according to the index and were followed-up for falls using two different fall definitions related to the cause of the fall. With all falls included, a significant prognostic separation was found between the low- and the high-risk group at 3, 6 and 12 months. A definition in which falls precipitated by acute illness, acute disease, or drug side-effects were excluded did not improve the accuracy of the fall prediction. The effect on physical functions of a high-intensity functional exercise programme was evaluated in a randomised controlled trial among 191 older people, dependent in activities of daily living, with a Mini-Mental State Examination score of ten or more, and living in nine residential care facilities. Participants were randomised to an exercise programme or a control activity, including 29 supervised sessions over 3 months, as well as to an intake of a milk-based 200 ml protein-enriched energy supplement (7.4 g protein per 100 g) or a placebo drink immediately after each session. The Berg Balance Scale, usual and maximum gait speed, and one-repetition maximum in lower-limb strength in a leg press machine were followed up at 3 and 6 months by blinded assessors and analysed using the intention-to-treat principle. Significant long-term effects of the high-intensity functional exercise programme were seen in balance, gait ability and lower-limb strength in comparison with the control activity. The intake of the protein-enriched energy supplement did not increase the effect of the training. The evaluation of the applicability of the exercise programme showed that there was a high rate of attendance, a relatively high achieved intensity in the exercises, and only two serious adverse events, neither of which led to manifest injury or disease, despite that most of the participants had severe cognitive or physical impairments. The applicability of the programme was not associated with the participants’ cognitive function. The evaluation of the fall-prevention effect of the exercise programme, during the 6 months following the intervention, showed that neither fall rate nor proportion of participants who sustained a fall differed between the exercise programme and the control activity, when all participants were compared. However, among participants who improved their balance during the intervention period, a significant reduction in fall rate was seen in favour of the exercise group. In conclusion, among older people living in residential care facilities, the Downton fall risk index appears to be a useful tool for predicting residents sustaining a fall, irrespective of the cause of the fall, even with a perspective of only a few months. A high-intensity functional exercise programme is applicable for use, regardless of cognitive function, and has positive long-term effects on balance, gait ability, and lower-limb strength. An intake of a protein-enriched energy supplement immediately after the exercise does not appear to increase the effect of the training. Participants who improve their balance function due to the exercise programme may reduce their risk of falling.

Many epidemiological studies assess the effects of time-dependent exposures, where both the exposure status and its intensity vary over time. The analysis of such studies poses the challenge of modelling the association between complex time-dependent drug exposure and the risk, especially given the uncertainty about the etiological relevance of doses taken in different time periods. / To address this challenge, I developed a flexible method for modelling cumulative effects of time-varying exposures, weighted by recency, represented by time-dependent covariates in the Cox proportional hazards model. The function that assigns weights to doses taken in the past is estimated using cubic regression splines. Models with different number of knots and constraints are estimated. Bootstrap techniques are used to obtain pointwise confidence bands around the weight functions, accounting for both the sampling variation of the regression coefficients, and the uncertainty at the model selection stage, i.e. the additional variance due to a posteriori selection of the number of knots. / To assess the method in simulations, I had to develop and validate a novel algorithm to generate event times conditional on time-dependent covariates and compared it with the algorithms available in the literature. The proposed algorithm extends a previously proposed permutational algorithm to include a rejection sampler. While all the algorithms generated data sets that, once analyzed, provided virtually unbiased estimates with comparable variances, the algorithm that I proposed reduced the computational time by more than 50 per cent relative to alternative methods. I used simulations to systematically investigate the properties of the weighted cumulative dose method. Six different weight functions were considered. Simulations showed that in most situations, the proposed method was able to capture the shape of the true weight functions and to produce estimates of the magnitude of the exposure effect on the risk that were close to those used to generate the data. I finally illustrated the use of the weighted cumulative dose modelling by reassessing the association between the use of selected benzodiazepines and fall-related injuries, using administrative data on a cohort of elderly who initiated their use of benzodiazepines between 1990 and 2004.

People aged ≥65 years (older people) have a higher chance of falling than other age groups. However, based on qualitative research, older people do not believe that falls prevention information and strategies have personal relevance. This suggests that older people believe that falls are more likely to happen to other older people than themselves, that is, they might be comparatively optimistic about their chance of falling. It is important to understand comparative optimism about falling as it is a consistent reason given by older people for not participating in falls prevention activity. This thesis used a mixed methods design with a sequential strategy to investigate community-dwelling older people's comparative optimism about falling. Three studies were undertaken, using semi-structured interviews, cognitive interviews and telephone interviews to collect data. The semi-structured interview study, guided by the tenets of grounded theory, aimed to develop an explanation of why older people might be comparatively optimistic. A sampling frame (age, sex and direct and indirect history of falling) was used to guide recruiting respondents. Older people (N = 9) were interviewed about their chance and other older people's chance of falling. Interviews were analysed using the constant comparison method. The cognitive interview study investigated potential problems in survey items in order to refine them for the telephone interview study. Items were developed to measure older people's comparative optimism about falling. Older people (N = 13) were cognitively interviewed, and interviews were content analysed. The telephone interview study aimed to determine whether older people were comparatively optimistic about falling, and whether the direct and indirect experience of falling was associated with comparative optimism. A random sample of older people (N = 389) living in South Australia were telephone interviewed (response rate = 75%). The semi-structured interview study identified that it was a 'threat to identity' for respondents to say they had a chance of falling because of intrinsic risk factors. Respondents used strategies to maintain or protect their identity when discussing their chance of falling in the future or their reasons for falling in the past. In the cognitive interview study, respondents reported difficulty in rating their chance of falling, as they believed falls were unexpected and unpredictable. They reported difficulty in rating other people's chance of falling, as they believed they did not know other people their age, did not have enough information and/or did not know the answer. In the telephone interview study, most respondents believed they had the same chance (42%), or a lower chance (48%) of falling in the next 12 months, than other older people. Having fallen in the last 12 months was significantly associated with a lowered comparative optimism, but knowing other older people who had fallen was not associated with comparative optimism. This is the first quantitative study to report that the majority of a representative sample of community-dwelling older people were comparatively optimistic about their chance of falling. Self-presentation concerns about having a chance of falling support the core category to emerge from the semi-structured interview study. Messages such as 'you can reduce your risk of falls' may be ignored by older people. Alternative messages should promote identities that are relevant to older people, such as being independent, mobile and active, but these messages should be tested in further research. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1374964 / Thesis (Ph.D.) - University of Adelaide, School of Psychology and School of Population Health and Clinical Practice, 2009

People aged ≥65 years (older people) have a higher chance of falling than other age groups. However, based on qualitative research, older people do not believe that falls prevention information and strategies have personal relevance. This suggests that older people believe that falls are more likely to happen to other older people than themselves, that is, they might be comparatively optimistic about their chance of falling. It is important to understand comparative optimism about falling as it is a consistent reason given by older people for not participating in falls prevention activity. This thesis used a mixed methods design with a sequential strategy to investigate community-dwelling older people's comparative optimism about falling. Three studies were undertaken, using semi-structured interviews, cognitive interviews and telephone interviews to collect data. The semi-structured interview study, guided by the tenets of grounded theory, aimed to develop an explanation of why older people might be comparatively optimistic. A sampling frame (age, sex and direct and indirect history of falling) was used to guide recruiting respondents. Older people (N = 9) were interviewed about their chance and other older people's chance of falling. Interviews were analysed using the constant comparison method. The cognitive interview study investigated potential problems in survey items in order to refine them for the telephone interview study. Items were developed to measure older people's comparative optimism about falling. Older people (N = 13) were cognitively interviewed, and interviews were content analysed. The telephone interview study aimed to determine whether older people were comparatively optimistic about falling, and whether the direct and indirect experience of falling was associated with comparative optimism. A random sample of older people (N = 389) living in South Australia were telephone interviewed (response rate = 75%). The semi-structured interview study identified that it was a 'threat to identity' for respondents to say they had a chance of falling because of intrinsic risk factors. Respondents used strategies to maintain or protect their identity when discussing their chance of falling in the future or their reasons for falling in the past. In the cognitive interview study, respondents reported difficulty in rating their chance of falling, as they believed falls were unexpected and unpredictable. They reported difficulty in rating other people's chance of falling, as they believed they did not know other people their age, did not have enough information and/or did not know the answer. In the telephone interview study, most respondents believed they had the same chance (42%), or a lower chance (48%) of falling in the next 12 months, than other older people. Having fallen in the last 12 months was significantly associated with a lowered comparative optimism, but knowing other older people who had fallen was not associated with comparative optimism. This is the first quantitative study to report that the majority of a representative sample of community-dwelling older people were comparatively optimistic about their chance of falling. Self-presentation concerns about having a chance of falling support the core category to emerge from the semi-structured interview study. Messages such as 'you can reduce your risk of falls' may be ignored by older people. Alternative messages should promote identities that are relevant to older people, such as being independent, mobile and active, but these messages should be tested in further research. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1374964 / Thesis (Ph.D.) - University of Adelaide, School of Psychology and School of Population Health and Clinical Practice, 2009

Diss. (sammanfattning) Umeå : Univ., 2004. / Härtill 5 uppsatser.

Made available in DSpace on 2015-07-22T20:50:54Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-10-28. Added 1 bitstream(s) on 2015-08-11T03:26:00Z : No. of bitstreams: 1 Publico-11922.pdf: 2026305 bytes, checksum: 6748d516ad453759f76cc254710a50b1 (MD5) / OBJETIVO: avaliar o efeito de um programa de treinamento de força muscular progressiva e propriocepção, na força muscular do quadríceps, no equilíbrio, na qualidade de vida e na redução do risco de quedas em mulheres com osteoporose pós-menopausa. MÉTODOS: Foram selecionadas cem mulheres sedentárias com idade entre 55 e 75 anos com osteoporose pós-menopausa, randomizadas em dois grupos: grupo intervenção composto por 50 pacientes submetidas a 18 semanas de treinamento de força muscular progressiva do quadríceps (a 50%, 60%, 70% até 80% de 1-RM – uma repetição máxima), e de propriocepção, associados ao tratamento clínico medicamentoso para osteoporose; e grupo controle também composto por 50 pacientes que receberam apenas o tratamento clínico medicamentoso. Força muscular, equilíbrio, mobilidade funcional e qualidade de vida foram avaliados no início e ao final da pesquisa através do Teste de Uma Repetição Máxima (1-RM), Berg Balance Scale (BBS), Timed Up & Go Test (TUG) e SF-36. Número de quedas foi avaliado 6 meses que antecederam à pesquisa e nos 6 meses seguintes. RESULTADOS: 85 pacientes concluíram a pesquisa. Os valores para SF-36 melhoraram em todas as oito sub-escalas no grupo intervenção (p ≤ 0.0018), Timed Up & Go Test (p < 0,0001), do teste de 1-RM (p < 0,0001), da Berg Balance Scale (p < 0,0001), e, ainda, uma redução do risco de quedas no grupo intervenção comparada ao grupo controle (IRR 0.263, 95% IC 0.10, 0.68). CONCLUSÃO: A associação do treinamento de força muscular progressiva para quadríceps e o treinamento proprioceptivo é efetivo na redução do risco de quedas, no aumento da força muscular do quadríceps, na melhora do equilíbrio estático e dinâmico, na melhora da capacidade funcional e da qualidade de vida em mulheres com osteoporose pós-menopausa. / OBJECTIVE: To evaluate the effect of a progressive muscular strength and proprioception training program on the muscle strength of the quadriceps, balance, quality of life and reduction in the risk of falls in postmenopausal women with osteoporosis. METHODS: One hundred sedentary postmenopausal women with osteoporosis, ages ranging from 55 to 75, were selected and randomized into two groups: the intervention group comprised of 50 patients who underwent a 18-week of progressive load training for the quadriceps muscle (50%, 60%, 70% up to 80% of 1- RM – one maximum repetition) and proprioception training associated to a drug treatment of osteoporosis and the control group that included 50 patients who only underwent a drug treatment of osteoporosis. The muscular strength, balance, functional mobility and quality of life were evaluated in the beginning and end of the research through the One Maximum Repetition Test (1-RM), Berg Balance Scale (BBS), Timed Up & Go Test (TU & GT) and SF-36. The number of falls was evaluated 6 months preceding the research and in the following six months. Results: Eighty-five patients concluded the research. The program promoted a significant difference among the groups for SF-36 in the eight sub-scales (p ≤ 0.0018), Timed Up & Go Test (p < 0.0001), 1-RM test (p < 0.0001), Berg Balance Scale (p < 0.0001) and also a decrease in the number of falls in the intervention group compared to control (IRR 0.263, 95% CI 0.10, 0.68). Conclusion: The association of progressive strength training for the quadriceps and the proprioceptive training is effective for the prevention of falls, increasing the muscle power, the static and dynamic balance and increasing the speed of the motor responses, therefore improving the performance of daily activities. / TEDE / BV UNIFESP: Teses e dissertações

A queda em idosos é um problema significativo em saúde pública, já que este tipo de acidente pode resultar em fraturas, diminuição da mobilidade e aumento da mortalidade. Neste contexto, o Tai Chi Chuan (TCC) pode ser visto como uma prática corporal promissora na Atenção Primária à Saúde (APS). Nesta dissertação, foram produzidos dois artigos. No primeiro, avaliamos a relação entre a prática de TCC, como atividade de grupo em uma Unidade de Saúde, no equilíbrio estático e dinâmico de idosos. Para isto, 80 idosos da comunidade (≥ 60 anos) foram convidados a realizar entrevista e avaliação de equilíbrio e a participar de um grupo de TCC (amostra por conveniência). Os participantes foram avaliados antes e seis meses após o treinamento da “Sequência Simplificada de TCC de 24 Movimentos” (baseada no estilo Yang), 1x/semana. As 19 pessoas que frequentaram ≥8 aulas foram consideradas praticantes. Foram realizadas 26 aulas durante o estudo, com uma média de 18 participantes. Ocorreu uma melhora de aproximadamente dois pontos na Escala de Equilíbrio Funcional de Berg (p<0,001) no grupo de praticantes sendo que 100% destes, ou melhoraram ou mantiveram os escores anteriores. Tratase de uma das primeiras avaliações da prática de TCC realizada no âmbito da APS, no Brasil. No segundo artigo, (um relato de experiência) descrevemos as condições necessárias para a prática do TCC e o programa de treinamento de forma detalhada. Concluindo, o TCC é uma prática corporal utilizada para a promoção da saúde. Acreditamos ser possível sua inserção na APS trazendo, desta forma, benefícios na melhora do equilíbrio de idosos da comunidade. / Falls in the elderly is a significant problem in public health, since this type of accident can result in fractures, decreased mobility and increased mortality. In this context, the Tai Chi Chuan (TCC) can be seen as a promising body practice in Primary Health Care (PHC). In this dissertation, two articles have been produced. In the first article, we evaluated the relationship between the practice of TCC, as a group activity in a Health Unit in static and dynamic balance in elderly people. In order for this to happen, 80 community elderly (≥ 60 years) were invited to participate in interviews and evaluations of balance and as well as in a TCC group (convenience sample). Participants were evaluated before and six months after the training of “24 simplified TCC forms” (based on Yang style), 1x/week. The 19 people who attended ≥ 8 classes were considered practitioners. During the study, 26 lessons were conducted, with an average of 18 participants. There was an improvement of approximately two points on the Berg scale of balance performance (p <0.001) in the group of practitioners and 100% of these, either maintained or improved their previous scores. This is one of the first evaluations of the practice of TCC within the PHC, in Brazil. In the second article (an experience report) we described the necessary conditions for the practice of TCC and the training program in detail. In conclusion, TCC is a body practice that is used to promote health. We believe it is possible its insertion into the PHC bringing thus benefits in improving balance of older adults.