Going with the flow

Tai chi can help dementia patients relax, according to a new Christchurch study. JANE DUNBAR reports.

Staff at Princess Margaret Hospital have made a discovery - tai chi classes can help elderly patients with dementia relax, become less agitated and easier to manage during the traditionally difficult time of the day for dementia patients, late afternoon.

The finding is significant, says lead researcher Dr Matthew Croucher, from the Psychiatry of Old Age academic unit.

Not only is tai chi fairly inexpensive and brings numerous health benefits, it could also potentially reduce the use of medications to treat dementia.

"Health professionals and the community have been becoming more concerned about the use of medications for people with challenging behaviours in dementia because of unwanted side effects," says Croucher. This research suggests that tai chi can in some cases be an alternative to medication in helping patients to be calmer, he says.

Tai chi classes were first introduced to Princess Margaret Hospital patients through a Presbyterian Support Services programme aimed at preventing falls among the elderly, by helping to improve balance and mobility.

The physiotherapy team working within the Psychiatry Service for the Elderly was impressed by the classes and suspected that tai chi could have wide benefits for patients with dementia, depression and anxiety.

Physiotherapy assistant Gillian Bastion was encouraged to train in tai chi and daily tai chi classes began for patients receiving treatment at the service's day hospital, the Mabel Howard Clinic, and two inpatient wards, K1 and K2.

The classes seemed to have such a settling effect on some patients it was clear there was room for some interesting research. A study was then run over the summer of 2009-10.

"Staff in the dementia specialty unit at PMH sometimes have to nurse patients who become unsettled and distressed," says Croucher. "This can be a particular problem at the end of the afternoon for people with dementia and is called 'sundowning'." In Ward K1, tai chi is run in the mid-afternoon to provide patients with a meaningful and fun activity at this potentially difficult time of day.

"The study revealed evidence to support the theory that tai chi can help with the nursing of elderly patients with challenging behaviour," Croucher says.

As far as the PMH research team is aware, there has been no international research in this area. Researcher Susan Gee says the short-term settling effect of tai chi was greatly appreciated by nursing staff because calmer patients meant the ward was easier to run.

As for teaching tai chi, physio assistants Bastion and Rachael Beever say the visual aspect of the discipline makes it relatively easy to teach dementia patients.

"Because it's so visual, they can follow it to the best of their ability, and if they just get parts of it, it's still good for them," says Beever.

"It's often a surprise that people can do more than we expect," Bastion adds. "They copy rather well."

The classes are offered as a choice, not something patients have to do. Even just watching can have a beneficial effect for patients, says Bastion. "It's calming in itself just to watch someone moving to gentle music."

Tai chi has different effects for different patients, with improving balance being a big benefit, she says. "But for those patients suffering from dementia and related illnesses, the relaxing gentle rhythmic exercise seems to have a settling effect."

Bastion has adapted her tai chi lessons to suit the patients. She runs shorter sessions (half an hour), with an emphasis on the repetitive, the gentle and the rhythmic.

The study was made possible by a grant from the Alzheimer's New Zealand Charitable Trust and a summer-studentship within the University of Otago, Christchurch Medical School, funded by the Canterbury Health Care of the Elderly Education Trust.

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