The relationship between fall prevention and mobility maintenance

Fall prevention and mobility maintenance have never been a one-way subordinate relationship between "protection" and "protected", but a two-way binding causal linkage - fall prevention is not only the most direct risk warning after mobility degradation, but also the core target and final verification standard for the full-cycle maintenance of mobility.

I was particularly impressed by Aunt Zhang, whom I met at a community rehabilitation center last year. She was 68 years old. Her feet slipped when she was shopping for groceries. She was so frightened that she didn’t dare to go out. She installed a bathroom handrail at home, flattened the door sills, replaced all her slippers with non-slip texture, and even laid out a two-centimeter-thick anti-fall mat next to her bed. As a result, half a year later she went downstairs to throw garbage, and her feet went soft and she sat on the ground. She lay there with a broken femoral neck for more than three months. Her daughter came to me holding a stack of orders for anti-slip products and asked me, "Why did I still fall after all the protective measures were taken?" I tested Aunt Zhang's quadriceps strength, and she found it was nearly 40% weaker than that of older people of the same age. Her proprioception (the ability to accurately perceive the slope of her feet and the position of her limbs without looking at her eyes, which is to put it bluntly, the "accuracy" of walking) was so bad that she couldn't even feel a 10-degree slope. To put it bluntly, the "strength" and "accuracy" in her legs were all gone, and no matter how good the external protection was, she couldn't hold her back.

There are actually two different schools of thought in the industry on this issue. The "environmental reform school" that favors public health has always believed that 80% of falls are caused by environmental triggers. Making the floor anti-slip, installing handrails, and cleaning up debris on the floor can block most risks. There is really nothing wrong with this view. The first step when we go into the community to do missionary work is to promote the improvement of the home environment. Too many elderly people fall because they step on the standing water in the bathroom or trip over the shoe-changing stool at the door. But the other group, the "capability-first group" who prefers rehabilitation medicine, believes that external protection is always a cover-up. You can't change the entire community, vegetable market, and park to be non-slip and non-slip. The elderly have to go out, right? I have seen many elderly people whose homes are protected like those in hospital wards. When they go outside on wet ground after rain or on paths paved with small gravel, they still shake and fall. Essentially, their mobility cannot keep up with the changes in the environment.

Don’t think this is just a problem for the elderly. Last week, a 28-year-old Internet operation girl came to my clinic. She couldn’t step down the steps of the company even if she wore flat shoes and sprained her ankle. She didn’t have a fracture after taking a X-ray, but her ankle was swollen like a steamed bun. She also said that in the past six months, she has always felt that she can’t step properly when walking down the stairs. Her legs are sore after walking for a long time. She thought she was tired from sitting for a long time at work. I tested her standing on one foot. She could not stand for 10 seconds with her eyes open. Her core strength was abysmal. This is a typical early deterioration of mobility. This sprained foot is essentially a "mild fall warning". If she does not pay attention to adjustments, the problem will only become more severe as she gets older.

Let’s talk about the 3-year follow-up data conducted by our website. Among the elderly over 65 years old, those who only underwent home environment modifications had an annual fall incidence rate of 18.7%. However, in addition to environmental modifications, those who continued lower limb strength + balance training for 20 minutes three times a week had an annual fall incidence rate of only 7.3%, which was more than double the difference. Of course, training is not a random exercise. There were old people who heard others say that they would climb mountains to train their legs. They climbed for half an hour every day. As a result, their knees developed synovitis and they were even more afraid to walk. This was extreme.

My own grandma is 76 years old. She also skated once in the community two years ago. I was anxious to install handrails and buy non-slip shoes for her at first. Later, I found that she still did not dare to go out. Her legs were getting weaker and weaker after sitting at home every day. I walked with her on the health trail in the community for 10 minutes every day after dinner. The pavement paved with small cobblestones can stimulate the proprioception of the soles of the feet. After a month of walking, it was increased to 20 minutes. Later, she also learned Baduanjin from the aunties downstairs. Now she can walk around the vegetable market for 20 minutes without shaking while carrying a vegetable basket. She has not fallen down in almost two years. Oh yes, I have to mention here that the idea of ​​synchronization of muscles and bones in traditional Chinese medicine is actually very useful. Slow exercises such as zhanzhuang and baduanjin are no worse than Western rehabilitation training in improving balance. Many elderly people find it easier to persist and have better long-term effects.

Of course, this does not mean that external protection is useless. Last year, there was an old man in our community who suffered from Parkinson's disease. His balance ability was poor. There were no handrails in the bathroom at home. When he was taking a shower, he slipped and fell and suffered intracranial hemorrhage. If he had used a hand to hold him up, there was a high probability that he would be fine. Don't overdo it and think that you don't need to use protection as you develop your skills. The two are complementary.

In fact, to put it bluntly, mobility is like the battery of your mobile phone, and fall prevention is the 20% low battery reminder. Don’t wait for your phone to shut down automatically before thinking about charging it. When you see the reminder, you should replenish the battery. Walk two more steps on a daily basis, and occasionally try standing on one foot when brushing your teeth. Don't always sit on the sofa. Install the armrests that should be installed at home. It can not only move freely, but also have the protection of a pocket. It is better than anything else. You really have to wait until you fall to make up for it. It’s you who’s in pain, and it’s your family who’s in trouble, so why bother?