The relationship between fall prevention and mobility maintenance is

Fall prevention and mobility maintenance are a symbiotic relationship of mutual cause and effect and two-way support - mobility degradation is the first intrinsic cause of falls, and scientific fall prevention and control itself is to delay the loss of mobility. The two are never a sequential relationship of "problems first and then remedy them", but are parallel health management items throughout the entire life cycle, especially in the middle-aged and elderly stages.

I met the 72-year-old Aunt Zhang when I was volunteering at a community rehabilitation site two years ago. It was a follow-up examination after her femoral neck fracture. It was really a pity to talk about the previous operation: her legs and feet were just a little stiff at first, so she could go to the park and pick up her grandson. But she accidentally heard from a neighbor that an old man had fallen and was paralyzed. She was so scared that she didn't dare to go out. She sat at home every day, and even asked her husband to mop the floor for fear of slipping. It turned out that after only three months, her legs felt weak even when she was changing shoes. That day, she stepped on a drop of water from the bathroom door and sat on the ground and broke her bones.

In fact, there are many people like Aunt Zhang who oppose "fall prevention" and "movement". Even practitioners in different fields have quite different priority judgments on the two. The first thing teachers in public health prevention and control always emphasize is environmental improvement. I have done home inspections with a team from the Centers for Disease Control and Prevention before. Their data shows that 42% of falls among people over 60 years old are directly related to environmental hazards - protruding thresholds, toilets without handrails, and slippery wooden floors. If these problems are not solved, no matter how good your mobility is, you will still be at risk of falling. The views of this school are very practical: first fill in the visible holes, and then talk about improving capabilities. Otherwise, the risk is too high for the elderly to run in a minefield.

But my friends who work in rehabilitation don’t see it that way. They have many cases where the fall prevention facilities at home are not fully installed, but they still fall frequently. Xiao Li, a rehabilitation practitioner I know, has an 81-year-old patient. After his last fall, his son installed handrails everywhere on the walls of his home, replaced his slippers with non-slip ones, and even wrapped the corners of the table with sponges. As a result, he fell twice in half a year. Once he staggered when he stood up to get a water glass, and once he couldn't lift his foot while walking and caught it on the edge of the carpet. Later, I followed Xiao Li to do lower limb strength and balance training three times a week, and practiced some simple movements such as sitting to standing transfers and standing on one foot with eyes open. I persisted for half a year. Now I haven’t fallen in two years, and I can even carry a vegetable basket downstairs to buy groceries. In the logic of rehabilitation practitioners, environmental modification is always the bottom line, and mobility is the core moat to prevent falls. If you have enough muscles and a good sense of balance, you can hold yourself steady even if you step on a pebble. If your legs are so weak that you can't stand, even if you have a ten-meter-thick sponge at home, you may still be unable to sit still and fall.

In the past two years, the industry has gradually reached a consensus that the relationship between the two is not about who comes first, but must be done together. Last year, I worked with the community on a fall prevention intervention project. I first moved into the home to change the environment for the elderly. I removed door thresholds and installed handrails when needed. I also held free balance training classes and taught everyone how to do simplified Tai Chi and Baduanjin. During the follow-up, an aunt told me that she used to hold onto the wall when squatting down to pick up keys because she was afraid of falling. After practicing for two months, she can now go to the square to dance for half an hour at night without falling. You see, this is a positive cycle: measures to prevent falls minimize the risk. The elderly dare to move, their mobility gradually improves, their balance and muscle strength improve, and the risk of falling naturally drops again. It is a win-win situation.

Of course, not everyone is suitable for "training more". Last year, when we had a free clinic with geriatric experts, a doctor mentioned that for the elderly over 85 years old, or those with Parkinson's disease or stroke sequelae, they should not blindly pursue improving their mobility. Instead, they should put the priority of preventing falls. Use a walking aid when necessary, and don't force yourself to "walk", otherwise it will easily cause big problems. After all, everyone’s physical foundation is different, so you can’t apply the same standard to everyone.

In fact, the relationship between the two is very similar to riding an old-fashioned bicycle. If you leave it alone every day, the chain will easily rust and the tires will become flat, which will lead to problems.； But you also have to keep an eye on the road when riding, don't plunge into puddles and rocks, put on fenders when you need them, and brake when you need to. To put it bluntly, whether it is preventing falls or improving mobility, the ultimate goal is not to "not fall", but to enable the elderly to go out happily, buy groceries by themselves, and chat with their old friends. This is the real quality of life, right? Last time I had dinner with the director of the Rehabilitation Department, he said that many people nowadays have a too narrow understanding of fall prevention. They always think that it means "don't move", but in fact it means "move well and move safely." If the relationship between the two is smoothed out, a lot of unnecessary sins can be avoided.