Weebles wobble but they don't fall down

My grandma was the matriarch of the family. Strong, smart and stubborn.
You can see it from the way she walks. She would keep her back straight, clasp her hands together behind her back, and wobble a little from side to side while she observed, directed and commented at things around her. Expectedly, convincing her to exercise was as difficult as nailing jelly to a tree.

Once she almost fell while stepping out of her en-suite. She slipped in the corridor, between the foot of the bed and the wardrobe, but did not fall as she got stuck between the 2 pieces of furniture. We laughed about it and she exclaimed how glad she was that she was overweight.

While the incident was truly hilarious, i couldn’t help but consider all the what-if’s.
-What if she fell and got a fracture?
-What if she loses confidence and develops a fear of falling?

And for every scenario, I had a solution in my mind.

Then it struck me that that was all crisis management. Why am I finding solutions for the aftermath when I can prevent the fall entirely?
How should I go about doing it?

So, I did my readings and you see, falls are multi-factorial. The most common ones being frailty, polypharmacy, vitamin D deficiency, multi morbidity, impaired sensorium and home hazards. Interestingly, most of these factors are modifiable!

Since I’m a physiotherapist, let me share a little about frailty.

Frailty syndrome is a physical phenotype describing only physical components. It includes criteria such as skrinking, weakness, physical endurance, low physical energy, and slow walking speed.

Exercise programs have been shown to reduce the risk of falls, improve the fear of falling, increase or maintain physical performance, improve balance, especially in the pre-frail elderly, as well as reverse the frailty status.

If we are familiar with elderly, we will understand that each elderly can present very differently with the same conditions, especially frail elderly.

Tailored exercise programs not only target their weakest areas and most likely factor for falls, but also ensure they are able to perform at their optimum capacity while paying heed to other comorbidities. This reduces the risk of accidents during the exercise session and recovery period.

For non-frail and pre-frail elderly, I would suggest for them to keep a regular,
non-individually tailored exercise program at the very least, for maintenance
of physical performance. Both physiotherapist guided exercises and
general exercise programs offered in the community are shown to be
beneficial for reducing fall risks.

Ever since my grandma’s near fall incident, I’ve been coming up with different ways to encourage elderly to participate in exercise that they find meaningful. Exercises can be fun and relevant while increasing their confidence and physical performance. Why procrastinate when it is so simple?

Falls prevention can be as easy as abc with the right guidance. Consult your physiotherapist consult today for a fall-free tomorrow!

我的婆婆是家庭的当家人。她坚强，聪明，也顽固。她走起路來雄赳赳气昂昂的也不输给兵营里的指挥官。就因为如此，可绞尽脑汁都不能说服她锻炼。

又一次，她差点儿在主卧卫生间的门口摔倒。当时，她右边是床脚，左边是衣柜，就因为卡在两件家具之间而没有摔到地上。听她敍述时，我们都笑得合不拢嘴。她也理直气壮地说超重也有好处。

虽然这件事真的很搞笑，但我还是忍不住考虑所有的假设。 例如她跌倒并且骨折该怎么办？如果她失去信心并且从此害怕行走那又该怎么办？对于每种情况，我都有一个解决方案。

但我突然意识到这简直就是危机管理。我为什么不专注于防止摔倒呢？我应该从哪里着手呢？

当时我就读了许多研究报告，发现了导致跌倒的因素有很多。最常见的是体骼脆弱，並且同时服用多种药物，缺乏维生素D，拥有多类慢性病，五官感觉障碍和住宿环境不理想。有趣的是，大多数的因素都是可以修改的！

既然我是物理治疗师，我主要关注体骼脆弱的问题。

体骼脆弱的定义是由五种标准拼合而成的。它以肌体收缩，肌肉的力度，人体耐力，精力和行走速度为标准。

研究显示，規划锻炼可以降低老年人跌倒的风险，改善对跌倒的恐惧，增加或保持身体表现，改善平衡度，以及扭转虚弱状态。

由于了解老年人，我很明白老年人身心虽然处于相同的条件，但体能表现却能有很大的差异·。对于体质较弱的老年人来说，量身定制的规划锻炼是最理想的。它不仅能针对个人身体机能最弱的部分，专攻最可能的跌倒因素，同时也确保运动符合个人的活动程度，顾及到个人的病例。量身定制的規划锻炼也能降低运动时和恢复期间发生事故的风险。

对于其他的老年人，我建议他们至少保持一个定期的锻炼计划，以保持身体健康，肌肉强壮。物理治疗师的指导练习或社区提供的一般規划锻炼都有助于降低跌倒的风险。

自从婆婆的事件，我开始构思各种鼓励老年人运动的方法。强身健体且有規划的运动应该是有趣，与日常生活的需要相应，增加老年人的自信心。为何不现在就采取行动化解将来的危机呢？

预防摔倒就像abc一样简单。今天就与您的物理治疗师预定，打造一个不摔倒的将来！

References
Pfortmueller CA, Lindner G, Exadaktylos AK. Reducing fall risk in the elderly: risk factors and fall prevention,
a systematic review. Minerva Med 2014;105:275-81.
Goodwin VA, Abbott RA, Whear R, et al. Multiple component interventions for preventing falls and fall-related injuries among older people: systematic review and meta-analysis.
BMC Geriatrics. 2014;14:15
Tricco AC, Thomas SM, Veroniki AA, et al. Comparisons of Interventions for Preventing Falls in Older Adults: A Systematic Review and Meta-analysis. JAMA. 2017;318(17):1687–1699.
Zhuang J, Huang L, Wu Y, Zhang Y. The effectiveness of a combined exercise intervention on physical fitness factors related to falls in community-dwelling older adults. Clin Interv Aging. 2014;9:131–140.

#跌倒 #物理治疗 #复健 #预防 #falls #prevention #physiotherapy #rehab