How are the mighty fallen?

Donald NorfolkDame Edith Evans was an actress of considerable hauteur. This sometimes made it difficult for her to cope with the physical problems of old age. When she was 87 she confessed: ‘The trouble with growing old is you tend to fall down a lot. I’ve learned the trick though. When you fall down at my age the great secret is not to try and get up too quickly. Just lie there. Have a look at the world from a different angle.’ This may have shown admirable courage, but it would surely have been far better if Dame Edith had taken steps to prevent the falls themselves. This can be done by eliminating hazards in the home, like frayed carpets and badly placed furniture. The North East Ambulance Service, in an attempt to prevent the toll of broken wrists and fractured hips among elderly residents in their area, provided them with the free services of a handyman who would examine their homes and do their best to eliminate these accident ‘hot spots.’ This led to a 23 per cent drop in the number of falls they suffered.

In the UK two thousand elderly people die each year from falls, many of which occur on the stairs. The details of these accidents were fed into a computer database, which revealed that a high proportion of the trips occurred on the top or bottom step. When asked to suggest a remedy, the computer suggested removing the top and bottom step! A more practical solution was suggested by psychologists who carried out a cinematic study which revealed that many people on climbing the stairs clip the edge of the tread above. The team found that this could be avoided by training people to lift their feet a couple of inches higher. When making the reverse, downward journey the risk of falls can be reduced by not carrying loads which obscure the vision and prevent the free use of the hand rail.

Other falls occur when walking over uneven ground. These stumbles can be minimised by carrying out a simple, balancing exercise. To see if you’re at risk, slip off your shoes and stand on first your right leg and then your left. Are you steady and secure, or are you tottering from side to side? If you find it difficult to maintain a steady, one legged balance on a level floor, just imagine how insecure you must be when walking over an irregular, or slippery, slope. Most of the time we’re walking we’re called to balance our weight on a small section of one foot. This is an incredible feat of legerdemain, since it involves balancing a beanpole of five or more feet on a base which at times is no larger than a beer mat. This can only be done when the feet are supple, the coordination good and the leg muscles strong.

A few years ago the British Medical Journal reported that a physiotherapist from Gottenburg, Sweden had given a group of 70-year-old women a series of exercises designed to improve their balance. At the end of the five week course, of twice-weekly exercise classes, the group showed noticeable improvements in both balance and self-confidence. In the weeks that followed they also suffered fewer falls. I was delighted to read this report, for the exercise which proved most useful was the one I’d been prescribing to patients for over forty years. I’ve always called it ‘The Stork’. It’s an exercise which is as simple to describe as it is carry out. It involves no more than standing on one leg for 20-30 seconds. This can be done in idle moments while brushing the teeth, waiting for the kettle to boil or standing in line in a check-out queue. Or, if you prefer, the exercise can be done as part of a yoga programme, adopting the one legged pose known as ‘natarajasana’. By the regular performance of this exercise you’ll improve your balance, enhance your poise and reduce your liability to falls.

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