I returned to work yesterday after having more than a week off and kept busy updating myself on the new admissions and changes in my regular caseload. I have said before that I really enjoy my job and that has not changed. Long walks and nature observation are stress relieving pastimes, but working with people is most rewarding for me.
I walked in a room to introduce myself to a new patient and recognized her right away from her admission a couple of years ago. She had a past history of a stroke that had left her weak on one side. When I last saw her, she was using a wheeled walker or cane to walk and used a wheelchair for distances. She had gone on a bus tour, and when the group stopped for lunch, she fell while walking into the restaurant and broke her hip. She required surgery and will be in hospital for an extended period of time.
This is a very nice lady, without cognitive impairment. I asked her if she had been using her cane or walker when she fell. Well, the answer was a sheepish, "No". I stopped myself from lecturing because it was obvious she knew she had taken a costly risk.
A big part of my job is fall prevention education. We do a number of tests to determine the risk of falling and the need for an adaptive aid. Many things can impair balance, including strokes, degenerative neurological diseases and peripheral neuropathies, most often caused by diabetes.
But many people develop weakness and balance problems because of inactivity and disuse. When is the last time you saw an adult playing hopscotch, or walking in tandem steps on a curb stone? Children often perform high balance activities as part of play.
One of the tests we do has 14 components to score a person's fall risk. We ask the patient to stand on one foot for 5 seconds, repeating with each leg. People who cannot do this tend to shuffle or walk quickly and need to use a gait aid. It should be easy to maintain a one legged stance for 20 to 30 seconds and this can improve with practice.
Another position we ask a person to take is a tandem stance, one foot in front of the other. Most of my patients are unable to do these two activities.
Our universal government health plan covers 75% to 100% of the cost of a new rollator walker and I do many prescriptions for people who need one. The problem is that people will not always use them. Pride and independence seem to be present in two year olds and eighty year olds. I feel I have done my best work when I prevent someone from having a bad fall rather than getting them back on their feet after a broken hip. Doing simple balance exercises, engaging in regular activity, and using suitable adaptive aids can help maintain independence for many years.
My new patient will always need a walker, if she is able to walk independently again. If she could only go back in time to that bus and disembark with her cane!