The relationship between fall prevention and mobility maintenance

The former is the direct externalization result of the latter level, while the latter is the most fundamental intervention point for the former - what we often call "accidental falls". More than 90% of them are not real "accidents", but are early warnings of deterioration of mobility or lack of maintenance. Simply relying on external remedies such as wearing non-slip shoes and installing handrails can reduce the risk of falls by less than 30%.

Last year when I was doing a fall screening for the elderly in the community, I met the 72-year-old Aunt Zhang. She fell in front of her home the previous winter and fractured her hip. She lay down for three months before she could barely get off the ground. When talking about that fall, she always slapped her thighs and regretted: "It was just a thin layer of ice on the floor tiles at the door. I didn't pay attention. If I had worn non-slip shoes at that time, it would have been fine." But we tested her lower limb muscle strength, which was 32% lower than that of healthy elderly people of the same age. When asked about her daily habits, she almost never goes out because she is afraid of getting tired. She always walks on the wall at home. She can only get 2 points (out of 5 points) in the gait stability test. Not to mention stepping on ice, even if she walks on flat ground, she will most likely lose her balance even if she stumbles over a small stone.

What’s interesting is that the domestic rehabilitation community’s current thinking on fall intervention has actually been in two very different directions. One group of researchers in the field of public health advocates "environmental priority". The elderly fall monitoring data released by the National Health Commission in 2023 also supports this idea: 60% of home falls are indeed directly related to environmental hazards such as piled debris, slippery floor tiles, and lack of handrails. Therefore, in recent years, various places have been particularly vigorous in promoting aging-friendly renovations, which has indeed helped many elderly people with mobility issues avoid many risks. The other group is the "ability first" that clinical rehabilitation practitioners prefer, and the case statistics we have are consistent: 82% of outdoor falls and repeated falls, the core triggers are gait imbalance, lower limb muscle weakness, proprioceptive degradation and other mobility problems - even if your home is covered with non-slip mats, if you are shaking while standing, you may still fall downstairs to buy vegetables.

Don't think that this is something only the elderly need to worry about. Two months ago, I received a 32-year-old patient. He stepped downstairs wearing high heels and broke his ankle. He said that he was "unlucky". After evaluation, the proprioception of the ankle joint was ridiculously poor and the ankle joint was closed. She couldn't even stand for three seconds. She usually sat in the office for a long time and took less than 2,000 steps a day. After work, she slumped on the sofa and checked her mobile phone. Her muscle mass was 8% lower than the normal standard. In fact, her mobility had already shown a red light, but she didn't take it seriously. It’s quite vivid to say that mobility is like a spare mask in your pocket. You always think it is dispensable. When you really need to use it, you find that you don’t have a reserve, and you can only “suffer”.

Many people also have a misunderstanding of mobility maintenance. They either think that they have to go to the gym every day and exercise, or they have to walk 10,000 steps a day to be called exercise. In fact, how can it be so rigid? The Uncle Li I knew had knee arthritis before, and it hurt when he walked a few hundred meters. He was always afraid to go out for fear of falling. Later, he practiced with a community rehabilitation practitioner for three months. He did three sets of silent squats, two sets of ankle pumps, and one-leg standing exercises with his eyes closed every day. Now he can walk two stops while carrying ten kilograms of vegetables at the vegetable market. Last month, he stepped on a banana peel that someone threw and it shook twice. Before, he would have been sitting on the ground.

There is still a saying on the Internet that "to prevent falls, you have to move less. The more you move, the higher the probability of falling." This is actually not entirely wrong. If you have just had a joint replacement or have a severe balance disorder, you must follow the doctor's advice to control the amount of activity. However, for most people, the less they move, the faster they lose muscle, the more their balance ability deteriorates, and they are more likely to fall. The American College of Sports Medicine's 2022 exercise guidelines for the elderly also mention that 20 minutes of lower limb strength + balance training three times a week can reduce the risk of falls by 47%. This data is based on tracking 120,000 samples and is highly reliable.

Having said that, in fact, preventing falls is not something you need to worry about until you are older, nor is it a problem that can be solved by buying two pairs of non-slip shoes and installing a few handrails. Pay more attention to your body signals: For example, your legs feel weak when you go up two floors, you are unsteady when standing with your eyes closed, and you always rub the ground when walking. These small details are actually reminding you that it is time to "recharge" your mobility. After all, being able to go where you want to go steadily is better than anything else.