Mirror, Mirror, On the Wall . . . Part 4

Wouldn't it be great if we had a mirror on the wall which could tell us who's the fairest of all?  But then there'd be no need for television shows like America's Next Top Model.  Personally, I'd prefer the crystal ball that could tell me which stock to buy or sell, and more importantly, when!  Of course, neither of these prediction devices exists, at least not where I live.  But we continue to be enamored as a society about developing models (no, not those kinds) to predict the future.  Case in point was yesterday's look at diabetics' risk for developing dementia.

Well, one of the bigger risks for falling is living long enough, right?  If it's a simple slip & trip w/o injury, then no big deal.  But for our elderly, we worry about serious injuries especially conditions like hip fractures which portend tremendous disability.  But there are those who recover amazingly quick to their premorbid condition.  So of course, we want to know what sets them apart, right?

Well, in a prospective observational study published earlier this week in JAMA Internal Medicine, the authors concluded that post-fall recovery was linked to pre-fall function.  No fecal matter, Sherlock!  In other words, as if you couldn't already have guessed, the less disabled & therefore more functional you were prior to your fall, the better your chances of recovering quickly.  To arrive at their conclusions, the authors followed for 14yrs 754 community-dwelling participants avg 86yo, all of whom were not disabled in their activities of daily living at baseline, and of whom 130 sustained a serious fall.

But as one can imagine, there's a tremendous variation even among those who can perform their basic ADLs.  So the authors scored each participant according to 4 ADLs, 5 instrumental ADLs & 4 mobility tasks.  Those with least disability were most likely to recover quickly & totally.  Those with greatest disability were most likely not to recover.  Mortality also appears to be associated w/disability.

One other point: aside from those with gradual disability over the year preceding the fall, most elderly are relatively stable in their functional status.  But I would recommend that we should encourage them to exercise regularly, focusing not just on endurance (aerobics) but also strength, balance & flexibility.  Better to prevent the fall than have to recover afterwards.

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