‘A Walking Stick Is a Friend That Steadies You When the World Tilts.’ – Traditional Proverb.
Editor-In-Chief, Chester “Trip” Buckenmaier III, MD, COL (ret.), MC, USA
During my medical career, I was involved in managing the consequences of falls in my patients. In those days, I was more consumed with providing care in reaction to a patient’s fall, usually in the form of a regional anesthetic to manage perioperative pain. Now that I have a few more decades under my belt, the issue of falls in friends and family has taken on more personal significance. In her 80s, my mother experienced a fall, severely injuring her shoulder; my 80s father-in-law sustained a fall, breaking his neck; my wife fell a few months ago, breaking her patella; and my sister-in-law recently fell, injuring her face. A common thread among these tragic family injuries is older age, universal shock and surprise at the fall. They all said versions of, “I was fine; then I was on the ground.”
Falls are a constant theme in the human collective experience. As a young boy, I played “smear the …” (it was a different time), a simple game where everyone tried to tackle the boy with the football. I was particularly good at this schoolyard pastime and ran with the ball for an extended period before being “smeared” by my comrades. The falls my body sustained then were impressive and, beyond the occasional bruise (a mark of a good play day), I would be no worse for wear the following day. Now in my sixth decade, I can only marvel at my tumbling grandchildren or the spectacular tackles on television. This is not to say I am disabled; I take considerable pride in being able to routinely walk distances that I would not have considered as a much younger man. I have become keenly aware that gravity, which always works, is far more dangerous to my body’s function and mobility than it was several decades ago.
I am a firm believer in the adage, “When you stop moving, you die,” a metaphor for the vital importance of continued physical activity as we age. Hippocrates, the father of Western medicine, famously stated that “walking is man’s best medicine.” I imagine my older family members are rolling their eyes as they read this, since I am constantly encouraging them to walk for their health.
There does seem to be a paradox in this advice since falls in older individuals, and the ensuing consequences, most often occur while folks are ambulating. My patients would often exclaim, “I was walking and bam! I was suddenly on the ground,” similar to the statement following the falls sustained by my family members mentioned earlier. If only there were a device that could help people of all ages avoid sudden fall injuries. Of course there is.
Walking canes have been around since prehistory, serving as implements of defense and survival. Canes signified status in ancient civilizations and became a notable accessory of European fashion beginning in the 1600s, as gentlemen who carried swords fell out of fashion (thankfully). Sadly, at some point in American culture, the cane became synonymous with infirmity, old age and weakness. I certainly do not share this misperception. When I see folks ambulating with a cane (or any mobility device), I praise their intelligence and their desire to remain functional. Canes are not indicative of someone who has lost their mobility; they are symbols of individuals who are fiercely holding on to their independence. I have literally begged the octogenarians in my life to adopt a cane. Will the use of a cane eliminate the possibility of a fall? Absolutely not, but mobility assistance devices never work when they are not used or remain safely hidden in the car trunk from society’s prying eyes. I would think the real indignity and consequences of falling would seem a far greater embarrassment than the perceived fear of social stigma erroneously associated with using a cane.
I have had to make many adjustments over the years to the realities of aging. I can no longer play the violent, rough-and-tumble games of my youth. Then again, my taste for these activities has waned as I have matured, along with my ideas of fun. Ageism in medicine is an issue that I have commented on numerous times in this column. Falls in aging patients are a significant medical symptom that medical professionals should aggressively explore. Falls are also a component of an aging nervous system and tired joints.
I have experienced too many of my friends and family having their lives negatively impacted by unexpected falls. Even at the tender age of 62, I will not tread in the forest without my trusty walking stick. Everyone should be reminded to maintain good situational awareness of their environment to avoid unnecessary falls. More mature folks benefit from an additional point of contact with terrain. Federal medicine providers should be on the vanguard of proclaiming canes cool again in our mobility-challenged patient population. As we encourage our older patients to remain mobile, we should also discuss the advantages and nobility of mobility assistance devices.