Strike One

 

While meeting with Bert for the first time, he shared with me that he had fallen approximately 10 times in the last 6 months; this had been the first time that someone had noticed. The most rudimentary of gait assessments showed that Bert needed more support than his straight cane could offer.

Bert acknowledged that he was having some difficulty walking, “I know my balance ain’t worth a nickel,” he said to me.

“No offense, but if you have fallen 10 times in 6 months, it may not be worth a half-pence,” I added. Bert smiled and agreed.

I wanted to place the ‘ball in his court’: “I can try to help you improve your balance with physical therapy, but even if we are successful, it won’t improve overnight. In the meantime, though, what are some options that you have available to you to help reduce your risk of falling again?”

“Well…” Bert paused and looked over my shoulder at the rolling walker that I had seen folded and resting against the wall behind me. I had been quietly hoping that he might bring it up without my mentioning it. “…I suppose that walker would be a lot more sturdy for me to use.”

Trying to point out the potential benefit of the walker, I asked him if he had used in it in the past and – if so – if he felt more stable when he used it. He reported that he had used it in the past but wasn’t using it now because he is always in a hurry trying to get his wife what she needs and how the apartment was so small that he felt as though the walker might be too cumbersome were he to use it. I needed to redirect him immediately.

“Great, so you do feel more stable with the walker and you have a sense that it would provide you with the additional support that you need in the short term to prevent a fall, so you can avoid going back the ED and not have to be concerned about who might have to care for the misses in your absence. What can I do to help make the apartment more accommodating for you and the walker?”

I spent the next 10-15 minutes rearranging the furniture in the common area of his apartment. The kitchen table and chairs were relocated. The coffee table was moved and his recliner rotated, which (of course) necessitated moving the television so that it directly faced his recliner. After the furniture was rearranged, the patient walked throughout the apartment with his walker. His cadence improved with the increased stability.

“Can you appreciate how much more quickly you can move with the walker than you can with the cane? It seems as though you don’t have to be so deliberate and your pace is faster.” He did feel more at ease, but he had a concern. “How am I going to carry things around the house for Josie if I have to use this thing?” he asked.

Of course, I had an answer already prepped: “That is easily remedied with a $25 tray that we can put on the walker, sir. You will be able to move more stuff around on the walker with that tray than you could ever hold in one hand. And you can reduce the number of trips you need to make across the apartment by carrying more as well.”

He sat down in his recliner with his walker in front of him, seemingly pleased with the modifications that we had made together; he remained in his chair as we discussed the plan of care moving forward and his expectations of future visits. When I asked him when I could return, he quickly stood up, pushed his walker aside and staggered across the room to his desk to look at his calendar.

“Bert, I thought you were going to try use the walker to help with your balance, but…”

“I was in a hurry.” he interrupted. “I can’t use it all the time.”

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