Great Strides Forward

When Irene Mottley fell and fractured her hip last November, the senior citizen didn’t know whether she would be able to walk again with complete confidence. However, eight months later, with help from staff at St. Paul’s Hospital’s Falls Prevention Clinic, she has regained her stride.

“The clinic helps me be my own person – I think that’s important to seniors. The exercises they give at the clinic are very, very good, and I’m getting a lot better.”

Mottley is one of the approximately 400 British Columbia seniors who have benetfitted from the Falls Prevention Clinic since its inception in 2007. The clinic, comprising a multidisciplinary team of geriatricians, a physiotherapist, an occupational therapist and a social worker, specializes in finding ways to prevent and address falls – a leading cause of health decline among seniors.

Falling down

Every year, one in three Canadians over the age of 65 experiences a fall. Fully 90 per cent of hip fractures are due to falls; 50 per cent of fall victims never regain their former mobility; and 20 per cent die within a year of hip fracture.

Dr. Wendy Cook, clinical assistant professor of geriatric medicine and head of the Falls Prevention Clinic, says that falls are largely preventable and often just the tip of an iceberg of multiple health problems.
“Our goal is to evaluate and optimize any age-related changes, underlying health issues, polypharmacy (use of multiple medications) or functional impairments that can lead to decreased physical performance, falls and fractures,” says Cook.

The clinic, which works closely with the clinicians and specialists in the larger Elder Care Ambulatory Clinic at St. Paul’s, is the only program in Vancouver able to offer elderly patients multidisciplinary care and active programs like research-based balance classes, coordinated by physiotherapist Julie Cheng.

“Falls are complex,” says Cheng. “One fall may have several contributing factors; sometimes it’s like detective work to find out why it happened.
“Poor balance is a big reason why seniors fall. Weakness, slow reaction time and poor postural control all contribute to poor balance. The likelihood of accidents also goes up when there is cognitive decline.”

Walk this way

The clinic hopes to explore the connection between cognitive impairment and gait abnormalities using a new high-tech electronic walkway purchased with donor support.

The electronic walkway will allow the clinic team to perform “dual task gait evaluations” on seniors (e.g., walking while reciting word lists) to better understand the correlation between motor skills and brain function.

The walkway’s ability to digitally measure and record the length, timing and pressure mass of the stride is not only a revolutionary tool in gait analysis and rehabilitation, but may also prove useful in early disease diagnosis.

“Relatively recently, walking was considered to be automatic and independent of cognitive function,” Cook says. “Now we recognize they are closely linked and that the way a person walks provides a window to their brain. Changes in walking pattern and speed have been linked with impairments in cognitive function and may even predate changes on traditional tests of cognition.”

This potentially life-saving work at the Falls Prevention Clinic is just one of the many programs that has consolidated St. Paul’s reputation as a leader in seniors care.