Tag Archives: Falls



Have you ever yearned after being a ballet dancer – that is often the case in growing up and mothers often dutifully take their children to ballet classes as I did for my three children until the tummy aches occur before lessons or with competing interests they can’t fit it into their busy schedules.

But there are some children who feel they have missed out  Or feel they want to rekindle that yearning and as adults they find a studio to reconnect or even start as a beginner.  Moreover, there are significant number of middle – aged adults who decide to join ballet classes and reap the physical and mental benefits of this challenging dance form.

I remember my daughter and friends who dance at any opportunity  often attended a well known studio ‘Pineapple’ in Convent Garden. They have classes for a wide variety of different types of dance classes.

women who do ballet over 50

L to R These women are all keen ballet dancers, or use ballet movements to stay fit and active –-these ladies are aged 50-68yrs

Subsequently  I came across an ex-ballerina from Sadlers Wells Ballet company in an acupuncture class as she wanted to learn to treat common injuries. She was teaching middle – aged pupils at Pineapple and was proud of the fact that she had a pupil of 76yrs!

Isabel McMeekan was principal dance at the Royal Ballet now runs classes for adults including Assoluta class for the over 60’s.  This is a unique class specifically created for 60 year olds and over, involving gentle stretching, core work, barre work and centre practice.



Hence, I was not shocked when a professional colleague told me she had just enrolled for regular ballet classes. As we talked I could appreciate the positive health benefits of maintaining flexibility and bone density well into your later years to stall the onset of osteoporosis and could also ward off dementia. That’s as well as improving your figure, looks and confidence, relieving stress — and maybe even helping your love life.

We know that about 9 percent of adults age 65 and older report having problems with balance. Poor balance can be a contributing factor to falling, which can result in broken bones and hospital admissions.

Hence, because it is well recognised that:-

The single most serious threat that older people face is falling

Good balance is essential to being able to control and maintain your body’s position while moving and remaining still. Good balance helps you:

• Walk without staggering
• Arise from chairs without falling
• Climb stairs without tripping

You need good balance to help you stay independent and carry out daily chores and activities. Problems with sense of balance are experienced by many people as they age.

Inevitably practising ballet is going to be invaluable in addressing maintaining good balance.

My story of joining an adult ballet class

I did ballet as a child until about the age of 12 when transitioning to secondary school and puberty meant focussing on other things in life. It wasn’t until 9 years ago, in my late 30s, when I joined an adult ballet class, that my love of ballet was reignited! The combination of dance to classical music is unique to ballet, and though I have tried and have enjoyed many other activities (yoga, ballroom, Zumba and flamenco amongst many other things), ballet is what I have stuck at with a passion for the last 9 years! Certainly the movements and positions we get into remind me of my childhood, and the music makes me feel nostalgic and emotional. Perhaps it is all this emotion combined with the fact that I’ve had a seriously good work out keeps me so addicted to ballet!
Music is an essential part of ballet, and through ballet I have learnt to love the piano again too. I found I was enjoying the music so much at the class, I would go home to bang out the tune immediately on the piano! Memories of my old piano teacher came flooding back…and I have since made contact with her through email. These two pastimes have brought me much joy and satisfaction in recent years, I feel my childhood has returned to me in middle age!



You may feel this is something you thought was too late to start but there is a chance out there and with the added bonus of physical and mental health benefits.










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Posted by on February 9, 2017 in Training and Advice


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Rat poison to be replaced?

Warfarin has been used to thin the blood to decrease the tendency for thrombosis or as secondary prophylaxis (prevention of further episodes) in those individuals that have already formed a blood clot (thrombus) since I was born – for many years.
As GP’s we are now committed and compelled to take part in clinical-led commissioning and I shall be referring examples of this frequently.
Clinically-led commissioning is a continual process of analysing the needs of a community, designing pathways of care, then specifying and procuring services that will deliver and improve agreed health and social outcomes, within the resources available.
One such example is the provision of anticoagulation therapy services and for many months in Ealing Central Commissioning Group (ECCG) have been reviewing
how anticoagulation therapy is currently initiated including looking at recommendations for the new oral anticoagulants (noac) dabigatran, rivaroxaban and apixaban and the anticipated reduction in need for vitamin K antagonist monitoring services (INR monitoring).

You may be aware that anyone who takes warfarin must be monitored on a regular basis by blood test(INR) which until recently involved regular visits to the hospital to attend a clinic. As part of the commissioning we have taken over the monitoring of INR in general practise. But due to the complexity of initiating and stabilising treatment commissioning has been a long involved process to assure generalised commitment, safe practise and most of all taking into account the full cross section of patients needing this treatment.
The discovery of warfarin was centered in Canada and the United States1. In the early part of the 20th century, farmers in the northern prairie states of Canada and the USA began planting sweet clover plants imported from Europe. Although the sweet clover proved to be nutritious when used as fodder, it also brought a fatal disease which decimated cattle herds and horrified farmers: sweet clover disease, in which affected cattle developed relentless, spontaneous bleeding. Schofield, a veterinary pathologist in Alberta, reported in 1921 that the disease was caused by consumption of spoilt sweet clover hay. The fresh plant was known to contain the compound coumarin, which was not pathogenic. The mystery of why spoilt hay caused the disease was solved by Karl Paul Link and his co-workers in 1940 : in mouldy hay, coumarin is oxidised to 4-hydroxycoumarin and then coupled with formaldehyde and another coumarin moiety to form dicoumarol, an anticoagulant. This was responsible for the disease. Dicoumarol was patented in 1941 and was therapeutically used as an anticoagulant.
In 1951, a navy recruit unsuccessfully attempted suicide with 567 mg of warfarin. His surprising full recovery induced research into the anticoagulant potency of warfarin in humans. It was found to be far superior to dicoumarol. Clinicians quickly discarded dicoumarol in favour of “rat poison” warfarin : it was introduced commercially in 1954. In that same year, President Eisenhower was treated with warfarin following a heart attack.
As an aside I remember several years ago a delightful 98year old lady appearing in surgery asking to register provided she was not too old. She had been the Professor of Agriculture of Warsaw ( and honorary Professor at Glasgow)and believe or not in the waiting room at the same time she rediscovered an old student ( at that time 88yrs) a patient well known to me and he had been a farrier and a reputable breeder of Welsh mountain Ponies in South Wales before retiring to Ealing. It turned out that she had introduced sweet clover to Poland!

Warfarin is used used by more than 75,000 patients for short term or long term use and not only is it cheap at 2p a tablet but its anticoagulant effect is well tried and tested and its effect can be easily reversed in the event of gastro-intestinal bleeding or need of surgery. The anticoagulant level is easily measured. However, warfarin is slow to take effect and stabilise; constant monitoring is necessary as there is significant interaction with alcohol and some medication, food stuffs commonly leafy vegetables and cranberry juice and all foods containing Vitamin K and should be taken carefully
diet sheet

Patients must be totally compliant and maintain a record of INR readings(the yellow book)image
there is a risk of bleeding but someone would have to fall 200 times to have significant blood loss ie from bruising.
Recently a new class of drugs have been released and Rivaroxaban will be the drug of choice in Ealing- this decision has been met after consultation with our local consultant cardiologists, who we meet with in the surgery or at joint meetings. At present it will only be used in those patients who may need to be travelling frequently, with a uncontrolled INR, adverse effect with Warfarin or those who have had a stroke whilst taking Warfarin. As it is a new drug careful monitoring needs to take place and trials carried out to support a more widespread use.


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Falls Awareness


Falls Awareness Week, 2013

Theme; Healthy Feet 

This week we were sitting in the sun having a nice cup of coffee and the phone rang. My husband answered and it was Burton Alan ( named after his birthplace to indicate which Alan) someone he had come across at the Builder’s  Merchant  when ordering gravel several years ago and they had kept in touch since.  He is now 74 years of age and a few years earlier he had bought some land and single- handedly started  building his own four bedroomed detached house ( having constructed a Wooden chalet to live in whilst it was being built). Considering he had been a Chemical Engineer specialising in water purification  this was no mean feat. He had made great progress,  the roof was completed and he was working on the  interior finishes (nearly finished in his mind but for me there seemed a lot to do). 
Last month one evening he had gone Line Dancing  in the village hall. On leaving, the outer door of the Hall  had slammed back on him and he had fallen. He was helped up, got to the car and drove home. After a restless night he felt he should go to the local hospital as the leg was very painful and paracetamol was not working even with a tot of whiskey! When he got there he had fractured his hip and was admitted to have surgery to have the femur pinned.
 This was why he had phoned as he was now home from hospital and the convalescent clinic after 3 weeks and needed a little job doing. When we had visited him soon after surgery he was not yet walking  but was sitting up in bed drawing his electrical diagrams so we weren’t surprised he was backing ‘home’ in the chalet as he was anxious to get back to his  almost finished house. Now Alan is not the most organised and tidiest of people and when we arrived the land where  the house and chalet stood was a building site and by no means in any order pipes, equipment,plastic buckets etc strewn everywhere and to get to the chalet it was through this detritus and walking through long grass concealing even more hazards. His car was parked at the end of the path for him to use to go to the shop in the next village. As we walked along we cleared visible objects to one side and found him sitting on the veranda surrounded by paperwork, wires,tools various bits of furniture including a new sofa he had recently bought from someone at the Line Dancing group!! We sat down and over a cup of tea tried to talk about the practicalities of staying in this situation but as if he didn’t hear  he merely veered the subject back to how he could finish the house and was working out the amount of voltage the EDF ( electricity board) needed to supply to the house, taking into account the length of the cable and resistance in Ohms it would produce. ( a test on our knowledge of basic physics) The job he wanted my husband to do was to fill in a hole over a pipe in the path through the long grass leading to the house. After  we wandered around looking for a shovel, pick axe to loosen the hardened aggregate  and empty the wheelbarrow full of various tools my husband went off under his supervision to fill in the hole!!!
During this time I tried to discuss other options and discuss falls prevention, probably best managed by staying with relatives. He said the physiotherapist had visited earlier and  he was puzzled as to  why the hospital physiotherapist had recommended walking as much as possible but this domiciliary physiotherapist had recommended doing static exercises and very little walking. No mention of falls assessment !  We did our best to make sensible suggestions but his parting words were ‘thank you for coming over to do that I must take you out for a meal sometime and I’ll be in touch.
I wrote this as an extreme example of how difficult it is to make people aware of hazards not only for themselves but for those around them. I remember when I used to take up the rugs in my mothers house knowing full well as soon as I turned my back she would put them down. Do all parents teach their children to put their toys away. A blind friend of mine was obsessional about counting toys in and out of the toy box and also told me her worst nightmare was walking down a street with black bags on the footpath as no way could she see them even the outline ( bear that in mind when you put your bags out)
The irony of this tale is that Line Dancing is a good way of improving balance and strengthening leg muscles! 
Hence, falls awareness is for everyone whatever the age and every parent should teach their children this from the word go. I am sure everyone has a tale to tell of a fall that should not have happened.  Do you put salt on the path outside your home  in icy weather? Do you put something to one side or away if it is in the way even if it is not your property or do you just step over it?Do you check your elderly or disabled relatives home for hazards and tactfully remove them? Many people especially in West London have low VitaminD and a high percentage of elderly people  have osteoporosis both conditions indicate a greater risk of fracture and delayed healing. 
Sometimes it is difficult to change someone’s ways but it is worth a try, it may simply be replacing a light bulb, supplying a cordless phone, fitting grab rails in the bathroom  or taking away a mat or tidying an electric cable. 
Everyone can be at risk of having a fall, but older adults are more vulnerable than others. This is mainly due to long-term health conditions that can increase the chances of a fall.
Other groups who are particularly at risk are young children and people whose job involves working at heights.
Falls are a common but often overlooked source of injury and sometimes death. In 2009 in England and Wales, there were 3,593 deaths as a result of falls.
Around 30% of adults who are over 65 and living at home will experience at least one fall a year. This rises to 50% of adults over 80 who are either at home or in residential care.
Most falls do not result in serious injury. However, 20% of older adults will require medical attention for a fall and 5% will experience a serious injury, such as a broken bone.
Falls can also have an adverse psychological impact on elderly people. For example, after having a fall a person can lose confidence, become withdrawn and may feel as if they have lost their independence.
Falls and accidents seldom “just happen.” But there are many simple things that older people can do to prevent falls, and their potentially devastating consequences aswell as
taking  care of your health by exercising and   making sure that you get enough calcium and vitamin D.
How Can I Prevent Falling?
At any age, people can make changes to lower their risk of falling. 
Some tips to help prevent falls outdoors are:
Use a walking stick
Wear rubber-soled shoes so you don’t slip
Walk on grass when pavements are uneven or slippery
Put salt or kitty litter on icy paths
Some ways to help prevent falls indoors are:
Keep rooms free of clutter, especially on floors
Wear low-heeled shoes
Do not walk in socks, stockings, or slippers
Be sure rugs have skid-proof backs or are tacked to the floor
Be sure stairs are well lit and have rails on both sides
Put grab bars on bathroom walls near bath, shower, and toilet
Use a nonskid bath mat in the shower or bath
Keep a torch  next to your bed
Use a sturdy stepstool with a handrail and wide steps
Add more lights in rooms
Buy a cordless phone so that you don’t have to rush to the phone when it rings and so that you can call for help if you fall.
You can also do exercises to improve your balance. While holding the back of a chair, sink, or counter:
Stand on one leg at a time for a minute and then slowly increase the time. Try to balance with your eyes closed or without holding on.
Stand on your toes for a count of 10, and then rock back on your heels for a count of 10.
Make a big circle to the left with your hips, and then to the right. Do not move your shoulders or feet. Repeat five times.
 Ealing has been proactive and has a falls clinic and for many years we have therapists who visit the home to carry out a falls assessment and often it is easier for them 
to give advise rather than relatives. If you feel this would be helpful attend the events held in Ealing next week or contact your surgery I you have a concern about yourself or someone you know . Also look out for events and help from ageuk  which supports these events and they originally set up the falls assessment team.?
posted by Dr Bayer




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