We have all heard Grandparents talk in a fearful voice about ‘the fall’. “Mrs Beckett who lives at number 52 was fine until ‘the fall’ but after that she never left the house….. Until they took her out in a box…” It is up there with stroke, heart attack and cancer in perceived danger and whilst those events are somewhat unlucky with a few lifestyle factors thrown in, most of the falls are certainly preventable as I explained here.  How do we stop the nounifying of falling over? What happens in the decade between 55 and 65 that catastrophizes something that is essentially a normal occurrence. Beyond physiology it could have a lot to do with retirement and perception. Harriet Thompson a 92yr old American runs marathons. I don’t believe she has atypical physiology. She took up running when she was 76. She doesn’t look likely to have a fall, I believe she could ‘fall over’ during her exertions but due to her high impact training she probably wouldn’t break a hip.  The oldest man to swim the channel is a 73 year old surgeon. Despite his age he managed to keep a good enough core temperature to complete the epic swim without suffering hypothermia. He has always swum but again I don’t believe he has special biology. A local GP I spoke to advised my mother never to retire expounding many cases of patients who had seemed to age overnight, develop cognitive impairments or simply die. Perhaps it is the perceived state of no longer being a useful contributor to society or there merely being no need to leave the house every day and travel to work. The sudden decrease in regular social contact that requires mental agility as well as the logistics to organise the ‘what’ ‘where’ and ‘when’ of life.

The current elderly are known as ‘the silent generation’. A notoriously hard working cohort who with little leisure time due in part to a lack of labour saving devices didn’t really participate in active hobbies unless they were well off. Many didn’t really have past-times so early retirement could often revolve around administration of the household, perhaps a bit of gardening, some childcare and some loneliness whilst they accommodated to this new chapter.

There is much poverty in this silent generation and understandably ARCO (Associated retirement community operators) who commissioned research into barriers to exercise for the over 65s in 2015 found 29% of subjects quoted cost as a barrier to regular exercise. Other barriers included needing someone to go with (28%) and 25% said they felt they would go if there were more people their age going. Another significant barrier was illness or injury.  The weather is an important factor we don’t always account for, with anything inclement driving most elderly people indoors with a cup of tea and a Hobnob. Despite having grown up with the great British weather we appear to be no more comfortable with it than our Mediterranean counterparts.

I believe the answer to most of these problems is exercise and activity. Many elderly only come into contact with exercise via the hospital as physiotherapy is prescribed for all manner of ills. This is rather depressing as can be the clinical pale green physio department with shrouded couches and curtains. Not a place to begin a fruitful relationship with your musculoskeletal or cardiovascular system. But I have a plan. It will require some investment until the health benefits become obvious but hear me out. On the day after retirement with carriage clock, flowers and hopefully a hangover all in place an invitation arrives on the doormat. I say invitation…it’s really a summons. It will say please call your GP practice and make an appointment ASAP.  A quick physiotherapy assessment in a GP practice (once you have had kids you are more likely to know where your local GP is than where the local leisure centre is) to identify any red or yellow flags (see here) that would contraindicate exercise then a referral to a named personal trainer at the nearest leisure centre. They would write up an exercise and activity plan in accordance with current exercise guidelines and set exercise goals (most important for motivation). Who would pay for this high quality tailored service I hear the high rate tax-payer cry… So if falls cost NHS £4.6m per day and diabetes, where inactivity could be a primary cause, costs the NHS around £23b annually, a regular gym trip could very easily slash both those costs, pay the nominal gym fee and have some to spare for a personal trainer. The added bonus is some social activity and community. Leisure centres would become the daily domain of the elderly and in my utopic Britain there would be minimal pyjama paralysis (see here) and ‘bed blocking’ (see here) (a term I detest) because those elderly would be lifting weights, doing triathlons and entering Tough Grandmudders. And then maybe the legend of ‘the fall’ would cease to engender the fear accorded to it for so long