muscle weakness. Elderly people without these risk
factorshave a 12 percent chance of falling in a year.
Those with all three risk factors have almost a 100
percent chance. Jean Gavrilles had at least two. Her
balancewaspoor.Thoughshedidn’tneedawalker,he
hadnoticedhersplay-footedgaitasshecamein.Herfeet
wereswollen. Thetoenailswere unclipped.Therewere
sores betweenthe toes. And theballs of her feet had
thick, rounded calluses.
Shewasalsoonfivemedications.Eachwasundoubtedly
useful,buttogethertheusualsideeffectswouldinclude
dizziness. In addition, one of the blood pressure
medicationswasadiuretic,andsheseemedtodrinkfew
liquids, risking dehydration and a worsening of the
dizziness. Her tongue was bone-dry when Bludau
examined it.
Shedidnothavesignificantmuscleweakness,andthat
wasgood. Whenshegot out of her chair,he said, he
notedthatshehadnotusedherarmstopushherselfup.
Shesimplystood up—a signofwell-preserved muscle
strength. From the details of the day she described,
however, shedid notseemto be eatingnearly enough
calories to maintain that strength. Bludau asked her
whetherher weighthadchangedrecently.Sheadmitted
thatshehadlostaboutsevenpoundsintheprevioussix
months.
Thejobofanydoctor,Bludaulatertoldme,istosupport
qualityoflife,bywhichhemeant twothings:asmuch
freedomfromtheravagesofdiseaseaspossibleandthe
retentionofenoughfunctionforactiveengagementinthe
world.Mostdoctorstreatdiseaseandfigurethattherest