Carrying the Laundry

If I could only ask one question to assess someone’s overall health it would be:  can you walk up and down a flight of stairs carrying a laundry basket? If you can accomplish this task I know that you have reasonable cardiovascular capacity, good balance, good core strength, reasonable vision, joints (knees, hips, shoulders, elbows, hands and feet) that work and adequate higher mental function. The fact that you even have a laundry basket in use indicates self-care.

When deciding if a patient’s knee problems require further evaluation I will ask about stability on the stairs. The risk of fall indicates the need for immediate orthopedic referral rather than conservative care.

Shortness of breath during activities can indicate a lack of blood flow through the coronary arteries. Walking on a flat surface is not taxing enough to provoke symptoms in mild disease – but a flight of stairs can trigger angina. I am not as worried about people who become short of breath visiting friends in fifth-floor walk-ups if they are not accustomed to so many flights of stairs.

Balance and core strength go hand in hand. Tied in with balance is proprioception (knowing where in space you are). Carrying a load requires back, abdominal, shoulder and arm strength. Keeping track of which step is next requires balance and the ability to know which step is the last. We all know what happens when we miss the last step – or think that there is one more.

Doing the laundry is a higher-level executive function. Inability to properly sort dirty clothes, operate the equipment, and finish the multi-step tasks could indicate cognitive decline. On the other hand, not doing the laundry could be because higher level functioning has not yet developed (e.g., college students).

I learn a lot about my patients during our few moments of chatter at the start and end of the visit. Lot of information is gleaned through seemingly casual banter.