DR ELLIE CANNON: Is walking good for my mum when she falls over so much?

My mother is 75, very small and frail, and often falls over. But she seems obsessed with walking everywhere to get some exercise, which she says will make her stronger. I’m afraid the more she walks, the more likely she is to fall. Am I right, or is the exercise good for her?

Exercise, especially walking, is good for a 75 year old. It strengthens bones and muscles and has other benefits such as preventing heart disease and helping you stop feeling lonely.

But falls are a serious problem, especially for older, frail people – and the cause of thousands of hospitalizations and even deaths every year.

So this is a classic case of weighing risks and benefits.

The general practitioner must be able to refer anyone who falls regularly to a fall clinic. There, an assessment will look at all possible causes — such as side effects of medications or heart problems — and come up with strategies to reduce them, including much safer ways to exercise than walking.

The Royal Osteoporosis Society (theros.org.uk) has excellent fact sheets and videos on exercises that help maintain balance and strength. On the home page of the website, click the “Information and Support” tab, then select “Exercise and Physical Activity for Osteoporosis” from the drop-down menu. Scroll down until you see the “Stay Steady” subheading, then click the link below that and you’re in the right place. Age UK also offers exercise classes in some areas.

Well-fitting, supportive shoes and slippers can also help, as can making sure the eyes are checked regularly. In the home, loose rugs, clutter and dim lighting should all be avoided.

Last year my doctor told me to stop taking citalopram, the antidepressant I’ve been taking for years, because they don’t work in the over 65s. I was given mirtazapine and felt very anxious and depressed again. I recently read in your column about a 72-year-old man who was told by his doctor to take citalopram. Was my GP wrong?

Citalopram is part of a family of antidepressants called selective serotonin reuptake inhibitors, or SSRIs. It is one of about eight medications commonly prescribed for a variety of conditions, including depression, anxiety, obsessive compulsive disorder, eating disorders, and pain conditions. Some are specific, such as escitalopram for anxiety.

The practice of different GPs may vary depending on their experience, but in general we all follow National Institute for Health and Care Excellence (NICE) guidelines or specialist psychiatric records such as the Maudsley Prescription Guidelines.

Geriatric psychiatry is a specialty in itself, as the way mental health problems manifest changes with age. Other problems play a role, such as memory loss. If a patient is taking numerous medications, we have to be careful that they don’t interact – and for these reasons we often use lower doses of antidepressants in the elderly.

Sertraline, citalopram and escitalopram are recognized within geriatric psychiatry as the SSRIs to be used. Your medication may have been stopped for other reasons, such as possible side effects, bleeding from the gut, glaucoma, or heart disease.

For example, if someone is taking regular anti-inflammatories or the blood thinner warfarin, we do not recommend taking an SSRI due to the risk of bleeding from taking both at the same time. Mirtazapine would be a good alternative.

Switching antidepressants is not an easy feat for a patient, as it can cause side effects while the new drug stabilizes, although these things level out after a while. However, this should also be considered as part of the process.

Since a few months my urine smells unpleasant and looks quite dark. It’s similar to when I’ve had a urinary tract infection, but I don’t have a burning sensation or pain when I go to the toilet. I’ve increased my fluid intake and switched to decaf coffee, but nothing has changed. I take the antacid omeprazole and naproxen for my aching knees. Can you help?

A prolonged change in the urine should be investigated by the doctor. It’s best to start by asking if you can provide a sample for testing and have a phone consultation with the results. Urinary tract problems are an important reason for people of all ages to see a doctor.

The most common change in urine odor is caused by infection, especially in women.

This may be accompanied by a burning sensation, pain and a frequent urge to urinate small amounts frequently. But the symptoms can be milder with just a change in odor or cloudiness.

This can be diagnosed with a urine dipstick test and a urine culture in the lab, which takes about two days.

One change in urine that is vital to monitor is blood. This can also be seen on the dipstick test. While we would all recognize an obvious amount of blood in the urine, small amounts can also occur and not be obvious. It may look dark rather than red. Blood in the urine can usually be from an infection or kidney stones, but can also indicate bladder cancer or serious kidney problems.

Naproxen is a non-steroidal anti-inflammatory drug, or NSAID, used to address joint pain or swelling, and is also known to pose a long-term risk for kidney problems.

Changes in the smell and color of urine can also, less commonly, be a sign of type 2 diabetes or liver problems.

This ‘mild’ Covid is still a threat

There’s a lot of Covid going around right now and last week I caught it! I was intrigued that my virus seemed to follow the same pattern I’ve been seeing with friends recently – it felt like a normal cold, lasting a few days. I had a mild cough that oddly went away as soon as my test came back positive. Everyone I speak to who has contracted Covid in the past month or so seems to have had the same experience, without the old warning signs like an elevated temperature or change in taste or smell.

This would suggest that three years later, Covid-19 is a very different virus than we started with. That said, extremely vulnerable people, such as blood cancer patients or those waiting for a transplant, still need to be careful.

It is estimated that about one in 25 people currently has the virus, so chances are one of us will catch it.

The ‘superpower’ of Paris is nothing to envy

Reality TV star Paris Hilton was on the interview circuit this past week promoting her memoir and speaking about growing up with ADHD — attention deficit hyperactivity disorder.

I know there are some who believe that ADHD does not exist, but I am not one of them.

Symptoms include inattention and impulsivity, and it can have a drastic effect on patients’ time at school, work, and their relationships. Diagnosis and treatment, whether in childhood or as an adult, can be of tremendous benefit.

The 42-year-old heiress to the property, who was diagnosed with the condition as a child, is on medication and now sees it as her “superpower.” I’m all for this kind of positive approach.

But I cringe when I hear people say “I’m a little ADHD” or that they self-diagnosed using an online questionnaire, when they’ve never seen a doctor. It’s a serious condition and it’s important that we don’t play it down.