The fall risk conversation: what to ask the doctor, and what a good fall check looks like

Why this conversation matters

The CDC reports that more than 14 million older adults, about one in four, fall each year, and that falls are the leading cause of injury for people 65 and over. Most falls have more than one cause, and many of those causes can be changed. But the doctor cannot work on a fall nobody mentions. Many older adults do not bring it up because they are afraid of losing their independence. So you bring it up.

Before the visit

• Write down every fall and near-fall in the last year, with what the person was doing and whether they were hurt.
• Bring every medicine, including sleep aids, allergy pills, and supplements, or a complete list.
• Note dizziness on standing, trouble seeing at night, numb feet, new trouble getting up from a chair, or fear of falling.
• Ask the person what they think is going on. They often know.

What a good fall check covers

The CDC's STEADI program gives clinicians a short routine: ask about falls, look at the risks, and act on them. You can ask for each part by name.

• Three screening questions: Have you fallen in the past year? Do you feel unsteady when standing or walking? Do you worry about falling?
• Strength and balance: a timed walk, standing from a chair without hands, standing on one foot. Physical therapy can improve all three.
• Medicines: a review for anything that causes dizziness, sleepiness, or low blood pressure, and whether any can be lowered or stopped. Only the prescriber makes that call.
• Blood pressure lying and standing, to check for a drop on standing.
• Vision: when was the last eye exam, and are bifocals a problem on stairs?
• Feet and shoes: numbness, pain, and footwear that slips.
• Vitamin D, bone density, and heart rhythm, when the doctor thinks they matter.
• The home: whether an occupational therapist can do a home safety visit, which Medicare often covers after a hospital stay when a doctor orders it.

Questions to ask

• Which of these medicines could make a fall more likely, and is there a safer option?
• Would physical therapy for balance and strength help, and can you order it?
• Is a walker or cane the right tool, and can someone fit it properly?
• Would a home safety evaluation by an occupational therapist be covered?
• Is there a community balance class you would suggest?
• What should we do if there is another fall?

The day after a fall

• Any fall with a head strike, a blood thinner, new confusion, or pain that stops them from bearing weight is a same-day call to the doctor or a trip to the emergency room.
• Even a fall with no injury is worth a call. It changes the risk for the next one.
• Ask what they were doing and what time it was. Night trips to the bathroom and rushing to the phone are common.
• Fix the one thing that caused this fall this week, then work through the room-by-room list.
• Consider a medical alert button if they are alone for stretches, and practice using it.

In CarePair

Note falls in the journal with the date and what happened. The list is exactly what the doctor and the physical therapist want to see, and it is the honest starting point for the home-or-move conversation later.