Your doctor may not ask about falls unless you bring them up, so plan to raise the topic yourself. Start with three simple screening questions, bring a full list of your medicines, and ask what the next step should be. The Medicare Annual Wellness Visit is a good time to do it.

Why you need to bring it up

Every adult 65 and older should be asked about falls at least once a year, and after any fall. Most people will not raise it on their own, and fewer than half of people who fall tell their doctor.

That matters, because falling once doubles the chance of falling again. Your appointment may be about something else entirely, yet a fall check may be the most important thing your doctor does for you that day.

The three key questions

The CDC's STEADI program, the standard U.S. approach used by doctors, starts with three questions. If you answer yes to any of them, you are considered at risk and should get a closer look:

  1. Have you fallen in the past year? If yes, how many times, and were you hurt?
  2. Do you feel unsteady when standing or walking?
  3. Are you worried about falling?

Answer honestly, even about a fall that "didn't count" because you were not hurt or because you tripped over something. Near falls and a fear of falling count too.

Do a self-check before your visit

The CDC Stay Independent checklist has 12 yes or no statements, such as "I need to push with my hands to stand up from a chair" and "I often have to rush to the toilet." A score of 4 or more means increased risk. Even with a lower score, a fall in the past year still puts you at risk.

You can fill out the checklist at home and bring it with you. The NCOA Falls Free CheckUp is an online version that scores your answers for you.

The Medicare Annual Wellness Visit

If you have Medicare, the Annual Wellness Visit includes a review of your functional ability and safety, which covers fall risk screening. You pay nothing for the visit if your provider accepts assignment, and the Part B deductible does not apply.

Some things to know:

  • The wellness visit focuses on screening and planning. If your doctor finds a problem and does a full fall assessment, that part may be billed as a regular office visit.
  • Physical and occupational therapy for balance, walking, strength and home safety may be covered under Medicare Part B, with coinsurance.
  • If you were recently discharged from a hospital or rehab, the month after discharge is a very high-risk time. Mention falls at your follow-up visit.

What to bring

  • Every medicine you take, in the bottles if possible: prescriptions, over-the-counter products, vitamins, supplements, herbals and eye drops
  • Your Stay Independent checklist, filled out
  • Fall details: when, where, what you were doing, whether you felt dizzy first, whether you could get up on your own and how long it took
  • Your glasses, hearing aids and walking aid, if you use them
  • A family member or friend, if you would like help remembering and taking notes

Questions to ask

  • "Based on my answers, am I at risk for falling?"
  • "Could any of my medicines be raising my risk?"
  • "Can you check my blood pressure lying down and then standing?"
  • "Would you test my strength and balance, or refer me to a physical therapist?"
  • "When was my last eye exam, and do I need one?"
  • "Should my hearing be checked?"
  • "Should we talk about my bone health, including vitamin D?"
  • "Is there a balance or exercise program near me you would recommend?"
  • "Would a home safety evaluation help?"

Doctors often test strength and balance with the Timed Up and Go, the 30-Second Chair Stand and the 4-Stage Balance Test. If you feel unsteady and steady yourself on furniture at home, your doctor may send you straight to physical therapy.

For adult children

If you are helping a parent, offer to come to the appointment and bring the medicine list. Talking about "staying independent" or "safe mobility" often lands better than talking about "falls." If your parent believes "old people just fall," remind them that falls are treatable, not just part of aging.

After the visit

Ask when you should follow up. Guidelines suggest checking back within 30 to 90 days, and sooner for people at high risk.

For local aging services in Tampa Bay, contact the Senior Connection Center (Hillsborough, Polk, Hardee, Highlands and Manatee) or the Area Agency on Aging of Pasco-Pinellas, or call the Florida Elder Helpline at 1-800-963-5337.

How Home Safety Solutions can help

A home safety visit gives your doctor something an office visit cannot: a look at how you actually move through your own home. Your written report includes suggestions for what to share with your physician. Learn what happens during a home safety visit. Call (813) 365-9171 or email info@homesafety.solutions.

Related reading: CDC Stay Independent self-check (PDF) · Medicare: yearly wellness visits · Does Medicare pay for a home safety assessment? · NCOA Falls Free CheckUp · Is it normal to fall as you get older?

This article is general education, not medical advice. Talk with your doctor, pharmacist, or therapist about your own situation.