Fall Risk Assessment Questions for Doctor

Falls Are Treatable, Not Inevitable

One in four Americans over 65 falls each year. Falls are the leading cause of injury-related death in older adults and the most common reason for emergency department visits in this age group. But the dangerous part isn't the statistic — it's the assumption. Families and even some physicians treat falls as an inevitable consequence of aging rather than as a clinical event with identifiable, often modifiable causes.

A fall is a symptom. It has a cause — sometimes several causes working together — and many of those causes are treatable once identified. The questions you ask at the doctor's appointment determine whether a fall triggers a real clinical workup or gets filed under "be more careful."

Questions About Medications

Medications are the single most modifiable fall risk factor in older adults, and they're the one most often overlooked.

"Which of my parent's current medications increase fall risk?" Ask the doctor to review the full medication list specifically through a fall-risk lens. The AGS Beers Criteria identifies classes of drugs that are potentially inappropriate for older adults, many because they increase fall risk: benzodiazepines (Ativan, Xanax, Valium), sedative-hypnotics (Ambien, Lunesta), anticholinergics (Benadryl, certain bladder medications), opioids, and some blood pressure medications that cause orthostatic hypotension (a sudden drop in blood pressure when standing).

"Could we reduce the dose or discontinue any medications that contribute to dizziness or unsteadiness?" Deprescribing — the supervised reduction or elimination of unnecessary medications — reduces fall risk in older adults. This isn't a conversation about taking away needed treatment; it's about whether the risk-benefit ratio of each drug still makes sense given your parent's current health status.

"Should we check for orthostatic hypotension?" This is a simple in-office test: blood pressure is measured while lying down, then immediately after standing. A significant drop (20+ mmHg systolic or 10+ mmHg diastolic) explains dizziness and falls on standing. It's commonly caused by blood pressure medications, dehydration, or autonomic dysfunction, and it's manageable once identified.

Questions About Physical Function

"Can we do a Timed Up and Go test today?" The TUG takes less than a minute: your parent stands up from a chair, walks 10 feet, turns around, walks back, and sits down. A time over 12 seconds suggests elevated fall risk and warrants further evaluation. It's a baseline metric that can be repeated at future visits to track whether interventions are working.

"Would a physical therapy referral for balance and strength training help?" Evidence-based exercise programs — particularly those focused on balance, lower extremity strength, and gait training — reduce falls by 23-40% in older adults. Physical therapists can design a home exercise program tailored to your parent's specific deficits. Medicare Part B covers outpatient physical therapy with a doctor's referral.

"Should we check their vision and hearing?" Undiagnosed vision changes (cataracts, glaucoma, macular degeneration) directly increase fall risk by impairing depth perception and obstacle detection. Hearing loss contributes to fall risk through reduced spatial awareness and the cognitive load of compensating for poor hearing. Both are correctable, and both are often years out of date in elderly patients who haven't been retested.

"Are their shoes and assistive devices appropriate?" Bring the shoes your parent wears most often to the appointment. Loose slippers, smooth-soled shoes, and worn-out sneakers are fall hazards. If your parent uses a cane or walker, the doctor or physical therapist should verify it's the right height and that your parent uses it correctly — a walker set too high or too low changes gait mechanics in ways that increase instability.

Questions About Underlying Conditions

"Could the falls be related to a heart rhythm issue?" Cardiac arrhythmias (particularly atrial fibrillation and bradycardia) can cause sudden dizziness, lightheadedness, or brief loss of consciousness that results in falls. If your parent's falls seem sudden or unexplained — they weren't tripping over anything, they just went down — ask about cardiac monitoring.

"Should we screen for neuropathy?" Peripheral neuropathy — numbness or tingling in the feet, common in diabetes — impairs the sensory feedback that keeps balance stable. If your parent can't feel the floor properly, their brain can't make the micro-adjustments that prevent falls.

"Is vitamin D deficiency a factor?" Low vitamin D levels are associated with muscle weakness and increased fall risk in older adults. A simple blood test checks the level, and supplementation is straightforward if deficiency is found.

After the Assessment

If the doctor identifies multiple fall risk factors (medication-related dizziness, balance deficits, vision problems, home hazards), ask for a written fall prevention plan with specific action items and a timeline. "Be careful" is not a plan. "Discontinue Ambien by March 15, start physical therapy for balance training twice weekly, schedule ophthalmology appointment within 30 days, and install grab bars in the bathroom" is a plan.

Document every fall and near-fall going forward — date, time, location, what your parent was doing, and what they landed on. Bring this log to the next appointment so the doctor can evaluate whether the interventions are reducing fall frequency.

The Caregiver's Guide to Doctor Communication includes a fall risk assessment preparation worksheet with all the questions above organized by category, plus a printable fall incident tracker for documenting events between appointments.