CEO Blog

Last week I had my annual visit with my primary care doctor. It was routine. I felt fine. Nothing hurt. I wasn’t sick. That’s probably the best time to visit the doctor. It was a sunny, spring morning and I walked the few blocks from home over to his office for my appointment.

Annual visits typically include some health screenings: a blood test, a urine sample, a blood pressure check, stepping on the scale (where I somehow managed to gain three pounds on the walk over to the doctor’s office). Erin, the medical assistant, handed me a clipboard with questions about how I was feeling today, and if there were any health complaints I had experienced over the past few weeks. She asked a few more questions in the exam room, including this one…

“Have you fallen recently?”

And this one. . .

“In the past two weeks, how often have you felt down, depressed or hopeless?”

Hmmm. Another health-related milestone. My annual health assessment now includes a fall-risk assessment and a depression screen. A new rite of passage. Welcome to your sixties.

Rites of passage are often associated with growth and maturity. Formal and informal events that mark growth and development: the first day of kindergarten, passing the driver’s exam, graduation, your first real job, first apartment—milestones that mark eras and stages in life. There are adult milestones, too. As my circle of friends began to turn 50, there were conversations about having a colonoscopy (mostly about the prep.) We started paying more attention to those quarterly statements from our 401K. More of us began to deal with health issues, and those of our aging parents. We attended a lot of graduations, and our children’s weddings. We started becoming grandparents. We began to see ourselves as middle-aged.

A decade later, I’m asked about falling.

So, as I answered Erin’s questions (“no” on both counts), I also had a moment of self-awareness about where I am on life’s journey. My professional life and my personal experience bumping up against each other.

Why ask people about falls?

Falls are one of the leading causes of preventable injuries and deaths in the US. Data from the National Safety Council shows that falls account for nearly one-third of all non-fatal injuries, and 20 percent of preventable injury deaths. For older adults, the risk is even greater. Falls among adults 65 and older are the leading cause of injury death. Older adults who are not physically active, and those who have difficulty performing Activities of Daily Living (ADLs) are more likely to fall. Others may be at risk due to poor vision, side effects from medication and other factors. In 2021, emergency departments recorded nearly 3 million visits by older adults related to injuries from falls. Even a seemingly minor fall may require hospitalization or rehab. Falls and the fear of falling are often cited as the reason individuals consider assisted living or residential care services.

Falls can be devastating, but many falls are preventable. A patient identified as at-risk for falls can be encouraged to engage in physical activity and exercise, referred to a physical therapist, be screened for medication management, or enrolled in an evidence-based program to promote strength, balance and agility. A “home safety assessment” can reduce or eliminate fall and trip hazards by improving lighting, installing grab bars, even removing throw rugs. Reducing the risk of falls often involves simple, practical steps to improve safety and awareness.

Why ask about feeling down?

The question about feeling “down, depressed or hopeless” is part of the Patient Health Questionnaire (PHQ-2), two questions asked as part of a patient interview to identify persons at risk for depression and anxiety. Depression may be related to medical condition, stress, social isolation or even lack of exercise. Depression and anxiety are not an inevitable part of aging, but some older adults are at risk due to the factors noted above.

Depression is not always expressed as “sadness.” This is especially true in older adults. The person may be irritable or restless or have difficulty concentrating or making decisions. There may be changes in eating or sleeping habits. Sometimes symptoms may be overlooked. Age bias may mean that symptoms or severity of the condition may be discounted, especially if family, friends or healthcare professionals see it as a normal or inevitable part of growing older. And there may be cultural or social attitudes about mental health or mental health treatment that downplay or minimize the importance of behavioral health.

One outcome of not recognizing or treating depression and anxiety is a rising number of suicide deaths in older adults. Older adults comprise 17 percent of the US population, but they account for 22 percent of suicides. The highest rate of suicide deaths is among men ages 75 and older. Screening for depression is an important step in addressing mental health awareness and treatment.

In the end, the main reason to ask these questions is to help identify conditions that are treatable, even preventable. Identifying risks and addressing problems can improve health outcomes. Screenings can lead to conversations and action plans and a better path to treatment and prevention. They shift the discussion from medical care to health promotion and help build partnerships between physicians and patients.

Visit the Benjamin Rose website for more information on identifying risks and preventing falls and to learn more about Behavioral Health Services for older adults.

If you or someone you know needs help, The 988 Suicide and Crisis Lifeline provides 24/7, confidential support to people in suicidal crisis or mental health-related distress. Call or text 988 to be connected with a counselor.