Have you fallen?

I got most of the following information from an article in JAMA (Journal of the American Medical Association). It was written by a retired physician, Dr. Bruce Campbell. At a visit to his doctor, he’s asked whether he has fallen in the past six months. He lies and says no. That’s what I do! Like him, I think it doesn’t count if you’ve done something like, in my case, tripping over a garden hose. (I have no trouble getting up.) I learned, in his article, why we’re always asked that question.

In the U.S., falls are reported every year by more than 14 million people over the age of 65 and are associated with about 90 percent of hip fractures. A history of one or more falls in the six months prior to a surgical procedure is associated with postoperative complications, higher levels of post-hospital care, and increased 30-day readmission rates.

The Centers for Medicare and Medicaid Services requires medical personnel to ask if you’ve fallen. It gathers this data to track the proportion of enrollees who have been assessed for their risk of falling.  This information, collected by doctors’ offices, is tied to reimbursement. The greater the proportion of patients queried, the better the reimbursement. (That’s what he wrote!)

As Dr. Campbell notes, admitting to a fall might trigger a cascade of medical tests, such a neuropsychiatric evaluation or stress test. Even his 90-year-old mother, who lived in a senior living apartment, lied about falling. When she fell and couldn’t get up, she called her son instead of the office. (She kept her phone in her pocket.) She was afraid she’d be hauled off to the hospital on a stretcher and subsequently moved to assisted living or a nursing home.

Dr. Campbell continues to lie. As will I.

Next week: What if you hit your head from a fall?

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