Navigating the Health Care System

Advice Columns from Dr. Carolyn Clancy

Former AHRQ Director Carolyn Clancy, M.D., prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan.

When kids fall down, they can usually get up and return to play quickly. But for older adults, falls can be serious.

Among adults over age 65, falls are a threat to health and independence. They are also common. More than one-third of adults over age 65 fall each year. They account for about 2 million emergency department visits, data collected by the Agency for Healthcare Research and Quality shows. About three-quarters of those treated are women.

One-third of older adults who fall suffer moderate to serious injuries, including hip fractures and head trauma. Falls often send seniors from a hospital to a nursing home or long-term care facility for follow-up care. This may be difficult physically and emotionally.

While there's no simple solution to stop falls and their serious effects, there is progress. We're learning more about why falls occur and, more important, steps to prevent them.

Falls happen for many reasons. Aging often causes declines in vision, balance, and strength, making falls more likely. As we age, we are also more likely to take medicines that can cause dizziness, slow our reaction time, or cause other side effects. Finally, how a person's home is set up can increase the risk for falls.

Here are some things you can do to reduce the chance that you or a loved one will get hurt by a fall:

Know Your Medicines

  • Make sure your doctor knows which medicines you take. I can't overstate how important it is to keep a current list of all of your prescription and over-the-counter drugs. Show this list to your doctor and pharmacist at each visit. Your doctor or pharmacist can tell you, for example, if a medicine to treat blood pressure can cause dizziness and how to avoid problems.
  • Find out if a new medicine replaces one you already take. Ask your doctor or pharmacist if the new drug will cause side effects with drugs you already take.
  • Ask how to take new medicine correctly. Make sure you find out how often to take it and whether you should take the drug with food. Tell your doctor if you have side effects.
  • Be sure to monitor your heart rate, blood pressure, or blood sugar at home, if recommended by your doctor.
  • Remember that alcohol interacts with many medicines. It can make side effects, like dizziness, worse.

Stay Strong with Exercise

  • Talk to your doctor before you start an exercise program. Doctors can recommend specific exercises that are best for you.
  • Consider exercises recommended for older adults. They include tai chi for balance and coordination; walking for balance, ankle strength and endurance; and strength training, which improves muscle endurance and overall strength. Water aerobics is a good choice for people with arthritis because it is gentle on the joints.
  • Listen to your body and know your limits. But keep in mind that it takes time to build and regain strength.

Create a Safe Environment

  • Have your home checked. Home assessments help determine the safety of your home and identify ways to make it safer. Suggestions may include installing grab bars in the bathtub and making sure rugs are securely fastened. Area Agencies on Aging (AAAs) can provide information and referrals to local home modification programs.
  • Talk to your doctor to see if a cane, walker or other device can help you maintain balance. Make sure the device is adjusted for your height.
  • Ask your doctor or hospital about a personal medical response system. Research shows that people who have fallen are more likely to fall again. Technology offers a good defense against that risk. Personal medical response systems activated by a wristband or pendant alert family or emergency services if you fall. Your doctor or hospital is probably familiar with local response systems in your area.

There's no doubt about it: Falls can be serious. That's why preventing falls before they happen is the wisest course of action.

I'm Dr. Carolyn Clancy and that's my advice on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality

AHRQ News and Numbers: Falls Send More than Two Million Seniors To Hospital Emergency Departments. October 7, 2009. http://www.ahrq.gov/news/nn/nn100709.htm

Check Your Medicines: Tips for Using Medicines Safely. AHRQ Pub. No. 10-MO52-C. September 2010. http://www.ahrq.gov/consumer/checkmeds.html

Translation of an Effective Tai Chi Intervention Into a Community-Based Falls-Prevention Program. Am J Public Health 2008 July; 98(7): 1195-1198.

Centers for Disease Control and Prevention

Preventing Falls: What Works: A Compendium of Effective Community-Based Interventions from Around the World. 2008. http://www.cdc.gov/ncipc/preventingfalls/

Administration on Aging

Find AAA's and SUAs. http://www.aoa.gov/AoARoot/AoA_Programs/OAA/How_To_Find/Agencies/find_agencies.aspx

Current as of March 2011
Internet Citation: What You Can Do To Prevent A Fall. March 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/columns/navigating-the-health-care-system/030111.html