Nov. 26, 2025
Understanding fall risk
In this episode, hosts Ron Aaron and Dr. Rajay Seudath welcome Dr. Kathleen Berger to explore a critical issue affecting older adults: fall risk. From common causes and warning signs to prevention strategies and clinical insights, this conversation sheds light on how falls can be avoided—and why awareness is key to staying safe and independent.
Docs in a Pod focuses on health issues affecting adults. Clinicians and partners discuss stories, topics and tips to help you live healthier.
Search for Docs in a Pod on your favorite podcast platform.
Show transcript
Podcast transcript
INTRO
Welcome to Docs in a Pod, presented by WellMed. Over the next half hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Rajay Seudath and award winning veteran broadcaster Ron Aram will share information to improve your health and well-being. And now here are Ron Aaron and Dr. Rajay Seudath.
RON AARON
Hello everybody, and welcome to the award winning Docs in a Pod. I'm Ron Aaron and our podcast available wherever you get your podcasts. We're also on the radio in several cities in Texas and Florida as well. Our co-host, Dr. Rajay Seudath is with us. Dr. Seudath is a board certified family medicine physician, a Tampa native and lead physician for Optum. He's at the University location in Tampa. He earned his medical degree from the University of South Florida Morsani College of Medicine. Dr. Seudath has a passion for primary care and guiding his patients to meet their health care goals. He also enjoys time with his family. He enjoys time traveling as well. Dr. Seudath, great to have you with us.
DR. RAJAY SEUDATH
So good to be back. Thank you for having me.
RON AARON
When you look at what we're talking about today, my guess is you see this in patient after patient after patient, and that's falls.
DR. RAJAY SEUDATH
That is correct.
RON AARON
Let's take a moment and introduce our special guest. We've had her on before, and it's a delight to talk with her again. Dr. Kathleen Berger is a skilled and compassionate general practitioner. You can find her at WellMed at Fannin in Houston, where she provides high quality care for her patients. She's got a doctorate in medicine from the prestigious University of Guadalajara. Dr. Berger brings extensive international training and expertise to her practice. She is a professional and enjoys the kind of work that comes with a general practitionerÕs work. She spent a whole lot of time in New York at the Upper East Side Rehabilitation and Nursing Center. She further honed her medical skills doing a surgical residency at Bronx Lebanon Hospital Center and Lincoln Hospital, both in the Bronx in New York. Following her residency, Dr. Berger completed a surgical fellowship at Queens Hospital in Queens, New York. When she is not doing all of this, she's started taking jujitsu. We'll find out that pursuit as well. Dr. Berger, good to see you again, and I think I asked you this before. Once you left New York, where in the world in Houston so you find great bagels?
DR. KATHLEEN BERGER
That's a good question. There's a place here in Katy. They're pretty decent. They make a good schmear as well, but still not quite the same as in New York, but pretty close.
RON AARON
As you mentioned to us off the air, I said, hey, what are you doing when you're not doing doctor? And you said, well, lately you've taken up jujitsu. Why?
DR. KATHLEEN BERGER
Because my son does it, and I've been watching him do it for the last couple of years and they opened an adult class for beginners, and I thought that'd be a good way to get some exercise in and get in shape. That was for my personal health. Also to show my patients to achieve our health goals, exercise is a big part of that.
RON AARON
It's like martial arts?
DR. KATHLEEN BERGER
It is. It's just not as brutal for lack of a better word because there's no punching or kicking.
DR. RAJAY SEUDATH
If you know the Olympic sport Judo, that is kind of the noncombatants form of jujitsu. Jujitsu usually is referring to Brazilian jujitsu, which has become very, very popular. Actually, one of our care coordinators did Brazilian jujitsu, and we were actually showing our case manager who's this little tiny blond girl, even though you have a smaller mass, applying that force in the right ways and knowing how the body works. So, the case manager and I were all on the floor doing different locks and stuff like that. We just spread out three yoga mats, and we were kind of rolling on the floor showing this is what you do. It's amazing how much energy you expend when you've got somebody in tied up like a pretzel. You really wear out a lot of exercise, and that's very good for your health. It's very good to kind of master your own body and understand your own limitations.
RON AARON
That's pretty cool.
DR. KATHLEEN BERGER
I agree.
RON AARON
I wrestled in high school, and it's amazing the amount of energy involved. A three-minute period is like an hour.
DR. RAJAY SEUDATH
Absolutely.
RON AARON
Enough fun. Let's talk about falls. Dr. Berger, when you look up statistics on seniors and falls, it's phenomenal.
DR. RAJAY SEUDATH
Yes.
DR. KATHLEEN BERGER
Absolutely. Falls in adults are the leading cause of traumatic brain injury. About 25,000 adults per year die due to falls. Falls are also the most common cause of non-fatal related injuries. About 1 in 4 adults, or about 14 million people, refer to falling each year. I think it was 1 in 10 falls result in an injury that restricts their activities of daily living like restricts their ability to function as they normally would, which can increase risk of morbidity or contribute to cognitive decline. In 2019, there was a statistic that referred to 83% of hip fracture deaths, and about 88% of ER visits and hospitalizations that resulted in a hip fracture were due to falls.
RON AARON
That's huge.
DR. KATHLEEN BERGER
Yes. We see it, unfortunately quite frequently in the elderly population.
RON AARON
Why? Why are people falling?
DR. KATHLEEN BERGER
There are different factors that increase the risk of falls. Of course, as we age, our balance tends to decline. We can have medical conditions that increase the risk of falls. Like, if we're on blood pressure medication and our blood pressure drops too low, that can result in dizziness and falls. Patients with diabetes can have neuropathy. That will decrease their ability to sense things around them. Footwear as well. If they don't have the proper footwear or if their shoes are too tight, for example, that can contribute to increased risk of tripping and then falling. Low vitamin D has been associated with an increased risk of falls. Medications. Patients that are on too many medications or on medications that can cause dizziness can increase risk of falls as well.
RON AARON
Hold that thought. We're going to come right back to you. If you're just joining us, you're listening to the award winning Docs in a Pod. I'm Ron Aaron and Dr. Rajay Seudath is with us as well as our guest, Dr. Kathleen Berger. We're talking about seniors and falls. As Dr. Berger pointed out, the numbers of people who are at risk of falling and the numbers of people who fall, the numbers are staggering. Dr. Berger, I remember a doctor telling me a few years ago, if you have fallen, odds are you will fall again.
DR. KATHLEEN BERGER
Yes. I think the statistic is your chance more than doubles once youÕve fallen one time to fall subsequently. So, your risk doubles after a fall to fall again.
RON AARON
Now, should we do more to teach people how to fall safely? You take a look at people who are stunt performers in movies. They fall all the time, and generally they don't break their hips.
DR. RAJAY SEUDATH
Well, that's true. But a lot of those stunt guys are not over at the age of 65. So, that's one thing. Having that increased age does put you at a higher risk for falling in general. One of the things I try to explain to patients is just balance itself. If you think about your balance, there's five things that go into balance. One is your sense of touch on the floor. Do you feel your feet on the floor? The second sense is where are your joints in space? That's called proprioception. If you close your eyes and you put your head over your hand, over your head, you know it's above your head. If you put your hand below your head, you know where it is.
RON AARON
How do you know?
DR. RAJAY SEUDATH
Because of the proprioception. The other one is the gyroscope in your ear, the otoliths. That let you know where you are in relation to gravity. Then the final one is your vision. If your vision is not good, that will affect your balance. Tying all of those four different senses is the bottom of your brain, your cerebellum. So, anywhere along those lines like diabetes, neuropathy, blood pressure, drinking. Anything that affects those five parts can cause you to be at risk at falls.
RON AARON
Dr. Berger, is there a time of day we are most at risk for falls? I'm thinking of waking up in the middle of the night and tottering off to the bathroom and tripping and falling.
DR. KATHLEEN BERGER
Statistically, I don't know what time of day falls occur more frequently, but yes, nighttime is very frequently when we see patients fall because they're more disoriented. Especially patients with cognitive decline or dementia. We'll see those more at night just because they can tend to become more disoriented at night in general. But I don't know. I don't have the number on statistically when it's more frequent. It can be any time of day.
DR. RAJAY SEUDATH
Right. Also, the location. Like you said, going to the bathroom at night. We often see patients after they've evacuated their bowels, after they've emptied their bladder, you can have a transient dip in your blood pressure. So, you stand up, and your blood pressure kind of goes down and you've already emptied your bladder, so there's less volume in your body. So, you stand up, and then all of a sudden you go down.
RON AARON
Well, you fall in a bathroom, there's a lot of bad stuff you can hit your head on.
DR. RAJAY SEUDATH
Yes, absolutely.
RON AARON
Right?
DR. RAJAY SEUDATH
That's correct. If you've got one of those raised lips for your bathtub, you've got the vanity, you've got the toilet itself. You know the old joke, oh, it's okay. The ground broke my fall. Yeah. That guy wasn't lying. You're happy if you just hit that, but if you hit one of those other things all the way down, that can cause more damage.
RON AARON
Dr. Berger, one thing Dr. Seudath mentioned, and I guess it's absolutely right, the whole sense of balance. I know WellMed offers a balanced training course for seniors. A Matter of Balance is what the course is called. How important is understanding whether you've got a balance problem?
DR. KATHLEEN BERGER
Very, very important. A lot of patientÕs don't realize that they do have a problem. So, educating them is a big part of what we do in primary care. Most patients, assuming again, that their cognitive function is intact, are open to hearing that advice and more open to following our recommendations. When it's a patient with dementia or cognitive decline, we really lean more on the family to help us implement any strategies that we're going to use to help lower that risk of falling.
RON AARON
I know that someone who may need an assistive device like a cane or a wheelchair, very often they really are resistant. My mother-in-law, for example, who is almost 90, has several canes her doctor keeps giving her. Whenever I see her, I'll say, hey, Virginia, where's that cane? Oh, it's safe at home.
DR. RAJAY SEUDATH
Yes. Absolutely.
RON AARON
WeÕre going to come right back. We'll get right back to you. I'm Ron Aaron, along with Dr. Rajay Seudath, our co-host and Dr. Kathleen Berger, our guest. We're talking about falls and risk of falling right here on the award winning Docs in a Pod.
AD
WellMed and you can rely on WellMed and Optum doctors to care for and understand the health needs of older adults. Our commitment to quality is why the Institute of Health Care Improvement recently designated WellMed and Optum as an Age-Friendly Health System. This means WellMed and Optum care teams provide reliable, evidence-based, high quality care to older adults. To get the benefits of an Age-Friendly care team, go to wellmedhealthcare.com to find a doctor near you.
RON AARON
Thank you so much for sticking with us right here on the award winning Docs in a Pod. Our podcast is available wherever you listen to your podcasts. You also can hear us on the radio in several cities in Texas and Florida as well. I'm Ron Aaron and our co-host, Dr. Rajay Seudath is with us, and we're talking with Dr. Kathleen Berger. Dr. Berger and Dr. Seudath and I have been talking about the fall and the risks of falling. A moment ago, Dr. Seudath, I was talking about my mother-in-law who has a bunch of canes at home. Now I think it's down to one in every room, but she never uses them.
DR. RAJAY SEUDATH
That's absolutely right. That is one of the things that we see so often in our patients. We say, well, how about trying this cane or trying this walker.
RON AARON
By the way, why do you think she has them? Because she's falling.
DR. RAJAY SEUDATH
Absolutely. For me, when it comes to those assistive devices, I like the rollator. It's got four wheels, it's got a seat, it's got handbrakes. You can paint it flames, you can hang fuzzy dice from it and really make it your own. I like those because I find that patients can actually prevent the fall. Or I find it gives them a sense of security and they can become more active to tone their muscles, which prevents falls.
RON AARON
I call those walkers.
DR. RAJAY SEUDATH
You can call those walkers. But again, I think walkers are more of a general term. Because the walker can be the one that doesn't have any wheels on it versus the one that has the four wheels and has the seat. So, I feel that those are better than canes. I feel that canes allow you to walk faster. They don't necessarily prevent falls.
RON AARON
Dr. Berger, what are your thoughts?
DR. KATHLEEN BERGER
Yeah, I agree. If you explain it to the patient that way, they are usually more likely to go along with your recommendations. I had a patient the other day who has had recurrent falls, but doesn't always follow up with me. I tried to convince her to use a walker. I was able to convince her to use a cane. But, my goal is to eventually have her agree to use a walker. Once she sees that she has a little more independence. As Dr. Seudath said, walkers are probably a little better at decreasing risk of falls than canes are, but at least she's using something. She hasn't fallen since, but she definitely is a candidate for a walker. A rollator is an excellent option.
RON AARON
When I had my knee replacement surgery, I had a walker I used for several weeks. It obviously it gives you independence. You can get around.
DR. RAJAY SEUDATH
Ron, when that happened, did you feel like an old man? Because that's what I often hear. That's the reason they don't want to use it. I'll just look like an old person. I'll be this decrepit old person if I use it. Did you feel that way?
RON AARON
I didn't feel too old. The answer is no. I hadn't thought of it that way. But my kids reacted. I've got young kids. I've got a 14 year-old daughter and 12 year-old twin boys. This is a few years ago, so they were younger. At first, they were put off by it, and then it was fine. Then they asked if they could they use it.
DR. RAJAY SEUDATH
Great.
RON AARON
And they decorated it.
DR. RAJAY SEUDATH
That's another thing that I say to try and get people past that idea that this is acknowledging that I'm old.
RON AARON
Depth perception. Yes.
DR. RAJAY SEUDATH
Right. I think that idea of making it your own, of decorating it, making it somehow with your own touch and your own flair that adds to the acceptance and to the normalcy of using this piece of equipment.
RON AARON
Dr. Berger, if we make you Queen of America for a day, would you see that all of the folks who are at risk of falls would use a walker?
DR. KATHLEEN BERGER
That's a good question. I would have to assess their fall risk. There are different scales that we use to see also that they're going to be compliant with it. Because I can recommend it but I would want to make sure they're actually going to use it. So, I don't think every patient that's at risk of falling needs a walker or a rollator. But yes, there would be a lot more people using walkers or rollators if I were queen for a day. Absolutely.
RON AARON
What are some of the assessment tools that you use to determine how much at risk a patient is for falling? What are you looking at?
DR. KATHLEEN BERGER
Their ability. The Karnofsky scale is one of the ones that that's used to determine their ability to do their activities of daily living on their own. How much assistance do they require? Have they fallen before? Are they needing any assistance at home in general? Are they able to care for themselves? Have they been hospitalized? Do they have conditions that make them a candidate for disability? Have they had strokes, etc., which can leave them with weakness, which increases the risk of falls as well. So, all those factors combined is how we how we evaluate the patient to see if they would need a walker or another assisted device.
RON AARON
How much does fear of falling play into this? Because as we agreed, if youÕve fallen, you probably will fall again. Part of that is walking in ways that you think will prevent falling because you've fallen before it ends up putting you at greater risk.
DR. KATHLEEN BERGER
Yes, absolutely. It kind of makes them almost self-conscious and may actually increase their risk of falling again because they're they think they're being more cautious, but they may make a mistake in how they step. Or they may be distracted by just the fear of falling itself.
DR. RAJAY SEUDATH
Right.
DR. KATHLEEN BERGER
So, reassuring them and giving them the tools to help lower risk of falls. There are a couple of options for that.
RON AARON
Like what?
DR. KATHLEEN BERGER
Physical therapy is a big one. Physical therapist can help strengthen their muscles that help with their balance. They can help train them in how to use their walker more efficiently to help lower risk of falls. There's a couple of programs that are listed in the CDC website that they can sign up for. One is called Stepping On. The other one is called Otago. They're both exercise programs that are designed to train people, so they don't fall. Then optimizing their medical conditions. If they have diabetes or making sure their neuropathy is being treated, optimizing their medications. If they're on too many medications, try to remove anything that they don't need or try to remove any medications that are known to increase risk of falls. So, those are those are some of the tools that we use. Sometimes I'll just print exercises for them in the office that are good for balance, especially if they're not very elderly so to speak. If they're in their 60s or 70s, they're usually a little more functional and they're more open to doing their own training at home. 75 and up, those are the patients that I usually evaluate to either go to a physical therapy program like at Memorial Hermann. They have a very good rehabilitation program. Or I sign them up for physical therapy home health to be done at their home.
RON AARON
What are some of the home exercises people could try?
DR. KATHLEEN BERGER
Strengthening their hip girdle muscles, their hamstrings, their quadriceps, their core. But you really you need to use all your muscles for your balance. Especially if you're using a walker. You need upper body strength as well to be able to maneuver that device. So, different sets of exercises that strengthens those groups of muscles.
RON AARON
Now, speaking for a friend, once you've fallen, sometimes it's very difficult to get up on your own.
DR. RAJAY SEUDATH
Absolutely.
RON AARON
Unless there's a grab bar hanging down from the sky.
DR. RAJAY SEUDATH
That's what I wanted to talk about. Clearing paths in the house if the house is very cluttered. The other things are grab bars. You can have grab bars installed in the bathroom making sure that the path that you're going to use with your rollator or with your cane is clear. Sometimes you have to work with family members of the patient themselves to try and get those things. So, like you said, grab bars. Some home health programs or rehab programs can teach people how you get up if you're on the floor. What are some of the ways you can pick yourself up if it's possible?
RON AARON
You mentioned grab bars. Again, speaking for a friend who has a wife who thinks that they don't add to the Feng Shui.
DR. RAJAY SEUDATH
Well, then you need to consult your Feng Shui master and find out where on the dragon's back those handles can go.
RON AARON
That would be the answer. Grab bars really can be lifesavers.
DR. RAJAY SEUDATH
Absolutely.
RON AARON
That's cool. Dr. Berger, we've only got a couple of minutes left. When you think about the risk of falling, the number of people who have fallen, and an aging population, those numbers are going to go up even more.
DR. KATHLEEN BERGER
Yes, I think we've kind of touched on it. But prevention, like discussing fall risk, which is usually part of our annual wellness exam, their fall risk needs to be assessed. But along with that questionnaire that's done, really talk to the patient and ask them if they have any problems with their balance. Ask them if they've fallen and give them some of the exercises that I usually print. Or just to tell us if they start having any balance issues or any reasons why they'd be afraid to fall so we can intervene before the fall happens. I think that'll help mitigate some of the falls. Just seeing the patients more frequently once we've given them a plan of care. That kind of gives them confidence that we really are involved in lowering that risk and they're more likely to comply with what we're recommending. I think that's going to help decrease those numbers.
RON AARON
Dr. Seudath, last thoughts.
DR. RAJAY SEUDATH
I would just say talk to your doctor or your provider if you have any worries about falls. If you're worried about your balance, talk to your doctor.
RON AARON
Perfect. Dr. Rajay Seudath, our co-host. Thank you. Great guest, Dr. Kathleen Berger. Appreciate you being with us. We want to see some video on you doing your jujitsu. We'll work on that. I'm Ron Aaron and thanks for joining us on the award winning Docs in a Pod.
OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.
DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.
Docs in a Pod airs on Saturdays in the following cities:
- 7 to 7:30 a.m. CT – San Antonio (930 AM The Answer)
- 7 to 7:30 a.m. CT – DFW (660 AM, 92.9 FM [Dallas], 95.5 FM [Arlington], 99.9 FM [Fort Worth])
- 6:30 to 7 p.m. CT – Houston (1070 AM/103.3 FM The Answer)
- 7 to 7:30 p.m. CT – Austin (KLBJ 590 AM/99.7 FM)
Docs in a Pod also airs on Sundays in the following cities:
- 1:30 to 2 p.m. ET – Tampa (860 AM/93.7FM)
- 5 to 5:30 p.m. CT – San Antonio (930 AM The Answer)
Healthy aging Podcasts
