To find out if you’re at risk for falling, please do the following:
- Please identify Yes/No for each statement below
- Add up the number of points for each Yes response.
- If you score 4 points or more, you may be at risk for falling. Discuss these results with your doctor.
| Yes? | No? | Statement | Why it matters |
|---|---|---|---|
| Yes 2 | No o | I have fallen in the last 6 months. | People who have fallen once are likely to fall again. |
| Yes 2 | No o | I use or have been advised to use a cane or walker to get around safely. | People who have been advised to use a cane or walker may already be more likely to fall. |
| Yes 1 | No o | Sometimes I feel unsteady when I am walking. | Unsteadiness or needing support while walking are signs of poor balance. |
| Yes 1 | No o | I steady myself by holding onto furniture when walking at home. | This is also a sign of poor balance. |
| Yes 1 | No o | I am worried about falling. | People who are worried about falling are more likely to fall. |
| Yes 1 | No o | I need to push with my hands to stand up from a chair. | This is a sign of weak leg muscles, a major reason for falling. |
| Yes 1 | No o | I have some trouble stepping up onto a curb. | This is also a sign of weak leg muscles. |
| Yes 1 | No o | I often have to rush to the toilet. | Rushing to the bathroom, especially at night, increases your chance of falling. |
| Yes 1 | No o | I have lost some feeling in my feet. | Numbness in your feet can cause stumbles and lead to falls. |
| Yes 1 | No o | I take medicine that sometimes makes me feel light-headed or more tired than usual. | Side effects from medicines can sometimes increase your chance of falling. |
| Yes 1 | No o | I take medicine to help me sleep or improve my mood. | These medicines can sometimes increase your chance of falling. |
| Yes 1 | No o | I often feel sad or depressed. | Symptoms of depression, such as not feeling well or feeling slowed down, are linked to falls. |