Check Your Risk for Falling

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.