Fall Risk Assessment

Click Here to Take The Quiz

I have fallen in the last year

Yes

1 / 10

I have been told to use a walker or a cane.

Yes

2 / 10

I lose my balance when I walk.

Yes

3 / 10

I have stopped doing things I enjoy because of a fear of falling.

Yes

4 / 10

I need to push off with both arms to get out of a chair.

Yes

5 / 10

If I am standing still, without holding onto anything, I sway.

Yes

6 / 10

I take short, narrow, steps when I walk.

Yes

7 / 10

I stumble or look at the ground when I walk.

Yes

8 / 10

I have lost feeling (peripheral neuropathy) in one or both feet.

Yes

9 / 10

My medication or blood pressure makes me feel sleepy or light-headed.

Yes

10 / 10

You scored a 0

Low Risk For Falls

Congratulations! You scored at a low risk for falls. This does not guarantee that you are not at risk. Ask your healthcare provider they think that you should be evaluated by a physical therapist. Remember, the CDC recommends a fall screening annually for seniors.

You scored a 5

Moderate Risk for Falls

You scored a moderate risk for falls. Based on your score it is highly recommended that you have a thorough balance assessment from a physical therapist who specializes in balance.

You scored a 9

High Risk for Falls

You scored a high risk for falls. Based on your score it is highly recommended that you have a thorough balance assessment from a physical therapist who specializes in balance.