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Fall Risk Assessment

Fall Risk Assessment

Quiz Questions

  • 1.
    I have fallen in the last year
    • A.
      Yes
      (2 points)
    • B.
      No
      (0 points)
  • 2.
    I have been told to use a walker or a cane.
    • A.
      Yes
      (2 points)
    • B.
      No
      (0 points)
  • 3.
    I lose my balance when I walk.
    • A.
      Yes
      (1 points)
    • B.
      No
      (0 points)
  • 4.
    I have stopped doing things I enjoy because of a fear of falling.
    • A.
      Yes
      (2 points)
    • B.
      No
      (0 points)
  • 5.
    I need to push off with both arms to get out of a chair.
    • A.
      Yes
      (1 points)
    • B.
      No
      (0 points)
  • 6.
    If I am standing still, without holding onto anything, I sway.
    • A.
      Yes
      (1 points)
    • B.
      No
      (0 points)
  • 7.
    I take short, narrow, steps when I walk.
    • A.
      Yes
      (1 points)
    • B.
      No
      (0 points)
  • 8.
    I stumble or look at the ground when I walk.
    • A.
      Yes
      (1 points)
    • B.
      No
      (0 points)
  • 9.
    I have lost feeling (peripheral neuropathy) in one or both feet.
    • A.
      Yes
      (1 points)
    • B.
      No
      (0 points)
  • 10.
    My medication or blood pressure makes me feel sleepy or light-headed.
    • A.
      Yes
      (1 points)
    • B.
      No
      (0 points)

Quiz Outcomes

  • 1.
    0 to 4 points:
    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.
  • 2.
    5 to 8 points:
    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.
  • 3.
    9 to 13 points:
    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.