Key Questions to Identify Fall Risk:
1.) Have you fallen in the past year?
2.) Are you afraid of falling?
3.) Do you have unsteadiness/balance problems?
If you have answered "yes" to any of these questions, you have a risk of falling. Further assessment is recommended.
1.) Have you fallen in the past year?
2.) Are you afraid of falling?
3.) Do you have unsteadiness/balance problems?
If you have answered "yes" to any of these questions, you have a risk of falling. Further assessment is recommended.
General Health Questionnaire:
1.) Have you fallen in the past year? ❑ Yes ❑ No
2.) Are you afraid of falling? ❑ Yes ❑ No
3.) Do you use any assistive device to ambulate? ❑ Yes ❑ No
4.) Do you ever feel dizzy or lightheaded? ❑ Yes ❑ No
5.) Do you have trouble getting up from a chair? ❑ Yes ❑ No
6.) Do you have trouble stepping up or down curbs or steps? ❑ Yes ❑ No
7.) Do you need to steady yourself by leaning on someone/something? ❑ Yes ❑ No
8.) Do you see well: during the day/at night? ❑ Yes ❑ No
9.) Do you have Diabetes? ❑ Yes ❑ No
10.) Do you have blood pressure issues? ❑ Yes ❑ No
11.) Do you have arthritis/painful joints? ❑ Yes ❑ No
12.) Do you have Parkinson’s disease/had a stroke? ❑ Yes ❑ No
13. Do you have unsteadiness/balance problems? ❑ Yes ❑ No
14.) Do you take any medications? ❑ Yes ❑ No
15.) Have you had seizures in the past? ❑ Yes ❑ No
16.) Did you have hip replacement done in the past year? ❑ Yes ❑ No
1.) Have you fallen in the past year? ❑ Yes ❑ No
2.) Are you afraid of falling? ❑ Yes ❑ No
3.) Do you use any assistive device to ambulate? ❑ Yes ❑ No
4.) Do you ever feel dizzy or lightheaded? ❑ Yes ❑ No
5.) Do you have trouble getting up from a chair? ❑ Yes ❑ No
6.) Do you have trouble stepping up or down curbs or steps? ❑ Yes ❑ No
7.) Do you need to steady yourself by leaning on someone/something? ❑ Yes ❑ No
8.) Do you see well: during the day/at night? ❑ Yes ❑ No
9.) Do you have Diabetes? ❑ Yes ❑ No
10.) Do you have blood pressure issues? ❑ Yes ❑ No
11.) Do you have arthritis/painful joints? ❑ Yes ❑ No
12.) Do you have Parkinson’s disease/had a stroke? ❑ Yes ❑ No
13. Do you have unsteadiness/balance problems? ❑ Yes ❑ No
14.) Do you take any medications? ❑ Yes ❑ No
15.) Have you had seizures in the past? ❑ Yes ❑ No
16.) Did you have hip replacement done in the past year? ❑ Yes ❑ No
Consult an appropriate healthcare professional to resolve risk factors related to falls.