Staying Independent Screener

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Staying Independent Screener

Check Your Risk of Falling

Falls are the main reason older adults lose their independence. This self-assessment is designed to identify your fall risk while also helping you understand the factors that contribute to an increased likelihood of falling.

^*I have fallen in the last 6 months.

A person who has already fallen is at greater risk of falling again.

Yes

No

^*I use or have been advised to use a cane or walker to get around safely.

A person who uses or has been advised to use a cane or walker is more vulnerable to falls.

Yes

No

^*Sometimes I feel unsteady when I am walking.

Unsteadiness or needing support while walking are signs of poor balance.

Yes

No

^*I am worried about falling.

Knowing how to prevent a fall can reduce your risk of falling or being injured.

Yes

No

^*I need to push with my hands to stand up from a chair.

Needing help to rise from a chair may indicate weak leg muscles, a key risk factor for falls.

Yes

No

^*I have trouble stepping up onto a curb.

Trouble stepping up onto the sidewalk can be a sign of poor balance and strength.

Yes

No

^*I often have to rush to the toilet.

Rushing to the toilet, especially at night, increases your risk of falling.

Yes

No

^*I've lost some feeling in my feet.

Loss of feeling or numbness in your feet can make you trip and fall.

Yes

No

^*I take medication that sometimes makes me feel light-headed or more tired than usual.

Side effects of some medications can increase your fall risk.

Yes

No

^*I take medication to help me sleep or improve my mood.

Sleep or mood medications can make you feel dizzy or sleepy, which can increase your risk of falling.

Yes

No

^*I often feel sad or depressed.

Not feeling well, moving less, or feeling less alert can increase your risk of falling.

Yes

No

Results

Your score:

If you scored 4 points or more on the screener, you may be at risk of falling.

Talk to your doctor or another health care provider to explore ways to reduce your risk. Understanding your fall risk can help you take steps to protect your health and maintain your independence.

To help improve your strength and balance:

This checklist was developed by the Greater Los Angeles VA Geriatric Research Education Clinical Center and affiliates and is a validated fall risk self-assessment tool (Rubenstein et al. J Safety Res; vol. 42, n°6, 2011, p. 493-499). Adapted with permission of the authors.

Prefer to complete this screener on paper? Click here to download a blank copy (PDF).