La Crosse Falls Prevention

Assess Your Risk

Assess your risk of falling by completing the quiz below. Read each statement and circle the number that corresponds with "YES" or "NO" for each. When complete, add up the number of points. If you score four points or more, you may be at risk of falling. Discuss this quiz with your healthcare provider.

I have fallen in the last six months. Why It Matters: People who have fallen once are likely to fall again.	YES	NO
	2	0
I use or have been advised to use a cane or walker to get around safely. Why It Matters: People who have been advised to use a cane or walker may already be more likely to fall.	YES	NO
	2	0
Sometimes I feel unsteady when walking. Why It Matters: Unsteadiness or needing support while walking are signs of poor balance.	YES	NO
	1	0
I steady myself by holding onto furniture when walking at home. Why It Matters: This is also a sign of poor balance.	YES	NO
	1	0
I am worried about falling. Why It Matters: People who are worried about falling are more likely to fall.	YES	NO
	1	0
I need to push with my hands to stand up from a chair. Why It Matters: This is a sign of weak leg muscles, a major reason for falling.	YES	NO
	1	0
I have some trouble stepping up onto a curb. Why It Matters: This is also a sign of weak leg muscles.	YES	NO
	1	0
I often have to rush to the toilet. Why It Matters: Rushing to the bathroom, especially at night, increases your chance of falling.	YES	NO
	1	0
I have lost some feeling in my feet. Why It Matters: Numbness in your feet can cause stumbles and lead to falls.	YES	NO
	1	0
I take medicine that sometimes makes me lightheaded or more tired than usual. Why It Matters: Side effects from medicines can sometimes increase your chance of falling.	YES	NO
	1	0
I take medicine to help me sleep or improve my mood. Why It Matters: These medicines can sometimes increase your chance of falling.	YES	NO
	1	0
I often feel sad or depressed. Why It Matters: Symptoms of depression, such as not feeling well or feeling slowed down, are linked to falls.	YES	NO
	1	0
TOTAL:

Add up the number of points. If you scored four points or more, you may be at risk of falling. Be sure to discuss this quiz with your healthcare provider.

To print a copy of this assessment, click here.