Free Fall Screen for Older Adults

Powered by: Fall-Proof Seniors

Falls are a leading cause of injury and death among older adults. As we age, our risk of falling increases due to a variety of modifiable and unmodifiable factors. That’s why it’s important to regularly assess your fall risk and take steps to prevent falls. Our free fall screening questionnaire is a quick and handy way for older adults to determine their fall risk. This questionnaire, endorsed by the CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) campaign, is designed to identify your overall risk for falls and is supplemented with clinical guidance on how to proceed. Take the first step in protecting yourself from falls by completing our free fall screening questionnaire today.

Click “Yes” or “No” for each statement below.

1. I have fallen in the past year Yes No 2. I use or have been advised to use a cane or walker to get around safely Yes No 3. Sometimes I feel unsteady when I am walking. Yes No 4. I steady myself by holding onto furniture when walking at home. Yes No 5. I am worried about falling. Yes No 6. I need to push with my hands to stand up from a chair. Yes No 7. I have some trouble stepping up onto a curb. Yes No 8. I often have to rush to the toilet. Yes No 9. I have lost some feeling in my feet. Yes No 10. I take medicine that sometimes makes me feel light-headed or more tired than usual. Yes No 11. I take medicine to help me sleep or improve my mood. Yes No 12. I often feel sad or depressed. Yes No

This fall screen is adapted from the CDC STEADI fall screening protocol and the Stay Independent Questionnaire. (Rubenstein et al. J Safety Res;
2011: 42(6)493-499). To accurately account for fall risk, if question 1 is answered “yes” then moderate or high fall risk will always be calculated.