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Fall risk – the short self-check

Self-check

Fall risk – the short self-check

Twelve statements, two minutes: how likely are you to fall?

Tick what applies to you. At the end you will see your score with a short explanation – and you can print a report or save it as a PDF to take to your next appointment.

Everything is worked out on your own device. Your answers are not stored anywhere and are not sent anywhere – not even to us.

The questionnaire comes from the US Centers for Disease Control and Prevention (STEADI programme). The statements below are the original wording.

  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

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