Is your loved one at a high risk for falls? Take this easy 10-question test to find out.
Fall Risk Checklist
Answer each question with “Yes” or “No” as it applies to your loved one:
1. Is the person you care for 65 or older? Yes ____ No ____
2. Does s/he have 3 or more current health issues that have been diagnosed by a doctor? Yes ____ No ____
3. Has s/he fallen in the past 3 months? Yes ____ No ____
4. Has s/he had any recent incontinence episodes? This includes both daytime and nighttime leakage, as well as trouble making it to the bathroom in time. Yes ____ No ____
5. Does the person you care for have vision problems? If s/he has a prescription for glasses or contacts, mark yes if they are not always worn around the house. Yes ____ No ____
6. Does s/he have any difficulty with day-to-day activities such as getting dressed, brushing teeth and hair, bathing, going to the bathroom, eating or preparing meals? This includes using a cane, walker or wheelchair to move around. Yes ____ No ____
7. Are there dimly lit areas, pets, clutter or other items in the home that can trip your loved one? This includes missing or dim light bulbs, lamp cords, medical equipment tubes, uneven floors or stairs, items that need a step stool to be retrieved, throw rugs and anything stacked on the floor or stairs. Yes ____ No ____
8. Does s/he take 4 or more prescription drugs? Yes ____ No ____
9. Does the person you care for experience any pain with movement? This includes both permanent pain with a specific movement, or pain that comes and goes. Yes ____ No ____
10. Does s/he have any issues with memory or confused thinking? This includes people who show symptoms of dementia or Alzheimer’s, who are easily confused, or who seem to have poor judgment or memory. Yes ____ No ____
Total Score: Yes ____ No ____
*If you answered “Yes” to 4 or more questions, your loved one has a high risk of falling.
Click here for ways you can reduce your loved one’s fall risk at home: Preventing Falls at Home: A Home Safety Checklist
Download our printable fall risk checklist in English here:
Download our printable fall risk checklist in Spanish here:
More Fall Prevention Resources:
- How to Help a Loved One After Falling: Step-by-Step Illustration
- Fall Prevention Webinar Video
- Preventing Falls at Home: A Safety Checklist
- Video: Fall Prevention Part II – Impact, Assessment and Hidden Risks
- National Fall Prevention Month
For additional caregiver resources and support, visit the Shield HealthCare Caregiver Community.
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