Fall Risk Self-Check

How many times have you fallen in the past 12 months?

I was injured in a fall and needed medical care

I have reduced activity because I am afraid of falling

I take sleeping pills, sedatives, or anti-anxiety medication

I take blood pressure medication or diuretics

I take 5 or more medications a day

I drink alcohol 3 or more times a week

I often feel dizzy

I feel faint or my vision blurs when standing up

Poor vision makes thresholds or stairs hard to see

I wear multifocal or progressive lenses

I use a cane, walker, or other mobility aid

I need to push with my arms or feel unsteady when standing up

Climbing stairs is difficult for me

My legs feel weak or I cannot stand for long

I do not walk or exercise at least twice a week

The bathroom floor is slippery with no anti-slip mat

There are trip-prone thresholds between rooms

There is no grab bar in the bathroom or beside the toilet

The path to the bathroom is dark at night

Cords, rugs, or clutter are on the floor

Stairs or the entrance have no handrail