Are you worried that your loved one might be a fall risk? This quiz can help you evaluate their needs. If you answer "yes" to four or more questions, please contact your primary care provider and request an assessment by a physical therapist to prevent falls. If you wish to learn more about our center activities, please contact us at  +1 (703) 246-8743 TTY 711 for further information.

General Questions

1. Has your loved one fallen in the past year?
2. Does your loved one feel unsteady when standing or walking?
3. Is your loved one worried or afraid of falling?
4. Does your loved one live alone?
5. Does your loved one have more than one chronic condition (e.g. diabetes, hypertension, cardiac problems, arthritis, Parkinson’s, stroke, dementia)?

Does your loved one suffer from any of the following issues:

1. Pain 
2. Depression 
3. Incontinence 
4. Dizziness when changing positions (e.g. sitting to standing) 
5. Osteoporosis 
6. Does your loved one have ankle or foot problems (e.g. decreased sensation in feet, foot deformities such as hammertoe, uneven legs)?

Vision and Hearing

1. Does your loved one have vision problems (e.g. decline in visual acuity, altered depth perception, decreased night vision, decreased peripheral vision)?
2. Do they wear bifocals?
3. Do they clean their lenses every day?
4. Does your loved one have hearing problems?
5. Do they wear hearing aids? Do they change their batteries frequently?

Muscle strength and balance

1. Do they have difficulty rising from a chair? Do they need assistance?
2. Do they have difficulty walking? Does s/he need to hold onto furniture, seem unsteady on their feet or need to lean on you?
3. Do they need help going up the stairs?
4. Do they need support getting in and out of the tub and/or up from the toilet?
5. Do they use a cane, walker or wheelchair?

Medications

1. Does your loved take more than four prescribed medications?
2. Does your loved one take over the counter medications? 
3. Does your loved one take a Vitamin D supplement?
4. Does your loved one take other supplements?

Home hazards

1. Is your loved one’s home clutter free?
2. Are there throw rugs in the home?
3. Are there grab bars in the bathroom?
4. Do stairs have handrails and are lights installed on all staircases?
5. Does the house have adequate lights? 
6. Are kitchen cupboards within reach?
7. Does your loved one use a stool or ladder to reach cupboards?

SOURCE: Questions are a compilation of items on various STEADI brochures and A CDC Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults, 2015