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Fall Risk Questionnaire

Twelve statements, about two minutes, and no equipment. This is the CDC’s own fall-risk screening questionnaire — the one handed to patients in clinic waiting rooms — and it’s the sensible place to start.

Unlike the other tools here, it asks nothing physical of you. You can do it sitting down, and you can do it on someone else’s behalf if you’re worried about a parent.

Fall Risk Questionnaire

Twelve statements. Answer yes or no to each one honestly — nobody sees this but you. It takes about two minutes, and at the end you’ll get a score plus a specific list of what to do about anything you flagged.

1 I have fallen in the past year.People who have fallen once are likely to fall again.
2 I use or have been told to use a cane or walker to get around safely.People who have been advised to use a walking aid may already be more likely to fall.
3 Sometimes I feel unsteady when I am walking.Unsteadiness or needing support while walking are signs of poor balance.
4 I steady myself by holding onto furniture when walking at home.This is also a sign of poor balance.
5 I am worried about falling.People who are worried about falling are more likely to fall.
6 I need to push with my hands to stand up from a chair.This is a sign of weak leg muscles, a major reason for falling.
7 I have some trouble stepping up onto a curb.This is also a sign of weak leg muscles.
8 I often have to rush to the toilet.Rushing to the bathroom, especially at night, increases your chance of falling.
9 I have lost some feeling in my feet.Numbness in your feet can cause stumbles and lead to falls.
10 I take medicine that sometimes makes me feel light-headed or more tired than usual.Side effects from medicines can sometimes increase your chance of falling.
11 I take medicine to help me sleep or improve my mood.These medicines can sometimes increase your chance of falling.
12 I often feel sad or depressed.Symptoms of depression, such as not feeling well or feeling slowed down, are linked to falls.

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Take this to your doctor. This questionnaire is the same screen used in clinics, and the whole point of it is to start a conversation. Print this page or write down your score and which statements you answered yes to.

This tool is educational and does not diagnose anything. Questions and scoring come from the CDC’s STEADI “Stay Independent” brochure. Nothing you enter here is saved or sent anywhere.

Answer honestly, not optimistically

This is the part that decides whether the result is worth anything.

Every statement on this list is one people routinely soften.

Sometimes I feel unsteady. I only hold the furniture occasionally. I could get out of the chair without pushing if I really tried. I’ve watched patients do this in front of me (especially with other family members present) with no consequence attached to the answer — the instinct to downplay is that strong.

Nobody sees this. It isn’t going in a file, it doesn’t get sent anywhere, and it can’t be used to take anything away from you.

The only thing an optimistic answer buys you is a less accurate result.

If you’re filling this in about a parent rather than yourself, the same warning applies in reverse — and it’s usually better to ask them the questions directly than to guess at the answers.

How the scoring works

Each statement you agree with adds points — most are worth one, and two of them are worth two, because a fall in the past year and having been advised to use a walking aid are the strongest single indicators on the list.

Four points or more means you’ve screened as being at increased fall risk.

That’s the CDC’s threshold, and in a clinic it would trigger a fuller assessment.

There’s one override worth knowing about: if you’ve fallen in the past year, you’re in the at-risk group regardless of your total.

Having fallen once is among the strongest predictors of falling again, and the screening algorithm treats it that way even when everything else looks fine.

What a score above 4 actually means

It means a conversation with your doctor is warranted.

It doesn’t mean you’re going to fall.

Screening tools sort people into “worth a closer look” and “not right now,” and they’re deliberately tuned to catch more people than will actually go on to fall — because missing someone is worse than an unnecessary check-up.

What makes this screen useful is what it asks about.

Look back over the twelve statements: leg strength, balance, medication side effects, sensation in the feet, bladder urgency, low mood. Nearly every one of those is treatable.

That’s the reason to screen — not to predict the future, but to find the specific, fixable things that are stacking the odds.

The tool gives you a personalized list of next steps for each statement you flagged. That list is the useful output, more than the number.

Take the result to your doctor

Print this page, or write down your score and which statements you answered yes to, and bring it to your next appointment.

Doctors are generally not able to raise fall risk unprompted in a fifteen-minute visit that’s already about something else.

Walking in with a completed screen and a number changes that — it turns a vague worry into an agenda item, and it’s probably the same screen they’d have used anyway.

Specific things worth asking for, depending on what you flagged: a medication review, a check of your blood pressure lying and standing, a vision test if it’s been over a year, vitamin D levels, and a referral to physical therapy for gait and balance training.

Then measure what a questionnaire can’t

A questionnaire records what you’ve noticed.

The performance tests measure what’s actually happening, and the two don’t always agree — people underestimate and overestimate themselves in roughly equal numbers.

Doing all four gives you and your doctor a great starting place.