Level 9: Fall Risk Assessment Quiz

1. To get out of a chair, I need to push off with both arms

Yes

No

2. In the last year, I have fallen

Yes

No

3. My blood pressure or medication makes me feel sleepy or light-headed

Yes

No

4.

Yes

No

5. I have lost feeling (peripheral neuropathy) in one or both hands

Yes

No

6. When I walk, I lose my balance

Yes

No

7. I have been told to use a cane or walker

Yes

No

8. I stumble or look at the ground when I walk

Yes

No

9. When I am walking, I take short, narrow steps

Yes

No

10. When standing still, without holding onto anything, I sway

Yes

No