Fall Risk

From Patient Determinants
Revision as of 09:29, 8 June 2015 by Admin (Talk | contribs)

Jump to: navigation, search

This is a Fall Risk Questionnaire to determine the risk for falls. With a score 4 points or higher, there may be a risk for falling.

Return to the CDC Health Risk Assessments or Patient Well-Being Assessment

Why it matters
1. I have fallen in the last 12 months Yes (2) No (0) 3
2. I use or have been advised to use a cane or walker to get around safely Yes (2) No (0) 3
3. Sometimes I feel unsteady when I am walking Yes (1) No (0) 3
4. I steady myself by holding onto furniture when walking at home Yes (1) No (0) 3
5. I am worried about falling Yes (1) No (0) 3
6. I need to push with my hands to stand up from a chair Yes (1) No (0) 3
7. I have trouble stepping up onto a curb Yes (1) No (0) 3
8. I often have to rush to the toilet Yes (1) No (0) 3
9. I have lost some feeling in my feet Yes (1) No (0) 3
10. I take medicine that sometimes makes me feel light-headed or more tired than usual Yes (1) No (0) 3
11. I take medicine to help me sleep or improve my mood Yes (1) No (0) 3
12. I often feel sad or depressed Yes (1) No (0) 3
_____
Add up the number of points for each "yes" answer. If the score is 4 or more, there may be a risk for falling. (Total Score)

If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?
□ Not difficult at all
□ Somewhat difficult
□ Very difficult
□ Extremely difficult

Interpreting PHQ-9 Scores

Diagnosis Total Score For Score Suggested Action
Minimal depression 0-4 ≤ 4 The score suggests the patient may not need depression treatment
Mild depression
Moderate depression
5-9
10-14
5-14 Physician uses clinical judgement about treatment, based on patient's duration of symptoms and functional impairment
Moderately severe depression
Severe depression
15-19
20-27
> 14 Warrants treatment for depression, using antidepressant, psychotherapy and/or combination of treatment

The PHQ-9 is described in more detail at the Pfizer website.