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La Crosse Stop Falls

 

La Crosse County
300 4th Street North
La Crosse, WI 54601
608.785.5700

 

La Crosse Stop Falls

Assess Your Risk

Assess your risk of falling by completing the quiz below. Read each statement and circle the number that corresponds with "YES" or "NO" for each. When complete, add up the number of points. If you score four points or more, you may be at risk of falling. Discuss this quiz with your healthcare provider.


  1. I have fallen in the last six months.

Why It Matters: People who have fallen once are likely to fall again.

YES

NO

20
  1. I use or have been advised to use a cane or walker to get around safely.

Why It Matters: People who have been advised to use a cane or walker may already be more likely to fall.

YES

NO

20
  1. Sometimes I feel unsteady when walking.

Why It Matters: Unsteadiness or needing support while walking are signs of poor balance.

 

YES

NO

10
  1. I steady myself by holding onto furniture when walking at home.

Why It Matters: This is also a sign of poor balance.

 

YES

NO

10
  1. I am worried about falling.

Why It Matters: People who are worried about falling are more likely to fall.

 

YES

NO

10
  1. I need to push with my hands to stand up from a chair.

Why It Matters: This is a sign of weak leg muscles, a major reason for falling.

 

YES

NO

10
  1. I have some trouble stepping up onto a curb.

Why It Matters: This is also a sign of weak leg muscles.

 

YES

NO

10
  1. I often have to rush to the toilet.

Why It Matters: Rushing to the bathroom, especially at night, increases your chance of falling.

 

YES

NO

10
  1. I have lost some feeling in my feet.

Why It Matters: Numbness in your feet can cause stumbles and lead to falls.

 

YES

NO

10
  1. I take medicine that sometimes makes me lightheaded or more tired than usual.

Why It Matters: Side effects from medicines can sometimes increase your chance of falling.

 

YES

NO

10
  1. I take medicine to help me sleep or improve my mood.

Why It Matters: These medicines can sometimes increase your chance of falling.

 

YES

NO

10
  1. I often feel sad or depressed.

Why It Matters: Symptoms of depression, such as not feeling well or feeling slowed down, are linked to falls.

 

YES

NO

10
TOTAL:
 

 

Add up the number of points. If you scored four points or more, you may be at risk of falling. Be sure to discuss this quiz with your healthcare provider.

To print a copy of this assessment, click here.