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    Fall Risk Self-Assessment

    12 yes/no questions adapted from the CDC STEADI fall risk tool. Honest answers give the most useful result.

    1.Have you fallen in the last year?

    2.Do you ever feel unsteady when standing or walking?

    3.Do you have to hold furniture when walking at home?

    4.Are you worried about falling?

    5.Do you have trouble stepping up onto a curb?

    6.Have you stopped some activities (like going out alone) because you might fall?

    7.Has your vision gotten worse in the last year?

    8.Are you taking 4 or more medications?

    9.Do you live alone?

    10.Are there any throw rugs in your walking paths?

    11.Are there dim or burned-out lights in stairwells or hallways?

    12.Is there a grab bar by the toilet and in the shower?

    0 of 12 answered