1 Fall-Risk Assessment
Learn how to use fall-risk screening, focused assessment, and combined findings to identify concerns and guide individualized clinical follow-up.
Fall-risk assessment: and follow-up
Fall-risk assessment combines a quick check for possible risk with a closer evaluation of specific risk factors. A positive screen is a reason to assess further, not a prediction that a fall will occur. Interpret findings together and in the context of the person’s usual function.
questions and checklist results
For older adults, the questions ask whether the person has fallen in the past year, feels unsteady when standing or walking, or is worried about falling. A “yes” to any question indicates increased risk and calls for a ; the screen alone is not a complete assessment.
The flags risk at a score of or higher. Assess the specific factors contributing to the score and the person’s fall history. A reported fall still warrants attention even when the checklist score is lower.
Fall history and mobility
Ask how many falls occurred and explore when and where each happened, what the person was doing, whether there was an injury, and what happened immediately beforehand. Fall circumstances can point to areas for further assessment. For example, repeated falls while walking to the bathroom at night may make mobility, vision, toileting needs, or environmental conditions relevant to explore.
Assess gait, strength, and balance, including functional observations and performance on mobility tests. In the , the person stands, walks, turns, returns, and sits. A time of seconds or longer indicates increased fall risk in CDC materials. Observe gait, balance, turning, and use of any walking aid, and interpret the result alongside the person’s history and other findings.
Positional symptoms and blood pressure
Ask about symptoms when changing position and assess blood pressure in the relevant positions. In the example, blood pressure changes from mm Hg systolic and mm Hg diastolic after lying down to mm Hg systolic and mm Hg diastolic after standing; the person also reports dizziness. The systolic pressure has dropped by mm Hg, making this an abnormal orthostatic finding associated with increased fall risk.
Record symptoms and measurements, and communicate the finding for clinical follow-up. The CDC measurement procedure includes readings after lying for minutes and after standing for and minutes.
Medication and other assessment factors
Review prescription and nonprescription medicines and note effects relevant to fall risk, including sedation, dizziness, confusion, or low blood pressure. Sleep medication and opioid use alongside daytime drowsiness are findings to consider in the assessment. Medication changes require review by the prescriber or pharmacist; identifying a possible risk is not a reason to stop a medicine independently.
The also considers vision, feet and footwear, and relevant health conditions. The assessment identifies areas of concern rather than establishing that a particular factor caused a fall.
Interpreting findings together
Interpret the number and circumstances of falls, observed mobility, balance, symptoms, measurements, medication effects, and health conditions together. A fall history is meaningful, but it is only one part of the assessment. For example, short, shuffling steps, steadying oneself on a wall, and not using a prescribed walking aid are concerning findings even when no prior falls are reported.
A normal finding in one area does not cancel a concerning finding in another. Use the combined findings and the person’s usual function to guide individualized follow-up.