Fall Risk Assessment

What is a fall risk assessment?

For older adults, falls can be dangerous: 1 in 5 falls causes a serious injury, such as broken bones or a head injury.

Many people assume that falls are a common or inevitable part of aging. But in many cases, you can prevent falls from happening. Healthcare providers use a fall risk assessment to identify your risk factors for falling and make helpful recommendations.

Why do you need a fall risk assessment?

Some people try to reduce their fall risk by limiting their activity or striving to be more careful. But these well-intentioned behaviors aren’t enough.

A fall risk assessment is important because knowing which factors increase your chances of falling helps you:

• Minimize your risk of falling or hurting yourself.
• Reduce your unique risks.
• Maximize your ability to move and be active.
• Maintain a healthy, independent life.

Who needs a fall risk assessment?

All adults 65 years and older should have an initial fall risk screening. Your healthcare provider might ask you whether you:

• Feel unsteady when standing or walking.
• Have fallen in the past year.
• Worry about falling.

If you answer yes to any of these questions, your healthcare provider will recommend an additional, more thorough evaluation.

How often should fall risk assessments be conducted?

According to practice guidelines from various organizations, you should have a fall risk assessment at least once a year. However, in some cases, your healthcare provider might recommend more frequent screenings.

What increases my risk of falling?

Many different conditions can increase your risk of falling, such as:

• Advanced age.
• Balance problems.
• Difficulty walking (gait disorders).
• Easily distracted (mild cognitive impairment).
• Heart palpitations.
• Low blood pressure (orthostatic hypotension) when standing up.
• Vision problems.

In addition, certain treatments, lifestyle habits and other factors can raise your risk as well:

• Home hazards, such as floor clutter, poor lighting and slippery rugs.
• Medications that make you dizzy, sleepy or unsteady, such as antidepressants, antipsychotics and benzodiazepines.
• Not enough vitamin D (vitamin D deficiency).
• Prior falls.
• Low level of physical activity.

What does a fall risk assessment include?

A fall risk assessment may include several steps.

Symptoms, history and medication review

Your healthcare provider may:

• Ask you to describe your previous falls, such as what caused the fall, what happened after the fall and whether you received medical treatment.
• Ask about your activity level and ability to perform daily tasks.
• Review the medications you’re taking to see if any increase your risk of falling.

Tests and follow-up care

Your provider may also:

• Check for low blood pressure and heart palpitations.
• Perform a physical exam using multiple tests.
• Order lab tests to check vitamin levels or a DEXA scan to check for osteoporosis.
• Refer you to an occupational therapist to identify potential hazards at home and other areas that could lead to falling.

What tests do healthcare providers use during a fall risk assessment?

Healthcare providers often use these fall risk assessment tools to test your balance, strength and pattern of walking (gait):

• 30-Second Chair Stand Test: Your healthcare provider asks you to sit in a chair with your arms crossed to prevent you from using your arms for support. Then they count the number of times you can stand up and sit down in 30 seconds.
• Four Stage Balance Test: You hold four different positions for 10 seconds each. Positions vary in difficulty with the fourth one involving standing on one foot.
• Timed Up & Go (TUG): You start by sitting in a chair with armrests. Next, you get up and walk 10 feet at your usual pace and return to the chair to sit down. If it takes you 12 seconds or more to complete this exercise, you likely have a high fall risk.
• Cognitive test: Your healthcare provider might also use a brief cognitive test to check for any problems with thinking.

What results should I expect from a fall risk assessment?

After you’ve completed your fall risk assessment, your healthcare provider will let you know whether you have a low or high risk of falling.

Even if you’re low risk, your healthcare provider may still make preventive recommendations.

What are common recommendations to lower fall risk?

Your healthcare provider might recommend that you:

• Get up slowly to prevent dizziness.
• Have an assistive device tailored to you, such as a cane that’s the correct fit for your height.
• Install grab bars in the bathroom.
• Switch medication or reduce the dose of any medications that increase fall risk.
• Take vitamin D supplements if you are vitamin deficient.
• Try group exercise classes geared toward older adults, such as Tai Chi.

Your provider may also recommend working with other healthcare professionals to keep you as healthy as possible, such as:

• Eye doctor to correct any vision problems or conditions (such as cataracts).
• Physical therapist to build strength and improve balance.
• Occupational therapists to improve your home environment, such as removing slippery rugs and adding handrails.

A note from Cleveland Clinic

Falls can be serious for any older adult. A fall risk assessment is the best way to address your risk factors. Reducing your risk of falling and getting hurt helps you lead a healthier, more independent life. Changes may include wearing the right shoes, taking a supplement and working with a physical therapist. If you’re 65 or older, talk to your healthcare provider about having a comprehensive fall risk assessment.