Fall Risk Assessment Tool

Current risk of the subject: Unknown

Health profile of the subject:

Does the subject use sedatives?
Does the subject suffer rheumatic disease?
Does the subject suffer any pain?
Dizziness or unsteadiness last year?
Does the subject use antiepileptics?
History of previous falls?
Urinary incontinence last year?
Is the subject female?
History of previous strokes?
Diabetes blood glucose 126?
Does the subject live alone?
Does the subject use a walking aid?
Does the subject use antihypertensives?
Fear of falling (Deshpande)?
Does the subject suffer Parkinson?
Revised Walking Subscore:
How does the subject feel:
MMSE score:
Number of ADL disabilities (0-6):
Hearing impairment?:
Subject's number of IADL:
Visual acuity (3 meter):
Visual stereognosis:
Number of drugs used by the subject:
physical activity level:
Contrast sensitivity?:

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