Fall Risk Assessment Tool

Current risk of the subject: Unknown

Health profile of the subject:

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

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