Fall Risk Assessment Tool

Current risk of the subject: Unknown

Health profile of the subject:

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

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