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Fall Risk Questionnaire: CDC Stay Independent

This CDC self-assessment is for adults 65 and older. Prior falls and changes involving balance, strength, walking, sensation, medicines, urgency, or mood can identify topics worth discussing with a healthcare professional.

Answer all 12 questions

Choose Yes or No for each statement.

0 of 12 answered
  1. I have fallen in the past year.
  2. I use or have been advised to use a cane or walker to get around safely.
  3. Sometimes I feel unsteady when I am walking.
  4. I steady myself by holding onto furniture when walking at home.
  5. I am worried about falling.
  6. I need to push with my hands to stand up from a chair.
  7. I have some trouble stepping up onto a curb.
  8. I often have to rush to the toilet.
  9. I have lost some feeling in my feet.
  10. I take medicine that sometimes makes me feel light-headed or more tired than usual.
  11. I take medicine to help me sleep or improve my mood.
  12. I often feel sad or depressed.
Screening result
Incomplete

Answer every question to see a score and screening interpretation.

    CDC Stay Independent screening record. Educational result; not a diagnosis or prediction.

    Understanding this screening

    The score ranges from 0 to 14. A score of 4 or more meets the CDC brochure’s screening threshold. The CDC STEADI algorithm also treats a reported fall as a reason for further assessment, even when the questionnaire score is below 4.

    A Yes answer identifies something worth discussing; it does not prove the underlying cause described in the brochure. This screening does not diagnose a condition, calculate the probability of a future fall, or label anyone safe or unsafe.

    Useful next steps

    • Discuss the completed result with a healthcare professional.
    • Do not start, stop, or change a medicine based only on this questionnaire; discuss medicine concerns with a qualified healthcare professional.
    • Use the Four-Stage Balance Test and Timed Up & Go only as separate physical assessments with an assistant nearby.

    Sources and resources