Your risk of falling, from the CDC "Stay Independent" check.
Please circle "Yes" or "No" for each statement below.
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.
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Stay Independent, CDC STEADI. Developed by the Greater Los Angeles VA Geriatric Research Education Clinical Center and affiliates; a validated fall risk self-assessment tool (Rubenstein et al., J Safety Res 2011;42(6):493-499).
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