What Questions Are Asked at the Falls Screening? A Comprehensive Guide

According to the Centers for Disease Control and Prevention (CDC), more than one in four adults 65 and older fall each year. A crucial step in prevention is understanding what questions are asked at the falls screening, a process designed to identify and mitigate fall risks.

Quick Summary

Falls screening questions often cover fall history, feelings of unsteadiness, and worry about falling. Healthcare providers use these questions, along with physical tests, to pinpoint individual risk factors and craft effective prevention plans.

Key Points

• Three Key Questions: Initial screenings often focus on three core questions about recent fall history, unsteadiness, and fear of falling to identify potential risk.

• Medication Review is Crucial: A thorough assessment includes a detailed look at all medications and supplements, checking for side effects like dizziness that increase fall risk.

• Physical Performance is Assessed: Beyond questions, expect physical tests like the Timed Up-and-Go (TUG) to objectively evaluate your balance, gait, and mobility.

• Home Environment Matters: Questions will be asked about your living space, including potential hazards like poor lighting or loose rugs, to reduce environmental risks.

• Mental and Emotional Health Included: Screenings also address fear of falling and cognitive function, as these factors significantly influence balance and activity levels.

• Screening Leads to Action: A positive screening result initiates a personalized plan, which can include exercise programs, physical therapy, and home modifications to reduce your risk.

Understanding the Initial Screening Questions

The initial falls screening is typically a quick and straightforward process, often conducted during a routine annual wellness visit. The core of this screening is a set of simple yet powerful questions designed to quickly identify individuals who may be at a higher risk of falling. The CDC's STEADI (Stopping Elderly Accidents, Deaths & Injuries) initiative highlights three key questions that are central to this process.

These three foundational questions are:

1. Have you fallen in the past year? This question is a strong indicator of future risk. Studies have shown that a history of falling is one of the most reliable predictors of a future fall. If the answer is yes, a clinician will likely follow up with more detailed questions, such as the number of times you've fallen, if any injuries occurred, and the circumstances surrounding the incident.
2. Do you feel unsteady when standing or walking? Concerns about balance and stability are critical to a falls risk assessment. This question helps a healthcare provider understand a person's self-perception of their mobility. A positive answer indicates a need for further evaluation of balance and gait.
3. Are you worried about falling? A significant fear of falling can lead to a person restricting their activities, which can ironically increase their risk. By reducing physical activity, they may weaken their muscles and decrease their balance, creating a vicious cycle. Addressing this fear is an important part of a comprehensive fall prevention strategy.

The Deeper Dive: Comprehensive Assessment Questions

If the initial screening raises concerns, a more comprehensive fall risk assessment is necessary. This in-depth evaluation goes beyond the initial questions to explore a wider range of potential risk factors. The following sections cover the typical areas a provider will investigate.

Medications and Medical History

A provider will review your complete medical history and current medications, as many drugs can affect balance and increase fall risk. Questions may include:

• What medications, including over-the-counter drugs and supplements, are you currently taking?
• Do any of your medications cause dizziness, lightheadedness, or drowsiness?
• Do you have any chronic health conditions, such as diabetes, arthritis, or heart disease, that could impact your mobility?
• Have you experienced any changes in your blood pressure, especially when standing up?

Physical Performance Tests

Clinical assessments often include simple physical tests to objectively measure balance, strength, and gait. A provider will observe you performing various tasks, asking you to demonstrate mobility. These tests may include:

• Timed Up-and-Go (TUG) Test: You'll be asked to stand up from a chair, walk a short distance (usually 10 feet), turn around, walk back, and sit down again. The time it takes reveals a lot about your mobility and balance. The provider may ask, "Did you feel unsteady during this exercise?"
• 30-Second Chair Stand Test: This test measures leg strength and endurance. You will be asked to stand up and sit down as many times as you can in 30 seconds. The provider will ask, "Did you feel any weakness or instability?"
• 4-Stage Balance Test: This involves standing in progressively more difficult positions for 10 seconds each. The provider will ask, "How confident do you feel holding each of these positions?"

Lifestyle and Environmental Factors

Questions about your daily routine and home environment are crucial for identifying modifiable risk factors. A provider may ask:

• What are your daily activities like? Do you exercise regularly?
• Do you wear corrective lenses? When was your last eye exam?
• What kind of footwear do you wear most often?
• Are there any potential tripping hazards in your home, such as loose rugs or poor lighting?
• How often do you consume alcohol?

Cognitive and Psychological Assessment

Cognitive decline and psychological factors can also play a role in falls. The screening will often include questions to address these areas:

• Have you noticed any changes in your memory or ability to think clearly?
• Are you experiencing symptoms of depression or anxiety?
• How significant is your fear of falling?

Taking Action After the Screening

Following a falls screening, the healthcare provider will discuss your results and recommend a personalized prevention plan. This is an essential part of the process, as screening alone does not reduce fall risk. Interventions can range from physical therapy and exercise programs to medication adjustments and home safety modifications. It is a proactive step toward maintaining independence and quality of life. For more detailed information on preventing falls, you can consult resources such as the CDC's STEADI website, a trusted source for fall prevention strategies.

Comparison of Fall Risk Assessment Types

Assessment Type	What It Involves	Key Characteristics	Advantages	Disadvantages
Initial Screening	Asking a few key questions (past falls, unsteadiness, fear)	Quick, verbal or written questionnaire	Fast, easy to implement in any setting	Can miss subtle risk factors, reactive rather than proactive
Comprehensive Assessment	Detailed history, physical tests, medication review	Multi-faceted evaluation by a healthcare professional	Identifies specific risk factors, leads to personalized plan	More time-consuming, requires clinical setting
Home Safety Evaluation	On-site inspection of living space	Focus on environmental hazards (clutter, lighting)	Directly addresses environmental risks where most falls occur	Requires in-home visit, may not address underlying health
Physical Therapy Evaluation	Specialized tests for balance, gait, and strength	Performed by a trained physical therapist	Offers specific and targeted exercises for improvement	May not cover all medical or environmental aspects

The Path to Proactive Prevention

A falls screening is not just a list of questions; it is a critical opportunity to gather information that can significantly improve your safety and well-being. By answering honestly and engaging fully with your healthcare provider, you can transition from simply reacting to falls to proactively preventing them. The information gathered during a falls screening empowers you and your care team to develop a targeted strategy that addresses all facets of your unique fall risk profile, ensuring a safer and more independent future. Don't wait for a fall to happen; use the screening process as your starting point for robust prevention.

Frequently Asked Questions

What is the primary purpose of a falls screening?

The primary purpose of a falls screening is to quickly and effectively identify individuals who are at an increased risk of falling, allowing healthcare providers to recommend preventive measures before a fall occurs.

Who should get a falls screening?

All adults aged 65 and older should undergo a falls screening at least once a year, as recommended by organizations like the CDC, or anytime they express concern about falling or have had a recent fall.

How can I prepare for a falls screening?

To prepare for a falls screening, be ready to discuss any past falls, bring a list of all your medications, and be prepared to answer questions about your home environment and daily activities.

What happens if I'm identified as being at high risk during the screening?

If you are identified as high-risk, your healthcare provider will perform a more comprehensive assessment and develop a personalized intervention plan, which might include balance exercises, medication adjustments, or home safety recommendations.

Can certain medications increase my risk of falls?

Yes, many medications, including sedatives, antidepressants, and some blood pressure medications, can increase fall risk due to side effects like dizziness, drowsiness, or orthostatic hypotension.

Does being afraid of falling increase my risk of actually falling?

Yes, a fear of falling can lead to reduced physical activity, which weakens muscles and decreases balance, ironically increasing the risk of a fall. This is why a falls screening asks about your worry level.

Is a falls screening the same as a full assessment?

No, a falls screening is a brief, initial step. It is a set of simple questions to see if further investigation is needed. A full assessment is a much more detailed and comprehensive evaluation conducted if the screening indicates a higher risk.