Alabama Bone & Joint Clinic Fall Risk Assessment
This file is a fall risk assessment form developed by the Greater Los Angeles VA Geriatric Research Education Clinical Center. It includes questions to help determine an individual's fall risk based on their medical history and current health status. Users should discuss their results with their doctor.
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How do I fill this out?
To fill out this form, answer each question honestly based on your experiences over the past year. Tick 'Yes' or 'No' for each question. Discuss your results with your doctor if you answer 'Yes' to four or more questions.
How to fill out the Alabama Bone & Joint Clinic Fall Risk Assessment?
1
Read each question carefully.
2
Answer 'Yes' or 'No' based on your experiences from the past year.
3
Tick the appropriate box for each question.
4
Review your answers.
5
Discuss your results with your doctor if necessary.
Who needs the Alabama Bone & Joint Clinic Fall Risk Assessment?
1
Elderly individuals to assess their fall risk.
2
Patients recovering from surgery who may have balance issues.
3
Individuals with chronic conditions affecting mobility.
4
Doctors who need to evaluate patient fall risks.
5
Caregivers assessing the fall risk of those they care for.
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What are the instructions for submitting this form?
Submit the completed form to your doctor via their provided email address or fax number. Alternatively, you can bring the form to your next appointment for a thorough discussion. For some practices, online submission forms may also be available; check with your healthcare provider.
What are the important dates for this form in 2024 and 2025?
This form can be utilized at any time during 2024 and 2025 for fall risk assessment.
What is the purpose of this form?
The purpose of this form is to help evaluate an individual's risk of falling based on their past experiences and current health conditions. It is particularly useful for elderly individuals or those with conditions affecting their mobility. By filling out this form, you can better understand your fall risk and take necessary precautions to prevent falls.
Tell me about this form and its components and fields line-by-line.
- 1. Has Fallen in Past Year: Indicates if the individual has had a fall in the past year.
- 2. Uses Cane or Walker: Indicates if the individual uses any walking aids.
- 3. Feels Unsteady: Indicates if the individual feels unsteady while walking.
- 4. Holds onto Furniture: Indicates if the individual holds onto furniture for support while walking.
- 5. Worried About Falling: Indicates if the individual is worried about falling.
- 6. Needs Hand Assistance to Stand: Indicates if the individual needs to push with hands to stand up.
- 7. Trouble Stepping onto a Curb: Indicates if the individual has difficulty stepping up onto a curb.
- 8. Rushes to Toilet: Indicates if the individual often rushes to the toilet.
- 9. Lost Feeling in Feet: Indicates if the individual has numbness in their feet.
- 10. Medicine Light-headed or Tired: Indicates if medicines make the individual feel light-headed or tired.
- 11. Medicine for Sleep or Mood: Indicates if the individual takes medicine for sleep or mood.
- 12. Feels Sad or Depressed: Indicates if the individual often feels sad or depressed.
What happens if I fail to submit this form?
Failing to submit this form may result in an incomplete assessment of fall risk. This can hinder taking precautionary measures to prevent falls.
- Missed Risk Evaluation: Failing to assess fall risks properly can result in missed opportunities to address and prevent potential falls.
- Delayed Medical Advice: Not submitting this form may delay getting the necessary medical advice and intervention.
How do I know when to use this form?
- 1. Post-Surgery Assessment: Use this form to assess fall risk after surgery.
- 2. Annual Check-up: Include this form in annual health check-ups for elderly patients.
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