Fall Prevention –Developing a Fall Risk Questionnaire – Part IV

Alan Desmond
August 9, 2011

In an effort to quickly identify potential risk factors, I developed a fall risk questionnaire several years ago that I use routinely in my practice.( A copy of the questionnaire and accompanying “Physician’s Guide will be posted next week). The Fall Risk Questionnaire is a 15 item checklist to be filled out by the patient prior to examination. This allows me a quick review of potential problems that may be affecting the patients balance, but would not be uncovered by standard vestibular evaluation.

The questions are answered in a “Yes/No” format, and a ‘Yes” answer indicates the need for further questioning or examination. In sequential order, the questions inquire about:

Questions 1 and 2: History of or fear of falling

Questions 3, 4 and 5: Symptoms suggestive of vestibular dysfunction

Question 5 and 6: Symptoms suggestive of somatosensory loss and/or peripheral neuropathy of the lower extremities*

Question 7: History of visual problems known to increase fall risk

Question 8: Symptoms suggestive of orthostatic intolerance

Question 9 and 10: Use of medications

Question 11 and 12: Symptoms suggestive of poor motor control or cerebellar dysfunction

Question 13: Information regarding active versus sedate lifestyle

Question 14: Opens the door to discussion of patients emotional state, possibility of depression

Question 15: Provides insight as to patient’s motivation level and plants the seed that there may be some work involved in reducing fall risk.

*Question 5 –Difficulty walking in the dark can be the result of either vestibular or somatosensory loss.  In the dark, you lose one of the three inputs for balance.  Most people will maintain stability if they still have two functional inputs.  However, if they have reduced vision AND reduced somatosensation, or reduced vision AND reduced vestibular function, they now have two factors that can lead to a loss of balance.  Question 5 can apply to decreased vestibular OR decreased somatosensory input. Next week I will provide a copy of the questionnaire and Physician’s Guide.



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