Fall Prevention, Part V – Desmond Fall Risk Questionnaire: a fifteen-item self-assessment designed to identify common risk factors for falling, and a physician’s guide with suggestions for management.
Fall Risk Questionnaire and Physician Guide
Desmond Fall Risk Questionnaire
Please answer all questions
Name __________________________Date ________________
1. ___Yes / No___ Have you had a fall or near fall in the past year?
2. ___Yes / No___ Do you have a fear of falling that restricts your activity?
3 ___Yes / No___ Do you experience dizziness or a sensation of spinning when you lie down, tilt your head back, or roll over in bed?
4. ___Yes / No___ Do you feel uneasy or unsteady when walking down the aisle of a supermarket or in an area congested with other people?
5. ___Yes / No___ Do your feet or toes frequently feel unusually hot or cold, numb or tingly?
6. ___Yes / No___ Do you wear bifocal or trifocal glasses, or is your vision notably better in one eye?
7. ___Yes / No___ Do you experience loss of balance, or a lightheaded/faintfeeling when you stand up?
8. ___Yes / No___ Do you take medication for depression, anxiety, nerves, sleep or pain?
9. ___Yes / No___ Do you take four or more prescription medications daily?
10. ___Yes / No___ Do you feel like your feet just won’t go where you them to go?
12. ___Yes / No___ Do you feel like you can’t walk a straight line, or are pulled to the side while walking?
13. ___Yes / No___ Has it been longer than six months since you participated in a regular exercise program?
14. ___Yes / No___ Do you feel that no one really understands how much dizziness and balance problems affect your quality of life?
15. ___Yes / No___ Are you interested in improving your balance and mobility?
Physicians Guide to the Desmond Fall Risk Questionnaire
Question # 1 and #2: A previous fall may indicate increased risk for future falls. Inquire as to the circumstances of the fall. Fear of falling can lead to restricted activity
Questions #3, #4 and #5: A positive response to any of these questions indicates the possibility of a vestibular disorder. Patients with Benign Paroxysmal Positional Vertigo (BPPV) are at risk for falling if they tilt their head back. Patients with vestibular disorders tend to be more reliant on vision for postural control. When the visual feedback is unreliable (moving visual scene) or unavailable (dark) they are at risk for loss of balance and falling. Vestibular evaluation may be indicated (e.g., ENG, Posturography, Rotary Test).
Questions #5 and #6: The sense of touch is an important contributor to balance and orientation. The stretch receptors in the legs, the fingertips, and the soles of the feet, all provide sensory feedback for balance. An assessment for peripheral neuropathy may be indicated.
Question #7: Vision plays an important role in balance, and patients with visual deficits have greater risk for falls. Visual problems associated with decreased postural stability include: 1.) visual acuity less than 20/50, 2.) asymmetric vision impairing binocular vision and depth perception, 3.) slow pupillary reaction causing increased adaptation time when going from a lighted to a dark room, and vice versa, and 4.) impaired peripheral vision.
Multifocal glasses have been shown to increase the risk of falling (Lord et al, 2002). Ophthalmology evaluation may be indicated.
Question #8: Orthostatic hypotension may result in an increased risk of falling when assuming the upright position. Diabetes and many medications used to regulate heart rate and blood pressure can lead to orthostatic hypotension.
Question #9 and #10: The use of four or more daily prescription medications or the uses of tri-cyclic anti-depressants and/or benzodiazapines are associated with increased risk for falls (Tinnetti et al, 1994).
Questions #11 and #12: Poor motor control is a sign of possible cerebellar dysfunction. The integration of vestibular, visual and somatosensory information takes place in the cerebellum. Cerebellar dysfunction can result in slow or inappropriate reaction to self movement or external visual stimuli.
Question #13: Inactive patients may have accelerated decrease in muscle mass and decreased reaction time when faced with a possible fall
Question #14: Physicians often underestimate (compared to the patient) the impact that a balance problem has on the patient’s quality of life (Honrubia et al, 1996).
Question #15: Therapy for improved balance requires motivation and commitment. Patient compliance is important to a successful fall prevention program.