Are You At Risk For A Fall?

Please read the following questions and answer them by checking Yes or No.


Healthy Vision Checklist
  Have you ever fallen before?
       Yes
       No
  Are you 65 or over?
       Yes
       No
  Do you experience difficulty or dizziness when getting up from a chair?
       Yes
       No
  Are you unsteady with quick turns or on uneven ground?
       Yes
       No
  Do you feel unsteady reaching for objects overhead or on the ground?
       Yes
       No
  Have you noticed a decline in your vision or hearing?
       Yes
       No
  Do you have weak muscles or stiff joints?
       Yes
       No
  Do you have any condition that affects feeling in your feet or ankles?
       Yes
       No
  Are you on four or more medications?
       Yes
       No
  Do you frequently drink alcohol?
       Yes
       No
  Do you experience difficulty sleeping?
       Yes
       No
  Are there hazards in or around your home?
       Yes
       No
  Have you had a recent illness or injury that has caused a lifestyle change?
       Yes
       No
  Have you been diagnosed with any chronic neurological condition or other serious medical problems?
       Yes
       No

The more “Yes” answers you have above, the greater your risk for a fall. But you can take control of your environment, health and lifestyle to lower that risk and stay safe. In this booklet, you will find many suggestions for becoming more health conscious and making your home safer so that you and your loved ones can stay vital, independent and on your feet!



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