We recently wrote about why every client needs a falls risk assessment and management plan, and why “call an ambulance” isn’t a plan at all. But before a plan can be built, the risk has to be identified. That’s often the hardest part, and a falls risk screening tool gives you a quick, consistent way to start.
Falls risk in a community-dwelling neurological client isn’t always obvious. It doesn’t always look like a limp, a stick, or a visible wobble. Sometimes the signs are far more subtle, and easy to miss in a review meeting or a routine check-in.
Watch the task, not just the walk
Balance should be automatic and subconscious. When a client has to actively concentrate on staying upright, they’re spending cognitive bandwidth that should be going elsewhere. A simple tell: can they talk and walk at the same time? Clients managing a genuine balance problem often go quiet when walking, or stop walking altogether to answer a question. That pause is a warning sign, not good manners.
Watch the environment, not just the home
A client managing well at home, in a familiar layout they’ve adapted to, tells you very little about how they’ll cope in the community. Supermarkets, leisure centres, garden centres, allotments, car parks, cinemas, pubs, clubs and festivals are all part of genuine independence. Every one of them presents a different, less predictable set of demands than the home environment a client has already mastered.
It’s also worth being cautious about reading too much into a clean falls history. No fall in the past year doesn’t mean no risk, particularly for clients who have, consciously or not, already started avoiding the situations that would expose it.
Know the risk factors that are easy to overlook
Alongside the obvious balance and mobility issues, several less obvious factors raise falls risk substantially and are worth asking about directly:
- Wearing glasses or a hearing aid
- Being on medications that affect alertness or blood pressure
- Urgency incontinence, particularly at night or in dim conditions
- A previous fall combined with a fear of falling, which increases risk more than either factor alone
A 12-question falls risk screening tool
If you want a quick, structured way to flag risk with a client or their support team, this checklist is a useful starting point. It is adapted from the CDC’s STEADI “Stay Independent” checklist.
| Statement | Yes | No |
| I’ve fallen in the past year | ||
| I use or have been advised to use a walking stick or frame for safety | ||
| I sometimes feel unsteady when walking | ||
| I hold onto furniture to steady myself when walking at home | ||
| I am worried about falling | ||
| I need to use my hands to push to stand up from a chair | ||
| I have some trouble stepping up onto a kerb | ||
| I often have to rush to the toilet | ||
| I have lost some feeling in my feet | ||
| I take medicine that sometimes makes me feel light-headed or more tired than usual | ||
| I take medicine to help me sleep or improve my mood | ||
| I often feel sad or depressed |
Scoring: four or more “yes” answers indicate the client is at risk of falls. Fewer than four “yes” answers, but a fall within the past year, also indicates risk. A single confirmed fall overrides a lower score elsewhere.
A simple physical test
Alongside the questionnaire, the 30-second chair stand test gives you an objective measure of leg strength and endurance. Use a sturdy dining chair without arms and ask the client to fold their arms across their chest. Count how many full stands they complete in 30 seconds. If they need to push up with their hands, score zero.
A below-average score for their age and sex indicates an increased risk of falling. For example, that means fewer than 12 stands for a man aged 70 to 74, or fewer than 10 for a woman of the same age. The full age and sex reference scores, plus the test protocol, are on Physiopedia.
The published reference scores start at age 60, but the test is just as useful with younger clients. In our clinical view, a score of fewer than 12 in a younger person is very significant. It suggests that something other than age is affecting their balance, and it should be taken seriously and followed up with a full clinical assessment.
Why this matters
A falls risk screening tool isn’t a substitute for full clinical assessment. But it gives you, as the case manager, a quick and consistent way to flag when that fuller assessment is needed, and a shared reference point to raise with the wider MDT.
For wider context on identifying and assessing falls risk, see NICE guideline NG249 on falls assessment and prevention. It is aimed at people aged 50 and over, so for younger clients this kind of screening supports your own clinical judgement rather than replacing it.
Once risk is identified, that’s where a proper falls risk assessment and management plan comes in, translating “this client is at risk” into a written, practised plan that the whole support team can follow.
If you’d like support using this falls risk screening tool with a client, or putting a full assessment and management plan in place, get in touch with our team.