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Table 2 ‘Aachen Falls Prevention Scale’

From: The ‘Aachen Falls Prevention Scale’ - development of a tool for self-assessment of elderly patients at risk for ground level falls

Part I
Self-questionnaire (10 questions, one point per question answered ‘yes’, 10 points max.):
  Yes no
Do you have problems with hearing or vision?   
Do you feel unsafe or have you been falling recently?   
Are you afraid of falling?   
1. Do you take medication for sleep, cardiac problems, diuretics, or sedatives?   
2. Do you loose urine or stool involuntarily?   
3. Do you have memory problems?   
4. Do you feel lonely at times and think that your life is without value?   
Do you use a walking aid on a regular basis?   
5. Do you suffer from Parkinson’s, Arthritis or Rheumatism?   
6. Are there many traps that might cause a fall in your home?   
Part II   
Self-Test with your partner   
Stand freely, do not lean or hold on anybody, measure the time until you have to do a corrective action with your arm, upper body or lower extremity.
Standing test   
Successfully completed: 20 seconds or more   
Failed: less than 20 seconds   
  Yes no
Conclusion and self-assessment:   
How would you grade your falls risk on a scale of 1 to 10 (10 … max. risk)?
If you score 5 points or worsening within the last weeks we recommend that you contact a physician for further assessment.