| Item | Item Score | Patient Score |
|---|---|---|
| 1. History of falling (immediate or previous) | No 0 Yes 25 | ______________ |
| 2. Secondary diagnosis (≥ 2 medical diagnoses in chart) | No 0 Yes 15 | ______________ |
| 3. Ambulatory aid None/bedrest/nurse assist Crutches/cane/walker Furniture | 0 15 30 | ______________ |
| 4. Intravenous therapy/heparin lock | No 0 Yes 20 | ______________ |
| 5. Gait Normal/bedrest/wheelchair Weak* Impaired† | 0 10 20 | ______________ |
| 6. Mental status Oriented to own ability Overestimates/forgets limitations | 0 15 | ______________ |
| Total Score‡: Tally the patient score and record. <25: br="" low="" risk="">25-45: Moderate risk >45: High risk | ______________ | |
* Weak gait: Short steps (may shuffle), stooped but able to lift head while walking, may seek support from furniture while walking, but with light touch (for reassurance).
† Impaired gait: Short steps with shuffle; may have difficulty arising from chair; head down; significantly impaired balance, requiring furniture, support person, or walking aid to walk.
Also watch Video on Fall Assessment in Seniors
‡ Suggested scoring based on Morse JM, Black C, Oberle K, et al. A prospective study to identify the fall-prone patient. Soc Sci Med 1989; 28(1):81-6. However, note that Morse herself said that the appropriate cut-points to distinguish risk should be determined by each institution based on the risk profile of its patients. For details, see Morse JM, Morse RM, Tylko SJ. Development of a scale to identify the fall-prone patient. Can J Aging 1989;8;366-7.
† Impaired gait: Short steps with shuffle; may have difficulty arising from chair; head down; significantly impaired balance, requiring furniture, support person, or walking aid to walk.
Also watch Video on Fall Assessment in Seniors
‡ Suggested scoring based on Morse JM, Black C, Oberle K, et al. A prospective study to identify the fall-prone patient. Soc Sci Med 1989; 28(1):81-6. However, note that Morse herself said that the appropriate cut-points to distinguish risk should be determined by each institution based on the risk profile of its patients. For details, see Morse JM, Morse RM, Tylko SJ. Development of a scale to identify the fall-prone patient. Can J Aging 1989;8;366-7.
