| Points |
Criteria |
| 7 |
history of a fall within past 12 months |
| 3 |
altered elimination – incontinence, frequency, urgency |
| 3 |
- cognitive impairment – inability to recall recent events
- Confusion, impaired judgment
|
| 3 |
sad, depressed |
| 3 |
- intrinsic factors
- orthostatic hypotension
- syncope
- arrhythmia
- peripheral neuropathy
- seizure history
- parkinsons
- hx stroke
- neuromuscular disorder
|
| 2 |
communication – HOH, language barrier, tracheostomy |
| 2 |
visual impairment |
| 2 |
diuretics or laxatives |
| 4 |
anti-hypertensive medication |
| 6 |
opioid medication |
