46 PCN Fall Risk Assessment

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
Very High Risk 19 points or greater
High Risk 14-18 points
Medium Risk 10-13 points
Low Risk 9 points or less

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Reference Notes for Palliative Care Consultation Copyright © 2018 by Robert F. Johnson MD, MEd is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

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