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Falls Risk Assessment
Elderly Falls Research
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Choose from the following:
Age 65 and older?
Take 4 or more medications daily?
Use cane, walker, wheelchair or furniture to walk?
Have poor vision or poor hearing?
Use oxygen all or part of the time?
Have incontinence or urgency?
Have had a stroke?
Drink 1 or more glasses of beer, wine or alcohol on a daily basis?
Need help to get into or out of bed?
Female?
Please provide the following information:
Town Resident: (Yes/No)
required
Email:
required
*** Please use the following Email address above: fallsresearch@west-springfield.ma.us ***