A falls risk assessment is a structured evaluation of factors that increase a person’s risk of falling. Multiple components – brief screening questions (“Have you fallen in the past year?” “Do you feel unsteady when standing or walking?” “Are you worried about falling?” – any “yes” = increased risk); medical history review (prior falls, fractures, fear of falling, medications, vision, hearing, conditions affecting balance); physical assessment (blood pressure sitting and standing looking for orthostatic hypotension, vision test, gait observation, balance tests like Timed Up and Go test); environmental review (home hazards); medication review (sedatives, anticholinergics, antihypertensives, hypoglycemia-causing diabetes meds); footwear assessment. STEADI (CDC) widely used algorithm screens, assesses, intervenes. American Diabetes Association recommends fall risk evaluation as part of annual diabetes care for older adults. Multiple diabetes complications increase risk. Studies show 1.5-2x higher fall risk in adults with diabetes vs without. Diabetes-specific factors – peripheral neuropathy (reduced sensation in feet/lower legs; impaired proprioception; balance affected; affects 40-50% of long-duration diabetes); autonomic neuropathy (orthostatic hypotension – BP drop on standing causing dizziness/falls; 20-30% of diabetes patients); retinopathy (visual impairment; reduced contrast sensitivity, depth perception); cataracts (4x more common in diabetes; affect vision); hypoglycemia (sudden weakness, dizziness, confusion; causes falls); polypharmacy (multiple medications including insulin, sulfonylureas, blood pressure meds, statins, often multiple); foot complications (charcot foot, calluses, ulcers affecting gait); sarcopenia (muscle loss more common in long-duration diabetes); cognitive impairment (mild cognitive impairment 2x more common in diabetes); fear of falling itself increases falls. Combined effect – older adults with diabetes need active fall prevention. Multifaceted intervention based on identified risks. STEADI 3-step framework – SCREEN (brief questions), ASSESS (full evaluation if positive), INTERVENE (address modifiable factors). Specific interventions for diabetes patients – diabetes management (prevent hypoglycemia especially with insulin/sulfonylurea users; consider deintensification in older adults; CGM helpful); maintain A1C 7-8% in older adults (avoid tight control causing hypoglycemia); vision (annual comprehensive eye exam, cataract surgery if affecting vision, updated glasses); foot care (regular foot exams, orthotics, appropriate footwear, treat neuropathy); exercise (balance training – tai chi has best evidence, strength training, aerobic exercise); medication review; vitamin D supplementation if deficient; home safety; use cane or walker if balance issues; address orthostatic hypotension; manage cognitive concerns.
STEADI 3 Key Questions (CDC Screening)
| Question | Risk if “Yes” |
|---|---|
| Have you fallen in the past year? | Increased risk; full assessment needed |
| Do you feel unsteady when standing or walking? | Increased risk; full assessment needed |
| Are you worried about falling? | Increased risk; full assessment needed |
Diabetes-Specific Fall Risk Factors
| Factor | Mechanism |
|---|---|
| Peripheral neuropathy | Reduced sensation, balance affected |
| Autonomic neuropathy | Orthostatic hypotension |
| Diabetic retinopathy | Vision impairment |
| Cataracts (4x more common) | Vision impairment |
| Hypoglycemia | Sudden weakness, dizziness |
| Polypharmacy | Multiple medication interactions |
| Foot complications (Charcot, calluses) | Gait abnormalities |
| Sarcopenia | Reduced strength |
| Cognitive impairment | Reduced judgment, awareness |
Common Assessment Tools
- STEADI 3-question screen (CDC).
- Timed Up and Go (TUG) – over 12 seconds suggests risk.
- 30-second chair stand test – strength assessment.
- 4-stage balance test (feet together, semi-tandem, tandem, single-leg).
- Tinetti POMA (Performance Oriented Mobility Assessment).
- Berg Balance Scale (14-item; PT/research).
- Functional Reach Test (forward reach distance).
- Morse Fall Scale (inpatient).
- Annual fall history review.
Fall Prevention Interventions
- Exercise – balance training (tai chi best evidence), strength training, walking.
- Medication review – eliminate unnecessary meds; switch high-risk to lower-risk.
- Vision – annual eye exam, cataract surgery if needed, updated glasses.
- Hearing – hearing test, hearing aids if needed.
- Foot care – regular foot exams, podiatry, orthotics, proper footwear.
- Home safety – remove rugs, improve lighting, install grab bars, eliminate clutter.
- Vitamin D supplementation if deficient.
- Address orthostatic hypotension (slow position changes, hydration).
- Use cane or walker if balance issues.
- Prevent hypoglycemia (especially insulin/sulfonylurea users).
- Maintain A1C 7-8% in older adults (avoid tight control).
- CGM device to detect/prevent hypoglycemia.
- Address cognitive concerns.
- Address fear of falling (cognitive behavioral approaches).
Home Safety Checklist
- Remove or secure throw rugs.
- Clear walkways of clutter.
- Adequate lighting throughout home.
- Night lights in bedroom, bathroom, hallway.
- Stair handrails on both sides.
- Mark stair edges with bright tape.
- Grab bars in bathroom (shower, toilet).
- Non-slip mats in shower/tub.
- Shower chair if needed.
- Raised toilet seat if needed.
- Cordless phone or medical alert system.
- Frequently used items within easy reach.
- Cords organized, not in walkways.
- Outdoor walkways well-lit and even.
The Bottom Line
A falls risk assessment is a structured evaluation of factors that increase a person’s risk of falling. Multiple components – brief screening questions (“Have you fallen in the past year?” “Do you feel unsteady when standing or walking?” “Are you worried about falling?”); medical history review; physical assessment (blood pressure sitting and standing, vision test, gait observation, balance tests like Timed Up and Go); environmental review; medication review; footwear assessment. STEADI (CDC) widely used algorithm screens, assesses, intervenes. American Diabetes Association recommends fall risk evaluation as part of annual diabetes care for older adults. Multiple diabetes complications increase risk. Studies show 1.5-2x higher fall risk in adults with diabetes vs without. Diabetes-specific factors – peripheral neuropathy (reduced sensation in feet/lower legs; impaired proprioception; affects 40-50% of long-duration diabetes); autonomic neuropathy (orthostatic hypotension – BP drop on standing; 20-30% of patients); retinopathy (visual impairment); cataracts (4x more common); hypoglycemia (sudden weakness, dizziness, confusion); polypharmacy; foot complications; sarcopenia; cognitive impairment; fear of falling itself. Older adults with diabetes need active fall prevention. STEADI 3-step framework – SCREEN, ASSESS, INTERVENE. Specific interventions for diabetes patients – diabetes management (prevent hypoglycemia especially with insulin/sulfonylurea users; consider deintensification in older adults; CGM helpful); maintain A1C 7-8% in older adults (avoid tight control causing hypoglycemia); vision (annual comprehensive eye exam, cataract surgery, updated glasses); foot care; exercise (balance training – tai chi has best evidence, strength training, aerobic exercise); medication review; vitamin D supplementation if deficient; home safety; use cane or walker if balance issues; address orthostatic hypotension; manage cognitive concerns. Multiple assessment tools – STEADI 3-question screen, Timed Up and Go (over 12 seconds suggests risk), 30-second chair stand test, 4-stage balance test, Tinetti POMA, Berg Balance Scale. For adults with type 2 diabetes – annual fall risk screening especially after age 65; address modifiable factors aggressively; prevent hypoglycemia; manage diabetic complications; exercise for balance and strength; home safety modifications; report falls or balance concerns to healthcare team promptly. See our broader diabetes complications guide for context.
