What it is built on
- Assessment and management. World guidelines for falls prevention and management for older adults (Montero-Odasso et al., Age and Ageing, 2022)
- Screening tests. CDC STEADI: Timed Up and Go, 30-second chair stand, 4-stage balance test
How to use it: Free Evidence-Based Physiotherapy Note Templates
Falls history
- Falls in the last 12 months Number
- What happened Written answer Where, when, injuries, could they get up.
- Worried about falling Tick box
- Feels unsteady standing or walking Tick box
Tests
- Timed Up and Go (seconds) Number STEADI uses 12 seconds or more as a sign of higher risk.
- 30-second chair stand (repetitions) Number Compare with age and sex norms.
- 4-stage balance test: last position held 10 seconds Choose one: Feet together · Semi-tandem · Tandem · Single leg · None
- Walking and aids Written answer
Risk factors
- Present Choose any: Many medicines or sedatives · Low blood pressure on standing · Poor eyesight · Foot problems or unsafe footwear · Home hazards · Continence urgency · Cognitive change · Low activity
- Home environment Written answer
Plan
- Strength and balance program started Tick box
- Referrals (GP, occupational therapy, optometry, podiatry) Written answer
- Plan and next review Written answer
A starting point, not clinical advice. Check that it fits your patients, your practice and the rules where you work before you use it.