Fall risk screening: questions, tests and what the results mean
A fall risk check starts with a few questions about past falls, worry about falling and feeling unsteady. If any answer is yes, short tests of walking, leg strength and balance help sort out how high the risk is. (AGS workgroup, 2025) (World Falls Guidelines, 2022)
Who should be checked
- Why it matters: in 2018, 27.5% of adults 65 and older living at home reported at least 1 fall in the past year, and 10.2% reported a fall-related injury. In 2021, 38,742 deaths resulted from fall-related injuries. (USPSTF, 2024)
- USPSTF: for adults 65 and older at increased risk of falling, it recommends exercise to prevent falls (grade B), and an individual decision on a multifactorial plan (grade C). It does not grade screening itself. A practical way to find people at increased risk, it says, is to ask about past falls or problems with physical function and limited mobility. (USPSTF, 2024)
- CDC STEADI: a fall prevention approach for adults 65 and older built on three steps: screen for fall risk, assess risk factors that can be changed, and intervene. (USPSTF, 2024) STEADI is based on the 2011 American Geriatrics Society and British Geriatrics Society (AGS/BGS) guideline. (AGS workgroup, 2025)
- Medicare: the first yearly wellness visit includes a review of functional ability and safety that covers fall risk at a minimum, by direct observation or screening questions. (42 CFR 410.15) Part B covers a yearly wellness visit once every 12 months, and you pay nothing if your provider accepts assignment. (Medicare.gov) See Medicare wellness visit vs a physical.
The screening questions
STEADI's Three Key Questions are yes or no questions about whether you have fallen in the past year, whether you are worried about falling, and whether you feel unsteady when standing or walking. (AGS workgroup, 2025)
They are 3 items of the longer Stay Independent questionnaire, a 12-item self-report form scored from 0 (lowest risk) to 14 (highest risk). A score of 4 or more means an increased risk of falling. The AGS workgroup advises asking the Three Key Questions first and the rest of the form only if one of them is positive. (AGS workgroup, 2025)
The World Falls Guidelines advise asking older adults at least once a year whether they have fallen in the past 12 months, and if so, how often, how and with what result. If time allows, they add questions about dizziness, fainting, problems with walking or balance, and concern about falling that limits daily activities. Clinicians should ask, because many falls are never mentioned. (World Falls Guidelines, 2022)
The tests and what they involve
STEADI uses three standard tests of gait, strength and balance: the Timed Up and Go, the 30-second chair stand and the 4-stage balance test. (Stevens and Phelan, 2013)
- Timed Up and Go (TUG): you stand up from a chair, walk to a line 10 feet away, turn around, walk back and sit down while someone times you. (Stevens et al., 2020)
- 30-second chair stand: you sit down and stand up fully as many times as you can in 30 seconds. It measures leg strength and endurance, and the count is compared with norms for your age and sex. (Yang et al., 2025)
- 4-stage balance test: you stand in four positions, holding each for more than 10 seconds to pass, as used in a US national study of the STEADI steps. (Lohman et al., 2017)
- Gait speed: the World Falls Guidelines prefer timing your usual walking speed, with under 0.8 meters per second as the line for a problem. (World Falls Guidelines, 2022)
Where time or space is short, the AGS workgroup says a clinician should at least watch you get up from a chair and walk in the exam room. (AGS workgroup, 2025)
How the results are read
Timed Up and Go cut-offs used by each source: (Stevens et al., 2020) (World Falls Guidelines, 2022)
| Source and age | Below the cut-off | At or above the cut-off |
|---|---|---|
| STEADI program, ages 65 to 84 | Under 12 seconds | 12 seconds or more: higher fall risk (Stevens et al., 2020) |
| STEADI program, ages 85 and older | Under 15 seconds | 15 seconds or more: higher fall risk (Stevens et al., 2020) |
| World Falls Guidelines | 15 seconds or less | More than 15 seconds: gait or balance problem (World Falls Guidelines, 2022) |
- Chair stand: a count below the norm for your age and sex points to leg weakness. One paper quotes 14 stands for men and 12 for women aged 60 to 64 as examples of the norm. (Yang et al., 2025)
- STEADI risk groups: in a US national study, people who answered no to all three key questions were placed at low risk. Those with a yes who passed the balance and chair stand tests were at moderate risk. Those who did not pass and had several falls or a hip fracture were at high risk. Over follow-up, the moderate group had 2.62 times and the high group 4.76 times the odds of falling compared with the low group. (Lohman et al., 2017)
- World Falls Guidelines risk groups: no falls, or a single fall that was not severe with no gait or balance problem, means low risk, rechecked every year. A single fall that was not severe together with a gait or balance problem means intermediate risk. A fall with any of these means high risk: an injury, 2 or more falls in 12 months, known frailty, being unable to get up without help for at least an hour, or a suspected blackout. (World Falls Guidelines, 2022)
Where they differ: STEADI programs use a Timed Up and Go cut-off of 12 seconds at 65 to 84 and 15 seconds at 85 and older. (Stevens et al., 2020) The World Falls Guidelines use more than 15 seconds, note that the TUG predicts falls less consistently, and prefer gait speed. (World Falls Guidelines, 2022) On who is screened, the AGS workgroup keeps yearly fall screening for all adults 65 and older, while the World Falls Guidelines rely on asking about falls during health visits and after a fall. The AGS group also advises using clinical judgment on whether to get a heart tracing (ECG) rather than doing one routinely. (AGS workgroup, 2025) (World Falls Guidelines, 2022)
A screening result is not a diagnosis. Your doctor decides what your result means for you.
What happens after a higher-risk result
For people at high risk, the World Falls Guidelines advise a fuller check of risk factors with a plan made together with the person. People at intermediate risk are offered targeted exercise or a physical therapy referral to improve balance and strength, and everyone gets advice on preventing falls. (World Falls Guidelines, 2022) The USPSTF lists balance, gait, vision, blood pressure on standing, medicines, the home, thinking and mood among the risk factors such a check looks at. (USPSTF, 2024) A suspected blackout during a fall leads to its own evaluation. (World Falls Guidelines, 2022)
This page does not give exercise, medicine, vitamin D or equipment advice. What the USPSTF recommends to prevent falls is on falls prevention for adults 65 and older. For the bone side of fracture risk, see bone density test results.
Questions people ask
What are the three key questions for fall risk?
They ask whether you have fallen in the past year, whether you are worried about falling, and whether you feel unsteady when standing or walking. Each is a yes or no question. A yes to any of them leads to a closer look at gait, strength and balance. (AGS workgroup, 2025) (Lohman et al., 2017)
What is a normal Timed Up and Go time?
In the STEADI program, people 65 to 84 who took 12 seconds or more, and people 85 and older who took 15 seconds or more, were counted as at higher risk of falling. The World Falls Guidelines use more than 15 seconds and prefer a walking speed test. (Stevens et al., 2020) (World Falls Guidelines, 2022)
Is a fall risk check part of the Medicare wellness visit?
Yes. The first Medicare yearly wellness visit includes a review of functional ability and safety that covers fall risk at a minimum. Part B covers the yearly wellness visit once every 12 months, and you pay nothing if your provider accepts assignment. (42 CFR 410.15) (Medicare.gov)
Who should be checked for fall risk?
The American Geriatrics Society workgroup advises yearly fall screening for all adults 65 and older. The World Falls Guidelines advise asking older adults about falls at least once a year whenever they are in contact with health care. (AGS workgroup, 2025) (World Falls Guidelines, 2022)
What happens if my fall risk is high?
A higher-risk result usually leads to a fuller check of risk factors that can be changed and a plan made with your clinician. For adults 65 and older at increased risk, the USPSTF recommends exercise to prevent falls (grade B). Your doctor decides what your result means for you. (USPSTF, 2024) (World Falls Guidelines, 2022)