Fall risk assessment: the CDC STEADI questions and the Timed Up and Go test

What is a fall risk assessment?

A fall risk assessment is a structured way to ask whether someone is more likely than most to fall, and why. The Centers for Disease Control and Prevention (CDC) publish a set of tools for this under the name STEADI, short for Stopping Elderly Accidents, Deaths and Injuries. The tools are built for health care providers, and some are written for patients too.⁷

The CDC’s clinical resources page lists the tools by purpose. A patient brochure, Stay Independent, holds a short checklist. Functional assessments include the 30-Second Chair Stand Test, the 4-Stage Balance Test and the Timed Up and Go (TUG) test. Other items cover medicines linked to falls and measuring orthostatic blood pressure.⁷

This page explains two of them in plain language: the Stay Independent checklist and the TUG test. It does not score you, grade your result or tell you whether you are at risk. A tool is a starting point for a conversation with a doctor, nurse or physical therapist.

How common are falls, and why do the numbers matter?

The CDC says more than one out of four older people falls each year, and less than half tell their doctor. Falling once doubles the chance of falling again.⁴

The same CDC page reports about 4.5 million emergency department visits a year for falls by older people. Of these, 3.1 million patients were treated and released and 1.4 million were hospitalized. It also says one in 10 falls causes an injury that restricts activity for a day or more or leads to medical care.⁴ Nearly 319,000 older people are hospitalized for hip fractures each year, based on 2019 data.⁴

These figures are population averages. They do not tell you your own odds. They do explain why the CDC encourages older adults to raise the subject with a provider even if no injury has happened yet.

The Stay Independent checklist

The Stay Independent brochure from the CDC asks readers to answer yes or no to 12 statements. Two carry 2 points each and the other ten carry 1 point each.¹ The brochure says to add up the points for each yes answer, and that a total of 4 or more means you may be at risk for falling and should discuss the brochure with your doctor.¹

How the arithmetic works

The maximum is 14 points: 2 + 2 for the first two statements plus 10 × 1 for the rest. As an illustration of the rule only, a person who answered yes to “fallen in the past year” (2 points), “sometimes feel unsteady” (1) and “worried about falling” (1) would have 2 + 1 + 1 = 4 points, which is the level at which the brochure says to discuss it with a doctor.¹ Another person with three 1-point answers would have 3 points, below that line, but the brochure does not say that means no risk.

Notice how many statements are about things a provider can look at: medicines, feeling in the feet, leg strength, vision and mood. That is why the CDC pairs the checklist with a conversation, not a verdict.

The Timed Up and Go test

The CDC’s Timed Up and Go (TUG) form is a clinician’s tool, with the stated purpose of assessing mobility. It needs a stopwatch. The patient wears regular footwear and can use a walking aid if needed.²

1. Sit back in a standard armchair, with a line on the floor 10 feet (3 meters) away.²
2. On the word “Go,” stand up from the chair.²
3. Walk to the line at your normal pace, turn, and walk back to the chair at your normal pace.²
4. Sit down again. Timing starts at “Go” and stops when the person is seated.²

The CDC form says an older adult who takes 12 seconds or longer to complete the test is at risk for falling.² The form also lists things the observer should note, such as a slow tentative pace, loss of balance, short strides, little arm swing, steadying on walls, shuffling, and turning in one block. It says these changes may signal neurological problems that require further evaluation.²

This page does not time you and does not interpret a result. A single timed walk also cannot see everything the CDC lists as risk factors, such as medicines or vision.

Risk factors the CDC lists

The CDC’s fact sheet says most falls are caused by an interaction of multiple risk factors, and that the more risk factors a person has, the greater the chance of falling. Some risk factors can be changed.³

A rough sorting exercise helps: for each factor on your own list, ask whether it is a thing you can change (lighting, rugs, grab bars), a thing a provider can change (a medicine, a vision correction) or a thing that is simply part of your situation (age). The first two are where effort pays off.

What can reduce the risk after a screening?

The CDC’s fall prevention page lists five actions for older adults: talk to your doctor and ask them to evaluate your fall risk, review your medicines and ask about vitamin D; get screened for osteoporosis; do strength and balance exercises; check your eyes yearly; and make your home safer with fewer trip hazards, grab bars, railings on both sides of stairs and brighter lighting.⁵

The Physical Activity Guidelines for Americans say that among older adults physical activity reduces the risk of falling and injuries from falls, and that multicomponent programs are the most successful. These commonly combine muscle-strengthening and balance training. The guidelines add that low-intensity walking alone does not seem to reduce the risk of fall-related injuries and fractures.⁶

For the exercise side, see strength training for seniors and muscle loss after 50. For the home, see fall protection for seniors at home. No exercise or product can promise that a fall will not happen.

Where protective equipment fits

Some people also consider wearing protective equipment, such as hip protectors or an airbag vest. Equipment of that kind is about cushioning an impact if a fall happens. It does not change the risk factors above, and it is not a substitute for medicine reviews, exercise or a safer home.

Two comparison guides cover the topic: hip protectors versus an airbag vest and airbag vests for the elderly.

Frequently asked questions