0

2

4

No falls

1-2 falls

3 or more falls

0

2

4

Independent

Non-ambulatory

Assist required

0

2

4

Independent

Does not use

Assist required

0

1

1

Normal

Unstable

Requires assistive device

0

1

1

Normal

Balance problem while standing

Balance problem while walking

0

2

4

Adequate with or without glasses

Poor

Blind

0

2

4

Oriented times three

Intermittent confusion

Disoriented times three

2

3

4

Takes one or more medications daily

Takes 2-9 medications daily

Takes more than 9 medications daily

0

2

4

No change between lying and standing

Drop less than 20 mm Hg

Drop more than 20 mmHg

0

4

No restraint

Restraint used