Steadiness Screener

The next few slides will assess the challenges you are experiencing regarding your risk of falling. This will enable us to recommend the best solution for you. We do request some personal information from you in order for us to suggest age-appropriate solutions as well as for an audiologist to be in touch with you.

As we subscribe to the POPIA, we commit to only using your personal information for the purposes mentioned above.

Click the arrow below right to begin the screener

Please complete as many fields as possible so we can give you the best advice.

First Name *

Last Name

Date of birth

Phone *

Email *

The following 12 questions will give an indication of your history of falls, if any, and your general feeling and health as it relates to steadiness on your feet. If you are completing this on behalf of someone else (eg. a child), please insert answers appropriate to them.

Have you fallen in the last year? *

Yes

Why it matters?

People who have fallen once, are likely to fall again.

Have you used, or been advised to use, a cane or walker to get around safely? *

Yes

Why it matters?

People who have been advised to use a cane or walker may already be more likely to fall.

Do you sometimes feel unsteady when walking? *

Yes

Why it matters?

Unsteadiness or needing support while walking are signs of poor balance.

Do you sometimes steady yourself by holding onto furniture when walking at home? *

Yes

Why it matters?

This is a sign of poor balance.

Are you worried about falling? *

Yes

Why it matters?

people who are worried about falling are more likely to fall.

Do you need to push with your hands to stand up from a chair? *

Yes

Why it matters?

This is a sign of weak leg muscles, a major reason for falling.

Do you sometimes have trouble stepping up onto the curb? *

Yes

Why it matters?

This is also a sign of weak leg muscles.

Do you often have to rush to the toilet? *

Yes

Why it matters?

Rushing to the bathroom, especially at night, increases your chance of falling.

Have you lost any feeling in your feet? *

Yes

Why this matters?

Numbness in your feet can cause stumbles and lead to falls.

Do you take medicine that sometimes makes you feel light-headed or more tired than usual? *

Yes

Why it matters?

Side-effects from medicines can sometimes increase your risk of falling.

Do you take medicine to help you sleep or improve your mood? *

Yes

Why it matters?

These medicines can sometimes increase your chance of falling.

Do you often feel sad or depressed? *

Yes

Why it matters?

Symptoms of depression, such as not feeling well or feeling slowed down, are linked to falls.

Any questions or comments?

In order to suggest the closest, qualified iCAN audiologist to you, please select your province and insert the city/town and suburb in which you live.

Province in which you reside *

City/Town *

Suburb

This screener is now complete. Please click the submit button and an audiologist will be in touch.