On a scale from 1 to 10, with 1 being very confident and 10 being not confident at all, how confident are you that you do the following activities without falling? 12345678910 Very confidentNot confident at all 1. Take a bath or shower123456789102. Reach into cabinets or closets123456789103. Walk around the house123456789104. Prepare meals not requiring carrying heavy or hot objects123456789105. Get in and out of bed123456789106. Answer the door or telephone123456789107. Get in and out of a chair123456789108. Getting dressed and undressed123456789109. Personal grooming (i.e. washing your face)1234567891010. Getting on and off of the toilet12345678910Total NumberA total score of greater than 70 indicates that the person has a fear of falling. Δ
