Have you fallen in the last 6 months?
Do you use, or have you been advised to use, a cane or walker to get around safely?
Do you sometimes feel unsteady when you are walking?
Do you have to steady yourself by holding onto furniture when walking at home?
Do you worry about falling?
Do you need to push yourself up with your hands to stand up from a chair?
Do you have trouble stepping up onto a curb?
Do you often have to rush to the toilet?
Have you lost any feeling in your feet?
Do you take medication to help you sleep or improve your mood?
Do you take medication that sometimes makes you feel lightheaded or more tired than usual?
Do you often feel sad or depressed?
Do you have difficulty avoiding hazards in your path because you don't see well?