| Drug Class / Medication | Present? | |
|---|---|---|
| 1 | Benzodiazepines | |
| 2 | Non-Benzodiazepine Hypnotics (e.g., Z-drugs) | |
| 3 | Antidepressants (TCAs, SSRIs, SNRIs, etc.) | |
| 4 | Antipsychotics | |
| 5 | Antihypertensives | |
| 6 | Anticholinergics | |
| 7 | Opioids | |
| 8 | Muscle Relaxants | |
| 9 | Hypoglycemics (e.g., insulin, sulfonylureas) | |
| 10 | Diuretics |
| Risk Factor | Present? | |
|---|---|---|
| 1 | Recent dose change or new medication started | |
| 2 | History of falls | |
| 3 | Impaired balance/mobility | |
| 4 | Orthostatic hypotension | |
| 5 | Cognitive impairment |