Downton Fall Risk Index Calculator (Older Adults)
Score the Downton Fall Risk Index — previous falls, medicines, sensory deficits, mental state and gait — 0 to 11, where 3 or more means a high risk of falling.
How it works
Downton = previous falls (1) + 1 per medicine class (sedatives, diuretics, other antihypertensives, antiparkinsonian drugs, antidepressants) + 1 per sensory deficit (visual, hearing, limb) + confused (1) + gait not normal (1); 0–11. A score of 3 or more = high risk of falls.
The Downton Fall Risk Index (Downton, 1993) is a nursing scale for older adults in hospital, care homes and the community, and it is especially widely used in Spain and Latin America. It adds one point for each risk factor present: a history of falls, each of five fall-related medicine classes, each sensory deficit, confusion and any gait problem. A total of 3 or more indicates a high risk and should trigger a fall-prevention plan — medication review, vision check, walking aids, a safe environment and supervision.
Worked example
A care-home resident takes a diuretic (1), has poor eyesight (1) and walks safely with a frame (1), with no previous falls and no confusion: Downton = 3 / 11 — high risk of falls.
Sources: Downton JH. Falls in the Elderly. London: Edward Arnold, 1993
Frequently asked questions
What Downton score means high fall risk?
A score of 3 or more out of 11 indicates a high risk of falling. 0–2 is considered low risk, but falls can still happen, so basic safety measures apply to everyone.
Which medicines count in the Downton scale?
Tranquillisers or sedatives, diuretics, antihypertensives other than diuretics, antiparkinsonian drugs and antidepressants — one point for each class taken. Other medicines score 0.
Downton or Morse — which should I use?
The Morse Fall Scale (0–125) is designed for acute hospital inpatients; the Downton index is simpler and common in geriatric and long-term care, particularly in Spanish-speaking countries. Use the one your service has adopted.
How often should the Downton scale be repeated?
On admission, after any fall, when medicines or health change, and at regular intervals set by local policy.
Related calculators
Clinical decision tool for education and for use by trained clinicians alongside clinical judgement — not a diagnosis and not a substitute for medical assessment. Scores validated in specific populations may not apply to every patient.