More assessment tools
Name: _____________________ Today’s Date: _________
Please check the box that most applies for each activity:
| Activity | Need No Help
(2 pts. each) |
Need Some Help
(1 pt. each) |
Unable to Do At All
(0 pts. each) |
| 1. Using the telephone | ___ | ___ | ___ |
| 2. Getting to places beyond walking distance | ___ | ___ | ___ |
| 3. Grocery shopping | ___ | ___ | ___ |
| 4. Preparing meals | ___ | ___ | ___ |
| 5. Doing housework or handyman work | ___ | ___ | ___ |
| 6. Doing laundry | ___ | ___ | ___ |
| 7. Taking medications | ___ | ___ | ___ |
| 8. Managing money | ___ | ___ | ___ |
| Total Score: ___ = | ( __ x 2 =) ___ + | ( __ x 1=) ___ + | 0 |
Reference
From Lawton, M.P., and Brody, E.M. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. The Gerontologist, 9, 179-186. Copyright (c) by The Gerontological Society of America.
