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    Assessment Checklist

    If you’re doing an assessment on your own, use this list as a guide. Gently explore as many of these areas as you can to get a full picture of your loved one’s life.

    See also: How to assess your loved ones situation.

    Physical health

    • Make note of these factors; you may need the help of your loved one’s doctor.
    • Diagnosis of any chronic diseases such as diabetes, high blood pressure, arthritis, emphysema, or stroke.
    • Unusual weight loss or gain in a short amount of time.
    • Incontinence.
    • Balance problems: How steady is the person while walking?
    • Persistent fatigue or sleeplessness.
    • Swollen feet or legs, or limping.
    • Vision problems such as cataracts or use of vision aids.
    • Hearing problems: Is there a need for a hearing aid? If there is one, is it being worn? 
    • Dental problems including gum disease, halitosis and ill-fitting dentures. 
    • Complaints of pain.
    • List of health professionals being seen. 

    Mental health

    • Make note of these factors; a primary care doctor can help, but a geriatric psychiatrist or neurologist might be more helpful.
    • Diagnosis of any psychiatric disorders such as depression, anxiety disorder or psychosis.
    • Diagnosis of Alzheimer’s or other form of dementia. 
    • Recent hospitalizations for any of these problems.
    • Mood swings, including rage or hostility.
    • Forgetfulness or wandering off.
    • Sadness or loneliness.
    • Decreased interest in reading, writing and communicating.
    • Difficulty in maintaining friends.
    • Decreased interest in life.

    Medication use

    • List all medicines taken, prescription or over-the-counter, with frequency and dosage.
    • List all herbal remedies, supplements, traditional home remedies or vitamins being used.
    • Is the person able to take medications as directed and avoid interactions?
    • Are there any barriers to proper medicine use, such as forgetfulness, expense, poor understanding of purpose and results of use?

    Daily living

    • List special dietary needs and favorite foods.
    • Describe ability to dress, bathe, get up from a chair, use the toilet, use the phone, climb stairs, get help in an emergency, shop, prepare meals, do housework and yard work, and drive safely.

    Next: Assessing the safety situation»

    Home and community safety

    • Consider neighborhood safety. 
    • Consider home safety: Are there throw rugs? A need for handrails in the bathroom? Does the residence have working smoke alarms?
    • Is the person able to avoid telephone and door-to-door fraud?
    • What level of maintenance do the yard and house require?

    Support system

    • Know contact information for key family members, friends, neighbors and clergy.
    • Does the person have visitors or is he or she able to visit friends and family?
    • Is he able to visit a senior center?
    • List membership in organizations and groups.

    Appearance and hygiene
    Factors to assess:

    • Personal hygiene.
    • Overall appearance.
    • Oral care.Trimmed nails.
    • Well showered and shaven.
    • Combed hair.
    • Clean clothes.
    • Appropriately dressed for weather and occasion.

    Finances
    Factors to assess:

    • Insurance coverage.
    • Long-term care coverage.
    • Total assets.
    • Legal documents including trusts, living wills and durable powers of attorney.
    • Is there an attorney who knows this person?   

    Interests/lifestyles

    • Hobbies.
    • Reading preferences: Are glasses or larger-print books needed? Would books on tape be enjoyable?
    • Favorite TV and radio programs.
    • Exercise — gardening and walking count!
    • Musical instruments played.
    • Languages spoken, and is there a preferred language?
    • Favorite conversation topics.
    • Travel experience.
    • Important life events.
    • Religious/spiritual background.
    • Accomplishments.
    • Social activities.

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