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»