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Assessment Checklist

En español | 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.

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.

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.

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?   


  • 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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