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.
  

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.

More Caregiving Basics

• Signs you need a caregiver
• DISCUSS: What type of support is available for caregivers?