‘Table 1. Katz Index of Independence in Activities of Dally Living ‘Actos (5 0¢0 pains) __Indopendonco (1 pina epondenco(O paints bathing ‘Bathes self completely or needs hep in bathing only Neads help wath bathing more than one Point: 2 single part ofthe body, such as teback, genital _partof the body, getting in or out of 213, or dsabled extremity the batub or shower; requis total bathing Deesing Gets dothes fom doses and drawers, and puts Needs lp wth dressing sa or needs Point: ‘on clothes ae outer garments compete with to be completely dressed fasteners; may need hep tying shoes Toleting Goes o tol, gets on and of, arranges dothes, _ Needs help transeting tothe filet. Points: ‘leans genital are without hep and deaning sll, or uses bedpan or commode Trarsleeing| ‘Mores in and out of bed or chat unassisted, Needs hep in mosing fom bed to char Point: mechanical transfer ais ate acceptable or requitesa complete tarsfer Fecal and urinary continence eres complete sel-contol over urination ands partalor totally incontinent of Points: defecation bowel or Bader Feeding Gets food from plate into mouth without hep: Needs pati or ttl help wath feeding Points: ‘reparation f food may be done by another poison or requires parenteral feeding ‘Total point >to suprisin, econo panel asitnce 1th Speen deco, persona asa, ofl are Sear of 6= gh (patent sineperde Sore of = ou abet ry pence) Adpted wth permission fram Kt, Dows TD, Cas HR, rot AC Pogresin deweopment of tendo of AD. Geronilogs. 17 70729,Fable 2. Lawton Instrumental Activities of Dally Livi Senle (salt Rated Version) he ing, For each auestion. circe the point: for the answer that best applies |. Cerri inate sr us the sotegtnorie . Completely unable to travel unless special arrangements are made &. Can you ge shoppina tor gracorios? a, armplataby unable to do amy sapeine Commpletahy Unable to prepare ane meats Completary unable to do any nousewere 6. Can you aS your own manaymnan wore? ou Nw syW oNY oNy anu 7. Can you do your own launciry? Without help with some help You Cit "yor" answer quortion Bb) Ne Uf “no,” ancwor question Boy Bb. De you take your awn medicatian? Without help (in the right doses at the right time) ee eT eee tae cee eee Srromind= you te take 1 Completely unable to take own medication Bc, Wyou had to take medication, Could you do It? Without help (in the right doses at the right time) eee el eee eae ee eee ee Completely unable to take own medication Without help 2 With seme help. 2 Completely unable to handle money 4 oN Nu owe Nw ore Scores fae mmoanine anh. far 9, Rortinutar nations (ag. dachining scares over oe som a routes ‘Adapted wath perrnimion trom Lautan MAP, Brads Eh, Assesment af otcher people: watt IraiteeSininar ate matrarmantal aceite OF daih: bene: Cerontaieae TOES OT ITE“ae 3S ose Gri hse Euaraton Se Paparaa mn aar| trae pena sana tenmaamameapen same ate aegein Gone aerne pny on cngnata te, eee rales tel oteteet act nn Sanne swt, cner eh ot ep et es ‘att Chayanne 7 ‘ena paces wa cotss ows este te scene swaay Mess niyo lorie ean ‘hcg rn rene ‘crn Geman, feat nec tape oun Coase ‘enema ce etn, ‘enwn a ota ethane senpanaecan ra tetera Senta tary ‘ner ‘armpits dna etem eseny See eres Seren ume Ronn aay ew‘Table 3. Sample Focused Geriatric Physical Examination (cntruod) signs Physical sign or symptom Diferentil agnoses ‘Muscularseletal Diminished range of motion, pain Arthritis fracture Dorsal kyphosis, vertebral Cancey, compression fracture, osteoporosis ‘endemess, bck pain Cait dsturbances ‘Advorso ffects trom medication, ath, decondtioning, foot ‘abnormalities, Parkinson dace, stroke eg pain Intarmttant claudication, noropaty,osteoarthits, radiculopathy, venous insuclncy Muscle wasting ‘Alrophy, malnutiion Proximal muscle pain and weakness Polymsagla rheumatica skin fythom, ulceration oe pressure Anticoagulant use, oder abuse, lopathic thrombocytopenic purpura Dots, unexplained bruises Premalignant or malignant lstons Actinic keratoses, basal cel carcinoma, malignant melanoma, pressure Ulcer, squamous cel carnoma Neuroloakc ‘mor wth gay Parkinson disease sore When prfoming 2 gsc physical examination, pss shoud be alt fa some cf thse sigs ad semp tos. Table 4. Nutritional Health Checklist Statement. have an illness of condition that made me change the kind or 2 amount of food leat leat fewer than two meals per day. a eat few frults, vegetables. or milk products. 2 have three or mare drinks of beer, liquor, ar wine almost every-day. 2 Ihave tooth or mouth problems that make it hard for me to eat 2 Idon't always have enough money to buy the food Inced. 4 leat alone most of the me. 1 Hake three or more different prescription or over-the-counter 1 drugs per day. Without wanting to. {have lost or gained 10 tb in the past six z ‘months. Lam not always physically able to shop, cook, or feed myself. NOTE. The Nutritional Health Checklist wae developed for the Nutrition Sercaning Initintiue. Read the statements above, and circle the number in the “yo” colin for wach statement that applies 10 you. AGC up the circled numbers 2 O0e xOUr Lneatritional score. 0102 — You have good nutrition. Recheck your netritiona| score in-six months 3 to's — You are at moderate nutritional Ak aid you should sow what you can elo fo fmprowe your eauing frabits and lifestyle. Recheck your nutritional score in threeTable 5. Screening Version of the Hearing Handicap Inventory for the Elderly Yes Sometmes No Question point) @pont) _ (Opains) Does ahearing problem cause you to feel embarrassed when you meet new people? = Does ahearing probe cause you to fed fasted when talking to mernber of you famiy? Do you have dficuly hearing when someone speaks in whisper? — —_ —_ Bo you fel impaied by ahearing problem? — —— —_ Does ahearing problem cause you dfiaity whan visitng fiends, relatives or neighbors? Does ahearing problem cause you to attend religous services les often than you woulke? Does ahearing problem cause you to have arguments with famnly members? — Does ahearing problem cause you dfiaity when listering tothe television or radio? = —__ you fed that any dificuty with your hesring mts or hampers your pessonal or soc fe? _ — Does ahearing problem cause you dfiaity when ina restaurant with relatives or rends?_ — Raw score (umn ofthe points assigned to each of the iiems) — OIE A aw score of 0108 = 13 percent rcbablyofheaaneimparment (a handicap refer; 10 to 24 = 50 percent probabity of hearing Instron (to moderate hancepofra) 36 6 AD ~ pct probly of heingsrparmen nx banter) Adopted with pamisen fom Vonry M, Welton BE denticatin ofr pogo with bing probes. ASHA. 198225172. Table 6. Mini-Cognitive Assessment Instrument Step 1_ Ask the patient to repeat three unrelated words, Such as “ball,” cog,” and "window. Step 2. Ask the pationt to draw a simple clock sot to 1G minutes after eleven o'clock (11-10). A correct response is drawing of 2 circle with the numbers placed in approximately the correct positions, with the hands pointing to the 11 and 2. Step 3. Ask the patient to recall the three words from Step 1 ‘One point Is giwan for each item that ts recalled correctly Interpretation Number of iterns Clock drawing — Interpretation of correctly recalled test result Berets For Leaner ° Normal Positive ° Abnormal Positive 1 Normal Negative 1 Abnormal Positive 2 Normal Negative 2 Abnormal Positive 3 Normal Negauve s Abnormal Negauve oor Gemnonitio itr primary care Arn barn Phyaiclan. 200% 7 HE. SOO,