Assessment Checklist
If you’re doing an assessment on your own, use this list as a guide provided by the AARP. Explore as many of these areas as you can to get a full picture of your loved one’s life.
Physical health
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Make note of these factors; you may need the help of your loved one’s doctor.
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Diagnosis of any chronic diseases such as diabetes, high blood pressure, arthritis, emphysema, or stroke.
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Unusual weight loss or gain in a short amount of time.
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Incontinence.
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Balance problems: How steady is the person while walking?
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Persistent fatigue or sleeplessness.
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Swollen feet or legs, or limping.
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Vision problems such as cataracts or use of vision aids.
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Hearing problems: Is there a need for a hearing aid? If there is one, is it being worn?
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Dental problems including gum disease, halitosis and ill-fitting dentures.
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Complaints of pain.
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List of health professionals being seen.
Mental health
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Make note of these factors; a primary care doctor can help, but a geriatric psychiatrist or neurologist might be more helpful.
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Diagnosis of any psychiatric disorders such as depression, anxiety disorder or psychosis.
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Diagnosis of Alzheimer’s or other form of dementia.
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Recent hospitalizations for any of these problems.
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Mood swings, including rage or hostility.
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Forgetfulness or wandering off.
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Sadness or loneliness.
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Decreased interest in reading, writing and communicating.
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Difficulty in maintaining friends.
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Decreased interest in life.
Medication use
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List all medicines taken, prescription or over-the-counter, with frequency and dosage.
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List all herbal remedies, supplements, traditional home remedies or vitamins being used.
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Is the person able to take medications as directed and avoid interactions?
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Are there any barriers to proper medicine use, such as forgetfulness, expense, poor understanding of purpose and results of use?
Daily living
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List special dietary needs and favorite foods.
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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
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Consider neighborhood safety.
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Consider home safety: Are there throw rugs? A need for handrails in the bathroom? Does the residence have working smoke alarms?
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Is the person able to avoid telephone and door-to-door fraud?
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What level of maintenance do the yard and house require?
Support system
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Know contact information for key family members, friends, neighbors and clergy.
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Does the person have visitors or is he or she able to visit friends and family?
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Does the person visit a senior center for activities?
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List membership in organizations and groups.
Appearance and hygiene
Factors to assess:
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Personal hygiene.
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Overall appearance.
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Oral care.Trimmed nails.
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Well showered and shaven.
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Combed hair.
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Clean clothes.
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Appropriately dressed for weather and occasion.
Finances
Factors to assess:
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Insurance coverage.
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Long-term care coverage.
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Total assets.
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Legal documents including trusts, living wills and durable powers of attorney.
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Is there an attorney who knows this person?
Interests/lifestyles
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Hobbies.
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Reading preferences: Are glasses or larger-print books needed? Would books on tape be enjoyable?
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Favorite TV and radio programs.
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Exercise — gardening and walking count!
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Musical instruments played.
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Languages spoken, and is there a preferred language?
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Favorite conversation topics.
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Travel experience.
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Important life events.
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Religious/spiritual background.
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Accomplishments.
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Social activities.
Want to discuss the answers to the assessment you completed for a loved one? Let us assist you and your family.
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