II. Indications

  1. Assess functional capabilities of older patients

III. Survey

  1. Based on 9 criteria
    1. Use of the telephone (look up numbers, dial, answer)
    2. Traveling via car or public transportation (places outside of walking distance)
    3. Food or clothes shopping (regardless of transport)
    4. Meal preparation
    5. Housework
    6. Handyman work
    7. Laundry
    8. Medication use (Preparing and taking correct dose)
    9. Management of money (write checks, pays bills)
  2. Each criteria is graded on 3 part scale
    1. Independent: 3 points
    2. Assistance needed: 2 points
    3. Dependent: 1 point
  3. Two separate surveys completed
    1. Patient (self-rated)
    2. Informant (nurse, Caregiver or family member)

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