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