Activities of daily living 2

More assessment tools

Name: _____________________ Today’s Date: _________

Please check the box that most applies for each activity:

Activity Need No Help

(2 pts. each)

Need Some Help

(1 pt. each)

Unable to Do At All

(0 pts. each)

1. Using the telephone ___ ___ ___
2. Getting to places beyond walking distance ___ ___ ___
3. Grocery shopping ___ ___ ___
4. Preparing meals ___ ___ ___
5. Doing housework or handyman work ___ ___ ___
6. Doing laundry ___ ___ ___
7. Taking medications ___ ___ ___
8. Managing money ___ ___ ___
Total Score: ___ = ( __ x 2 =) ___ + ( __ x 1=) ___ + 0

Reference
From Lawton, M.P., and Brody, E.M. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. The Gerontologist, 9, 179-186.  Copyright (c) by The Gerontological Society of America.

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