OldSmarts™ Quality of life assessment

Complete, print, and bring to any visit you have with a health professional.

OldSmarts™ Quality of Life Assessment

OldSmarts™ Quality of Life Assessment

Basic info

Events - things that have happened to you since your last visit (existing patient) or in the past year (new patient)

Issues - how you felt most days in the past week

Wishes - what are ONE or TWO main things that would make your life better (besides good health and money)?


Recent Significant Events References

Called your PCP office - check out A Doctor’s Guide to a Good Appointment
Called a specialist office - check out Many Patients Don't Pursue Referrals
Car accident - check out Older Drivers
Death of a spouse - check out Mourning the Death of a Spouse
Death of a friend - check out Coping with the Death of a Friend

Great, no significant events recently - if any of the above happens, make sure your PCP knows!

Significant or Intolerable Issues References

Caring for someone else - check out 7 Tips to Avoid Caregiver Burnout
Chest pain or pressure - check out Heart Health
Constipation - check out Concerned About Constipation?
Difficulty walking - check out Gait and Balance Disorders in Older Adults
Dizziness - check out Dizziness and Vertigo
Fear of disability or being a burden - check out 5 Signs That Your Biggest Fear is ‘Being a Burden’
Indigestion/nausea - check out Indigestion
Low energy - check out Fatigue in Older Adults
Low mood - check out Depression and Older Adults
Managing your health problems - check out Health Screening
Managing your medications - check out Taking Medicines Safely as You Age and Saving Money on Medicines
Overall health/quality of life - check out Quality of life and 10 Things You Can Do to Improve Your Life Right Now
Pain - check out Pain: You Can Get Help
Poor sleep - check out A Good Night's Sleep and Aging Changes In Sleep
Shortness of breath - check out COPD
Unintentional weight loss - check out Unintentional Weight Loss in Older Adults
Urine leakage/incontinence - check out Urinary Incontinence in Older Adults

Great, no significant or intolerable issues right now - if anything develops, make sure you let your PCP know!

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