Assessment Checklist

Do You Suspect Inadequate Meals & Nutrition?.

• Does there appear to be a loss of interest in preparing well-balanced, nutritious meals?
• Are there unusual amounts of spoiled food in their refrigerator?
• Have food dates expired on staple foods, i.e., dairy and meat?
• Do they have many packages and cans of the same thing?
• Are there many dented cans and other containers?

Are There Unopened or Piled Up Bills?

• Is their mail piled up and unopened?
• Are there many more than usual magazine subscriptions coming to the home?
• Are some of their bills from unrecognizable sources?

Are There Recurring Memory Lapses?

• Are they missing doctor appointments or forgetting to make them?
• Are there unusual amounts of spoiled food in their refrigerator?
• Are they making mistakes with their medication? Too much?
• Are they forgetting to take their pills?
• Confusing medications in original containers with those laid out on a daily basis?
• Repeat prescriptions from more than one doctor or pharmacy?
• Are foods left cooking on the stove?
• Have pots been burned?

Does the Individual Suffer from Frequent Falls?

• Are medicines causing dizziness or loss of balance?
• Are they refusing to use a prescribed cane or walker?
• Are there loose rugs or uneven flooring areas in the home?

Is There a Lack of Interest or Feeling of Being “Sort of Down”?

• Has there been many peer, friend or relative losses recently?
• Has the sadness gone on for a long time?
• When was the last time they had a complete physical? Have you talked to their doctor?
• What kind of social activities do they engage in outside the home?

Are You Concerned About Unsafe Driving?

• Have you noticed a change in their driving capabilities?
• Do they get angry when you bring up a discussion about driving?
• Have you noticed changes in their agility, reflexes and eyesight?
• Have there been any recent accidents?

Do You Sense a Marked Change in Behavior Patterns?

• Is the home as neat and spotless as it used to be?
• Have they stopped attending church/religious services?
• Have they stopped keeping their beauty/barbershop appointments?
• Are they more irritable or otherwise moody, teary or sad?