Current medical conditions and medications (Fine - Some challenges - Concerning)
Vision, hearing, balance, and strength (Fine - Some challenges - Concerning)
Cognitive health (memory, judgment, decision‑making) (Fine - Some challenges - Concerning)
Fatigue or endurance limitations (Fine - Some challenges - Concerning)
Ask: Can I do these safely and consistently?
Bathing and personal hygiene (Fine - Some challenges - Concerning)
Dressing and grooming (Fine - Some challenges - Concerning)
Cooking and meal preparation (Fine - Some challenges - Concerning)
Housekeeping and laundry (Fine - Some challenges - Concerning)
Managing medications (Fine - Some challenges - Concerning)
Driving or transportation (Fine - Some challenges - Concerning)
Frequency of social interaction (Fine - Some challenges - Concerning)
Risk of isolation or loneliness (Fine - Some challenges - Concerning)
Sense of purpose and engagement (Fine - Some challenges - Concerning)
Tip: Revisit this assessment yearly or after major health changes and if there are concerning issues, talk to your PCP about local resources to help.