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Evaluation

Are you evaluating a nursing home resident with advanced dementia?

Age of the patient

years

Gender of the patient

Height

Weight of the patient

Weight loss in past 6 months

Weight loss in past 30 days

Number of pressure ulcers that are Stage 2 or higher

Has/Does/Is the patient ...

• been recently admitted to the nursing home?

• have dyspnea?

• completely dependent?

• spend most or all of the day in bed?

• have insufficient oral intake?

• bowel incontinent?

• have congestive heart failure?

Results

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