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Evaluation

Are you evaluating an elderly person who is living in the community?

Age of the patient

years

Gender of the patient

Number of hospitalizations in past year

Number of hospitalizations in the year previous to that (1.1-2 years ago)

Is the person currently working?

Does the person need assistance to bathe?

Maximum distance that the person can walk

Does the person have diabetes mellitus?

Is the person being treated with a loop diuretic (Lasix, other)?

Serum albumin

Serum iron

Select the appropriate answer for each finding

Religious participation

Self-reported health

Results

Please fill out required fields.