If you want to understand the health condition of yourself / your elderly with chronic illnesses such as 1) Health / Medical related ; 2) Social / Psycho Function; 3) Rehabilitation needs, please spend a few minutes to complete the online assessment.

(Please choose appropriate answer)


1.

Do you / Does your elderly have any of the following health condition? Check all that apply.
Arthritis / Pain
Cancer
Stress / Depression / Memory Problems
High Blood Pressure
Angina / Heart Condition
Diabetes / High Blood Sugar

2.

Did you / your elderly hospitalized at least three times last year?
Yes
No

3.

Have you / your elderly used emergency service at least three times last year?
Yes
No

4.

Did you / your elderly visit a doctor at least three times last year? (Does not have to be the same doctor each time)
Yes
No

5.

In general, do you / does your elderly have to take at least five different types of medicine?
Yes
No

6.

Are you / Is your elderly having trouble taking the medication accurately?
Yes
No

7.

Do you / Does your elderly rarely visit or contact with other family / friends / significant others?
Yes
No

8.

Do you / Does your elderly seldom participate in other social activities?
Yes
No

9.

Do you / Does your elderly ever feel depressed about your/his/her health?
Yes
No

10.

Do you / Does your family member aware that your elderly / you have hallucination?
Yes
No

11.

Do you / Does your elderly easily forget things happen to your family / friends/ relatives recently?
Yes
No

12. Do you / Does your elderly have difficulty in doing the following activities?

  Yes No
Shopping
Light housekeeping
Doing laundry
Preparing meals
Using transportation
Using telephone
Managing money
Bathing
Dressing
Getting out of bed
Getting out of chair
Walking around inside the house
Eating
Using the toilet

Contact Us : 2663 3001

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