Rate all 11 items
Clock Drawing Test (CDT)
CognitionHow many times have you been admitted to hospital in the last year?
General Health StatusIn general, how would you describe your health?
General Health StatusHow many of the following activities do you require help with? (Meal prep, shopping, transport, phone, housekeeping, laundry, meds, finances)
Functional IndependenceWhen you need help, can you count on someone willing and able to meet your needs?
Social SupportDo you use 5 or more different prescription medications on a regular basis?
Medication UseAt times, do you forget to take your prescription medications?
Medication UseHave you recently lost weight such that your clothing has become looser?
NutritionDo you often feel sad or depressed?
MoodDo you have a problem with losing control of urine when you don't want to?
ContinenceTimed Up and Go (TUG) Test: Time to rise from chair, walk 3m, return and sit.
Functional PerformanceVerified
Last Review: 2026
Last Comprehensive Review: 2026
