Activities of Daily Living

Date: Name:

Please check the box that most applies for each activity:

Activity Need No Help
(2 pts. each)
Need Some Help
(1 pt. each)
Unable to Do At All
(0 pts. each)
1. Using the Telephone ___ ___ ___
2. Getting to Places Beyond Walking Distance ___ ___ ___
3. Grocery Shopping ___ ___ ___
4. Preparing Meals ___ ___ ___
5. Doing Housework or Handyman Work ___ ___ ___
6. Doing Laundry ___ ___ ___
7. Taking Medications ___ ___ ___
8. Managing Money ___ ___ ___
Total Score: ___ = (___ x 2 =) ___ + (___ x 1=) ___ + 0
From Lawton, M.P., and Brody, E.M. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. The Gerontologist, 9, 179-186.  Copyright (c) by The Gerontological Society of America.  Used by permission of the Publisher.