Functional Assessment of The Elderly: I.Socio-Demographic

FUNCTIONAL ASSESSMENT OF THE ELDERLY
By: Nikky Rossel B. Flores
I. SOCIO-DEMOGRAPHIC
Name: Zosima Mansalay Sales Religion: Roman Catholic
Birthdate:July 14, 1955 Age: 64
Educational Attainment: Elementary Graduate
Gender: Female OSCA ID Number: 3084
Civil Status: Married Booklet: ( ) Yes (/ )No
Address: Zone 5 Brgy. Guindag-an, Tanauan, Leyte
II. PHYSICAL STATUS
SENSES
A.1 Eyesight YES NO REMARKS
Totally blind 
Sees light and shadows 
Recognize people by sight alone 
Can see well enough to read and write 
Use of aids: contact lens, eyeglasses 

Presence of cataracts, glaucoma, etc. 
A.2 Hearing
Totally deaf 
Recognize sound but cannot understand what is said 
Hears well 
Has hearing aids 

A.3 SENSE OF TASTE
Bitter 
Salt 
Sour 
Sweet 
A.4 SENSE OF TOUCH

Able to feel:
Light touch 
Pain 
Pressure 
Hot Temperature 
Cold Temperature 
A.5 SENSE OF SMELL

Ability to distinguish smell as:
Coffee 
Vinegar 
Spices 
Perfumes/Colognes 
A.6 SENSE OF BALANCE

One (1) leg standing balance test 
Able to maintain balance in standing position for 5 seconds 
Able to sit and stand from an 18-inch chair 
B. ACTIVITIES OF DAILY LIVING
B.1 FEEDING/EATING
Able to feed self 
Ability to prepare foods 
Able to open containers/bottle/packs 
C.2 HYGIENE
Able to bath self 
Able to dress and undress self 
Able to shave/comb hair, brush teeth, etc. 
Able to cut own nails 
C.3 MOBILITY
Able to move in and out of bed 
Able to walk at a distance of at least 50 meters 
Able to go up and down the stairs (4-8 steps) 
Able to reach objects from a height of at least 5 feet 
Able to reach objects from the floor 
Able to fetch water 
Able to change position:
 Rising & sitting on chair 
 Turning from L-R side and vice versa 
 Turn to supine 
 Turn to prone 
Able to open and lock the door 
Use of aids, e.g. walker, canes, etc. 
C.4 ELIMINATION
Able to control bladder and bowel elimination 
Able to cleanse self after elimination and defecation 

Able to flush the toilet after using. 
C. SOCIAL STATUS
 How do you relate with your husband? (ano an imo masisiring bahin hiton iyo relasyon nga mag-
asawa?) “Maupay man an amon relasyon. Maupay na ginsisilbihan ak niya, maswerte ak ha iya.” As
verbalized by the client
 How about with you children/grandchildren? (ano an imo masisiring hiton relasyon nimo ngadto
hiton imo mga anak/mga apo?) “Okay man, waray man problema kay gin-aatiman man ak nila ngan an
akon mga kinahanglan hira man an nahatag” as verbalized by the client
 How about with your friends of the same age? (ano an imo masisiring hiton relasyon nimo ngadto
hiton imo mga kasangkayan nga imo ka-edad?) “Maupay man gihap kay pirmi man ak nira
ginkakamusta. Damo man an nabisita ha ak” as verbalized by the client
D. EMOTIONAL STATUS
 How do you feel about receiving support from your children (ano it imo gin-aabat kon tinatagan ka
hin bulig hiton imo mga anak?) “Malipayon kay gintagan ak nira maupay nga pagtagad, diri ak nira
ginpapabay-an” as stated by the client
 Who supports you when you have problems either physical, financial, psychological in nature?
(hin-o iton nabulig ha imo o hin-o an madali dali nimo daupan kon mayda ka problema?) “An akon
mga anak ngan asawa an pirmi nabulig ha ak” as stated by the client______________
 What sort of decision do you need to make regularly? (Ano nga mga klase hin desisyon an masukot
mo himu-on?) “ An pag-inisip han mga problema ngadi ha balay.” As verbalized by the client
E. ADAPTIVE MECHANISMS
 How do you handle problems and life changes such as development of chronic illness, death of
spouse or close friend, loss/reduction of economic resources? (Ano an imo guinhihimo kun mayda
ka sugad hini na pagbag-o ha imo kinabuhi?) “Kun may-ada ak mga kasangkayan na namatay nahatag
ak abuloy. Nag-aampo nala gihap ak hito kay Hiya manla an maaram han nga tanan. Nagsusumat gihap
ak ha akon mga anak ngan asawa kun may-ada ako mga problema.” As verbalized by the client
 Do you believe that your coping skills are adequate for most/all of the situation in your life? Do you
have other solutions on how to cope with your problems? (Para ha imo iton nga imo abilidad para
masolbar it imo mga problema sakto na or mayda ka pa ba iba na solusyon para makabulig
masolbar it imo problema?) “Kun akon la nausa an magsolbar diri ko iton makakaya, kinahanglan nga
mag-ampo gihap kay amo iton an pinakamaupay na sandata” as verbalized by the client

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FUNCTIONAL ASSESSMENT OF THE ELDERLY

By: Nikky Rossel B. Flores

II. PHYSICAL STATUS

Sees light and shadows 

Recognize people by sight alone 

Can see well enough to read and write 

Use of aids: contact lens, eyeglasses 

Has hearing aids 

A.4 SENSE OF TOUCH

A.5 SENSE OF SMELL

A.6 SENSE OF BALANCE

Able to cleanse self after elimination and defecation 

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