Category | Score for "Yes" | Score for "No" |
---|---|---|
Does the patient take more than 4 different medications? | 1 | 0 |
Treatment with specific medications (cumulative score) | ||
Anti-histamine | 1 | 0 |
Anti-hypertensive | 1 | 0 |
Diuretics | 1 | 0 |
Medications interfering with the state of alertness | 1 | 0 |
Psychiatric medications | 1 | 0 |
Laxatives | 1 | 0 |
Anti-diabetic medications | 1 | 0 |
Level of consciousness | ||
Mild confusion | 1 | 0 |
Confused | 1 | 0 |
Vaguely conscious | 1 | 0 |
Unconscious | 1 | 0 |
Sedated | 1 | 0 |
Under the influence of medications | 1 | 0 |
Cognitive state | ||
Difficulties in orientation, time | 1 | 0 |
Difficulties in orientation, place | 1 | 0 |
Difficulties in orientation, people | 1 | 0 |
Memory problems | 1 | 0 |
Vision | ||
Normal/Sedated | 0 | |
Difficulties in vision | 1 | 0 |
Eyeglasses all day long | 1 | 0 |
Blindness | 1 | 0 |
Hearing | ||
Normal/Sedated | 0 | |
Difficulties in hearing | 1 | 0 |
Hearing aid all day long | ||
Deafness | 1 | 0 |
Mobility | ||
Fully independent/bedridden | 0 | |
Needs little help | 1 | 0 |
Needs significant help | 1 | 0 |
Needs much help | 1 | 0 |
Walking and stability | ||
Walks stably | 0 | |
Weakness | 1 | 0 |
Instability | 1 | 0 |
Paralyzed | 1 | 0 |
Bedridden | 1 | 0 |
Wheelchair | 1 | 0 |
Patient attached to limiting equipment (e.g., infusion set apparatus) | 1 | 0 |
Use of mobility aids | ||
Does not use | 0 | |
Cane | 1 | 0 |
Walks with the help of the nursing staff | 1 | 0 |
Walker | 1 | 0 |
Wheelchair | 1 | 0 |
Crutches | 1 | 0 |
Amputation/Artificial limb | 1 | 0 |
History of falling during the past 6 months | 9 | 0 |
Difficulty in getting out of a bed or a chair | 1 | 0 |
Patient feels weaker than before | 1 | 0 |
Patient feels dizzy | 1 | 0 |
Patient has decreased leg sensation | 1 | 0 |
Did the patient undergo general anesthesia during the past 24 hours? | 1 | 0 |
Urgency and a high frequency of the need to go to the toilet | 1 | 0 |
Does the patient go to the toilet during the night-time? | 1 | 0 |