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. Author manuscript; available in PMC: 2009 Jun 9.
Published in final edited form as: J Nutr Health Aging. 2009 Mar;13(3):256–259. doi: 10.1007/s12603-009-0068-z

Table 1.

The Dependence Scale Questionnaire

  1. Does the patient need reminders or advice to manage chores, do shopping, cooking, play games, or handle money?

  2. Does the patient need help to remember important things such as appointments, recent events, or names of family or friends?

  3. Does the patient need frequent (at least once a month) help finding misplaced objects, keeping appointments, or maintaining health or safety (locking doors, taking medication)?

  4. Does the patient need household chores done for him/her?

  5. Does the patient need to be watched or kept company when awake?

  6. Does the patient need to be escorted when outside?

  7. Does the patient need to be accompanied when bathing or eating?

  8. Does the patient have to be dressed, washed, and groomed?

  9. Does the patient have to be taken to the toilet regularly to avoid incontinence?

  10. Does the patient have to be fed?

  11. Does the patient need to be turned, moved, or transferred?

  12. Does the patient wear a diaper or a catheter?

  13. Does the patient need to be tube fed?

Items A and B are coded as follows: no, 0; occasionally (ie, at least once a month), 1; frequently (ie, at least once a week), 2. The other items are coded as follows: no, 0; yes, 1. Total Dependence Scale score is the sum of scores on all 13 items (range=0–15).