ADL Items: Do you need help from another person or special equipment or a device?

Walking across a small room

Bathing (either a sponge bath, tub bath, or shower)

Personal grooming like brushing hair, brushing teeth, or washing face

Dressing (like putting on a shirt, buttoning and zipping, or putting on shoes)

Eating (like holding a fork, cutting food, or drinking from a glass)

Getting from a bed to a chair

Using the toilet

IADL Items: Can you do these activities by yourself or without any help from anyone else?

Can you use the telephone without help (including looking up numbers and dialling)

Can you drive your own car or travel alone on buses or taxis

Can you go shopping for groceries or clothes without help (taking care of all shopping needs yourself, assuming you had transportation)

Can you prepare your own meals without help (plan and cook full meals yourself)

Can you do light housework without help (dish washing and bed making, etc.)

Can you take your own medicine without help (in the right doses at the right time)

Can you handle your money without help (write checks, pay bills, etc.)

Can you do heavy work around the house like washing windows, walls and floors without help

Can you walk up and down stairs to the second floor without help

Can you walk half a mile without help

Note: ADL=Activities of Daily Living; IADL=Instrumental Activities of Daily Living