Tuesday, July 31, 2007

Caregiving: caregiver self-assessment questionnaire

American Medical Association

Caregiver Self-Assessment


How are you?

"Caregivers are often so concerned with caring for their relative’s needs that they lose sight of their own wellbeing. Please take just a moment to answer the following questions. Once you have answered the questions, do a self-evaluation."

During the past week or so, I have...

 1. Had trouble keeping my mind on what I was doing.

     .......Yes No

 2. Felt that I couldn’t leave my relative alone.

     .......Yes No

 3. Had difficulty making decisions.

      .....Yes No

 4. Felt completely overwhelmed.

     .......Yes No

 5. Felt useful and needed.

     .......Yes No

 6. Felt lonely.

     .......Yes No

 7. Been upset that my relative has changed so much 

     from his/her former self.

     ........Yes No

 8. Felt a loss of privacy and/or personal time.

     ........Yes No

 9. Been edgy or irritable.

     ........Yes No

10. Had sleep disturbed because of caring for my relative.

     .........Yes No

11. Had a crying spell(s).

     .........Yes No

12. Felt strained between work and family responsibilities.

     .........Yes No

13. Had back pain.

     .........Yes No

14. Felt ill (headaches, stomach problems or common cold).

     .........Yes No

15. Been satisfied with the support my family has given me.

     .........Yes No

16. Found my relative’s living situation to be inconvenient or 

    a  barrier to care.

     .........Yes No

17. On a scale of 1 to 10, with 1 being “not stressful” to 10 

      being “extremely stressful,” please rate your current

      level of stress.      


18. On a scale of 1 to 10, with 1 being “very healthy” to 10

      being “very ill,” please rate your current health

      compared to what it was this time last year.


To Determine the Score:

1. Reverse score questions 5 and 15. (For example, a “No”

   response should be counted as “Yes” and a “Yes” response

  should be counted as“No”)

2.Total the number of “yes” responses.


To Interpret the Score:

Chances are that you are experiencing a high degree of distress:

• If you answered “Yes” to either or both Questions 4 and 

   11; or

• If your total “Yes” score = 10 or more; or

• If your score on Question 17 is 6 or higher; or

• If your score on Question 18 is 6 or higher.


Caregivingly Yours, Patrick Leer

1 comment:

  1. Thank you Patrick...I'm going to print this out if you don't mind. :o)


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