Functional Activities Questionnaire – FAQ

Geriatrics
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Functional Activities Questionnaire - FAQ
INSTRUCTION: Ask informant to rate patient’s ability to perform the following activities
[select name="Q1" value="Dependent (3 points)=3|Requires assistance (2 points)=2|Has difficulty but does by self (1 point)=1|Normal (0 points)=0|Never did the activity but could do now (0 points)=0|
Never did the activity and would have difficulty now (1 point)=1"] <-- Writing checks, paying bills, balancing checkbook
[select name="Q2" value="Dependent (3 points)=3|Requires assistance (2 points)=2|Has difficulty but does by self (1 point)=1|Normal (0 points)=0|Never did the activity but could do now (0 points)=0|
Never did the activity and would have difficulty now (1 point)=1"] <-- Assembling tax records, business affairs, or papers
[select name="Q3" value="Dependent (3 points)=3|Requires assistance (2 points)=2|Has difficulty but does by self (1 point)=1|Normal (0 points)=0|Never did the activity but could do now (0 points)=0|
Never did the activity and would have difficulty now (1 point)=1"] <-- Shopping alone for clothes, household necessities, or groceries
[select name="Q4" value="Dependent (3 points)=3|Requires assistance (2 points)=2|Has difficulty but does by self (1 point)=1|Normal (0 points)=0|Never did the activity but could do now (0 points)=0|
Never did the activity and would have difficulty now (1 point)=1"] <-- Playing a game of skill, working on a hobby
[select name="Q5" value="Dependent (3 points)=3|Requires assistance (2 points)=2|Has difficulty but does by self (1 point)=1|Normal (0 points)=0|Never did the activity but could do now (0 points)=0|
Never did the activity and would have difficulty now (1 point)=1"] <-- Heating water, making a cup of coffee, turning off stove after use
[select name="Q6" value="Dependent (3 points)=3|Requires assistance (2 points)=2|Has difficulty but does by self (1 point)=1|Normal (0 points)=0|Never did the activity but could do now (0 points)=0|
Never did the activity and would have difficulty now (1 point)=1"] <-- Preparing a balanced meal
[select name="Q7" value="Dependent (3 points)=3|Requires assistance (2 points)=2|Has difficulty but does by self (1 point)=1|Normal (0 points)=0|Never did the activity but could do now (0 points)=0|
Never did the activity and would have difficulty now (1 point)=1"] <-- Keeping track of current events
[select name="Q8" value="Dependent (3 points)=3|Requires assistance (2 points)=2|Has difficulty but does by self (1 point)=1|Normal (0 points)=0|Never did the activity but could do now (0 points)=0|
Never did the activity and would have difficulty now (1 point)=1"] <-- Paying attention to, understanding, discussing TV, book, magazine
[select name="Q9" value="Dependent (3 points)=3|Requires assistance (2 points)=2|Has difficulty but does by self (1 point)=1|Normal (0 points)=0|Never did the activity but could do now (0 points)=0|
Never did the activity and would have difficulty now (1 point)=1"] <-- Remembering appointments, family occasions, holidays, medications
[select name="Q10" value="Dependent (3 points)=3|Requires assistance (2 points)=2|Has difficulty but does by self (1 point)=1|Normal (0 points)=0|Never did the activity but could do now (0 points)=0|
Never did the activity and would have difficulty now (1 point)=1"] <-- Traveling out of neighborhood, driving, arranging to take buses
SCORE --> [calc memo="number" value="score1=(Q1)+(Q2)+(Q3)+(Q4)+(Q5)+(Q6)+(Q7)+(Q8)+(Q9)+(Q10)"] / 30
RESULT --> [calc memo="interpretation" value="score2=(Q1)+(Q2)+(Q3)+(Q4)+(Q5)+(Q6)+(Q7)+(Q8)+(Q9)+(Q10);score2>5?'Significant impaired function and possible cognitive impairment are present - further evaluation is recommended':score2>0?'Some impaired function and mild cognitive impairment may be present - further evaluation is recommended':'No impaired function'"]
[html]<hr>[/html][checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"][html]
reference: <a href="http://www.ncbi.nlm.nih.gov/pubmed/7069156" target="_blank">Pfeffer RI, Kurosaki TT, Harrah CH Jr, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol. 1982 May;37(3):323-9.</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/20592580" target="_blank">Teng E, Becker BW, Woo E, Knopman DS, Cummings JL, Lu PH. Utility of the Functional Activities Questionnaire for Distinguishing Mild Cognitive Impairment from Very Mild Alzheimer’s Disease. Alzheimer disease and associated disorders 2010;24(4):348-353.</a>[/html][/conditional]
Functional Activities Questionnaire - FAQ
INSTRUCTION: Ask informant to rate patient’s ability to perform the following activities
<-- Writing checks, paying bills, balancing checkbook
<-- Assembling tax records, business affairs, or papers
<-- Shopping alone for clothes, household necessities, or groceries
<-- Playing a game of skill, working on a hobby
<-- Heating water, making a cup of coffee, turning off stove after use
<-- Preparing a balanced meal
<-- Keeping track of current events
<-- Paying attention to, understanding, discussing TV, book, magazine
<-- Remembering appointments, family occasions, holidays, medications
<-- Traveling out of neighborhood, driving, arranging to take buses
SCORE --> numberscore1=(Q1)+(Q2)+(Q3)+(Q4)+(Q5)+(Q6)+(Q7)+(Q8)+(Q9)+(Q10) / 30
RESULT --> interpretationscore2=(Q1)+(Q2)+(Q3)+(Q4)+(Q5)+(Q6)+(Q7)+(Q8)+(Q9)+(Q10);score2>5?'Significant impaired function and possible cognitive impairment are present - further evaluation is recommended':score2>0?'Some impaired function and mild cognitive impairment may be present - further evaluation is recommended':'No impaired function'

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