|
A
|
Has food intake declined over the past 3 months due to loss of appetite, digestive problems, chewing or swallowing difficulties?
|
0 : severe decrease in food intake
|
|
1 : moderate decrease in food intake
|
|
2 : no decrease in food intake
|
|
B
|
Weight loss during the last 3 months
|
0 : weight loss > 3 kg
|
|
1 : does not know
|
|
2 : weight loss between 1 and 3 kgs
|
|
3 : no weight loss
|
|
C
|
Mobility
|
0 : bed or chair bound
|
|
1 : able to get out of bed/chair but does not go out
|
|
2 : goes out
|
|
E
|
Neuropsychological problems
|
0 : severe dementia or depression
|
|
1 : mild dementia or depression
|
|
2 : no psychological problems
|
|
F
|
Body Mass Index (BMI (weight in kg)/(height in m2)
|
0 : BMI < 19
|
|
1 : BMI = 19 to BMI < 21
|
|
2 : BMI = 21 to BMI < 23
|
|
3 : BMI = 23 and > 23
|
|
H
|
Takes more than 3 medications per day
|
0 : yes
|
|
1 : no
|
|
P
|
In comparison with other people of the same age, how does the patient consider his/her health status?
|
0 : not as good
|
|
0.5 : does not know
|
|
1 : as good
|
|
2 : better
|
| |
Age
|
0 : >85
|
|
1 : 80–85
|
|
2 : <80
|
| |
Total Score
|
0–17
|
