INSTRUMENTAL ACTIVITIES OF DAILY LIVING SCALE (Short version)

Ability to use telephone

Yes

NO

Q1

Operates telephone on own initiative-looks up and dials numbers, etc.

Q2

Dials a few well-known numbers

Q3

Answers telephone but does not dial

Q4

Does not use telephone at all

Mode of transportation

Q1

Travels independently on public transportation or drives own car

Q2

Arranges own travel via taxi, but does not otherwise use public transportation

Q3

Travels on public transportation when accompanied by another

Q4

Travel limited to taxi or automobile with assistance of another

Q5

Does not travel at all

Responsibility for own medications

Q1

Is responsible for taking medication in correct dosages at correct time

Q2

Takes responsibility if medication is prepared in advance in separate dosage

Q3

Is not capable of dispensing own medication

Ability to handle finances

Q1

Manges financial matters independently

Q2

Manages day-to-day purchases, but needs help with banking, major purchases, etc.

Q3

Incapable of handling money