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Age Well

Age Well

Section

Your mobility and physical health

Have you fallen in the last 12 months?
Are you worried about falling?
Have you noticed your balance, walking or strength has worsened over the past year?
Do you find it difficult to leave your home without help?
Have you unintentionally lost weight?

Managing at home

Do you live alone?
Do you feel you lack support if you need help?
Do you have a carer (family, friend or paid)?
Do you need help with daily tasks?
What do you need help with?
Select all that apply

Mood and memory

Do you often feel low in mood?
Do you often feel lonely?
Do you often feel anxious or worried?
Do you or someone close to you have concerns about your memory?

Medication confidence

Do you sometimes forget to take your medication?
Do you feel unsure about any of your medications?
For example, what they are for or how to take them.

Overall wellbeing

Thinking about your overall wellbeing today, how would you rate it?
On a scale from 0 to 10, with 0 being very poor and 10 being excellent