Item | Variable | Coding |
---|---|---|
Social situation | ||
1 | Living alone | 0 pt. = no, 1 pt. = yes |
Physical function | ||
2 | Falls in last 3Â months | 0 pt. = no, 1 pt. = yes |
3 | Mobility (MNA) | 0 pt. = goes out, 0.5 pt. = able to get out of bed/chair but does not go out, 1 pt. = bed or chair bound |
Sensory tests | ||
4 | Visual acuity test | 0 pt. = correct results, 1 pt. = no correct results |
5 | Whisper test | 0 pt. = both sides correct, 0.5 pt. = one side correct, 1 pt. = none correct |
Comorbidities – case history | ||
6 | Arterial hypertension | 0 pt. = no, 1 pt. = yes |
7 | Cardiovascular (MI, heart failure, circulatory disorder in feet, arrhythmia, stroke, cerebral hemorrhage, hemiplegic) | 0 pt. = no, 1 pt. = yes |
8 | Neurological (M. Parkinson, seizures) | 0 pt. = no, 1 pt. = yes |
9 | Chronic lung disease | 0 pt. = no, 1 pt. = yes |
10 | Dementia | 0 pt. = no, 1 pt. = yes |
11 | Gastrointestinal ulcer | 0 pt. = no, 1 pt. = yes |
12 | Osteoarthritis | 0 pt. = no, 0.5 pt. = hand/other joint, 1 pt. = hand and other joint |
13 | Urinary incontinence | 0 pt. = continent or independent and successful management of urine catheter 0.5 pt. = occasional accident 1 pt. = incontinent (catheterized, unable to manage alone) |
14 | Tumor | 0 pt. = no, 1 pt. = yes |
15 | Diabetes mellitus | 0 pt. = no, 0.5 pt. = without EOD, 1 pt. = EOD |
16 | Liver disease | 0 pt. = no, 0.5 pt. = light, 1 pt. = moderate to severe |
Self-estimated health/emotions | ||
17 | Subjective memory impairment | 0 pt. = no, 1 pt. = yes |
18 | General health (SF-12) | 0 pt. = excellent to good, 0.5 pt. = fair, 1 pt. = poor |
19 | Moderate activities (SF-12) | 0 pt. = not limited at all, 0.5 pt. = limited a little, 1 pt. = limited a lot |
20 | Climbing several flights of stairs (SF-12) | 0 pt. = not limited at all, 0.5 pt. = limited a little, 1 pt. = limited a lot |
21 | Interference by pain (SF-12) | 0 pt. = not at all, 0.25 pt. = a little bit, 0.5 pt. = moderately, 0.75 pt. = quite a bit, 1 pt. = extremely |
22 | A lot of energy (SF-12) | 0 pt. = all/most of the time, 0.5 pt. = a good bit/some of the time, 1 pt. = a little/none of the time |
23 | Downhearted and blue (SF-12) | 0 pt. = none/a little of the time; 0.5 pt. = some of the time; 1 pt. = a good bit/most/all of the time |
24 | Interference with social contacts (SF-12) | 0 pt. = none/a little of the time; 0.5 pt. = some of the time; 1 pt. = most/all of the time |
Measurements | ||
25 | Weight loss during the last 3 months (MNA) | 0 pt. = no, 0.5 pt. = 1–3 kg, 1 pt. = > 3 kg |
26 | GFR (ml/min//1.73m2) | 0 pt. = ≥ 60; 0.5 pt. = 30 to < 60; 1 pt. = < 30 |
27 | BMI (kg/m2) | 0 pt. = 18.5 to < 30; 1 pt. = < 18.5 or ≥ 30 |
28 | Anemia | Men: 1 pt. = < 13Â g/dL; Women: 1 pt. = < 12Â g/dL |
29 | Polypharmacy | 1 pt. = ≥ 5 medications |
30 | Barthel Index | 0 pt. = ≥ 85; 0.5 pt. = 35–80; 1 pt. = 0–30 points |