INTERVIEW OF CHOSEN ELDER ADULT


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Patient Questionnaire

INTERVIEW OF CHOSEN ELDER ADULT

Name:            ­­­­­­­­­­­­­­­­­­­­­________________________________ Age: ­­­­­­­­­­­­­­­________________

Brief Introduction (Background information):

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1. Philosophy on living a long life

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2. Thoughts about when a person is considered “too old”

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3. Opinion on the status and treatment of older adults

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4. Beliefs about health and illness

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5. Health promotion activities he or she participates in

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6. Something special that helped the person live so long

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7. Life span of other family members

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8. Special dietary traditions in patient’s culture attributed with aiding long life

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9. Any remedies/medications that have been handed down in family/group. If yes, describe. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

10. Patient’s description of current and past health status

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11. The values that guided life so far

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Additional Questions

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Summary

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Contrast of client’s responses with findings in current literature

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