Out of the Shadows
Uncovering Substance Use and Elder Abuse
American Medical Association Caregiver Self-Assessment Questionnaire
How are you?
Caregivers often are so concerned with caring for their relative's needs that they lose sight of their own wellbeing. Please take just a moment to answer the following questions. Once you have answered the questions, do a self-evaluation.
During the past week or so, I have
- Had trouble keeping my mind on what I was doing
- Felt that I couldn't leave my relative alone
- Had difficulty making decisions
- Felt completely overwhelmed
- Felt useful and needed
- Felt lonely
- Been upset that my relative has changed so much from his/her former self
- Felt a loss of privacy and/or personal time
- Been edgy or irritable
- Had sleep disturbed because of caring for my relative
- Had a crying spell(s)
- Felt strained between work and family responsibilities
- Had back pain
- Felt ill (headaches, stomach problems or common cold)
- Been satisfied with the support my family has given me
- Found my relative's living situation to be inconvenient or a barrier to care
On a scale of 1 to 10, with 1 being "not stressful" to 10 being "extremely stressful," please rate your current level of stress. _________
On a scale of 1 to 10, with 1 being "very healthy" to 10 being "very ill," please rate your current health compared to what it was this time last year. _________
Comments:
(Please feel free to comment or provide feedback)
Self-evaluation:
To Determine the Score:
- Reverse score questions 5 and 15. (For example, a "No" response should be counted as "Yes" and a "Yes" response should be counted as "No"
- Total the number of "Yes" responses.
To Interpret the Score:
Chances are that you are experiencing a high degree of distress:
- If you answered "Yes" to either or both Questions 4 and 11; or
- If your total "Yes" score = 10 or more; or
- If your score on Question 17 is 6 or higher; or
- If your score on Question 18 is 6 or higher.
Next steps:
- Consider seeing a doctor for a check-up for yourself.
- Consider having some relief from caregiving. (Discuss with the doctor or a social worker the resources available in your community.)
- Consider joining a support group.
Source: American Medical Association. (n.d.) Caregiver self-assessment questionnaire. Available from http://www.ama-assn.org/ama/upload/mm/36/caregivertooleng.pdf








