Seniors Helping Seniors

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Do you want some help?

Caregivers are often so concerned with caring for their relative’s needs that they lose sight of their own wellbeing.


Caregiver Self-Assessment Questionnaire

How are you?

Please take just a moment to answer the following questionnaire (prepared by the American Medical Association) and review what your answers mean at the bottom.

During the past week:

1. Had trouble keeping my mind on what I was doing yes no
2. Felt that I couldn’t leave my relative alone yes no
3. Had difficulty making decisions yes no
4. Felt completely overwhelmed yes no
5. Felt useful and needed yes no
6. Felt lonely yes no
7. Been upset that my relative has changed so much from his/her former self yes no
8. Felt a loss of privacy and/or personal time yes no
9. Been edgy or irritable yes no
10. Had sleep disturbed because of caring for my relative yes no
11. Had a crying spell(s) yes no
12. Felt strained between work and family responsibilities yes no
13. Had back pain yes no
14. Felt ill (headaches, stomach problems or common cold) yes no
15. Been satisfied with the support my family has given me yes no
16. Found my relative’s living situation to be inconvenient or a barrier to care yes no
17. On a scale of 1 to 10, with 1 being “not stressful” to 10 being “extremely stressful,” please rate your current level of stress.
18. 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.


To Determine the Score:

  1. Each "Yes" response adds 1 to your score, except for questions 5 and 15, for which a "No" response adds 1.
  2. Click here to calculate your score:

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 by getting support from an organization like ours.
  • Consider joining a support group.