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A Global Response to Elder Abuse - page 63 / 149

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PAGE 48

SECTION 1: SOCIAL HISTORY: (occupation, marriage, divorce, grief, misfortune, education, immigration, moves, other major events.)

In this section, ask subject to tell you a personal history. During this process, gather infor- mation on the above and fill it in below:

  • 1.

    Sex:

  • 2.

    Age:

Mp

or

Fp

  • 3.

    Language used during the interview:

  • 4.

    Occupation status (circle all that apply)

  • 1.

    Retired

  • 2.

    Unemployed

  • 3.

    Unable to work for medical reasons

  • 4.

    Employed full time as:

  • 5.

    Employed part-time as:

  • 6.

    Homemaker

  • 7.

    Other:

Type of work?

From what?

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