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A Global Response to Elder Abuse - page 65 / 149

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PAGE 50

  • 7.

    Marital Status

  • 1.

    Married p

2.

Widowed p

3.

Separated or divorced p

  • 4.

    Single p

  • 5.

    Common law p

  • different-sex partner p

  • same-sex partner p

6.

Significant relationship p

8. Living Arrangements Check all that apply:

1.

Alone p

2.

With spouse p

3.

With common law partner p

4.

With roommate p

5.

With child(ren) p

6.

With grandchild(ren) p

7.

With other relatives:

8.

With paid caregiver p

9.

Other:

How many?

How many?

If "Yes", explain:

How long have you been in the present arrangement?

Is it problematic (for example: family problem, needs more help, other)?

Yes p

No p N/A p

R/A p

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