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A Global Response to Elder Abuse - page 79 / 149

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PAGE 64

SECTION 5: LIVING WITH A CARE-RECEIVER

32. Do you live with anyone who is dependent on you?

Yes p No p N/A p R/A p

If "No" go to question 34.

If "Yes" what it your relationship to that person?

Do you give any of the following types of assistance to the care-receiver?

  • Bathing

  • Dressing

  • Toileting

  • Medication administration

  • Housekeeping

  • Meal preparation

  • Eating

  • Shopping

  • Transportation

  • Mobility

Other (Describe):

Yes p No p N/A p R/A p Yes p No p N/A p R/A p Yes p No p N/A p R/A p

Yes p No p N/A p R/A p

Yes p No p

N/A p R/A p

Yes p No p

N/A p R/A p

Yes p No p

N/A p R/A p

Yes p No p

N/A p R/A p

Yes p No p

N/A p R/A p

Yes p No p N/A p R/A p

  • If "Yes" on any of the above, are there any problems between you and that person?

Explain:

33. Does that person ever threaten or get aggressive with you (whether it is intention- al or not)?

Yes p No p N/A p R/A p

If "Yes", explain:

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