Resident Evaluation Form Dining
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- Emery Alexander
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1 Resident Name Date Evaluator Directions: Use this information to supplement your existing assessment. Exercise examples designed to improve skill areas are included with this resource. Flexibility in elbow Moves hand from Fine motor control Picks up utensils Grip Strength Holds utensils Holds a glass Hand eye coordination Gets food on fork or spoon Accurately delivers food to mouth Range of motion in shoulder and elbow Conveys food from Steadiness Conveys food from without spilling Upper body strength Is able to push up from chair to a standing position
2 Endurance Is able to eat an entire meal without tiring or becoming short of breath Lower body strength Can transfer from the chair to standing Balance Can sit at the table without leaning to one side Smell aromas of different foods Vision different foods by sight Is able to get food on a fork or in a spoon Taste tastes of different foods Touch sensitivity Can judge food temperature Hearing Can converse with others at the table Cognitive ability Uses utensils appropriately
3 Does not take food from other residents Remains at table throughout meal Health issues Related to Dining dining is affected by the health issue Altered sensation Pain in hands or joints Diabetes Medications Parkinson s disease Choking or swallowing disorder Others:
4 Exercise Suggestions to Improve Specific Skills Just doing of Daily Living (ADLs) is good exercise whether the resident does them independently or with some assistance. The activities suggested here can supplement the exercise obtained by doing ADLs but does not replace it. A resident should not engage in a new exercise program without approval of primary medical doctor. Use exercise videotapes appropriate for the specific audience. Resident Name Date Evaluator Check if needed Skills to Improve Suggested activities Check if completed Shoulder and elbow flexibility Waist flexibility Fine motor control Hand eye coordination Range of motion in shoulders Steadiness Grip strength Range of motion Upper body strength Swimming; water aerobics; stretching exercises Stretching exercises Put together puzzles, sort coins, play checkers, paint or draw, knitting, crocheting, crafts; play dominos; send cards to friends Playing cards, knitting, crocheting, crafts Raising arms over head; putting hands behind back; yoga postures that involve those actions See lower body strength exercises; See also, endurance exercises Squeezing a tennis ball; squeezing putty Swimming; water aerobics; gardening Weights lifting, swimming, catching a ball, playing pool
5 Check if needed Skills to Improve Suggested activities Check if completed Lower body strength Endurance Balance Vision Hearing Smell and taste Touch sensitivity in fingers, skin, mouth Cognitive ability Walking, biking, ride stationary bike; Toe raises; See also, balance activities Walking, biking, sitting upright in a chair Walking, biking, line dancing, standing on one foot, gardening Wear corrective lenses; use magnifying tools Wear corrective hearing aids; use head sets; turn on subtitles on television and films Evaluate medication side effects; Report loss of smell and taste to the resident s medical doctor; report loss to dentist Have the resident s doctor evaluate the cause of a loss of sensitivity; Protect hands and feet if sensation is decreased; Be aware of temperature (extreme cold or heat) and use gloves; Use canes and other assistive devices. Play board games, do puzzles, read; play dominos Other
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Resident Name Date Evaluator Directions: Use this information to supplement your existing assessment. Exercise examples designed to improve skill areas are included with this resource. Flexibility Can
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Resident Name Date Evaluator Directions: Use this information to supplement your existing assessment. Exercise examples designed to improve skill areas are included with this resource. Skill needed Corresponding
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