Physical: Tell me about your physical functioning.
1. What changes have you noticed with age (asking about sensory changes, motor slowness, functional abilities, and changes in reserve capacity, external aging signs)?
2. How do you feel about these changes?
3. What do you do to stay in shape?
4. What are your specific health concerns? Do you worry about your health more today than in the past?
5. Do you have certain illnesses or take certain medications? If so, can you describe them for me? Have these problems caused changes in your ability to handle daily life?
6. How do you handle these changes? Do you have concrete plans for what to do if you become physically impaired? If so, describe. How do you feel about the quality of your health care? How are you paying for care? When you look to the future, how do you see yourself changing in this area of life? You should note if the person’s assessment of his/her capacities fits in with your observations of functional status.
Cognitive: Tell me about your intellectual abilities.
7. What are the things you do well in or poorly in; what are your special talents or skills?
8. Do you feel as if you are a bright person?
9. Do you feel your "quickness of mind" has changed over the years? If so, how would you describe these changes?
10. Are you concerned with declining memory? What specific changes have you noticed in this area of life?
11. How do you cope with these changes?
12. When you look to the future, how do you see yourself changing in this area of life?
13. How would you define wisdom or intelligence?
14. Would you say that you have increased in wisdom over the years? In intelligence? Why or why not?
Emotional: Describe your personality.
15. Are you shy, outgoing, fun loving, anxious?
16. What things do you like or dislike…