HLFPPT Tool for Study on Issues Related to Elderly

Questions marked with a * are required

* How many times did you get admitted into a hospital during last 6 months?

More than 6 times

Less than 6 but more than 3 times

Less than 3 but more than 1 time

Not at all

* Have you been taking medicine/s for more than last six months?

Yes

No

* Do you know how to read and write?

Yes

No

* If yes, can you read without glasses?

Yes

No

* How would you rate the quality of your life as a whole?

I enjoy my life overall

I am happy much of the time

I look forward to things

I have a lot of Physical Energy

Pain affects my well - being