Health and longevity is related to lifestyle and predisposition to certain health conditions. Aging well depends on maintaining one’s health by making healthy choices. This checklist can help to identify aspects of the individual’s lifestyle that may result in health problems and those that promote good health. After completing the checklist, a good next step is to develop a plan for helping the person adjust their lifestyle choices wherever possible.
Checklist on Lifestyle
Do the person’s eating habits reflect awareness of and adherence to the Canada Food Guide? (For more information on the Canada Food Guide go to https://food-guide.canada.ca/en/
- YES
- NO
If not, what areas need to be changed?
What is the person’s weight and height? Is this a concern? How does it compare to the norm?
What does the person do for exercise? Is it done regularly? If not what are the possible physical activities the person may wish to start?
- Walking
- Golfing (without a ride-on cart)
- Yard and garden work
- Propelling a wheelchair (“wheeling”)
- Cycling
- Skating
- Continuous swimming
- Tennis
- Dancing
- Gardening
- Mopping the floor
- Yard work
- Vacuuming
- Stretching exercises
- T’ai Chi
- Golf
- Bowling
- Yoga
- Curling
- Dance
- Heavy yard work (e.g. cutting/piling wood
- Raking and carrying leaves
- Lifting and carrying groceries
- Climbing stairs
- Exercises (e.g. abdominal curls/push-ups
- Wearing a backpack to carry groceries or other items
- Weight/strength-training routines
Living Situation
Where does the person live?
- Central location close to amenities and services
- Good location close to some amenities and services
- Poor location, difficult to get to amenities and services
What are the risk factors associated with his/her place of residence?
- Air pollution
Checklist for Health
- Illness/injuries since last exam
- Ear trouble or deafness
- Hay fever-Asthma-Sinusitis
- Head injuries
- Heart disease
- Palpitations
- Shortness of breath
- Jaundice
- Haemorrhoids
- Venereal disease
- Tropical diseases
- Back injuries / back problems
- Foot troubles
- Bleeding disorders
- Use alcohol to excess
- Allergies
- Presence of Diabetes
- Thyroid (especially in the case of Down Syndrome
- Eye trouble
- Nose or throat trouble
- Headaches
- Fainting spells—convulsions
- Rheumatic fever
- Lung disease or chronic cough
- Indigestion
- Rupture
- Kidney and/or bladder trouble
- Varicose veins
- Skin disease
- Broken bones
- Rheumatism or joint trouble
- Nervous disorders
- Operations
- Drug allergies
- Diabetes management plan in place
- ECG
For Women:
- Breast Examination
- Gynecological Examination (including pap smear)
For Men:
- Prostate Examination
Medications:
Name / Dosage / Purpose
Sourced from “Transition Guide For Caregivers”, The Ontario Partnership on Aging and Developmental Disabilities http://www.opadd.on.ca