Free Online Screening

occupational therapist comforting older man after free screening at High Thrive Therapy in Maine

We know that the aging process can be a challenge, but sometimes we see potential issues looming that threaten to complicate health and wellness. The earlier we catch and address concerns before they become big problems, the better chance you have to maintain your health and independence.

 

Our free online screening tool helps us to understand you better and offers you insights that could help you get the care and attention you need early on. As always, we encourage you to share any questions and concerns with your health care provider. If your screening highlights any areas of concern for you, it may be wise to ask your health care provider for a referral for an occupational therapy evaluation and treatment at High Thrive Therapy in Portland, Maine.

Our evidence-based screening tool is used to assess early decline in many age-related developmental factors related to physical, emotional and occupational capacity. 
This screening takes 10-15 minutes. Complete the entire form below and click the Submit button.
If you'd like, a caregiver or family member can complete this screen with you or for you.

Our licensed occupational therapist will assess your results and reach out to you within 24 hours. If the therapist concludes that you should be seen for a more comprehensive evaluation, they will let you know and help you to get that appointment scheduled. 

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Free Online Screening

High Thrive Therapy LLC

Client Information

Primary Care Information

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Insurance Information

Primary Insurance: 

Secondary Insurance: 

Occupational Self Assessment - Daily Living Scales
Completed by:

Step 1: Below are statements about things you do in everyday life. For each statement, check how well you do it. If an item does not apply to you, check N/A and move on to the next item.

Step 2: Next, for each statement, check how important this is to you.

I have a lot of problems doing this

I have some difficulty doing this

I do this well

I do this extremely well

N/A

Not applicable to me

This is

not so important to me

This is important to me

This is more important to me

This is most important to me

Lot of

problems

Some difficulty

Well

Extremely well

N/A

Not so important

Important

More

Important

Most

Important

Bathing

Dressing

Lot of

problems

Some difficulty

Well

Extremely well

N/A

Not so important

Important

More

Important

Most

Important

Grooming: washing hands & face, brushing teeth, hair care, shaving

Lot of

problems

Some difficulty

Well

Extremely well

N/A

Not so important

Important

More

Important

Most

Important

Meal Preparation

Lot of

problems

Some difficulty

Well

Extremely well

N/A

Not so important

Important

More

Important

Most

Important

Toileting

Lot of

problems

Some difficulty

Well

Extremely well

N/A

Not so important

Important

More

Important

Most

Important

Walking

Lot of

problems

Some difficulty

Well

Extremely well

N/A

Not so important

Important

More

Important

Most

Important

Maintaining balance while walking

Lot of

problems

Some difficulty

Well

Extremely well

N/A

Not so important

Important

More

Important

Most

Important

Climbing stairs

Lot of

problems

Some difficulty

Well

Extremely well

N/A

Not so important

Important

More

Important

Most

Important

Driving

Lot of

problems

Some difficulty

Well

Extremely well

N/A

Not so important

Important

More

Important

Most

Important

House cleaning

Lot of

problems

Some difficulty

Well

Extremely well

N/A

Not so important

Important

More

Important

Most

Important

Laundry

Lot of

problems

Some difficulty

Well

Extremely well

N/A

Not so important

Important

More

Important

Most

Important

Grocery shopping

Lot of

problems

Some difficulty

Well

Extremely well

N/A

Not so important

Important

More

Important

Most

Important

Occupational self - Assessment Model of Human Occupation Clearinghouse, Department of Occupational Therapy University of Illinois at Chicago Daily Living Scales added by Patricia J Scott with permission from the Model of Human Occupation Clearinghouse, Department of Occupational Therapy University of Illinois at Chicago (2016)  -  Link

Fear of falling is a fall risk!

Fear of falling is a potential behavioral outcome of previous falls that may limit older adult activities. One in four older adults experience a fall each year, and one third of them develop a fear of falling. Fear of falling may lead to more sedentary lifestyle with subsequent deconditioning that creates an ongoing downward spiral leading to frailty and increased risk of future falls.

 

Fear of falling is a valid concern and your compassionate therapist will work with you to address and resolve the physical, emotional and environmental factors that contribute to the fear of falling. We'll work together to create a safer home environment and an action plan to build up your strength and balance to help you regain your confidence.

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Falls Efficacy Scale - Short FES-I

Now we would like to ask some questions about how concerned you are about the possibility of falling. Please reply thinking about how you usually do the activity. If you currently don’t do the activity, please answer to show whether you think you would be concerned about falling IF you did the activity. For each of the following activities, please tick the box which is closest to your own opinion to show how concerned you are that you might fall if you did this activity.

Getting dressed or undressed:
Taking a bath or shower:
Getting in or out of a chair:
Going up or down stairs:
Reaching for something above your head or on the ground:
Walking up or down a slope:
Going out to a social event (religious service, family gathering, club meeting:

Kempen GIJM, Yardley L., Haastregt JCM van, Zijlstra GAR, Beyer N, Hauer K, Todd C.

The Geriatric Depression Scale (GDS)

Choose the best answer for how you have felt over the past week:

 

1. Are you basically satisfied with your life? 

2. Have you dropped many of your activities and interests?

3. Do you feel that your life is empty?

4. Do you often get bored? 

5. Are you in good spirits most of the time? 

6. Are you afraid that something bad is going to happen to you? 

7. Do you feel happy most of the time? 

8. Do you often feel helpless?