Stress Factors related to Giving Care to a Loved One Form

ALWAYS
SOMETIMES
NEVER

Stopping work to give care

ALWAYS
SOMETIMES
NEVER

Amount of time giving care

ALWAYS
SOMETIMES
NEVER

Limiting social life to give care

ALWAYS
SOMETIMES
NEVER

Preparing meals

ALWAYS
SOMETIMES
NEVER

Doing Housework

ALWAYS
SOMETIMES
NEVER

Getting in and out of chair or bed

ALWAYS
SOMETIMES
NEVER

Dressing

ALWAYS
SOMETIMES
NEVER

Bathing or showering

ALWAYS
SOMETIMES
NEVER

Toileting

ALWAYS
SOMETIMES
NEVER

Dealing with incontinence or diapering

ALWAYS
SOMETIMES
NEVER

Feeding

ALWAYS
SOMETIMES
NEVER

Shopping

ALWAYS
SOMETIMES
NEVER

Managing finances

ALWAYS
SOMETIMES
NEVER

Name

Email

Phone No

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