Bristol Activities of Daily Living Scale

If you have been requested by the practice to complete a Bristol Activities of Daily Living Scale please use this form.

Bristol Activities of Daily Living Scale

Bristol Activities of Daily Living Scale

Bucks, R. S., Ashworth, D. L., Wilcock, G. K., and Siegfried, K. (1996)
Please use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.
Please use this date format: DD/MM/YYYY.

This questionnaire is designed to reveal the everyday ability of people who have memory difficulties of one form or another.

For each activity (No. 1 - 20), statements a - e refer to a different level of ability.

Thinking of the last 2 weeks, tick the box that represents your relative’s/friend’s AVERAGE ability. (If in doubt about which box to tick, choose the level of ability which represents their average performance over the last 2 Weeks. Tick ‘Not applicable’ if your relative never did that activity when they were well).

1. Preparing Food
2. Eating
3. Preparing Drink
4. Drinking
5. Dressing
6. Hygiene
7. Teeth
8. Bath/Shower
9. Toilet/Commode
10. Transfers
11. Mobility
12. Orientation - Time
13. Orientation - Space
14. Communication
15. Telephone
16. Housework/Gardening
17. Shopping
18. Finances
19. Games/Hobbies
20. Transport