1.How would you describe your appetite?

2.How often do you consume fruits and vegetables?

3.How often do you consume protein-rich foods (e.g., meat, fish, legumes)?

4.Do you experience any difficulty chewing or swallowing?

5.Have you noticed any unintended weight loss in the past six months?

1.Has the elderly individual experienced sudden weakness or numbness in the face, arm, or leg, especially on one side of the body?

2.Has the elderly individual experienced sudden confusion, trouble speaking or understanding speech?

Yes No Not Sure

3.Has the elderly individual experienced sudden difficulty seeing in one or both eyes?

Yes No Not Sure

4.Has the elderly individual experienced a sudden severe headache with no known cause?

Yes No Not Sure

5.Has the elderly individual experienced sudden difficulty with walking, loss of balance, or coordination?

1.Over the past two weeks, how often have you felt down, depressed, or hopeless?

2.Have you lost interest or pleasure in activities that you previously enjoyed?

3.How often have you experienced a significant change in appetite or weight (either decrease or increase) over the past two weeks?

Rarely or none of the time Some of the time Most of the time All of the time

4.Have you experienced sleep disturbances, such as trouble falling asleep, staying asleep, or sleeping excessively, over the past two weeks?

5.Over the past two weeks, have you experienced feelings of fatigue or loss of energy?

1.Age

2.History of falls:

3.Medications:

4.Vision:

5.Mobility and balance:

1.Age

Under 40 40-49 50-59 60 or above

2.Body Mass Index (BMI):

3.Physical activity level:

4.Family history of diabetes:

5.Blood pressure:

1.Have you experienced unintentional weight loss of 5% or more in the past year?

Yes No

2.Do you often feel exhausted or have low energy levels?

3.Have you noticed a decrease in your walking speed compared to your usual pace?

4.Do you have difficulty performing daily activities such as bathing, dressing, eating, or using the toilet?

5.Have you experienced a decline in your grip strength or do you have difficulty gripping objects?