A Clinical Self-Assessment Guide for Preserving Independence With Advancing Age

You're doing the longevity work. The strength training, the protein, the sleep, the supplements. And you should be — it matters.

But there's a gap nobody is talking about.

Between mitochondrial health and actually living where you choose, on your own terms, into your 80s and 90s — there is a body of clinical knowledge that almost never makes it into a medical visit or a longevity podcast. It lives in the geriatrics and rehabilitation literature. It has been validated by research. And it covers everything from the 90-second test that predicts whether a hospitalization will end your independence, to the legal documents your family needs to keep you home in a crisis, to what to actually ask your physical therapist so you get a program oriented toward resilience — not just safe discharge.

I built this workbook because it didn't exist — and because I watched someone I love navigate a crisis without it.

Author: Myrto Angela Ashe, MD, MPH Family and Functional Medicine Physician, in clinical practice since 1987

Who this is for:

This workbook is for two different types of people:

1. The person in their 60s or 70s who is already doing the longevity work and wants to make sure they've covered the part nobody talks about — the home environment, the support network, the legal and financial infrastructure, the cognitive and social reserve that determines whether you stay home when something goes wrong.
2. The adult child who is watching a parent navigate a crisis right now — a hip fracture, a hospitalization, a slow functional decline — without a map, without the right questions, and without any idea whether the next three months will bring recovery or a permanent new baseline.

If either of those descriptions fits you, this workbook is for you.

What is inside:

Domain 1 — Your Reserve: Physical, Physiologic, and Systemic The tests your physician is probably not running: the Timed Up and Go test, grip strength, the 6-minute walk, the 4-stage balance test, gait speed, the 5-times sit-to-stand. What each one measures, what your numbers mean, and what to do about them. Plus the internal systems assessment — cardiovascular, metabolic, respiratory, renal, bone — and the integrated picture that answers the real question: if something goes wrong, will you bounce back? Includes a complete pre-surgical reserve assessment with the specific questions to ask your surgical team before any elective procedure.

Domain 2 — Life Function A complete ADL and IADL assessment — every activity of daily living rated and tracked, with red flags, action thresholds, and what to do when something changes. Home condition as a clinical metric. Driving safety evaluation. Care utilization history and what a rising pattern predicts about the future.

Bonus Section — Medication and Supplement Review One of the most research-proven interventions for keeping older adults out of nursing homes — and one of the least practiced. The Beers Criteria explained in plain language. The medication categories highest risk in older adults. The supplement adulteration problem nobody talks about. And the specific questions to bring to your pharmacist every six months.

Domain 3 — Cognitive, Psychological, and Social Health Functional cognitive screening you complete yourself. The MoCA, BrainHQ, and CNS Vital Signs — what each measures and when to use them. The PHQ-9 and GAD-7 with full scoring. The UCLA loneliness scale — because loneliness is not a feeling, it is a biological risk factor with effects on cognition and mortality that rival smoking. And what to actually do about each finding.

Domain 4 — Sensory Function, Home Environment, and Safety Vision and hearing — what specialists miss and what to ask for specifically. Sleep apnea assessment — the diagnosis that is frequently missed even in rehabilitation settings. Mold and indoor air quality, including dust-based testing when water damage is a concern. A room-by-room home safety framework. And the section no other aging-in-place guide includes: home comfort and maintenance — heating, cooling, appliances, exterior care, and who is responsible for all of it.

Domain 5 — Support Network, Legal Scaffolding, and Financial Infrastructure Mapping your real support network — not the theoretical one. The modular escalation plan written down before a crisis. The four legal documents your family needs and what happens without them. And the complete financial landscape: what care actually costs in 2025, long-term care insurance, hybrid policies, annuities explained clearly, home equity, VA benefits, and Medicaid planning — with enough detail to have an informed conversation with a financial advisor and an elder law attorney.

The Post-Acute Event Protocol What to do when something goes wrong. The recovery window — what the research actually says about who recovers and when. Structured checkpoints at 2–4 weeks, 6–8 weeks, 3 months, and 6–12 months — with the specific questions to ask PT, OT, and the physician at each one. How to read the signals that tell you whether recovery is still happening or the new baseline has arrived. And the parallel financial activation checklist — because as service needs mount, the financial plan that was theoretical becomes operational.

The numbers:

150 pages, 5 clinical domains plus a bonus section and post-acute protocol

Dozens of tracking tables designed to be used annually and after every major health event

Dozens of checklists with specific language to use with your physician, PT, OT, pharmacist, elder law attorney, and financial advisor

Current 2025 cost data for home care, assisted living, long-term care insurance premiums, and financial planning tools

A note on what this is not:

This is not a book focused only on the importance of installing grab bars.

It is not a generic wellness guide or a list of tips for healthy aging.

It is a clinical framework — built by a physician, grounded in the geriatrics and rehabilitation research — for preserving your ability to live where you choose, on your terms, for as long as possible. And for navigating with clarity and agency when something goes wrong.

The work it describes starts now. Not when you need it. Not when your parent needs it.

Now — while the numbers are still movable and the plans can still be made.

Myrto Angela Ashe, MD, MPH Family and Functional Medicine Physician 39 years of clinical practice

This workbook is for informational purposes and does not constitute medical, legal, or financial advice. Work with qualified professionals in each domain to apply these frameworks to your individual situation.