australian [adelaide] longitudinal study of aging, waves 1 ...€¦ · additional clinical studies....
TRANSCRIPT
ICPSRInter-university Consortium for
Political and Social Research
Australian [Adelaide] Longitudinal Study of Aging,Waves 1–5 [1992–1997]
Wave 1 Data
Gary R. Andrews and George C. Myers
ICPSR 6707
AUSTRALIAN [ADELAIDE] LONGITUDINAL STUDY OF AGING, WAVES 1-5 [1992-1997]
(ICPSR 6707)
Principal Investigators
Gary R. Andrews and George C. Myers Flinders University of South Australia Centre for Ageing Studies
Third ICPSR Version April 2000
Inter-university Consortium for Political and Social Research P.O. Box 1248 Ann Arbor, Michigan 48106
BIBLIOGRAPHIC CITATION
Publications based on ICPSR data collections should acknowledge those sources by means of bibliographic citations. To ensure that such source attributions are captured for social science bibliographic utilities, citations must appear in footnotes or in the reference section of publications. The bibliographic citation for this data collection is:
Andrews, Gary R., and George C. Myers. AUSTRALIAN [ADELAIDE] LONGITUDINAL STUDY OF AGING, WAVES 1-5 [1992-1997] [Computer file]. 3rd ICPSR version. Adelaide, South Australia: Flinders University of South Australia, Centre for Ageing Studies [producer], 1999. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2000.
REQUEST FOR INFORMATION ON USE OF ICPSR RESOURCES
To provide funding agencies with essential information about use of archival resources and to facilitate the exchange of information about ICPSR participants' research activities, users of ICPSR data are requested to send to ICPSR bibliographic citations for each completed manuscript or thesis abstract. Please indicate in a cover letter which data were used.
DATA DISCLAIMER
The original collector of the data, ICPSR, and the relevant funding agency bear no responsibility for uses of this collection or for interpretations or inferences based upon such uses.
DATA COLLECTION DESCRIPTION
Gary R. Andrews and George C. Myers AUSTRALIAN [ADELAIDE] LONGITUDINAL STUDY OF AGING, WAVES 1-5 [1992-1997] (ICPSR 6707)
SUMMARY: The general purpose of the Australian Longitudinal Study of Aging (ALSA) is to gain further understanding of how social, biomedical, and environmental factors are associated with age- related changes in the health and well-being of persons aged 70 years and older. Emphasis is given to the effects of social and economic factors on morbidity, disability, acute and long-term care service use, and mortality. The aim is to analyze the complex relationships between individual and social factors and changes in health status, health care needs, and service utilization dimensions. Components of Wave 1 (1992-1993) (Part 1) included a comprehensive personal interview conducted via the Computer- Assisted Personal Interview (CAPI) system, a home-based assessment of physiological functions, self-completed questionnaires, and additional clinical studies. Wave 2 (1993-1994), Wave 3 (1994- 1995), Wave 4 (1995-1996), and Wave 5 (1996-1997) (Parts 2, 7, 8, and 10, respectively) included questions regarding changes in domicile, current health and functional status, new morbidity conditions, changes in medication, major life events, general life satisfaction, and changes in economic circumstances. For Wave 3 Clinical Data (Part 9) information about the health histories of the respondents was elicited, including information on medication, blood pressure, and physical and mental disabilities.
UNIVERSE: Persons aged 70 and older living in the metropolitan area of Adelaide, South Australia.
SAMPLING: The sample was randomly generated from within the Adelaide Statistical Division using the State Electoral Data Base as the sampling frame. The sample was stratified by gender and by the age groups 70-74, 75-79, 80-84, and 85 and older. Both community and institutionalized individuals were included. In addition, spouses aged 65 and older of specified persons also were invited to participate, as were other household members aged 70 years and older.
NOTE: The codebooks are provided as Portable Document Format (PDF) files. The PDF file format was developed by Adobe Systems Incorporated and can be accessed using PDF reader software, such as the Adobe Acrobat Reader. Information on how to obtain a copy of the Acrobat Reader is provided through the ICPSR Website on the Internet.
EXTENT OF COLLECTION: 6 data files + machine-readable documentation (PDF) + SAS data definition statements + SPSS data definition statements
EXTENT OF PROCESSING: CONCHK.PR/ MDATA.PR/ UNDOCCHK.PR/ DDEF.ICPSR/ REFORM.DATA/ RECODE/ SCAN
DATA FORMAT: Logical Record Length with SAS and SPSS data definition statements and SPSS export files
Part 1: Wave 1 Data Part 2: Wave 2 Data File Structure: rectangular File Structure: rectangular Cases: 2,087 Cases: 1,779 Variables: 1,586 Variables: approx. 395 Record Length: 9,222 Record Length: 2,386 Records Per Case: 1 Records Per Case: 1
Part 3: SAS Data Definition Part 4: SAS Data Definition Statements for Wave 1 Statements for Wave 2 Record Length: 80 Record Length: 80
Part 5: SPSS Export File Part 6: SPSS Export File for Wave 1 for Wave 2 Record Length: 80 Record Length: 80
Part 7: Wave 3 Data Part 8: Wave 4 Data File Structure: rectangular File Structure: rectangular Cases: 1,679 Cases: 1,504 Variables: 1,304 Variables: 461 Record Length: 7,193 Record Length: 3,624 Records Per Case: 1 Records Per Case: 1
Part 9: Wave 3 Clinical Data Part 10: Wave 5 Data Cases: 1,423 File Structure: rectangular Variables: approx. 165 Cases: 1,171 Variables: 393 Record Length: 7,202 Records Per Case: 1
RELATED PUBLICATIONS: Clark, M.S., and M.J. Bond. "The Adelaide Activities Profile: A Measure of the Lifestyle Activities of Elderly People." AGING CLINICAL AND EXPERIMENTAL RESEARCH 7, 4 (1995), 174-184. Andrews, G.R., L.K. Mawby, G.C. Myers, and S.J. Taylor. "Computer-Assisted Personal Interviewing (CAPI) in the Australian Longitudinal Study of Aging." Sydney, Australia: International Epidemiological Association 13th Scientific Meeting, 1993. Andrews, G.R., and C.M. Rungie. "Networks of Formal and Informal Support Amongst the Aging." New Orleans, LA: Gerontological Society of America, 1993.
F&w-.+,f.,.,.. .....F~~
QUEST IONNA1RE : SURVEY
B1aise 2.39 28-09-1992 00:25
1. Sequence Number —
2. I A6) Respondent - male or female?
{INTERVIEWER TO COMPLETE)
Male ..............................................................
female ............................................................
3. ( Al) Type of domicile?
{INTERVIEWER TO ANSWER)
Cmm.nityl ivi. g. ........ ............................. .... .....
Institution ............................................... . . ..
—
1
2
1
2
1
2
3
4
5
6
7
1
2
3
4
5
6
7
—
seqnum
sex
domicile
inst
Wmmun
commtyp
typcco
howmany
9. TABLE
The table contains the following 5 questions:
9.1
9.2
9.3
9.4
9.5
Guestion
Person
Person
Person
Person
Person
Person
Person
Person
Person
Person
10. (
11. (
12. (
13. (
. .
.
.
. .
.
?i5a)
Al)
What is their name?
See di splay cards number 1
What is their relationship to you?
what was their age last birthday?
What is their sex?
Male ............................................... .. . . . (1)
Female .................................................... . (2)
Are they registered .. the electoral roll?
Yes ... ...... . . . . .. ..
NO .........................
9.1
Please specify other
9.2
1 code
—
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (1)
. . . . . . . . . . .
9.3
—
—
—
—
9.4
Male Female
12
12
1 2
1 2
12
12
1 2
12
12
12
. . . . . . . . . . . (2)
9.5
Yes No
12
12
12
12
12
12
12
12
12
12
when were y.” born? (would y.” please give the exact date
dd, mm, yyyy) — —
A81 What was your age last birthday?
A9) Were y.” born in Australia?
14. see display cards number 2
(A1O) Inwhich country were you born? . . .. ... .. . . . . . ... .
15. lAIO. I Specify other country of birth?
16. ( All) In what year did you arrive in Australia?
17. ( A12) Which one of the following would YO” describe yourself
mmeO-name9
rekzfo-reld
thageO-thage9
Uzsexfl-thsefl
elecfO-eIecf9
ofhinst
birthday
age
birthcou
whichcou
yearauz
national
2
18. (A12a) Specify other nationality
Ye, No
19. ( A13) Do you {o= does .) speak a languaqe at home other than
English? 12
20. ( A14) Do you (or does ..) have any difficulty u.der.$tanding or
speaking English? 12
21. ( A15) Are YOU (or is . ) usually able to carry on a conversation
with a person who only spaks English? 12
22. ( 2.16) Which language do you prefer to use most of the time?
English ........................................................... 1
Other ............................................................. 2
1
2
3
4
5
6
7
8
25. see display cards number 3
( A191 who is your second interpreter? ............................ . . _
27. ( A20] What is your c“rr.nt marital stat., ?
Married ........................................................... 1
Othorig
otldang
d(ffundr
covrest
kzngpref
anyinmp
whointer
secinter
evrmar
maritst
3
28.
29.
A211 HOW l.a.g ha.. j.ou bee. $MARITST? (in YearSI
(INTERVIEWER - If 1.ss than one year, enter 0) ?
A22) 1s this your first marriage (live in relationship) ?
30. (A22. ) How long was your previous marriage? (in years)
(INTERVIEWER - If less than .“. yea,, enter 0]?
32. ( A24) 1 would now like to ask you some questions about your family
How many children do or did you have (including stepchildren and
adoPted children) ?
33. ( A25) How many so”, do or did you have?
34. ( A26) How many sons are still alive?
[INTERVIEWER - If only one ask - Is he still alive?]
35. { A27) How many sons are living with you?
[lNTERVIEI+ZR -If only one ask - Is he living with you?)
36. ( A28) How many live within one hours travel?
{INTERVIEWER -If only one ask - Does he live within one hour, travel?)
31. [ A29) How many live i. South Australia more than one hours travel
away ?
(INTERVIEWER - If only one ask - Does he live in SA] ?
38. ( A30) How many live elsewhere i. Australia?
(INTERVIEWER - If only one ask - Doe, he live in Australia?)
39. ( A31) How many live overseas?
IINTERVIEWER - If only’ one ask - Does he live oversea, ?)
40. ( A32) How many daughter. do or did you have?
41. ( A33) How many daughters are still alive?
{INTERVIEWER -If only one ask - Is she still living?}
42. ( A34) How many daughters are living with you?
{INTERVIEWER -If only one ask - 1s she living with you?}
43. ( A351 How many’ live 0.. hours travel?
(INTERVIEWER - If only o.. ask - Does she live within on. hours
travel? )
44. ( A36] How many live in South Aust Ialia more than one hours travel
—
—
—
—
—
—
—
hawmarr
marrbef
Ianfmarr
frmnml
chiLiren
showman
Sstlalv
slivyou
slivhor
slivsa
slivau2
sovemea
dhowman
dsflalv
dlivyou
dlivhor
dlivsa
4
.:,,
away?{INTERVIEWER - If only ... ask - Does she live in 5A?]
45. ( A37] How many live elsewhere in Australia?
[INTERVIEWER - If only one ask - Does she live in Australia?]
46. ( A38) How many live overseas?
{INTERVIEWER -If only o.. ask - Does she live overseas?)
47. (A38a) What is the age of your youngest living child? —
48. (A38b) What is the age of your eldest living child? —
49. IA38C1 What is your child-s age?
50. ( A39) Do You have anY qrand. hildren?
51.
52.
A40) How many qrandchildre” do you have?
A41) 1s your mother now living?
53. ( A42) How old is she (was she when she died)? (Years)
Yes No
54. 1 7+43) Is(w.as) she Your natural mother? 12
55. ( P.44) Is your father ... living? 12
56. ( A45) How old is he (was he when he died) ?
Yes No
51. ( A48) 1s (was) he your natural father? 12
58. {A48A) Did you have any brothers or sisters includinq step and
adopted brothers and sisters? 12
59. ( A49) How many brothers did y.. have while you were growing up,
including step a“d adopted brothers?
60. ( A50) How many of your brothers are “o’d living?
61. ( A52) How many brothers live in Adelaide II”terviewer if only o“e ask
- Does be live in Adelaide}?
62. (A49a) How many sisters did you have while you .. .. growing up,
including step a“d adopted sisters?
63. ( A51) How many of your sisters are no. li. in9?
64. ( A53) HOW many sisters live in Adelaide 11. ter. ie.er if o.lY O.. ask
- Does she live in Adelaide) ?
65. lA53a) what is the .qe of your y.au”.gest living brother fsister?
dlivaus
doversea
youngest
eldest
Oldyons
granch
hmgdcMn
mothliv
mothage
iwwtmo
fothIiv
fathage
sibs
bro
broliv
broadel
Sk
si21iv
youngbrs
5
‘1
66. (A53b) What is the age of your eldest living brother/sister? —
67. (A53c) What is your aqe of your brother/sister? —
Ye, NrJ
68. i h54) Are YOU a twin? 12
69. ( ASS) Ace you an identical twin? 12
10. ( B1) Does your wife, husband or partner have any illness or
health problems which limit his or her activities in any way? 12
72. ( B3) The followi.q questions concern the way you feel about
your health and your life:
How would you rate your 0..?..11 health at the present time?
Questions 13 through 76 :
meaning of the Labels:
Very likely . ....... ........ ...............................(1)
Likely ..... .. . .... . . .. . ..................................(2)
Unlikely . ... . .. ... . . . ..................................(3)
Very ””likely . . ... . .... . . .............................(4)
73. I B3al we would like to ask a few questions about various health
events in the f“t”re.
How likely do y.. think it is that yo” will need long-term care
in a nursi”q home at some point d“rinq your lifetime?
{INTERVIEWER - Show Prompt Card 2 ) 1234
74. ( B3c) How likely do you think it is that you will live for
another ten years?
[INTERVIEWER - Show P.ormpt Card 2 ) 1234
75. ( B3b) How likely do you think it is that your partner/spo.se
will “.ed long-term care in a nursing home at some point during
their lifetime?
{INTERVIEWER - Show Prompt Card 2) 1234
okiersis
brsisage
win
idenfwin
spousehl
likenh
Iveexp
Iiksnhsp
6
76. ( B3d) How likely do you think it is that your partner/spouse
will live for another ten years?
[INTERVIEWER - Show P rc=mpt Card 21 1234
77. ( B4) Would you say that your health is better, about the same,
or worse than most people your age?
Better ............................................................ 1
same ........................................................ ... . 2
Worse ............................................................. 3
Don, tK.ow ........................................................ 4
18. ( B51 1s your health now better, about the same, or not as good
as it was about twelve months ago?
Better”ow ........................................................ 1
About the same .................................................... 2
Notas good now .......................................... .. ..... 3
Do”at K”oW . ... . .. . . .. . . . ............................ . 4
Questions 79 through 98 :
Meaning of the labels:
Rarely or”oneof the time ........................................(1)
Some of the time ..................................................(2)
Quite abitof the time ...........................................(3)
Most orallof the time ...........................................(4)
79. ( B6) 1 am now going to read a list of statements describing how
People sometimes feel. Many of these statements may “or apply to
you but we have to ask them of everybody to get a comparison.
Please tell me how often you felt that way d“ri”g the past
week :
(INTERVIEWER - Show prompt card 3 }
1 was bothered by things that usually don Ot bother me
80. ( B7) 1 did not feel like eati”cj: my appetite was poor
81. ( B8) 1 felt that 1 could not shake off feeling lo. even with
help from my family and friends
82. ( B9) I felt that 1 was just as good as other people
83. ( B1O) 1 had trouble keeping my mind o. what 1 was doing
84. ( B1l I 1 felt depressed
85. ( B12) 1 felt that everthi”g 1 did was a“ effort
86. ( B131 1 felt hopeful about the future
81. ( B14) 1 thought my life had been a failure
88. i B15) 1 felt afraid
89. I B16) My sleep was restless
90. ( B17) 1 was haPPy
91. ( B18) lt seemed that 1 talked less than .s..1
92. ( B19) 1 felt lonely
93. I B201 People were .“friendly
1234
1234
1234
1234
1234
1234
1234
1234
1234
1234
1234
1234
1234
1234
1234
l~eexsp
hlthbtsm
btsm12m
cadl
c@sd2
cad?
c@sd4
C@sdscssd6
cesd7
cesdS
cesd9
a?sd10
cesdll
cesdJ2cesd13
cesd14
cesdlS
7
94.
95.
96.
97.
98.
B211 1 enjoyed life
B22) 1 had crying spells
B23) 1 felt sad
B24) 1 felt that people disliked me
B25) 1 could not get going
9’3. ( Cl) Now 1 have some questions about specific medical
conditions.
Have you ever had either pain/discc.mfort or pressure/heaviness
in y.”. chest lasting less than half an hour?
1234
1234
1234
1234
1234
cesd16cssdl 7
cesd18
cesd19
cesd20
102. ( C3) Do you get this pain . . discomfort, pressure or heaviness
when you walk at an ordinary pace on level ground?
Yes ...............................................................
No ................................................................
103. ( C4) If you ‘get this pain while you are walking, do you stop
or slow do.”, take an arginine, or co”ti”ue at the same pace?
Stop o. slowdown .. . . . .. . . .. .. .... . . .
Take a.a”ginine . . . . . . . . .. .. . . .. . .. .
Contin.ea. the same pace . . . . . . .. . . . . . . ..
1
2
1
2
3
1
2
3
4
1
2
1
2
3
1
2
1
2
wherepn
wkuphl
ordpace
whenpain
painreIv
howsoon
8
106.
107.
108.
109.
110.
111.
112.
113.
114.
115.
( c7) Have YOU had this pain or discomfort, pressure or
heaviness more than three times?
Yes .................................................... . . . . 1
No ................................................................ 2
see display cards number 4
( C8) About howoldwere yo. whe. you first had it? .................... _
( C9) Have you been bothered by this pain or discomfort,
p.e=ure OK heaviness in the past 12 months?
Yes ............................................................... 1
No ................................................................ 2
I C1O) In what year did you last experience this pain or
discomfort, pressure or heaviness? (Year)
Yes No
I C1l) Have you ever had a seve.e pain across the front of your
chest lasting half a“ hour or more? 12
( C12) Did you see a doctor because of this psi”? 12
( C14) How many of these attack* have you had?
( c16) How long was the ePi,ode of Pain in your last attack?
(Hours) - If less than one hour, e“te, 1 —
116.
117.
(c12a) What did the doctor say it was?
C13) Please specify what the doctor said it was?
c231 Do you get psi” in either leg when walking?
fnrethrs
howoldl
in.wtwlo
whenkzst
Painchst
docmr
howmanyQ
l.stlong
Usthosp
Whatsay
othcond
painleg
Stndstl
9
121. See display cards n.mher 4
( c27) About how old were you when you first had this pain? . ...
122.
123.
124.
125.
126.
127.
128.
129.
130.
131.
132.
( c28) Have you ever had a sudden 10SS of vision in either or both
eyes?
( C29) Did this condition last longer than 24 hours?
( c30) Have you ever had a sudden loss of speech, difficulty in
speaking, or slurred speech?
( C31) Did this condition last longer than 24 hours?
( c32) Have you ever had a sudden paralysis or weakness of an arm
andl.ar leg o. the sane side of the body?
I C331 Did this condition last longer than 24 hours?
( c341 Have you ever had a sudden numbness o. one side of the body?
{ c35) Did this condition last longer than 24 hours?
( c36) Do you usually cough? Exclude clearing your throat. Include
a cough with a first smoke or on first going out of doors.
I c371 Do you usually have a cough during the winter only?
I c38) DO you usually cough like this o. most days (or nights) for
.s much as three months each year?
133. I C391 Are you troubled by shortness of breath when hurrying on
1...1 ground or walking up a slight hill?
Yes . . . .... . ............................ . .. ....
. . .._
fes No
1
1
1
1
1
1
1
1
1
1
1
..
2
2
2
2
2
2
2
2
2
2
2
1
135. I C41) In the last 12 months has your chest sounded wheezy or
whi.stly frequently or only occasionally?
Frequently . . . . . . . . . . .. . 1
wkuphil
painrel
howld
vision
Ia2nel
speechO
tslhour
pamlys
hvlhrs
numbnes
Iwlvhrs
winton
shortbr
wheshvh
freqocc
10
only occasim.ally . .... ... ... .. .. ....................
136. I c42) 1. the last 12 months has it sounded wheezy Or whistlY
only when you have a cold or at other times as well?
O.lywhen has cold ..........................................
Atc.ther times ... . . . ........ .. ....................
137. See display cards number 4
( c43) Ab.a”t how old were you when you first had this
condition?
[INTERVIEWER - Read aqe categories if necessary) . . .. . ....
138. ( C44) In the last 12 months have you had an attack of wheezing
which made you feel short of breath?
139. ( C45) Have you had more than o“e such attack i“ the last 12
months?
140. I C461 Did You require medicine or treatment for that (those)
attacks?
141. ( C47) Have you had pain in your neck on most days for at least
one month in the past 12 months?
142. I c481 Have YOU had pain in your back on most day. for at le=t
one month i“ the past 12 nm”ths?
143. ( C49) Have you had pain or aching i“ any joints o“ most days for
at least one month in the past 12 months?
144. ( c521 Which joints are “s”ally involved whenever you have this
pain?
Hands ... .. . . . . .. . ...............................
. . . . .
. . . 1
.. . 2
....._
Yes No
12
12
12
12
12
12
1
abhowol
shrtbrea
mrethoa
reqmed
painneck
painback
painjoia
wh@maO-wh@jo7
145. ( C50) Have you had any Swollen joi”t$ which were painful when
touched .“ most days for at least one month i“ the last 12
months?
Yes .. .. .. . . . ........................... . .. . . 1
No .. .. . . . ........................... . .. . . . 2
146. I C531 Which j.ai”ts ace usually involved whenever you have this
swelling?
Hands . .. . . . . . ......... ............... .. . .. . 1
swo~oin
wh@wvO-wh@sw
11
147. ( C51) Have you had stiffness in your joints when first getting
out of bed .. most mornings for at least one month in the last
12 months?
Yes .................................................... .. .. 1
No ...... . .... . . . ............................ 2
148. ( C54) Which joints are usually involved whenever you have this
stiffness?
Feet . . . . .. . . ............................ .. .
1
2
3
4
5
6
7
8
14’3. ( C55) Did a doctor ever tell you that you had a cancer,
malignancy or turn... of any type? Exclude skin cancer but
include melanoma
Yes .................................................... 1
No .................................................... ... . . 2
150. See display cards number 5
I c56) Where was the cancer or what type of cancer was it?
[INTERVIEaR - lf more than one, enter the most recent one) . . . . _
151. Please specify other type of cancer?
152. ( c57) 1. what year were y.. first told that you had this cancer
(last one) ? (Year)
Yes No
153. I C58) Have y.. been hosPitalised overnight for this? 12
154. ( c59) Did . doctor ever tell you chat you had diabetes? 12
wh~’nstO-wh@!st7
cancer
whtcanc
spec~y3
whentold
hospitl
diabete
155. ( C60) When were you first told that you had diabetes? (Year)
12
156. ( c61) Are you currently receiving treatment for diabetes?
Yes .................................................... . . .
No ................................................................
157. I c621 What type of treatment are you receiving?
Insulin ...........................................................
Diet ..............................................................
Tablet sordr.gs ..................................................
158. I c63) Have you been hospitalised overnight for this condition?
Yes ...............................................................
No ................................................................
159. ( c64) 1 want you to tell me which of these medical conditions
YOU have ever suffered from and also tell me about any .ther
conditions YOU have had
(INTERVIEWER - Show Prompt card, 41
Enter total no. of conditions suffered from (note their names
.. paper)
160. TABLE
The table contains the following 6 questions:
160, 1 Which condition?
[INTERVIEWER - Enter condition code from list by enterirg the 4
letters in brackets EXACTLY as shown o“ the card)
160.2 Pleas. specify other condition
160.3 1. what year were you first told that you had this condition?
160.4 ii... y.” stayed in hospital overnight for this condition?
1
2
1
2
3
1
2
Curtreat
Whattype
luqdtoo
J20conds
Yes ......................................................... (1)
No ......................................................... (2)
160.6 Are you now prevented in any way from doing any activities because
of this condition?
Yes ......................................................... (1)
No .......................................................... (2)
morbidl-morbid63
othmrb40-othrmrb
diagyrl-diagyr63hspl-hsp63
sqfferI-sflemf3
liml-lim63
Question 160.1 160.2 160.3 160.4 160.5 160.6
Yes No Ye, No Yes No
Disease 121212
Disease _ 121212
Disease 121212
Disease 121212
13
Disease
Disease
Disease
Disease .
Disease
Disease .
Disease
Disease
Disease .
Disease .
Disease .
Disease
Disease
Disease
Disease
Disease
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
. ..
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
. .
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
. . .
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
..
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
.. 1
1 swallow—
. .
162. I c66) what causes this? causes
Ye, N.
163. ( c67) Are you troubled by indigestion? 12
164. ( c68] DO you suffer from vomiting at least once a week? 12
165. ( C69) 0. you bruise easily? 12
indiges
bruise
ifchskin
Constip
diarh
bowelmv
14
173. I C771 About how many times per night? —
bloadmv
Wine
nighhu
urdmes
plu”nur
holdur
accdur
ream
15
178. ( C821 Do you suffer regular or frequent headaches?
Yes .................................................. .. ... . 1
No ................................................................ 2
179. ( C83) How often do you get a headache?
Seve.altimes a week ... . .. ... .. .... ...................... 1
Once a week ............................................ . . . . 2
Several times a month .. . ... .. .... ....... .... .. ... . .. . 3
Once amo”th . ....... . . ... .. .......................... 4
Several times a year..... ......................................... 5
Once ayeaz or less ............................................... 6
Yes No
180. I C84) 1s your eyesight affected when you have the headaches? 12
181. ( c85) Do you suffer from dizziness or giddiness? 12
182. ( c86) Do your hands shake when you pick up an object? 12
183. ( c87) Is that always or sometimes?
Always .. ............. .. ............................ . . . 1
sometime. ................ ........................... . . . . . 2
184. ( C88) Do your hands shake at rest?
185.
186.
187.
Yes ...................................................... . . ... 1
No . .. .... ... . . ...... .. .. .. .... . ... ............ 2
Donst know .................................................... . . 3
Yes NO
188. ( c91) Have you had a fit in the last twelve months? 12
189. ( C93) Have you ever suffered from blackouts or loss of
co. scio. s”ess (other than due to trauma) ? 12
190. ( c941 Have you had a blackout or loss of conscio. s”ess in the
last twelve nm”ths? 12
191. ( Dl) The next few questions are about nv=dici. es.
headach
ojlnhed
eyeaff
dizdn
handsshk
shkprobe
shkrest
shkprob
fu
epil
fifhvmo
black
16
we are interested in any medicines prescribed by a doctor that
You have taken or were supposed to take in the last t.. weeks
we are also interested in all other medicines not prescribed by
a doctor such as aspirin, headache pills, laxatives, cold
medicine, cough medicine, etc.
could you please show me the medicines that y.. take.
[INTERVIEWER - CHECK CONTAINERS - Do not include ointments]
192. ( D3) Drug name?
[INTERVIEWER - Generic name prefer=edl
193. I D2) [INTERVIEWER - [NEXT I MEDIcINE)
194. ( D4) What stre.qth is it (or, if medicine, strength in single
dose) ?
(INTERVIEWER - CHECK LABEL)
Yes No
195. I D51 Have you taken this in the last two weeks? 12
196. [ D6) Did you take this yesterday? 12
197. ( D7) About how many days in the last two weeks did you take
this? —
198. ( D8) What is the .s..1 number of these caps.les/tablet s/doses
that you would take in a day?
[INTERVIEWER - If less than one, enter fraction]
199. ( D9) What do you take this for?
201. ( 011) How many’ $HWLONG[ll?
202. ( D12) Was this prescribed by a doctor?
Yes . . .. . . ... . . .......................... .. ...... 1
cOntseeO
hon.WrmO
I.wwk.so
yesterdO
dysli?wko
hmO
Whalforo
hwlongtl
hwmnyl
deco
17
No ................................................................ 2
203. ( D3] Drug name?
[INTERVIEWER - Generic “.anvepreferred)
204. ( D2) [INTERVIEWER - [NEXT] MEDICINE)
Container seen?
Ye, ................................................ . . . ...... . 1
No ................................................. . . .. . .. . 2
205. ( D4) What strength is it (or, if medicine, strength in single
dose) ?
(INTERVIEWER - CHECK LABEL I
Yes No
206. ( D5) Have you taken this in the last two weeks? 12
207. ( D6) Did you take this yesterday? 12
208. ( D7) About how many days i. the last two week-=.did you take
this?
209. i D8) what is the usual number of these caps.les/tablet s/doses
that you would take in a day?
{INTERVIEWER - If less than one, enter fraction)
210. I D9) What do you take this for?
211. I D1O) How 10.c3 ha.. you been taking this?
Weeks . .. . . ............................ . ... . 1
Months . . . . . . ... . . . . ... .. .... ..... . 2
Years . . . ... . . . . . . . . . . .. ........ . .. . 3
212. ( DIII HOW UW7Y SHWLONG III?
213. [ D12) Was this prescribed by’ a doctor?
214 D3) DI.g name?
[INTERVIEWER - Ge”ecic name prefecredl
drugl
contseel
honsbml
lsf2wks1
dysli?wkl
hml
Wha(forl
hwlongl
hwmny2
docl
drug2
18
215. ( D2) [INTERVIEWER - [NEXT] MEDICINE)
216. ( D4) What strength is it (or, if medicine, strength in single
dose) ?
(INTERvIEwER - CHECK LABEL)
Yes No
217. ( D5) Have you take. this in the last two weeks? 12
218. I 06) Did you take this yesterday? 12
219. ( D7) About how many days in the last two weeks did you take
this-?
220. ( D8) What is the usual number of these capsule s/tablet sldoses
that you would take in a day?
[lNTERVIEKER - If less than one, enter fractionl
221. ( D9) What do YOU take this for?
223. ( ml) How many $HWLONG[l]?
225. { D3) Druq name?
[INTERVIEWER - Generic name preferred)
226. ( D2) [INTERVIEWER - [NEXT] MEDICINE)
c0ntsee2
honsfrm2
lst2wks2
yesterd2
dys12wk2
wha(f0r2
hwlong2
hwmny3
doc2
drug3
contsee3
19
227. I D4) what strength is it (or, if medicine, strenqth in single
dose) ?
{INTERVIEWER - CHECK LABEL)
228. ( D5) Have YOU taken this in the last two weeks?
229. ( D6) Did you take this yesterday?
230. ( D7) About how many days in the last two weeks did you take
this?
Ye, No
12
12
—
231. ( D8) What is the usual number of these capsules/tablets/doses
that you would take i. a day?
{INTERVIEWER - If less than one, enter fraction]
232. I D91 What do YOU take this for?
234. ( DIII HOW many $HWLONG II]?
236. ( D3) Dru’g ..*?
(INTERVIEWER - Generic name preferred)
237. ( D21 IINTERVIEWER - [NEXT I MEDICINE I
238. ( 04) What strength is it (or, if medicine, strength i. single
dose) ?
[INTERVIEWER - CHECK LABEL) —
honstnd
IW2wks3yestsr&
dys13wk3
hm3
whaf0r3
hwlong3
hwmny4
doc3
drug4
c0ntsee4
honstrm4
Yes No
239. ( D5) Have you taken this in the last two weeks? 12
240. ( D6) Did you take this yesterday? 12
241. ( D7) About how many days i“ the last two weeks did you take
this?
242. ( D8) What is the usual number of these capsules/tablets/doses
that y.” would take i. a day?
{INTERVIEWER - If less than one, entez fraction)
243.
244.
D9) what do y.” take this for?
D1OI How long have you been taking this?
246.
247.
{INTERVIEWER - Generic “me preferred)
248. ( D2) [INTERVIEWER - [NEXT I MEDICINE)
Container seen?
Yes . . . . . . . .............................. ... .. 1
No ................................................................ 2
249. ( D4) What strength is it (or, if medicine, strength i. single
dose) ?
(INTERVIEWER - CHECK LABEL)
Yes No
250. ( D5) Have you taken this in the last two weeks? 12
251. ( D6) Did you take this yesterday? 12
252. ( 07) About how many days i“ the last two weeks did you take
this?
Lw2w&4
dyslZwk4
hnd
hwlong4
hwmny5
dod
drug5
c0ntsee5
honstrm5
I!@wkss
yaterd5
21
253. f D8) What is the usual n.ml.er of these caps.les/tablet s/doses
that you would take in a day?
{INTERVIEWER - If 1.ss than one, enter fraction)
hti
254. ( D9) What do YOU take this for?
256. ( D1l I How many $HWLONG[l I?
258. { D3) Dx3Y3 name?
{INTERVIEWER - Generic name preferred
259. I D2j (INTERVIEWER - INEXTI MEDICINE)
260. ( 04) What strength is it (or, if medicine, strength in single
dose) ?
[INTERVIEWER - CHECK LABEL)
261. ( D5) Ha”e YOU taken this i“ the last two weeks?
262. ( D6) Did y.. take this yesterday?
263. ( D7) About how many days in the last two weeks did you take
this?
264. 1 D8) What is the .s..1 number of the%. caps.les/tabl ets/doses
that YOU would take in a day?
{INTERVIEWER - If less than one, enter fraction}
Whngors
hwlong5
hwmny6
doc5
drug6
honstrm6
Yes No
12
12
lsf2wks6
ysstird6
dysl.Zwk6
265. ( D9) What do you take this for?
22
266. ( D1O) How long have you been taking this? hwIong6
267.
268.
D1l I How many $HWLONG[l I? —
D12) Was this prescribed by a doctor?
269. ( D3) Drug name?
(INTERVIEWER - Generic name preferred)
270. ( D21 [INTERVIEWER - [NEXT I MEDICINE)
271. { D41 what strength is it (or, if medicine, strength i. si.91e
dose) ?
[INTERVIEWER - CHECK LABEL)
Yes No
272. ( D5) Have you taken this i“ the last two weeks? 12
273. ( 06) Did you take this yesterday? 12
274. ( D7) About how many days in the last two weeks did you take
this? —
275. I D8j What is the .s.?.1 number of these caps.les/tablet s/doses
that you would take i“ a day?
{INTERVIEWER - If less than one, enter fraction)
hwmny7
doc6
drug7
c0ntsee7
honstrm7
M2wks7
yes&rd7
dys12wk7
whalf0r7
hwlong7
23
278. ( D1l) HOW many $HWLONGIII? —
280. ( D3) Drug name?
[INTERVIEWER - Generic name preferred]
281. I D2) IINTERVIEWER - [NEXT I f4En1c1NEt
282. ( D4) What strength is it (or, if medicine, strength in single
dose) ?
[INTERVIEWER - CHECK LABEL I
Yes No
283. ( D5) Have you taken thiz in the last two weeks? 12
284. [ D6) Did you take this yesterday? 1 2
285. ( D7) About how many days in the last two weeks did you take
this?
286. ( D8) What is the .s..1 number of these capsules/tablets/doses
that you would take in a day?
{INTERVIEWER - If less than one, enter fraction)
287. [ D9) What do you take this for?
289. I DII) HOW many $HWLONGI II?
hwmny7
doc7
drug8
lstzwkwsyestmf8
dyslZwk8
hm8
whafor8
hwlong8
hwmny9
doc8
24
291. ( El) Now 1 would like to ask you about accidents you may have
had both in and around your home or away from home.
Firstly, have you had any falls i. the past yea. - including
those falls that did not result i. injury as well as those that
did?
lf yes, how many?
292. ( E2) Did you receive medical treatment for injuries from any
of these falls or did you limit your usual activity for more
than two days due to inj. r’ie$ from any of these falls?
Medical treatment ................................................. 1
Limit activity .... . .. . . . .. .......................... 2
Both ................................................. . . . .. 3
Neither ............................................. . .. . .... 4
293. ( E3) In the last twelve months, how many falls did you have
with injuries that required medical attention or limited you in
doing your .s..1 activities for more than 2 days?
294. TABLE
The table contains the following 6 questions:
294.1 I E41 For each of the falls please answer the following questions.
,Where were you when you were injured? (Please specify e.g. kitchen
of own home) ,
294.2 ( E5) What were you doing at the time you were injured? (Please
specify such as washing dishes, walking upstairs)
294.3 ( E6) What went wrong? (Please specify such as slipped on rug)
294.4 ( E6a) How exactly was the injury caused? leg Landed on floor)
294.5 ( El) What were your injuries?
(Please specify - include body parts and nature of injury such as
cut or fracture]
294.6 ( E8) Did you stay in a hospital overnight because of your
i“j. ries?
Yes . . . . . .. .......................... . . . (1)
No .. . . . . . . ............................ (2)
Question 294.1 294.2
acsdha
medtrtmt
hwmnyfls
whersfeO-wherefe9
wlmtdoiOO-whatdoi
cautiaOO-sm4@09
howexacOO-howem
injuryO-injury9
hospitO1-hospitIO
Falls ..
Falls ...
25
Falls . .
Falls . .
Falls . .
Falls .,.
Falls .
Falls ...
Falls ...
Falls .
Question
Fall, .
Falls ..
Falls ..
Falls ..
Falls ...
Falls ..
Falls ...
Falls ...
Falls .
Falls ..
Quest ion
Falls . .
falls .
Falls .
Falls . .
Falls ..
Falls .
Falls .
Falls .
Falls ..
Falls .
294.3
294.4 294.5 294.6
Yes No
12
12
12
12
12
12
12
12
12
12
Yes No
295. ( E9) Now 1 would like to ask you about other accidents and
injuries you may have had in the past year. These may include
motor vehicle accidents, .accide. ts or injuries while doing your
daily tasks, and other i.j. rie3.
Have you had a“y other accidents and i“j. ries in the past yea..?
12
296. ( E9A) Did you receive medical treatment for any of these kinds of
i“ju. ies?,
12
297. ( E1O) Did you limit your usual activities for more than 2 days
acclstyr
medtreat
lmtactvy
26
Question
Accdt s
Accdts
Accdts
Accdts
Accdts
Accdts
Accdts
Accdts
Accdts
Accdts
Question
Accdt,
Accdts
Accdts
Accdts
Accdts
P.ccdts
Accdts
Accdts
Accdts
Accdts
12
m12accia
because of any of these injuries?
298. I E1l) In the past 12 months, how many times did you have
injuries (accidents other than falls) that required medical
attention or limited you in doing your usual activities for more
than 2 days? —
299. TABLE
The table contains the following 6 questions:
299.1 ( E12) where were you when you were injured? (Please specify such
as in kitchen of own home)
299.2 ( E13) What were y.” doing at the time you were injured? (Please
specify such as washing dishes, walking O. path)
299.3 ( E14) What went wrong? [Please specify such as slipped on rug)
299.4 (E14a) How exactly was the injury caused? I+ Landed on floor)
299.5 ( E15) What were your i.juries? (Plea-se specify and include body
parts and nature of injury such as cuts or fr.act”res)
299.6 ( E16) Did you stay in a hospital overnight because of Your
299.1 299.2
299.3
whereasll- whersac:
whtdng20-whtdng2
musfa10-sau@a19
excauseO-exu2use9
iajuryqo-iajulyq9
hospta10-hospta19
27
Question 299.4 299.5
Accdts .
Accdts ‘.
Accdts .
Accdt,
Accdts ..
Accdts ..
Accdts ..
Accdts ..
Accdts .
Accdts ..
300. ( E17) Are you now limited in any way in doing any activities
because of an injury at any time i. the past, other than those
we have already talked about?
Yes .. . .. . . . .... . .............................
299.6
Yes No
12
12
12
12
12
12
12
12
12
12
acclimit
. . . . . . 1
No. ...................... ......................................... 2
301. ( E18) What were your injuries?
(Please specify i“cl.dinq body part a“d “at. re of injury such
as cuts or fractures)
302. ( E19) What were you doing when you were injured? (Please
specify such as driving a car, playing football)
305. ( E22) 1“ the past twelve months, have you changed your driving
habits because of concerns related to your age or your health?
No change, Still drive .as before .......................... 1
Yes, drive less often .......................... . . . . . . . . 2
Yes, only local driving, shortdi stance ........ . . . . .....3
Yes, only dayl ight driving. . . . .. . ...........4
Yes, other .. . . . . ................... . . . . .. 5
306. [ E23] Please specify othez
whtinjry
doingwht
doyoudrv
hwoftndr
chngddrv
spec~j4
crstreet307. I E24) How often do you cross. the street as a pedestrian?
28
308.
309.
310,
311.
Atleast.ante.aday ...............................................
Once ortwice a week..... .......................... . .. . .....
Once ortwice a month .............................................
Less th.nonce .artwi.eanra.th .............................. ....
Never .............................................................
( E25) Are there any things about your home that make daily
living more difficult? (such as poor lighting, chair that is too
low)
Yes ...............................................................
No ................................................................
( E26) Please specify main difficulty
( E27) [INTERvIEWER - Show Prompt card 4A)
1 want y.. to indicate which, if any, of these bones YOU have
broke” one or more tines
TABLE
The table contains the following 4 quest io”$:
311.1
311.2
311.3
311.4
Question
Fracture
Fracture
Fracture
Fracture
Fract”ce
Fracture
Fracture
Fracture
[ E28) Which bone?
IINTERVIEWER - Enter the three characters in brackets 0. prompt
card ExAcTLY 1
( E29) HOW old were y.” when this happened?
( E30) How did this occur?
Fall at ground level ........................................
Fall from height ............................................
Motor .ehicle accident ......................................
Other accident ..............................................
Spontaneous break ...........................................
Other .. . . ... ... .. ................................
I E31) Did you have surgery for this?
Yes .........................................................
No ........
311.1 311.2
—
—
—
. . . . . . . . . .
311.3
1 code
123456
123456
123456
123456
123456
123456
123456
123456
. . . . . . . . . . . . . . . . . . . . . . . . .
311.4
Y*s No
12
12
12
12
12
12
12
12
—
(1)
(2)
(3)
(4)
(5)
(6)
(1)
(2)
1
2
3
4
5
1
2
spec(fy2
12afmcs
fmcbonO-Jmcbon
fmcageO-fmcage9frachowo-frachow
fracsu2Q-fiacsu29
1
2
1
2
3
4
5
6
1
2
1
2
3
1
2
1
2
3
Yes No
318. ( F9) Do you or have you ever used a heaci.g aid? 12
319. ( F1O) Do you use a hearing aid now? 12
320. ( F5) (With a hearing aid), do you find it difficult to follow a
conversation if there is background ooise, e.g. T.V.. Radio,
children playing? 12
321. ( F6) (With a hearing aid), do you have difficultly hearing what
a person says to you in a quiet room? 12
anywrg
hmsurg
hearing
ringnok
hwofring
asdhraidusehmid
backgrnd
diffqurm
30
322. ( F7) (With a hearing aid), can y.. make out what PeOPle are
saying on the telephone (with the receiver to your better ear) ?
Easily . .. . . . . . .. . . . . . .. . . .. . ..... ......
With some difficulty . . . . . .......................
With great difficulty . . . . . .............................
323. I F8) (INTERVIEWER - Do NOT a-k this question if NO hearing
difficulty at .11, but enter NA)
324. ( F1l) As an adult have you ever bee. to your own doctor about
problems with your hearing?
325. ( F12] As .“ adult have you ever bee. to your own doctor about
problems with noises in your head or ears?
326. ( F13) &s an adult have you ever visited a hospital about problems
with your hearing?
327. ( F14) As an adult have you ever vi. ited a hospital about problems
with noises in your head o. ears?
328. ( F15) Have you ever attended the National Acoustic Laboratory
with regard to your hearing or for fitting of a hearing aid?
329. ( F16) Have you ever worked in noisy places where you had to
shout to be heard?
[INTERVIEWER - If yes, for how long altogether?]
Never .......................... ... . . .. .. .. . .. ..
Forless than six months . . . . . . . . . . .. .. .. ..
heamnph
1
2
3
@-cfsOc
1
2
3
4
5
Yes No
1
1
1
1
1
..
.
330. ( F17] Now 1 am going to ask ‘f.. some q.estion, about your
sight :
Are you totally blind in either eye?
2
2
2
2
2
1
2
3
4
5
1
consdoch
dosnoise
hosphear
hospfwh
worknois
blind
Yes ........................ ..............
31
No .. ... . . . . . . . . ...................................... 2
333. ( F20) How old were YOU where you started wearing glasS~S or
contact lenses?
Yes No
334. [ F22) When wearing eye glasses or contact lenses can you see well
eno.qh to re.qnise the letter. in ordinary newspaper print? 12
335. ( F23) To recognise the letters in a headline? 12
336. I F24) To tell if a light is on or off i. a room? 12
331. ( F21) Do y.. use a magnifying glass for reading? 12
338. ( F25) Have you noticed that your eyesight is worsening in the
last 5 years? 12
Q.e5tions 340 through 348 :
Meaning of the labels:
Not Applicable . . . .. . . . . . . .......................... (1)
Not at all . . . . . . . . . . . .............................. [2)
A little . . ... . . ... .. . .................................(3)
Moderately . . ... . . . . . . ..............................(4)
A lot . . . . . . . . ...................................(5)
340. ( F27) Now I would like YOU to tell me to what extent does
vision interfere with your ability to do a number of things
[with glasses if applicable)
(INTERVIEWER - Show Prompt Card 5)
Firstly you= housework or retirement activities?
341. I F281 Your going outside in the bright sun?
342. I F291 Your ability to drive by day?
12345
12345
12345
whicheye
glfscoru
gkzmage
specread
rectdineIghronof
rnagglasswrsls5yr
Wtultdono-whddon
exosint
intirlsun
intdydrv
343. ( F301 Your ability to drive by night? 12345
344. ( F31) Your ability to recognize faces across the street? 12345
345. ( F32) Your ability to read? 12345
346. ( F33) Your ability to see in the distance? 12345
347. ( F34) Your ability to watch TV? 12345
349.
350.
351.
352.
353.
F35) Your ability to appreciate colors? 12345
F36) Do y.” have anything wrong with your speech?
Yes ..................................................... ......... 1
No ................. . ...... . ..................... ......... 2
F37) What condition causes this?
F38) Do you have full use of your arms and fingers?
Yes .......................... .. . . . .. .. . ... ........... 1
No ............................ . . .. . . .... .. ..... 2
F39) What condition causes this?
F401 Do you have full use of your feet and l.qs?
Yes ....................................................... . .... 1
No .............................. . . ... ........ .. . .... 2
354. ( F41) what condition causes this?
355. ( F42) Do you have any disfigurement or deformity caused by a.
illness or injury or that you have had from birth?
Yes .......................... .. . .. .. . .. . . .... .... .. 1
No ... .. .. . . . . . . .. . . . ................ 2
356. ( F43) What condition do y.. have?
351. ( f44) Do y.” have any condition that makes you S1OW at learning
or “ndersta”di”g things?
358.
359.
Pr..tice YOU U=.lly CJO tO h.. YOU .,. sick .. $+he. YOU ..ed
advice about your health?
‘f,, . .... . . . . . . . .. . . ... . . . 1
No . . .. . .... . . . . .................................. ... 2
360. ( G2) How many times ha.. you consulted a doctor in the last 2
33
in(faces
intreadg
intdstns
intcohr
speechl
cauzsppr
armfiigr
m-f
feetiegs
C4u@lg
di$ftffmt
whcondtn
slwleam
Causslln
regmedpr
hwmnydoc
More than10 ..........................................
361. I G3) In the last 12 months have you consulted any of the
following woP1e about your health?:
‘General Practione, ?,
362. Specialist DOCt O=?
363. Hospital Outpatients?
364. A Dietitian?
365. A Chemist for advice?
366. A. optician or Optometrist?
367. A Physiotherapist?
368. An occupational Therapist?
369. Speech Therapist?
370. A Chiropractor?
311. A Chiropodist or Podiatrist?
372. A Psychiatrist
373. A Psychologist?
374. A District, Home or Community Nurse?
375. A Social or welfare worker?
376. A Naturopath?
377. An Acupuncturist?
. . . . . 5
Yes No
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
318. ( G41 Have you consulted any other person about yo. z health other
than those 1 have already mentioned in the last 12 months? 1
379. ( G5) Please specify?
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
Ye, No
380. ( G6) Have you ever been a patienr in a n.rsin~ home? 12
381. { G7) Have you been a patient in a nursinq home in the last 12
months? 12
382. ( G8) HOW many different time$ were you in a nursing home in
the last 12 months?
383. ( G9) For about how many days. ..s that in total?
384. ( G1O) 1. the last 12 months, have you been in a hospital at
34
xpeclist
hospautp
dieticn
chemizt
opticianphysioth
accthpstspsechth
chiroprc
chirped
psychogdstnurse
socworti
m~~acupuns
consother
specconz
nurshm12
dysnrshm
hspon12m
385.
386.
387.
388.
389.
390.
391.
392.
393.
394.
395.
396,
least overnight because of illness or an accident?
Yes ....................................................... ..... 1
No .................................................... ... ..... 2
( G1l) How many different times were you in hospital in the last
12 months?
( G121 For about how many days was that in total?
( G13) Over the last 12 months have you spent more
in bed because of illness . . injury (other than $.
nursing home) ?
Yesillne.ss ........................ ......
Yes injury .............. . . ..............
No .......... ..... ... . . . . ..... . ....
( G14) For about how many weeks was that?
—
than a week
howital or a
. . . . . . . . . . . . . . . . . . . . 1
.......... ... ..... 2
.. ... ..... .. 3
—
( G15) Over the last 2 weeks have you stayed in bed .11 or most
of the day because of illness or injury (other than i. a
hospital or a nursing home)?
Yes .................................................... ... ...... 1
No ............ . .... . . ............................ ......... 2
( G16) What was the illness or injury that caused this?
( G17) (Apart from when you were in hospital) how many days did
y.. stay in bed in the last 2 weeks? —
( G18) (Apart from when you stayed i. bed) in the last 2 weeks
have you had to cut down on a.ythi”g you usually do becau=e of
illness or injury?
Yes .......................................................... .. 1
No ................................................. .. ...... .. 2
( G19) what was the illness or injury that caused this?
( G20) How many days did you cut down in this last 2 weeks (not
counting your days in bed) ?
( G21) DO you ever go to a day care c., day theraPy cent,. ?
Yes .. . . . . . .. . . . . ........................... . .. 1
No . . . . . . . .. . . . . ...................... .... .. .. . 2
I G22) How often do you go to the centrels)?
Daily . ... . . . . . . . . . . . 1
dyshsp12
dyshsptl
wkbed12
bsddys2w
iUinjry
IlObddysz
lmadwk
Iwdyslmt
dycrther
hwmnydyc
35
No ........................... .. .. . .. .. . ........ ..
398. ( H2) 1 would like to get some idea of how many natural teeth
Y.. ha,. in Your .PPer law. Including the wisdom teeth, there
are 16 teeth making “P a comP1ete set of teeth in the “PP.. jaw
Could y.” tell me the number of remaining teeth i. your “ppez
jaw?
399. ( H3) Do you have a denture or false teeth for your UP=, jaw?
400. ( H4) Have you lo, t all your teeth from y... lower jaw?
401. ( H5) I“cl”ding the wisdom teeth, there are 16 teeth making “p
a complete set of teeth i. the lower jaw (.1s.1
could you tell me the number of remaining teeth in your lower
jaw?
402. ( H6) Do you have a denture o. false teeth for your lower jaw?
403. ( H7) Are you ordinarily able to chew boiled vegetables?
404. ( H8) Are you ordinarily able to chew hamburger?
405. ( H9) Are y.” ordinarily able to chew fresh lettuce salad?
406. ( H1O) Are y.” ordinarily able to chew a piece of fresh carrot?
407. ( H1l] Are you ordinarily able to chew firm meat such as steak or
chops?
408. ( H12] Are you ordinarily able to bite off and chew a piece from a
whole fresh apple?
409. ( H13) How lonq ago did you see someone about your teeth,
de”t”res or gums?
,.. . 2
Yes No
12
i2
Yes N.
12
12
12
12
12
12
12
notthupp
natteeth
upperden
Iozaltu
ntthloj
lowerden
chwbveg
chwhamb
chwlttcs
chwfcrrtchwmeat
seedent
36
410.
411.
412.
413.
414.
415.
( H14) Would you say that you visit the dentist on a regular
basis, or do you only 5’0 when you are in discomfort or when you
need something fixed?
Regular basis . . .. . . ... . .. .. .......
Whe” in discomfort . . . . .. . . . ... .. . . . . ... .
Sornething.eeds to be fixed .......................................
I HIS) For your last course of dental treatment did you go to a
private dentist, a dental technician or . public hospital or
clinic?
Pri.ate dentist . . ... . . .. ..... . . . .. . . ........
Dental technician ...... . . . .. .. .. . ... .. . ....... ..
P.blic hospital .. . . . . . . . . . . . ... . ... ..
( H16) HOW old were you when you last had a tooth extracted?
[INTERVIEWER - If never enter 0)
( H17) If you needed to Pay a one hundred dollar dental bill
the next month, how much difficulty would that create
financially?
{INTERVIEWER - Show Prompt Card 6)
No difficulty . . . . . . . . .. . . .... . .. . .
in
. . . .....
( H19) If you needed co visit a dentist in the next month would
you face any other problems?
(INTERVIEWER - Show PromPt Card 7)
1
2
3
4
5
6
vstdeml
1
2
3
dnprpub
1
2
3
1
2
3
4
1
2
3
4
1
2
age;stex
@pybil
prbvsdnl
37
416. ( H20) What problems would you face?
417. ( 11) 1 am .OW qoing to ask you some .q.e*tio.s about your
weight. DO you wish to answer these questions i. stones and
pounds or kiloqrams?
Stones ............................................. ... .. . . . 1
Kilogram ............... . .......... .. . .. . .. . . .. . . . 2
418. I 12B) About how much do you weigh now? INTERVIEWER - For
example, if 10 stone 12 lbs, type 10.12 or if 8 sto.e 7 lbs,
type 8.7
419. [ 12A) About how much do you weigh now?
420. ( 13) Do you consider yourself now to be overweight,
underweight or about the right weight?
Overweight ..................................................... .. 1
Underweight .................................................... .. 2
About the lightweight . .. ... . . . .. .. ....................... 3
421. ( 14) Would 1’.. like to weigh more, less or stay about the same?
More .................................................. . . . . . 1
k,, .................................................... .. .. . 2
Stay about the same.... . . . . . .. ... . .. . . . . 3
Yes No
422. ( 15) During the past 12 nm.ths have you tried to lose weight? 12
423. ( 16) During the past 12 months have you changed what you eat
because of any medical reason or health condition? 12
424. ( 17) What was the nedical reason or health condition that
caused you to change what you eat?
Overweight oro&sity .......................... . . .. . . 1
High blood pressure or hypertension .......................... . .. 2
High blood cholesterol . . . .. . . . ........................ 3
Diabetes ................................................. . . .. 4
Heart disease ........................... ... ... . . . . . 5
Allergy ..... . ... . . .. . .. . .. .. . . 6
ulcer ........................... . ... .. ... .. . . 1
Other .........................
‘425. ( 18) Please SaPeCify?
426. I 191 Up to the present time, what
. . . . . . . . . . 8
s the most you have ever
natipmb
weightkp
weight
weight
ovundwgh
prefwghl
lstwt12m
chngeath
rsncheat
maxwghtweighed? (Females do not include any times when you were
pregnant)
38
427. ( 19a) Up to the present time, what is the most you have ever
weighed? (Females do not include any times when you were
pre.mant )
428. [ S1) The next series of question. relate to worn.?”o“lY:
At what age did your periods begin?
429. ( J2) At what age did you have your last period?
430. ( J3) Did your periods stop naturally, because of su=.gery or
for some other reason?
Naturally . .. .. . . .. . . .......................... 1
Surgery ... .. . .. .. . . . . ........................... ... 2
Other reason .. . . .. . ... . .. .............................. 3
431. ( J4) What was the reason?
Yes No
432. ( .J5) Do you still have your womb or uterus? 12
433. ( .76) Do you still have both your ovaries? iz
434. ( J7) Do you still have o“e ovary? 12
435. ( J8) How many times have you been pregnant includi”q any
miscarriages or still births?
436.
437.
438.
439.
440.
S9) HOW old were you when you had your first pregnancy?
J1O) Have you ever had a miscarriage?
Yes ... . . ... . .. . ........................... ... .... 1
No ... . . . .. .. .............................. .. .. 2
J1l) How many miscarriages have you had?
.712) HOW many live births have you had?
S131 How m.a”y children have y.” breast fed?
mmeght
prdbegin
mnpsslrt
otturesn
utrsintcovintct
noprgncy
frstpreg
misscn-g
nolnswg
nobirths
nobrstfd
39
q.estio.s we ask e.*rYOne t. get a comparison - What day of the
week is it?
(INTERVIEWER - code Response I
442. ( K2) What is the date - Day?
443. ( K3) What is the nm”th?
444. ( K4) What is the year?
445. ( K5) What season of the year is it?
446. ( K6) Without looking at a watch or clock, what is the time of
day ?
[INTERVIEWER - HO.CS a“d ~i”ute, .= 24 ho.= .lock .cceptable)
447. ( K7) What country are we i“?
448. ( K8) What city or tow. are we in?
449. [ K9) What is the name of the state . . Territory?
450. ( K1O) What is the “ante of this hospital, nursing home, hostel?
451. ( K1l) What is the name of this suburb?
452. ( K12) What floor of the building are we on?
453. ( K131 What are the names of 2 MAIN ROADS “ear your home?
454. ( K14) What is the name of the Prime Minister of this country?
455. ( K15) 1 am going to name three objects - After 1 have said them,
1 want you to rePeat them - Remember what they are becau,e 1 am
9.in9 t. ask Y.. t. name them a9. in in a few minutes:
...aPP1e. ..blbl e.. .penny ...
- Respondent remember, APPle?
456. ( K16) Respondent remembers Table?
451. ( K1l) ResPo”de”t remembers Penny?
458. ( K1O) [INTERVIEWER - After first trial repeat as often as
necessary until respondent can say’ all three (.P to 10 trials) .)
Try to remember these three Ehi”gs because 1 am going to ask you
to recall them i“ a little while
{INTERVIEWER - Record the nude= .f trials)
1234
1234
1234
1234
1234
1234
1234
1234
1234
1234
1234
1234
1234
1234
1234
1234
123.4
Q.esti.a”s 459 through 463 :
Meaning of the labels:
correct ..... .................. . . . . .. .... . ...(1)
week
date
month
year
CouJ@
city
state
namehosp
suburbjloor
pn”memin
thrthing
table
penny
maths
40
stop after five subtractions {INTERVIEWER - count only 1 error if
respondent makes subtraction error, but subsequent answers are 7
1,ss than the error).
,100 - 7 = 93?, 1234
460. 93 - 1 = 86? 1234
461. 86 - 7 = 79? 1234
462. 79 - 7 - 12? 1234
463. 72 - 1 = 65? 1234
464. ( K20) Now 1 am going to spell a word forwards and 1 want you to
spel 1 it backwards. The word is WORLD.
{INTERVIEWER - spell W-0-R-L-D aloud forwards)
Spell WORLD backwards - will you do this for me please?
Yes . . ....... . . . . ..................................... 1
No ... . .......... . . . . ...................................... 2
Questions 465 through 472 :
Meaning of the labels:
correct .... ..... ... .... . ....................................(1)
Incorrect . . .... .. . .... . . ..................................(2)
No codable reply, refusal .........................................(3)
Not asked .........................................................(4)
465. First letter - D? 1234
466. Second letter - L? 1234
461. Thicd letter - R? 1234
468. Fourth letter - 0? 1234
469. Fifth letter - W? 1234
410. i K211 Now what were the three things 1 asked you to remember?
Respondent remembers Apple? 1234
471. ( K221 Respondent remembers Table? 1234
412. ( K231 Respc.”de”t remembers Penny? 1234
413. ( K24) Please listen carefully to the following name and
address, then repeat it - .Joh” Brown, 42 West street, Kensington
John ?
eighsti
sevdne
sevehvo
Sf.rfjfv
spell
D
L
R
ow
rememb
tabl
penn
john
brown
41
415. Forty two?
correct .................................................... 1
Incc.rrec ........................................ .. . . .. .. . 2
476. West Street?
correct . . .. . . . . .... ........................... .. .. 1
Incorrec t................ . ... . . .. . . . ... ... .. .. .. 2
477. Kensington?
Correct .......................... . . . .. . . ... . 1
Incorrec t.......................................... .... .. ... 2
478. INTERVIEWER - Repeat add=ess until learned - up to 5 tries.
Then ask respondent to remember this name and address for
later.
please record the number of attempts taken to remember the
whole address.
Yes No
479. ( K25) 1 am going to say the names of some people who were famous
in the past and 1 would like you to tell me who they were o. why
they were farno”s.
,Charlie Chaplin? (Actor, comedian, film star, comic)
{INTERVIEWER - Any acceptable resPonse give”? ) 1
480. ( K26) JosePh Stalin? (Soviet, Russia., WW1l leader, communist
leader)
[INTERVIEWER - Any acceptable response give.?) 1
481. ( K27) Captain Cook? (ExP1o.. I, sailor, na. iqator, discoverer)
[INTERVIEWER - Any acceptable reqxmse given?) 1
482. ( K28) Adolf Hitler? (German, Nazi, WW1l leader)
{INTERVIEWER - Any acceptable response given?) 1
484. ( K31) What is the name and address 1 asked you to rememhec a
short time ago?
John ?
2
2
2
2
1
2
3
4
5
1
fonyhv
westsn
comes
ctum?e
joseph
captain
ado~
remember
Correct ...................................................... .
42
I“coc.ec .......................................................... 2
489. I K32) 1 want YOU to tell me, please, the meanin9s of some
words .
What does rePair ma” mea”?
Correct abstract definition such.. to fix ........................ 1
Partially correct, gives concrete example .s1”9 simile of repair .. 2
Incorrect, i“cl.di.g repetitic.” of word i“ sentence .. . . .. 3
Does”ot know, “ocodable rePly, refusal . ... .. . . . . . .. 4
Not asked .............. . ... . .. . .. .. . . . . . . . 5
4’30. ( X33) What does terminate mea”?
correct abstract de finiti.a” such.. stop ...................... ... 1
Partially correct, gives concrete example using simile of terminate 2
Incorrect, including repetition of word in sentence . . . . . . 3
Does”ot know, “ocodable reP1y, refusal ................. ........ 4
Not asked .......................................... . ..... . . . 5
491. { K34) What does compassion mean?
Correct abstraction such as pity, empathy or sympathy . ... . . ... 1
Partially correct, gives concrete example using simile of
compass ion.. ... . . . .............. .. .. ............2
Incorrect, i“cl.ding repetition of word i“ sentence . . . . 3
Does notknow,. o Cmdablereply, re fusal ......... . . . . . ..4
Not asked ........................................... . . . . . 5
492. ( K35) (INTERVIEWER - Po, the next 3 quest <.”., if resPonse is
vague, say - Could you tell me a bit more?)
ln what way are an apple and a banana .1 ike?
fort
wes
ksn
termin
banana
43
correct abstract io. s..chas both fruit .................. ... . . . 1
Paritally correct, gives concrete similarities such as both grow,
ca. eat both, both ha. epee l.... ..................................2
Incorrect .. . . . . . ... ................................ 3
Does not know, no codable reP1y, refusal ........................ . 4
Not asked ........................................... . ..... . . . 5
493. ( K36) In what way are a boat and a car alike?
correct abstraction such as both are a means of transport . . ... . 1
Partially correct, qi.es concrete similarities such .* both have
seat s........ . . . . . . . . . . ..........................2
lm. orrect, only mentioned ways different . ..... .. ............... 3
Does not know, no codable reP1y, refusal .................. . . . . 4
Not asked ......................................................... 5
494. [ K31) In what way’ are an egg and a seed alike?
correct abstraction such as beginnings of life, first stage of
development .... . .. . . . . . ........................... . 1
Partially correct, gives concrete similarities such as things grow
fr.mnbot h......................................... ... .......... 2
Incorrect -”ot alike ............................................. 3
Does not know, no codable reP1y, refusal .. . .. . . ............ 4
Not asked . . . .. .................... ... 5
495. I Lll Now 1 would like some information about how you sleep
HOW often do you have trouble falling asleep?
497. ( L3) Between the time you first fall asleep in bed at night
and the time you finally wake in the morning, how long on
average are you awake overnight?
tiblslp
waknight
hrsawkng
44
[INTERVIEWER - Enter number in minutes) —
499. ( L5) Where is the Pain?
503. ( L9) If you take intentional daytime naps .. sleeps, how long
are they usually?
{INTERVIEWER - Enter number in minutes] —
504. ( L1O] How many days per week would you fall asleep
unintentionally (..9. while watching TV, reading, or riding in a
car) ?
No dayS . . . . .. . . .. . ........................... . . ... 1
Oneor two days ................................................... 2
Three or four days .......................... . . . . . .. 3
Five orrnore days ................................................. 4
505. ( L1l) compared to one year ago, do you have sleep problems more
now, less now, or is your sleeping pattern about the same?
More now .................................................. . ... 1
Less ”.. .. .. . . . . . ......................... . .. . 2
About thes.mne .................................................... 3
wakepaia
sitepaia
wakearly
s@eep
dayap
houmap
unintaap
slpcmlyr
45
506. ( L12) HOW often do you usually take ,? sedative or sleepinq pill
that has been prescribed by a doctor to hel P you sleeP?
Night ly ................ ..... . . . .. . ....... ... .. .. .. 1
Afewtimes per week .............................................. 2
Afewtimespernmnth .. ..... ... . .. ........ . .. ... .... .. 3
I,e,, ofte” ............... ... ..... .. .......... ... ... .. . 4
Never .............................................. . .. ... . 5
507. ( L13) [INTERVIEWER - For next 5 question,, use 24-hour clock)
What is the usual time you go to bed at night?
508. (L13a) What is the usual time you turn the liqhts off intending to
qo to ,leep?
509. ( 1.14) What is the “s”=1 time you fall as1eeP?
510. ( L15) What is the usual time you finally wake in the morning?
511. ( L16) What is the usual time you get out of bed in the morning?
514. ( L19) Have you been told that you stop breathing or gasp for
breath during your sleep?
Yes ......................... ... . . .... .... ... .. .. .. 1
No ............................ . . . .. .. .... .. ... .. ... 2
516. ( L21) Do you have periods during .51eeP in which you have
regular twitching movements? (This does not refer to a single
twitch or jerk that may’ occur at sleep onset)
pressedt
tmetobedhunaff
fimeawaketimerise
freqsnar
slapnoea
freqapno
nactwitc
46
Yes No
518. ( L23) Do y.. usually sleep with your P.rtne,lse..,e? 12
519. ( L24) 1s your sleep normally disturbed by’ your partner 12
Yes No
521. ( Ml) Are you able to walk up and down stairs to the second floor
without help? 12
522. ( 142) Are y.” able to walk half a mile without help? 12
Questions 523 through 527 :
Meaning of the labels:
Nodifficulty at all .......................... .. . . . . .... (1)
A little difficulty ...............................................(2)
Sornediffic”lty ...................................................(3I
Alotofdiffic”lty ............................................... [4)
Just .nableto do it ..............................................(5)
523. ( M3) Now 1 am .30ing to ask you how difficult it is, on the
average, to do similar kinds of activities.
{INTERVIEWER - Show PrmmPt Card 8)
HOW much difficulty, if any, do you have pulling or pushing
large objects like a living room chair?
12345
524. ( f44) What about stO.pinc3, cro.chi.9 or kneel i.9? 12345
525. ( MS) Lifting or carrying weights ovec 10 po”mds (4 kilograms)
like a heavy bag of groceries? 12345
526. ( M6) Reaching 01 exLendi.q your arm, above shoulder level? 1 2 3 4 5
527. ( M7) Either writing or handling or fingering small objects? 12345
528. ( M8) (INTERVIEWER - Show P.ompt Card 91
1 am “.. qoinq to ask you about some everyday activities.
Please tell me if you had any difficulties or have had any help
freqtwtc
sleepam
sleeppt
Slplis
Shs?flr
wlkh/fml
pshplflw
Stpaknl
fftlolbs
rchovshl
difsmobj
noadlprb
47
from either a Person or from some equipment or device in doing
any of these activities in the last 12 months (apart from when
Y.. m.v have been in a hOspital OK a n.r, iw hone).
[INTERVIEWER - Note dew” c.” paper which activities ...s. a
problem and enter TOTAL number I
529. TABLE
The table contains the following 10 questions:
529.1 I M9) {INTERVIEWER - Enter activity code)
529.2 i M1O) 1“ doing this activity, have you received help from a
pers.n. special equipment O. both?
No Help .................................................... (1)
Person ...................................................... (2)
Special equipment ......................... ... .. . . .. . (3)
Both .................................................. . ... (4)
529.4 see display cards “umber 6
( M12) 1s this help provided by relatives or friends. If .5., who is
y.. r main helper?
529.5 See display cards number 7
( !413) Does any other relative .. friend help you?
(INTERVIEWER - Type a space before each code)
529.6 See display cards number 8
( M14) Do you receive .?”Y other help such as from a care
orga”isatio. ?
[INTERVIEWER - Read out categories)
529.9 [ M17) What is the main reason you are not receiving (more) help?
Need not import ante” ough now .......................... . . (1)
activZ-activ8
speceqZ-speceq8
hlpreql-hlpreq8
mainhlpl-mainhl.c
bathlpI-@anhlpl
batharl-tnmorl
diflil-diflc8
marehlpl-morehlb
rsnhlpl-rsnhIp8
48
529.10
Question
Activity
Activity
Act ivity
Activity
Activity
Activity
Activity
Activity
Quest ion
Activity
Activity
Activity
Activity
Activity
Activity
Activity
Activity
Quest ion
Activity
Activity
Activity
Act ivity
Activity
Activity
Activity
Activity
Question
Activity
Activity
Activity
Activity
Activity
Activity
Activity
( M18) Please specify main reason
529.1 529.2 529.3 529.4
1 code Yes No 1 code
123412
123412 —
123412 —
123412
123412
123412 —
123412
123412
529.5
ma. 24 codes
— — — . —— — — — — — —
— — — — — — — —
— — — — — —
— — — — — —
— — — —
— — — —
— — — — —
— — — — — — —
529.6 529.7 529.8 529.9
ma, 9 codes 1 code Yes No 1 code
123412 123456
123412 123456
123412 123456
123412 123456
123412 123456
123412 123456
123412 123456
123412 123456
529.10
spmnl-sprsn.$
49
Activity
530. ( Nll {INTERVIEWER - Show Prompt Card 10)
1 would now like to ask you about mme other activities. Please
tell me if you have had any difficulty 0. have had any help from
a PeKso. because of any problem in doing any of these activities
i. the last 12 months (except for when YOU have been in a
n“rsi”g home or i“ a hospital)
{INTERVIEWER - Note down on paper which activities C..=.. a
problem and enter TOTAL numberl
531. TABLE
The table contains the following 10 questions:
531.1 I N21 [INTERVIEWER - Enter activity code}
531.2 I N2.31 Do you receive any help to assist you in this activity?
Y,, . . . .... . ... .. .......................... . ..... (1)
No . . . ... . . . ........................... ..... {2)
531.4 See disP1ay cards “umber 9
( N4) 1s this help provided by relatives or frie.ds? If so, who is
Y.., main helpe~?
531.5 s., display cards number 10
( N5) Does a“y other relative or friend help you?
[INTERVIEWER - Type a space before each code}
531.6 See display cards number 11
I N61 Do you receive any other help such as from a care
orga. isat i.”?
IINTERVIEWER - Read out categories)
iactivl-iaclivlohlpil-Idpi10
reqhIpl-rsqhlp10
imnhlpl-imnhlp10
launhlpl-shophlp3
launor.qI-shopor@
idyp-id~o
indtnrl-indmrl O
50
531.9 ( N9) What is the main reason you are not receiving (more) help? irsnl-zisnZO
531.10
Question
lADLAct .
IADLAct .
lADLAct
lADI.Act .
lADLAct
lADLAct
lADLAct .
IADLAct .
lADLAct .
lADLAct .
Question
IADLAct
IADLAct
lADLAct
lADLAct
lADI.Act .
IADLAct .
lADLAct .
lADLAct .
lADLAct
lADIAct
Question
lADLAct
lADLAct
lADMCC
lADI.Act
IADI.?+ct .
lAD~Ct .
lADI.Act
lADLAct .
lADLAct
lADLAct
Question
Need not important e“o”gh now ...................... .. ..... (1)
won~t ask-pride ........................... ...... .. . ... (2)
Cost -can, ta. ffordit ............................. .. . ... [3)
No-one to help ........................................ ..... (4)
Unable to arrange help.. service .................. ........ (5)
Other ................................................. .... (6)
[ N1OI Please specify main reason
531.1 531.2 531.3 531.4
Yes No Yes No 1 code
1212
1212
1212
1212
1212
1212
1212
1212
1212
1212
531.5
max. 24 codes
— — — —
— — — — —
—
— — —
— — — — . —
— — . — — — —
— — — — .
— — —
— — — —
— — — — — — —
531.7
1 code
1234
1234
1234
1234
1234
1234
1234
1234
1234
1234
531.8
Yes No
12
12
12
12
12
12
12
12
12
12
531
531.9
1 code
123456
123456
123456
123456
123456
123456
123456
123456
123456
123456
..10
i2pecZ-i2pec10
51
lADLAct
lADLAct .
IADLACt .
IADLAct .
lADLAct .
lADLAct .
lADLAct .
lADLAct .
lADI.Act .
lADLAct .
Questions 532 through 534 :
Meaning of the labels:
More than cmce Per week . .. ..... .... . ....................(1)
Once a week ............................ .. . .. ... .... ... .....(2)
Twoorthree times a month ........................................(3)
Almost once anmnth ...............................................(4)
Less tha”o”ce a month .... .. ... . . .. . .. ..............(5)
Never .............................................................(6)
532. ( 01) Think of your children andlor children-in–law who do
“ot live with you. In the past twelve month$, how often did
YOU have personal contact with at least one of them? 123456
533. ( 02) Again thinking of your child..” and/oc children-in-law
who do “ot live with you. 1“ the Past twelve months, how
oft. ” did you have phone contact with at least o“e of them? 1 2 3 4 5 6
534. ( 03) Again thinking of your children andlor children-in-law
who do not live with you. 1. the past twelve months, how
often did you receive mail from at least one of them? 123456
535. ( Q4) Would y.. say YOU were very happy, reasonably happy, a
little ““happy, or very unhappy with the contact you have with
YOU, children and/Or child ~e. -i. -1aw?
Very happy .. . ... . . .. . ... . .. ... ... .. . 1
Reaso”ablyhaPpy ............................ .. ... ... .. .. . . 2
A little unhappy ................................... .. . .... . 3
Very unhappy ............................ . . .. .. .. . .. . 4
Cant say . . . . . . . .. . . .. .. . .. . .. . . 5
536. ( 05) Do y.. agree or disagree with the following staterne”t?
,Older people should be able to depend o“ their adult children
for the help they need?,
contchki
phcnchW
m~rchhi
Zatscont
depchild
52
Strongly disagree . .. .. . ..... .... . ......................... 4
537. ( 06) If you and your h.sba.d or wife or partner had health
problems which made you very dependent o. others, do you think
you would want to: ?
Stay athomwith outside help .................................... 1
Move in with children ............................ . ... ....... 2
Move toahornefor the aged ....................................... 3
Move toa nursing home ............................................ 4
Not applicable ...........................................
538. I 07) .% You know, parents and children sometimes support each
other in different ways. DO YOU help your children and/or
children-in-law in any of the following ways?
(INTERVIEWER - Show Prompt Card 11)
Give gifts?
539. I 08) Help out with money?
540, I 09) Help out when someone is ill?
541. ( 010) Help keep house or fix things around the house?
542. { 011) Take care of Czrandchildren or babysit for awhile when
parents are out?
543. ( 012) D. your children .ami{.r children-in-law support you i.
any of the following ways
When you are ill (or when your husband or wife is ill)?
544. ( 013) Give gifts?
545. I 014) shop or ... errands for Y.. ?
546. ( 015) Help out with money?
547. ( 016) Help keep house o. fix things around the house f.. YOU?
548. I 017) Prepare meals for YOU?
549. ( 0181 Drive YOU places such as doctor, sh.PPi..3. ch. r.h?
......(5)
12345
12345
12’345
12345
12345
12345
12345
12345
12345
12345
12345
12345
supppref
gifgorc
monfors
childill
hsmnIctd
siterand
chhlpill
gif@mc
chshopyo
monyfrmc
chprepmIchlddrve
53
Nevex . ... . . . . . . ...................................(6)
550. ( 01a) Think of your grandchildren (who do not live with
YOUI. 1. the Past twelve months. h.. often did YOU have
p.r.Onal contact with at least one of them? 123456
551. ( 02. ) Aqai” thinking of your grandchild.e” (who do not live
with y.”) . In the past twelve mva”ths, how oft. ” did y.” have
phone contact with at least one of them? 123456
552. ( 03a) Again thi.king of your qrandchildre” (who do “ot live
with y.”) In the past twelve months. how often did y.”
receive mail from at least one of them? 123456
553. ( 04a) Would 1’.. say you were very happy, reasonably happy, a
little unhappy, or very unhappy with the contact you have with
your grandchild,en?
Very happy . . . . ... ... . .. .. .. .. 1
Reasonably happy . ... . . . . . ........................ 2
A1ittleu”haPPy . . . . . . . . . ........................ 3
Ve.y”nh.appy . . . . . . . ............................. 4
Cant say . . . . . . . . .................................. 5
554. ( 05. ] Do you agree or disagree with the following statement?
‘older people should be able to depend on their adult
grandchildren for the help they need? ,
Questions 555 and 556 :
see display cards number 12
555. ( 019) (Apart from any child or children, children-in-law, or
.qrandchildren) , about how often do you spend some time with family or
relatives who do not live with you?
{INTERVIEWER - Read .mt categories)
556. ( 020) (Apart from your children, children-in-law or grandchild.=”) ,
about how often do you talk with family or other relatives o“ the
telephone?
IINTERVIEWER - Read out categ’.?cie,t
557. ( 0211 1. general, would you like to see more of your famil Y and
celatives than y.” do, about the same, or less?
More . . . .. . . . ......................... . ..... . 1
wntgdch
phcngdch
m@gdch
satscnt2
depgdch
contothr
phothml
seemrk
54
558. ( 022) (Apart from any child or children, children-in-law ..
grandchildren), how many relatives do YOU have that you feel close to
(that is people you feel at ease with and talk to about private
matters or can ..11 0. for help) ?
559. ( 023) Of these close relatives, how many live in Adelaide?
Questions 56o and 561 :
See display cards “umber 12
560. ( 024) About how often do you spend some time with friends who do not
live with you. that is you ‘go to see them or they come to visit you or
YOU go OUt GO do things tOgether?
(1NTERV1EW2R - Read out categories)
561. ( 025) About how often do you talk with friends .. the telephone?
{INTERVIEWER - Read o“t c.ateqories )
562. ( 026) How many close friends do you have, that is people you feel at
ease with a“d talk to about private matters or can call on for help? _
563. ( 027) Of these .1. s. friends, how many live in Adelaide? —
564. ( 028) From all the people you know, including your (partner) ,
relatives and friends is there any one special person that you
feel very close and intimate with - someone you share
confidences and feelings with, some.”. you feel you can depend
0“ ?
Yes ............................................................... 1
No .................................................... .. .... .. 2
565. See display cards number 13
(029) What is Eheirrelationship to you? .............................. _
566. (028.3) Again, from all the people you know, is there any other
special person that you feel very close and intimate with -
someone else you share confidences and feelings with, someone
else y.” feel YOU C.” depend 0“?
Yes ............................................................... 1
No ............................................. . . . . . 2
567. See display cards number 14
(029a) What istheir relationship to y.”? .............................. _
568. ( 030) If You were sick, is there someone. either i. your
household or “et, y.” could ..11 on to help around the house or
Othrsup
othmdel
Con(fmd
phfriend
Cl$fmd
c/fmel
cOnf&nt
confrelt
otcnfdnt
otcnrd
hshldcar
55
Yes No
570. ( 032) 1. an emergency is there someone YOU could call on to get
help for you right away? 12
571. ( 033) When you need some ext.. help can you count on anyone to
help with daily tasks like grocery shopping, house cleaning,
cooking, telephoning, taking you places? 12
carerO-mrer3
emgcnrer
exhlpavl
Other .. . . . .. . .. .. . .....................................
msthlpf7
1
2
3
4
5
6
7
8
573. ( 0351 1s there any-an.?who depends on you for help with things
like qetting around the house, or bathing?
Yes ... . . . .. . . . . ............................... ... .. 1
No ... . . . . . .. . . .......................... ........... 2
574. i 036) 1 now have a few questions about the person with whom you
have the greatest involvement in caring for.
careprov
crpronvh
56
575. I 037) About how many hours a week do you usually spend caring
for him or her? —
576. ( 038) How stressful iS it for you to care for him or her or to
arrange for his or her care?
very stressful .................................................... 1
Q.ite stressful ................................................... 2
Somewh.atstressf.l ................................................ 3
Notat all stressful .............................................. 4
Questions 577 through 584 :
Meaning of the labels:
Extremely satisfied ...............................................(1)
Very satisfied ....................................................(2)
satisfied . . . . . . . . . ................................(3)
Somewhat dissatisfied .............................................(4)
Very dissatisfied .................................................(5)
577. (038a) The next few questions are about your qe”eral
satisfaction with life. Could you choose a category from this
card which best applies to you.
[INTERVIEWER - Show PmrnPt Card 12)
A., you satisfied with the area where you live? 12345
518. 1038bl Are YOU satisfied with your own health and physical
condition? 12345
579. 1038. ) Ace you satisfied with your financial situation? 12345
580. (038d) Are you satisfied with your friendships? 12345
581. (038e] Ace you satisfied with your marriage? 12345
582. {Cnt!f) A.. you satisfied with your family life? 12345
583. 1038@ Are you satisfied with the way y.” handle problems that
come up in your life? 12345
584. (038h) Are yo” satisfied with your life i. ‘general? 12345
586. (038j) When it comes to makinq major family decisions, who has
the final say?
(Major decisions mea. things like when to retire, where to live
and how much money to spend on major purchases)
You .................................................... .. . . . . 1
Yo”rpart.erfspo”se ............................................... 2
hrqarov
Sb’spl’cr
satplace
saQhys
sa(fii
sa@ien
Satmarr
sa~ady
saQrab
famdecis
57
Youandyour partner/spouse equally ............................ . 3
588. ( 040) Specify type of pets
591. ( PI) The next few questions are about major events that
sometimes take place during . persons life:
Have you ever been a victim of a serious physical attack or
assault at any time in your life?
592. ( P21 In what year was the most recent occurrence?
593. ( P3) And in what month did it happen?
596. ( P6j 1. what year did that h.appe. most recently?
carepefi
@pepsts
Iikepefi
rsnopers
yrlsfocc
mthlstac
copeassl
Itinjill
mstrecyr
58
597. I P7) And in what month did it happen?
598. ( P8) UP to now, how well do YOU feel YOU hav, dealt with this
life-threatening illness or injury and any changes or problems
that may have resulted from it?
Very Well ...................................................... . 1
Q.ite well ........................................................ 2
Somewhat well .................................................... 3
Notto. well ...................................................... 4
599. ( P9) Did you have any other serious, but not life-threatening
illness or accidental injury that occurred or got worse in the
last 3 years?
600.
601.
P1O) In what year did that happen most recently?
P1l) A“d i. what month did it happen? —
602. I P121 up to now, how well d. YOU feel YOU ha.e dealt with this
illness or injury and any changes or problems that may have
resulted from it?
Very Well ......................................................... 1
Guite well ........................................................ 2
Somewhat well ............ ......................................... 3
Not too well .................................................... 4
603. ( P131 Have you moved to a new residence duri”q the past 3 years?
Yes ............................................................... 1
No ................................................................ 2
604. ( P141 1. what year was your most recent m.,.?
605. I P15) And in what month?
606. ( P16) 1“ what city or country a“d state did you live before you
moved here?
607. ( P17) So far, have the changes brought about in Your life by
this n.”,, bee”?
E“tirely good ......................................... .. . 1
Mo,tlygOOd ....................................................... 2
Mo*tly bad ............. .................................... .. 3
E“tirely bad . . . . . . . . . ........................... 4
cpinjill
othinjil
yrother
mnthothr
cpothfill
mvLu3y
yrlstmv
mthlstmv
prsvresd
impctmov
59
610. ( P20) In what year did that happen most recently?
611. I P211 find in what month did it happen?
612. I P221 Up to now, how well do you feel you have dealt with this
burglary or robbery and any changes or problems that might have
resulted from it?
Very Well . . . . . . . . ... .. . .............................. 1
Q.ite well .. . . . . . . .. ... . ........................... 2
Soroewhat well . . . . . . . . ... . ... .. .. ... ...... ..... 3
Not too well . . . . . ......................... . 4
615. ( P25) 1. what year was the most recent occurrence?
616. ( P26) And in what month did it happen? —
617. I P211 up to now. how well do Y.. feel You have dealt with this
experience and any changes or problems which may have resulted
from it?
Very Well . . . . .. . . . . . 1
copemov
roblst.?y
yrlsfrob
mnkpob
wperob
brvmenl
who
yrlstbrv
copbrv
60
2
3
4
1
2
1
2
3
4
5
6
7
1
2
—
622. ( P321 In what year did that happen?
623. ( P33) And in what month did it happen?
624. ( P3.YI up to now, ho. well do Y.. feel YOU have de.lt with this
event a“d any changes or problems that might have resulted from
it?
Very Well ............................................... ... ..... 1
Quite well ................................................ ...... 2
Somewhat well .............................................. . . .. 3
Not too well .......................... . .. .. . .. .... .. 4
625. ( Q1) The next few q.estio”s are about ~mokinq
Do YOU currently mmke cigarettes?
IOsscont
whom
othmqlev
what
yrmqjev
mnmqjev
copmqlev
smoker
61
626. ( Q2) How many cigarettes do you .s.ally smoke a day? —
627. ( Q3) How old were YOU when YOU first smoked cigarettes ~e9.larly?
629. ( Q5) Before you qave up smoking, how many cigarettes a day did
YOU usually smoke?
630. [ Q6) How old were you when you last smoked cigarettes
regularly?
631. ( Q71 Do YOU regularly smoke a Pipe or .i9ars?
632. ( Q8) Have YOU ever regularly smoked . PiPe or cigar, ?
cigsa%yagfstsmk
smkbfgup
Yes No
12
12
pipcigarregpipcg
633. ( Q9) The next few que,tions are .abo”t beverages that contain
alcohol
HOW often do y.” have a drink containing alcohol?
mstdrnk
62
HOW often do you have six or more drinks on one occasion? 12345
636. ( 012) How often during the last yea. have you found that YOU
were mot able to stop dri”ki”g c.”ce y.. had started? 12345
637. ( Q13) How often during the last year have you failed to do
what was normally expected from you because of drinking? 12345
638. ( Q14) How often during the last year have you needed a drink
i“ the morning to get yourself goinq after a heavy drinking
session? 12345
639. I Q15) How often during the last Year have y.. had a feelin9 of
guilt or remorse after drinking? 12345
640. I Q161 How often du=inq the last year have You bee. unable tO
remember what happened the night be fore because you had been
drinking? 12345
Questions 641 and 642 :
Ffeani”q of the labels:
No ................................................................(1)
Ye%, b“t “m in the last year .....................................(2)
Yes. d.rinq the last year . . . ..... ............................(3)
641. I Q17) Have you or someone else been injured as a result of your
dri”ki”g? 123
642. ( 018) Has . relative, a friend, a doctor or other health worker
bee” concerned about y.”. dri.king or suggested you cut down? 123
645. I RI) N.aw 1 have some questions about how you spend your
leisure time.
1. the past two weeks did you engage i“ vigorous exercise
(exercise which made you breathe harder or puff or pant such as
ten. is< j.99in9 etc. ?
natablst
freqfail
mamdrink
frqguilt
bssmernr
dmi@y
advsredc
sc&kprb
vigexcs
646. ( R2) How many sessions of vigorous exercise did you engage in
over the Past two weeks?
647. ( R3) How much time did you spend exercising vigorously during
the Past 2 weeks?
[INTERVIEWER - Enter number of minutes) —
648. [ R4) In the Past two weeks, did you enqaqe in less vigorous
exercise for recreation, sport or health-fitness purposes which
did not make you breathe harder or puff and pant?
Yes ........................................................ ..... 1
No ................................................................ 2
649. ( R5) How many se$sions of less vigorous exercise did you
engage in over the past two weeks? —
651, ( R71 How many times did you walk for recreation or exercise i.
the Past two week. ?
652. ( R8) 1“ the PaSt two weeks, in the course of your tasks around
the house, were you involved in moderate to heavy physical
exertion which made you breathe harder or puff and pant?
Yes ... . . . . ..................................... 1
No .. . . . . . . . ................................. .... 2
653. ( R9) How much time were you involved in moderate to heavy
physical exertion in tasks at (work or) home during the Past two
weeks?
[INTERVIEWER - Enter “umber of ho”., )
vigexc2w
tmvexc2 w
Isvigezc
Isvexci?w
wand wks
hwmnwk2w
exrthous
tmhvyexr
socmemb
655. i Rlll How many ‘group. do you belong to altogether? nogmups
656. TABLE
64
,,
The table contains the
656.1 What are they?
Question
Names ...
following 1 questions:
656.1
I
namesO-m7mes4
Names ...
Names ...
Names ..
Names ..
657.
658.
659.
660.
661.
662.
663.
( R12) How many qroup meetings or .gatheri”gs did you go to in
the past month?
( R131 Are YOU presently an officer of .anY of the cl.b, You
belong to such as president, secretary, treasurer?
Ye, .................................................... . . . ... 1
No ..................................................... . . .. ... 2
( R14) How many different offices do you hold (i. different
clubs) ? —
iR15a) Please specify other religion
( R16) In guiding your life, would y.” say that religion is very
important, somewhat important or not at all important?
very important . . . . . .. .......................... . 1
Somewhat important ................................................ 2
Notatallirpartant ........................... .. .. . . . .... 3
Do”, t know ........................................................ 4
( R17) 1 am 9oinq to ask you some q“estio”s about a n“mher of
activities in which you may participate, some of which 1 have
mentioned before. 1 now want you to tell me how oft.. y.”
Participate in each activity in a typical 3 month period. If you
like, you could think about the last 3 months.
How often have you prepared a main meal?
(Needs to play a s“bsta. tial part i. the organisation,
preps.atio. a.d .o.kin9 of a main meal, not j.st snacks)
mtgmnth
presselt
hwmnyoff
rsligion
religoth
relguide
Mpl
65
664. ( R18) How often have y.. washed the dishes?
(Must do it all or share equally eg. washing c.. wiping and
putting away, not just rinsing occasional items)
Less than o.ce a week ............................................. 1
Oneortwodays a week ............................................ 2
Most days .................. .. . . ... . .. .... .. . .......... . 3
Everyday ......................................................... 4
665. ( R19) How often have you washed clothes?
(organisation of washing and drying of own clothes, whether in
a washing machine, by hand or at a la.”drettel
Never .. . .. . . .... ... . . . ... . .. .. .... . . ........ . 1
About .ance a month . .. . .. . . . ... . .. .... ...... ........ . 2
Abo”tonce a fortnight . . . . . ... . .... .. .. . . .. ..... . 3
Once aweek or more .. . .. .. . . .... .. .... .. . . .......... 4
666. ( R20) How often have you done light housework?
(Such as dusting, Poli$hi”q, sweePinq, tidyi”q “p)
Never ........................................... .. . . . .. ..... 1
Once a fortnight or less . .. . .... . .. . . .. . . .. . ... . 2
About once a week . . . .. . . . .. . .. . .. .. .. . ..... . 3
Several days a week .. .... ..... . .. . .. .... .... . . ...... . 4
667. ( R21) How often h~”e YOU done heavy housework?
(Taking out the garbage, cleaning floors, vacuuming, washing
windows, moving chairs)
668. ( R22] How many hours of voluntary or paid employment have you
done ?
None .. . . . . .... . .. . . ... .. .. . .. .. . . . .. ... 1
Uptoten hours aweek ... . . . . . .. .. .... ............... 2
Tentothirty hours a week . . . . . . .... .. ................ 3
More than thirty hours a week . . . . . .... .. .. ............. 4
aap2
Mp3
saps
@@
Questions 669 and 610 :
Meaning of the labels:
Never . . . . . . . . . . . .... . .. ... .. ., ...(1)
66
About .mce a month ......................................... .. .(2)
About once. fortnight ............................................(3)
Once aweek or more ....................................... ... . (4)
669. ( R23) How often have y.. cared for other family members?
(caring for a sick relative, baby sitting, caring for a spouse
et. ) 1234
670. ( R241 How often have YOU done household sh0pPin9?
(Must play a substantial role in the oz.qanisation and b“yin.g of
the shoppimg eg. groceries, fruit a“d vegetables - Also includes
payimq household bills) 1234
671. ( R25) How often have you done personal shoppinq?
(must play a substantial role i. the organisation and buying of
the shopping .9. clothing, toiletries, gifts)
Never .................................................... ... ... 1
Once inthreemo”ths .............................................. 2
About once arm”th ................................................ 3
once. fortnight or more .......................................... 4
CNIestio”s 672 a“d 673 :
Meaning of the labels:
Never .............................................................(1)
Abcmto”ce a month ................................................(2)
Abo”tonce a fortnight ............................................(3)
O“ceaweek or more ...............................................(4)
672. ( R26) How often have you done light gardening? (Weeding,
watering, sweepi”q paths, potting) 1234
673. ( R27) How often have you done heavy gardening?
(Digging garden beds pr.ni”g, mowing lawns) 1234
614. ( R28) How often have you done household andlor car mai”te”ance?
675. ( R29) HOII often have you needed to drive a car or orqa”ise your
OW” transport?
(The emphasis is c.” r-he or%a”isatio” of transport, not the
jo. r.ey itself, i.eludes drivifw 0.. car, .at.hiw bus O, train.
calling taxi etc. Excludes transport for the person organised by
someone else. )
Never .. . .. . .......................... . 1
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676. I R33) How often have you invited people to your home?
(lmplies either casual or formal social co”t.act e.q. having
People t. dinner, inviting people for a cup of tea, card
evenings - l“cludes standing i“vltatio”s to family a“d close
friends. 1
Less tha” oncea f.art”ight ...... . .. ..... .... . .. . ... 1
About o”ceafortni.ght ........................... . .. .. . . 2
About o”ce. week ........................... ..... ...... . .... 3
More tha”o”cea week ............................. ... ... ..... 4
617. ( R30) How often have you spent some time on a hobby?
[Must require some active participation and thought ..9.
k“ittimg, crosswords, painting, garde”i”g, games, letter
writing, “ot just wat.hi”g television)
Never .............................................. .. ... .... 1
Abo”to”cearno”th ...... . . . . .. .. .... ...................... 2
About o“cea fc.rt”iqht . . . . ..... ..... ......... ... ... 3
Once aweekormcme ... . . . . . . .. ...... ..... ... ... .... 4
678. ( R31) How many hours have you spent reading books, magazines or
newspapers ?
Less tha. twohours a week .......................... .. ... .... 1
Twotofive hours a week . . . . .... ... .. . .... 2
Fi”etoten ho”r% a week . . ... .. . ... .... ................ 3
O.erte”hours a week ............................................. 4
679. ( R32) How many telephone calls have you made to friends or
family?
(Emphasis is on making calls NOT receiving calls)
Nom, ................................... .... .. .. ... ... 1
UPtothree calls a week . .. .... .. ... . ... .. ..... ... 2
Four tote” calls aweek .. . . . .. .. ..... . .. . .... ... 3
Over tencalls a week ... . . . . .. . ... ... . . ... .. 4
680. ( R34) How much time have you spent watching television or
listening to the radio?
(Emphasis is on watching/listening, “ot j“$t h.avi”g the
TV/radio o“ i“ the backqro”.d while doing other things)
Less tha”oneho. ra day . .... ..... .... . . .. ... 1
Onetothree ho. cs a day . . .... . .. ...................... 2
Three to five hours a day . .. . . 3
Over five hours a day ........................ . .. 4
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681. ( R35) How often have you participated in social activities at a
centre such as a club, a church, or a community centre?
(Bingo, senior citizens, RSL, a hotel, self-education courses]
Less th.nc.nce a month .......................... .... ........... 1
About .ance a month .......................... ... .... .. ........ 2
Abcmtonce a week .. ..... .. .... . .............................. 3
More than c.nce a week ........................... .... ... ....... 4
Questions 682 and 683 :
Meaning of the labels:
Never .............................................................[1)
Abcmtonce a month ... ...... .. .. .... ..........................(2)
About .“.. , fortnight ............................................ {3)
Once aweek or more ...............................................(4)
682. ( R36) How often have you attended religious services or meetings? 1 2 3 4
683. ( R31) How often have you participated in an outdoor social
activity?
(BBQs, picnics, spectator sports etc. ) 1234
684. ( R38) HOII often have you spent some time outdoors participating
in a recreational or sporting activity?
(Bowls, fishing, golf etc. Excludes spectator sports)
Never ................................................ .. . ..... 1
About once amo”th .............................. .... .. . .. . 2
Abo”to”ce a week .... . . . . ... . ........................... 3
More than once a week . . . .. . . . . .. ..... ..... ... . .. .. 4
685. ( R39) How oft.” have you walked outdoors for 15 minutes or
mare?
(sustained walking for about 1 mile. short stops for breath are
allowed. Can include walking to the shoP,, provided it is far
enough. )
About o“ceamo”thor less ........................................ 1
About cmce a fortnight .. . . ............. . ....... .. .. .. .. 2
About once a week . . . . . . . .... .. . . .. . .. . . .. 3
Most days .. .. . . . . . ..... . .... . . . .. .. 4
686. ( R40) How often have you gone for a drive or been o. an
OUtin.g?
(The comon factor is an outing for pleasure e.g. by bus, train
or car, excludes routine trips for a purpose such as shopping or
visiting friends)
Never .......................... .. . ..... . .... ... . . .. .. 1
About’ance a month ................................................ 2
Abe. tonce a fortnight ............................................ 3
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Once aweekorrnore ............................................... 4
Ye, No
687. ( R41) Do YOU own a car? 12
688. { T1) Now I would like to ask You about YOU. housing .~d
fina..es.
IS this house, flat or unit being rented by you or any other
.s..1 resident of the household?
12
689. ( T2) Who is the rent paid to?
South Australian Housinq Trust .......................... . .. .. . 1
Person l. dwell ing ................................................ 2
Landlord Or Real Estate Age”t ......................... . . .. .... 3
other. ................. ........................................... 4
690. ( T3) What is the total refit each week (total dollars) ? —
691. ( T4) 1s this house, flat or unit being paid off by y.. or is
it owned by you or any other “s”.1 resident of the household?
Yes, bei”gp.id off .. . ... . ........................... . .. ... 1
Yes, owned ................................ .. . . .. . . .. ... 2
No .................................................... . .. . .... 3
692. ( T5) What is the total repay rne”t each week (total dollars)? —
693. ( T6) In which of these categories does the market value of
your house, flat or unit fall?
(INTERVIEWER - Show Prompt Card 15 t
Upto seven tyfour thousand ........................... . . . .. ...
From Seve. tyfive thousand to one h“mdred thousand .. . . ......
From o.ehundred a“d o“e thousand to one hundred and fifty thousand
More tha”one hundred and fifty thousand ..........................
Not answered . . . . .. . . . . .............................
694. ( T7) When did y.” move into this house, flat or .“it?
Be fore 1910 . . . . .. . ......................... . ..
1970-1974 . .. .. . .. ............................ ...
1975-1919 . . . . . . . . . . . ......................... ...
After 1979 . . . . . . ......................... ...
695. ( T8) Please VPecify which year you moved into this house, flat
or ““it?
696. ( T91 How many main rooms do y.a” have in this house, flat or
70
1
2
3
4
5
1
2
3
4
OwnCar
renthous
landlord
wklyenl
ownpayof
Wwyrpay
mrktvafu
whenoccp
yearoccp
nroom.r
unit? (Do not include bathrooms, porches, balconies or f.Yers
697. [ TIO) Would you say that you find living i. this house, flat or
u.it very comfortable, comfortable or uncomfortable?
Very cc.nfortable ..................................................
comfortable .......................................................
U“cc.mfortable .....................................................
700. ( T13) For what reason do You intend t. move (again) ?
More or better personal care at new home ..........................
Closer tothi”gs or people ........................................
Better neiqhbo”rho’od ..............................................
Cost of rent or n!ort%ge or upkeep and repairs too high ...........
Modified or better designed or more suitable dwelling ...... .. ..
Family changes such as bereavement or to live with family . .. ...
Othex ..................................................... .. .. .
103. [T13c) Please specify other?
L
2
3
1
2
3
1
2
1
2
3
4
5
6
7
1
2
1
2
3
4
704, ( T14) [INTERVIEWER - Do not ask this qUeSti On at Retirene.t
villages]
Have you put your name dew” for any special aged accommodation
or retirement village?
Ye s........ . . . . . ...............................1
No . . .. . . . . . .......................... . . . .. 2
comfort
condreso
platiomv
reasmove
sechome
reashome
specrea8
mvspecac
71
705. ( T16] [INTERVIEWER - Show PmnPt Card 161
This card list. various social security cards.
Which of these do you (or your h.sband/wifel currently hold?
[INTERVIEWER - Prompt for .11 types]
Pensioner health benefits and concession card .................... 1
Pharmaceutical benefits card ...................................... 2
Health Bemefits card .............................................. 3
Health Care card .................................................. 4
Other ............................................................. 5
Nc.neof the above ................................................. 6
706, IT16a) {INTERVIEWER - Only ask if one of the answers to social
security cards is Other, otherwise enter NAI
707. see display cards number 15
( T151 [INTERVIEWER - Show PromPt Card 111
This card lists various source. of income. Which of these do
YOU or YOU, husband or wife cur,ently receive as income?
List all SO” ZC=S of income.
IINTERVIEWER - Type a space be fore each code)
.. . . .............. .. . ..... . .. . ---- ---- ---
108. I T1l) If we include the income from all these so. xces, a“d add
.s11 of your (and y.”. spouse, s) earnings, in which of these
9r0.P, wOuld YOU, total income be before tax O, anythinq else iS
take” out?
(INTERVIEWER - Show Prompt card 18 and enter relevant code)
709. I T20) How many people altogether live .“ this Income (that is
it provides at least half of their i.coms)?
710. I T18) What percentage of this total did you yourself receive?
Questions 711 and 712 :
Meaning of the labels:
Very Well .........................................................(1)
Fairly Well .... .. . . . .. ............................... (2]
Poorly ............................................................(3)
711. ( T21) How well doe, the amount of money you have take caze of y.”,
needs? 123
112. ( T22) How well does the amo””t of money you have take care of you,
large annual expenses? 123
Othbqfl
sOurciOO-s0urc
nsupinc
percurec
needsmet
Ii-gannds
713. ( T23) Do YOU usually have enouqh co buy those little extras
i.e. small luxuries?
72
114. I T24) suppose y.. needed money quickly, and you cashed in .11
of your (and your spouse- s) cheque and savings accc.u”ts, any
stocks a“d bonds, and real estate (other than your principal
home) .
About how m“ch would this arno””t to?
{INTERVIEWER - Show Prompt card 19 and enter relevant code)
715. ( U1l Now 1 have some background q.estio”s about topics such as
schooling and work experience.
716. ( U2) Since leaving school have you obtained a certificate,
diploma, degree or any other qualification?
Yes ............................................................... 1
No ................................................................ 2
717. see display cards number 16
{ U3) [INTERVIEWER - Show PrornPt Card 20)
Which of these groups best describe, your highest qualific.atio”? ....... _
718. [ U4) Please specify other
Yes No
719. { U5) Do you currently work in a job, business or farm? 12
120. ( U6) Have you ever worked in a job, business or farm? 12
721. I U7) How long ago did you last work? (in years)
tthmset
school
qualif
typqual
cumvorkevenvork
whenZO
reh”reo
723. ( U9) 1. what year did you retire?
7’3
726. ( U12) Specify what kind of work
727. ( U131 Did you work -
Fc.ra. employ er ................................................... 1
For wages or salary in your own business with employees ..... .. 2
For waqes or salary in your own business with no employees ..... .. 3
without pay in. family business ........................... . ... 4
Fc.rpayment in king.... ........................................... 5
Unpaid voluntary work ............................................. 6
Yes No
729. I u15) Did that job require You to perform heavY Physical work? 12
730. ( u16) Did you serve in the armed services overseas or in Northern
Australia during war time? 12
731. { U17) What kind of work did your hu,bandlwi f, do for most of
hi, /her life?
Worked at job, b.si.ess or farm ................................... 1
Never employ Ed .................................................... 2
Housewife . . .. . . . . . ........................... . .. 3
732. ( U18) Please specify kind of work
733. ( u19) Was he or she working -
For an employer ................................................... 1
For wages or salary i. your own business with employees . . 2
For wages or salary i. your own business with no employees . . 3
Witho.t payinafami lyb.siness .. . ..................... . 4
course
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forwhom
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spouse
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77
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