0. No 1. Yes Specify which activity then ask how often R takes part in the activity. IF NO SKIP TO Q396 Light Housework (vacuuming, mopping floors, ironing, making beds) Home Repairs. (DIY) Q392 Light gardening (weeding, pruning) 0. No 1. More than once a week 2. Once a week 3. One to three times a month 4. Hardly ever, or never Q393 Bowls 0. No 1. More than once a week 2. Once a week 3. One to three times a month 4. Hardly ever, or Q394 Light Housework (vacuuming, mopping floors, ironing, making beds) 0. No 1. More than once a week 2. Once a week 3. One to three times a month 4. Hardly ever, or never Q395 Home Repairs (DIY) 0. No 1. More than once a week 2. Once a week 3. One to three times a month 4. Hardly ever, or never I'm now going to ask about general health conditions and problems. Firstly have you ever been diagnosed /told you have any of the following health conditions. Q396 Angina
99 Not asked Q403 Low Blood Pressure? 0. No 1. Yes IF RATED NO ASK Q404 OTHERWISE SKIP TO Q405 Q404 Do you sometimes feel dizzy when you stand up? 0. No 1. Yes 8. No answer 9. Not asked Q405 Cancer 0. No 1. Yes Exclude non malignant skin cancer IF RATED YES ASK Q406 OTHERWISE SKIP TO Q409 Q406 What type was it? Textual answer…………….. Q407 At what age was it first diagnosed? Nn Age in years Q408 Is it a problem for you now? (Are you currently in remission) 0. No 1. Yes Q409 Sugar Diabetes 0. No 1. Yes IF YES ASK Q410 OTHERWISE SKIP TO Q412 Q410 How old were you when that happened? Nnn Age in years
The next test measures the strength in your legs. I want you to try to stand up from a firm straight backed chair, like a dining chair. First, fold your arms across your chest and sit so that your feet are on the floor; then stand up keeping your arms across your chest. Q471 Do you feel it would be safe to do this? 0. No 1. Yes First explain and then demonstrate the procedure. IF YES CONTINUE, IF NO SKIP TO Q478 Q472 Record outcome of single chair rise. 1. R stood without using arms 2. R used arms to stand 3. Test not completed. IF RATED 1 SKIP TO Q474 IF RATED 2 OR 3 RATE Q473 If respondent cannot rise without using arms, SAY “ Okay, try to stand up using your arms” Q473 If test not completed record the reason why a. Tried but unable b. R could not hold position unassisted. c. Not attempted, interviewer felt unsafe d. Not attempted, respondent felt unsafe e. R unable to understand instructions f. Other reason g. R refused SKIP TO Q478 Now I would like you to repeat the procedure but this time I want you to stand up straight as quickly as you can five times, without stopping in between and without using your arms to push off. When respondent is seated with feet resting on the and arms folded across the chest say ready?, begin. Start the stopwatch as soon as you say Begin. Count out loudly as they rise each
0. No 1. Yes, in the body 2. Yes, in the head 8. No answer 9. Not for shingles on the face, in the eyes, in the ears or on the scalp. MEN SKIP TO Q482 ASK OF WOMEN ONLY Q480 How old were you when you had your last menstrual period? Nn Age at last period Q480 Age of menopause is thought to be a risk factor for vascular dementia. Age of last menstrual period is asked because it is more specific and therefore easier to pinpoint. Try to complete even if only an approximation. Answer with age of last period, even if it was brought forward by hysterectomy or extended by HRT Q481 For how long did you have (have you had) hormone replacement therapy? yy.mm Length of time 77.77 Don’t know 88.88 No answer 99.99 Not asked/Not applicable Q482 Have you had any medical problem that we haven't covered? 0. No 1. Yes (specify) 8. No answer 9. Not asked Q483 Other medical problem that we haven’t covered Specify…………………………… And now some questions about your parents and your brothers and sisters. Q484 How old was your mother when you were born? Nn Age in years (roughly is ok) 77 Don’t know Q484 Maternal age at birth is thought to be a risk factor for dementia. It is important that we collect this information as accurately as possible. If the subject cannot remember, ask for mother’s year of birth or year of death, and subject’s age at her death. If this still
99 Not asked IF NONE ALIVE, SKIP TO Q490 Q489 And how many of them have reached the age of 70 years? nn Number aged 70+ 77 Don't know 88 No answer 99 Not asked IF NONE HAVE DIED SKIP TO Q491 Q489 Number still alive who are 70 or above Q490 And of those who have died, did any reach the age of 70 years? nn Number aged 70+ 77 Don't know 88 No answer 99 Not asked This next set of questions is your first degree blood relatives, that is, your parents, brothers and sisters, and your children. How many of them have been diagnosed as suffering from the following disorders? Q491. Down’s syndrome (what used to be known as a Mongol child. Q492. Senility/dementia/serious memory problems Q493 Alzheimer's disease Q494 Parkinson's disease Q495 Stroke Q496 Heart attack Q497 Sugar diabetes Q498 Leukaemia/lymphoma Q491 Enter the number of first degree relatives that have been diagnosed (since we last saw them). First degree relatives: parents, brothers, sisters, children, and sisters. Note: not second degree relatives: aunts, uncles, cousins. Rate 77 for Don't know, 88 for No answer, 99 for Not asked. If the subject has been adopted and has no information about their blood relative’s rate 77. In each case, if only one relative has been named, ask 'Anyone else?'
633 Did the subject have a weakness, tremor etc of hand that interfered with writing, drawing or folding 0. No 1. To some extent 2. To marked extent 3. Use of one hand/arm only 4. No answer 634 Low intelligence 0. No. 1. Yes 8. No answer 635 Poor grasp of language that interfered with questioning or illiterate 0 No 1. Yes, English not mother tongue 2. Yes, unable to read 3. Yes, unable to write 4. Neither read nor write 8. No answer 636 Slurring not specified as due to physical defect or 0. No 1. Yes 8. No answer 637 Interview conditions unfavourable e.g. noisy distracting environment. 0. No 1. Yes 8. No answer 638 Interviewee repeatedly falls asleep and has to be awakened. 0. No 1. Yes 8. No answer 639 Interviewee appears generally sleepy, but does not actually fall asleep. 0. No 1. Yes 8. No answer DIFFICULTIES 640 Lack of insight into present disability 0. No 1. Yes 8. No answer 641 Impaired ability to focus, sustain and shift attention. 0. No 1. Yes 8. No answer 642 Impaired judgement of situations and or persons. 0. No 1. Yes 8. No answer 644 Incoherent in clear consciousness (e.g. not sleepy) irrelevant or bizarre or random