THE CHANGING LIVES OF OLDER COUPLES STUDY

 

MACBAT HEALTH FOLLOW-UP STUDY

 

CODEBOOK FOR ALL WAVES OF THE STUDY

 

APRIL, 1991



 

 

 

 

                        GENERAL CODING INSTRUCTIONS

 

 

 

  1.  Code Seq. # on Facesheet as the Case ID.

 

 

  2.  Ranges are not acceptable at any location in the Interview.  If you come across a range, see Supervisor.

 

 

  3.  Interviews will have been edited, and some items "scored", in green by the Study staff prior to the coding process.  If editing conflicts with the DDE specifications, see Supervisor.

 

 

  4.  Although not indicated in the codebook or on the screens, many variables are coded to one decimal place (e.g., A1c, A2).  The DDE program will convert these 3-digit fields, but care must be taken to enter the correct values, usually involving the insertion of a lead 0--e.g., 4.3 seconds must be entered as 043.


 

 

 

FACESHEET

 

 

VAR #

 

20001         FS.  Coding Sequence #                                      

 

 

 

20002         FS.  Resp. ID# -- 1st 4 digits (CLOC ID #)                  

 

 

 

20003         FS.  Resp. ID# -- Last 2 digits                             

 

 

 

              [V20004 BUILD 6-digit Respondent ID# (V20002+V20003)]

 

 

 

20005         FS.  Result Code:                                           

 

01.  Complete IW

05.  Partial IW

 

 

 

20006         FS.  Respondent "history":  2 digits                        

 

BUILD = 00

 

 

 

20007         FS.  4-digit ID# of person to whom R is matched             

 

Code 1st 4 digits of ID# precoded on Facesheet

 

0000.  No matching Interview (V20003=00); no precoded ID# on

       Facesheet

 

 

 

20008         FS.  2-digit ID# of person to whom R is matched             

 

Code last 2 digits of ID# precoded on Facesheet

 

00.  No matching Interview (V20003=00); no precoded ID# on


   

 

 

[V20009:  BUILD 6-digit ID# (V20007+V20008)]

 

 

 

 

 

20010         FS.  "History" of person to whom R is matched:  2 digits    

 

BUILD = 00

 

 

 

20011         FS1. INTERVIEWER ID# (4 digits from label/box)              

 

 

 

20012         FS3. Date of Iw--MONTH                                      

 

Code MONTH (01-12)

 

99.  NA

 

 

 

20013         FS3. Date of Iw--DAY                                        

 

Code DAY (01-31)

 

99.  NA

 

 

 

20014         FS3. Date of Iw--YEAR                                       

 

Code last 2 digits of YEAR (89-91)

 

99.  NA

 

 

 

20015         FS4. Length of Iw                                           

 

Code MIN (001-240)

 

999.  NA

 

 

 


20016         FS6a.     Specimen Agreement--Urine                         

 

1.  YES

5.  NO

 

9.  NA

 

 

 

20017         FS6a.     Specimen Agreement--Blood                         

 

1.  YES

5.  NO

 

9.  NA

 


 

 

 

 

 

                        SECTION A: PHYSICAL PERFORMANCE

 

VAR #

 

20201          A0.   INTERVIEWER CHECKPOINT                             

┌────────────────┐

0 in 20202-20248├── 1.  R USES WALKER OR WHEELCHAIR

└────────────────┘  

2.  ALL OTHERS

 

 

 

A1.   SEMI-TANDEM STAND (EYES OPEN)

 

I would like you to try to stand with the side of the heel of one foot touching the side of the big toe of the other foot for about ten seconds. 

 

 

 

20202          A1a.  INTERVIEWER CHECKPOINT                               

 

1.  R USES CANE

┌──────────┐

0 in 20203├──────── 2.  ALL OTHERS

└──────────┘

0.  Inap, 1 in 20201

 

 

 

20203          A1b.  Do you think you could try doing this without your cane?                           

 

1.  YES

┌────────────────┐

0 in 20204-20233├── 5.  NO

└──────────┬─────┘

           ├──────── 8.  DK

           └──────── 9.  NA

 

0.  Inap, 1 in 20201; 2 in 20202

 

 

 


20204          A1c(A1). # OF SECONDS                                      

 

Code # OF SECONDS (001-100), except:

 

993.  TRIED, BUT UNABLE

995.  NOT PERFORMED FOR SAFETY REASONS

 

999.  NA

 

000.  Inap, 1 in 20201; 5, 8-9 in 20203

 

 

 

20205          A1d.  INTERVIEWER CHECKPOINT                               

┌──────────┐

0 in 20206├───────  1.  R HELD POSITION FOR 10 SECONDS

└──────────┘     

┌────────────────┐

0 in 20207-20217├── 2.  ALL OTHERS

└────────────────┘

 

0.  Inap, 1 in 20201; 5, 8-9 in 20203

 

 

 

A2.   SIDE BY SIDE STAND

 

Now I would like you to try to stand with your feet together, side by side, for about 10 seconds. 

 

20206          (A2). # OF SECONDS                                         

 

Code # OF SECONDS (001-100), except:

 

993.  TRIED, BUT UNABLE

995.  NOT PERFORMED FOR SAFETY REASONS

 

999.  NA

 

000.  Inap, 1 in 20201; 5, 8-9 in 20203; 1 in 20205

 

 

 


A3.   TANDEM STAND -- EYES OPEN

 

Now I would like you to try standing with the heel of one foot in front of and touching the toes of your other foot for about 10 seconds. 

 

20207          (A3). # OF SECONDS                                         

 

Code # OF SECONDS (001-100), except:

┌────────────────┐

0 in 20208-20209├─  993.  TRIED, BUT UNABLE

└────────────────┴─  995.  NOT PERFORMED FOR SAFETY REASONS

 

999.  NA

 

000.  Inap, 1 in 20201; 5, 8-9 in 20203; 2 in 20205

 

 

 

20208          A3a.  MOVES ARMS                                           

 

1.  YES               ┌────────────────────────┐

5.  NO                           USE SAME CODE FOR V20209

                    └────────────────────────┘

9.  NA

 

0.  Inap, 1 in 20201; 5, 8-9 in 20203; 2 in 20205; 993 or                   995 in 20207

 

 

20209          A3b.  TRUNK SWAYING                                        

 

 

 

20210          A4.   INTERVIEWER CHECKPOINT                               

 

1.  R HELD TANDEM STAND (EYES OPEN) FOR 10 SECONDS

┌────────────────┐

0 in 20211-20217├── 2.  ALL OTHERS

└────────────────┘

0.  Inap, 1 in 20201; 5, 8-9 in 20203; 2 in 20205

 

 

 


A5.   TANDEM STAND -- EYES CLOSED

                                                               

Next, I'd like you to try standing like you just did with one foot in front of the other, but with your eyes closed this time. 

 

20211          (A5). # OF SECONDS                                         

 

Code # OF SECONDS (001-100), except:

┌────────────────┐

0 in 20212-20213├── 993.  TRIED, BUT UNABLE

└────────────────┴── 995.  NOT PERFORMED FOR SAFETY REASONS

 

999.  NA

 

000.  Inap, 1 in 20201; 5, 8-9 in 20203; 2 in 20205 or                                                          20210

 

 

 

20212          A5a.  MOVES ARMS                                           

 

1.  YES               ┌────────────────────────┐

5.  NO                           USE SAME CODE FOR V20213

                    └────────────────────────┘

9.  NA

 

0.  Inap, 1 in 20201; 5, 8-9 in 20203; 2 in 20205 or 20210;                   993 or 995 in 20211

 

 

20213          A5b.  TRUNK SWAYING                                        

 

 

 


A6.   TANDEM WALK

 

I would like you to walk as if you were walking a tightrope.

 

Keep your feet in line, with the heel of the foot in front touching the toe of the foot behind.  You can move your arms to help keep your balance.  I'll be walking next to you and will time you to see how long it takes you to walk 10 steps.

 

20214          (A6). # OF STEPS                                           

 

Code # OF STEPS (01-10), except:

┌────────────────┐

0 in 20215-20216├── 93.  TRIED, UNABLE (NO STEPS)

└────────────────┴── 95.  NOT PERFORMED FOR SAFETY REASONS

 

99.  NA

 

00.  Inap, 1 in 20201; 5, 8-9 in 20203; 2 in 20205 or                                                            20210

 

 

 

20215          A6a.  TIME                                                 

 

Code # OF SECONDS (001-100)

 

999.  NA

 

000.  Inap, 1 in 20201; 5, 8-9 in 20203; 2 in 20205 or 20210                   93 or 95 in 20214

 

 

 

20216          A6a.  MOVES ARMS                                           

 

1.  YES               ┌────────────────────────┐

5.  NO                           USE SAME CODE FOR V20217

                    └────────────────────────┘

9.  NA

 

0.  Inap, 1 in 20201; 5, 8-9 in 20203; 2 in 20205 or 20210;                   93 or 95 in 20214

 

 

20217          A6b.  TRUNK SWAYING                                        


A7.   SINGLE LEG STANDS

 

I would like you to try to balance on one leg like this...

 

20218          (A7). # OF SECONDS                                         

 

Code # OF SECONDS (001-100), except:

┌────────────────┐

0 in 20219-20221├── 993.  TRIED, BUT UNABLE

└────────────────┘

┌────────────────┐

0 in 20219-20227├── 995.  NOT PERFORMED FOR SAFETY REASONS

└────────────────┘

999.  NA

 

000.  Inap, 1 in 20201; 5, 8-9 in 20203

 

 

 

20219          A7a.  MOVES ARMS                                           

 

1.  YES               ┌────────────────────────┐

5.  NO                           USE SAME CODE FOR V20220

                    └────────────────────────┘

9.  NA

 

0.  Inap, 1 in 20201; 5, 8-9 in 20203; 993 or 995 in 20218

 

 

20220          A7b.  TRUNK SWAYING                                        

 

 

 

20221          A7c.  STANDING LEG                                         

 

1.  RIGHT

2.  LEFT

 

9.  NA

 

0.  Inap, 1 in 20201; 5, 8-9 in 20203; 993 or 995 in 20218


20222          A7d.  INTERVIEWER CHECKPOINT                               

┌────────────────┐

0 in 20223-20227├── 1.  R HELD POSITION FOR 10 SEC.

└────────────────┘

2.  ALL OTHERS

 

0.  Inap, 1 in 20201; 5, 8-9 in 20203; 995 in 20218

 

 

 

20223          A7e.  Would it be unsafe for you to try the stand using your                 other leg?                                           

┌───────┐

0 in   ├──────────  1.  YES

                

20224-             5.  NO

20227          

└───────┼──────────  8.  DK

        └──────────  9.  NA

        

0.  Inap, 1 in 20201; 5, 8-9 in 20203; 995 in 20218; 1 in                     20222

 

 

 

20224          (A7f). # OF SECONDS                                        

 

Code # OF SECONDS (001-100), except:

┌────────────────┐

0 in 20225-20227├── 993.  TRIED, UNABLE OR HOLDS ONTO OBJECT

└────────────────┴── 995.  NOT PERFORMED FOR SAFETY REASONS

 

999.  NA

 

000.  Inap, 1 in 20201; 5, 8-9 in 20203; 995 in 20218;                           1 in 20222; 1, 8-9 in 20223

 

 

 


20225          A7g.  MOVES ARMS                                           

 

1.  YES               ┌────────────────────────┐

5.  NO                           USE SAME CODE FOR V20226

                    └────────────────────────┘

9.  NA

 

0.  Inap, 1 in 20201; 5, 8-9 in 20203; 995 in 20218; 1 in                     20222; 1, 8-9 in 20223; 993 or 995 in 20224

 

 

20226          A7h.  TRUNK SWAYING                                        

 

 

 

20227          A7j.  STANDING LEG                                         

 

1.  RIGHT

2.  LEFT

 

9.  NA

 

0.  Inap, 1 in 20201; 5, 8-9 in 20203; 995 in 20218; 1 in                     20222; 1, 8-9 in 20223; 993 or 995 in 20224

 

 

 

A8.   360 DEGREE CIRCLE

 

Stand facing me.  Then when I say, "Begin", I'd like you to turn all the way around in a circle, like this...

 

20228          (A8). # OF SECONDS                                         

 

Code # OF SECONDS (001-600), except:

┌────────────────┐

0 in 20229-20230├── 993.  TRIED, UNABLE

└────────────────┴── 995.  NOT PERFORMED FOR SAFETY REASONS

 

999.  NA

 

000.  Inap, 1 in 20201; 5, 8-9 in 20203

 

 

 


20229          A8a.  MOVES ARMS                                           

 

1.  YES               ┌────────────────────────┐

5.  NO                           USE SAME CODE FOR V20230

                    └────────────────────────┘

9.  NA

 

0.  Inap, 1 in 20201; 5, 8-9 in 20203; 993 or 995 in 20228

 

 

20230          A8b.  TRUNK SWAYING                                        

 

 

 

A9.   BENDING OVER

 

This next movement involves bending over to pick up a pencil.  If you've had an operation for cataracts within the past 6 weeks, you should not try this movement.

 

20231          (A9.) Have you had such an operation within the past 6 weeks?        

┌───────┐

0 in   ├─────────── 1.  YES

      

20232-             5.  NO

20233 

└───────┼─────────── 8.  DK

        └─────────── 9.  NA

            

0.  Inap, 1 in 20201; 5, 8-9 in 20203

 

 

 

20232          A9a.  Do you become dizzy or faint when you bend over?     

┌─────┐

0 in ├───────────── 1.  YES

                   3.  R answers "YES," but A9b is filled in

20233              5.  NO

└─────┤ 

      ├───────────── 8.  DK

      └───────────── 9.  NA

 

0.  Inap, 1 in 20201; 5, 8-9 in 20203; 1, 8-9 in 20231

 

 

 

A9b.  Now, when I say, "Begin", I'd like you to bend over and pick up this pencil and stand back up.

 


20233          (A9b). # OF SECONDS                                        

 

Code # OF SECONDS (001-300), except:

 

993.  TRIED, UNABLE

995.  NOT PERFORMED FOR SAFETY REASONS

 

 

999.  NA

 

000.  Inap, 1 in 20201; 5, 8-9 in 20203; 1, 8-9 in 20231 or                   20232

 

 

A10.  10 FOOT WALK

 

For the next exercise I am going to observe how you normally walk.  If you use a cane or something else to help you walk and would feel more comfortable with it, you may use it during the test.  However, if possible, I'd like you to walk without any aids.

 

20234          A10a. STEP CONTINUITY:                                     

 

01.  YES

05.  NO

┌────────────────┐

0 in 20235-20241├── 93.  TRIED, UNABLE

└────────────────┘   95.  NOT PERFORMED FOR SAFETY REASONS

 

00.  Inap, 1 in 20201

 

 

 

20235          A10b. TURN CONTINUOUS WITH WALKING; PIVOT                  

 

1.  YES                          ┌─────────────────┐

5.  NO                           USE SAME CODE   

                                 FOR V20236-20237

9.  NA                           └─────────────────┘

 

0.  Inap, 1 in 20201; 93 or 95 in 20234

 

 

20236          A10c. STAGGER, UNSTEADY                                    

 

 

20237          A10d. WALKING AID                                          

 


Now I would like you to do the same thing again.  Walk at your usual pace, go all the way to the end of the course, turn and come back.  Don't hurry, just walk at your usual pace.

 

20238          A10e. TIME                                                 

 

Code # OF SECONDS (001-950), except:

┌──────────┐

0 in 20239├───      993.  TRIED, UNABLE

└──────────┘

999.  NA

 

000.  Inap, 1 in 20201; 93 or 95 in 20234

 

 

 

Now, I would like you to walk down and back as fast as it feels safe and comfortable to you.

 

20239          A10f. TIME                                                 

 

Code # OF SECONDS (001-950), except:

 

993.  TRIED, UNABLE

 

999.  NA

 

000.  Inap, 1 in 20201; 93 or 95 in 20234; 993 in 20238

 

 

 

A11.  INTERVIEWER COMMENTS                                         20240  A11a. ANY DIFFICULTY FINDING 10' SPACE FOR WALKING?        

 

1.  YES

5.  NO

 

9.  NA

 

0.  Inap, 1 in 20201; 93 or 95 in 20234

 


20241          A11b. WHAT TYPE OF WALKING SURFACE?                        

 

1.  UNCARPETED

2.  LOW CARPET

3.  THICK/SHAG CARPET

 

7.  OTHER

 

9.  NA

 

0.  Inap, 1 in 20201; 93 or 95 in 20234

 

 

 

20242          A12.  Do you think it would be unsafe for you to try to stand up

from a chair without using your arms?                

┌───────┐                                             ┌──────────────────┐

0 in   ├─────────── 1.  YES                          NOTE:  If A12 is 

                                                    blank, but A13b is

20243-             5.  NO                           circled 94, code 5

20248                                               at A12.          

└───────┼─────────── 8.  DK                           └──────────────────┘

        └─────────── 9.  NA

 

0.  Inap, 1 in 20201

 

 

A13.  CHAIR STAND

 

Please sit so that your feet are on the floor and fold your arms across your chest.  Then try to stand up without using your arms.  (IF R IS UNABLE TO RISE WITHOUT USING ARMS, SAY: "Okay, try to stand up using your arms to push off".)

 

20243          A13a. NUMBER OF ATTEMPTS TO RISE, INCLUDING ROCKING AND WEIGHT

SHIFTING                                             

 

Code # (01-10)

 

99.  NA

 

00.  Inap, 1 in 20201; 1, 8-9 in 20242

 

 


 

20244          A13b. OUTCOME:                                             

 

01.  ROSE WITHOUT USING ARMS

┌───────┐

0 in   ├─────────── 02.  ROSE USING ARMS

      

20245- ├─────────── 90.  NOT ATTEMPTED, OTHER REASON

20248     

└───────┼─────────── 93.  TRIED, BUT UNABLE

       

        ├─────────── 94.  NOT ATTEMPTED, NOT SUITABLE CHAIR

        └─────────── 95.  NOT ATTEMPTED FOR SAFETY REASONS

         

00.  Inap, 1 in 20201; 1, 8-9 in 20242


20245          A14.  Do you think it would be unsafe for you to try to stand up

from a chair without using your arms, five times                     quickly?                                                   

┌───────┐

0 in   ├─────────── 1.  YES

      

20246-             5.  NO

20248 

└───────┼─────────── 8.  DK

        └─────────── 9.  NA

 

0.  Inap, 1 in 20201; 1, 8-9 in 20242; 02, 90, 93-95 in

 

 

 

A15. REPEATED CHAIR STANDS

 

For this exercise, please keep your arms folded across your chest.  I'd like you to stand up straight as quickly as you can five times without stopping in between.  After standing up each time, sit down and then stand again.  I'll be timing you with a stopwatch.

 

20246          (A15). # COMPLETED                                         

 

Code # COMPLETED, NO ARM USE (01-05), except:

┌────────────────┐

0 in 20247-20248├── 90.  NOT ATTEMPTED, OTHER REASON

└────────────────┼── 93.  TRIED, BUT UNABLE

                 └── 95.  NOT ATTEMPTED FOR SAFETY REASONS

 

99.  NA

 

00.  Inap, 1 in 20201; 1, 8-9 in 20242; 02, 90, 93-95 in                        20244; 1, 8-9 in 20245

 

 

 

20247          A15a. TIME                                                 

 

Code # SECONDS TO COMPLETE 5 STANDS (001-600), except:

 

999.  DID NOT COMPLETE 5 STANDS; NA

 

000.  Inap, 1 in 20201; 1, 8-9 in 20242; 02, 90, 93-95 in                      20244; 1, 8-9 in 20245; 90, 93, or 95 in 20246

 

 


 

20248          A15b. CHAIR HEIGHT: INCHES FROM FLOOR TO LOWEST POINT OF CHAIR                SEAT                                                 

 

Code # INCHES (120-220)

 

999.  NA

 

000.  Inap, 1 in 20201; 1, 8-9 in 20242; 02, 90, 93-95 in                      20244; 1, 8-9 in 20245; 90, 93, or 95 in 20246


 

 

 

               SECTION B: WAIST/HIP RATIO AND USE OF MEDICATIONS

 

 

 

 

VAR #

 

20301          B1.   What is your current weight?                         

 

Code # POUNDS (060-350)

 

998.  DK

999.  NA

 

 

 

20302          B2.   How tall are you without shoes on?--FEET             

 

Code FEET (3-6)

 

8.  DK

9.  NA

 

 

 

20303          B2.   How tall are you without shoes on?--INCHES           

 

Code INCHES (00-11)

 

98.  DK

99.  NA

 

 

 

[BUILD VAR 20304 -- HEIGHT IN INCHES]

 

 

 


B3.   WAIST/HIP RATIO

 

Now, I would like to measure your waist and hips.

 

WAIST:  RESPONDENT SHOULD BE STANDING ERECT WEARING ONLY ONE LAYER OF CLOTHING.  WAIST CIRCUMFERENCE SHOULD BE MEASURED TO THE NEAREST TENTH OF AN INCH.

 

MINIMAL WAIST:  (STAND FACING R.) PLACE TAPE MEASURE AROUND BODY AT NARROWEST POINT BETWEEN RIBS AND ILIAC CREST (POINT OF SMALLEST HORIZONTAL CIRCUMFERENCE).

 

20305          (B3.) # INCHES                                             

 

Code # INCHES (150-700), except:

 

997.  UNSUCCESSFUL

 

999.  NA

 

 

 

20306          B3a.  HOW OBTAINED:                                        

 

1.  MEASURED

2.  SELF-REPORT

 

9.  NA

 

 

 

B3b.  HIPS:  RESPONDENT SHOULD REMAIN STANDING.  HAVE R REMOVE ANY BULKY OBJECTS FROM HIP OR BACK POCKETS.

 

HIP CIRCUMFERENCE SHOULD BE MEASURED AT THE LEVEL OF THE ILIAC CREST (THE UPPER PELVIC BONE).

 

"Could you show me your hip bone?"  (POINT TO YOUR OWN HIP BONE.)

 

20307          (B3b.) # INCHES                                            

 

Code # INCHES (150-700), except:

 

997.  UNSUCCESSFUL

 

999.  NA

 

 


20308          B3c.  HOW OBTAINED:                                        

 

1.  MEASURED

2.  SELF-REPORT

 

9.  NA

 

B3d.  MAXIMAL HIP CIRCUMFERENCE:  (STAND TO THE SIDE OF R TO SEE MAXIMAL BUTTOCKS).  MEASURE MAXIMUM BUTTOCKS DIAMETER.

 

 

20309          (B3d.) # INCHES                                            

 

Code # INCHES (150-700), except:

 

997.  UNSUCCESSFUL

 

999.  NA

 

 

 

20310          B3e.  HOW OBTAINED:                                        

 

1.  MEASURED

2.  SELF-REPORT

 

9.  NA

 

 

 

20311          B3f.  Could I ask if you are wearing any undergarments, like a               brace or girdle, which might change your waist or hip                      measurements?                                        

 

1.  YES

5.  NO

 

9.  NA

 

 

Next I have some questions about use of medications.

 

20312          B4.   During the past 2 weeks, did you take any medicine prescribed

by a doctor?                                         

 

1.  YES

5.  NO

 

8.  DK

9.  NA


 

20313          B5.   We are also interested in drugs not prescribed by a doctor.  This would include such medicines as aspirin, Tylenol, antacids, laxatives and cold medicines.  During the past 2 weeks, have you taken any of these or any other medications

for which you did not need a doctor's prescription?  

 

1.  YES

5.  NO

 

8.  DK

9.  NA

 

 

 

20314          B6.   INTERVIEWER CHECKPOINT                             

 

1.  R SAID "YES" TO B4 AND/OR B5

 

2.  ALL OTHERS

 

 

 

[B7. NOT CODED]


 

 

 

                  SECTION C: VISION, CONCENTRATION AND MEMORY

 

 

 

VAR #

 

C1.   IMMEDIATE RECALL OF STORY

 

Now I would like to ask you to try to remember a short story.  I'm going to read you the story first and when I'm through, I'm going to wait a few seconds and then ask you to tell me as much as you can remember.

 

The story is:

 

(Read slowly.)  Three children were alone at home and the house caught on fire.  A brave fireman managed to climb in a back window and carry them to safety.  Aside from minor cuts and bruises, all were well.  WAIT A FEW SECONDS, THEN SAY: Please tell me the story.

 

20401          C1a.  THREE CHILDREN                                       

 

1.  PRESENT                      ┌─────────────────┐

2.  ABSENT                       USE SAME CODE   

                                 FOR V20402-20406

9.  NA                           └─────────────────┘

 

 

20402          C1b.  HOUSE ON FIRE                                        

 

 

20403          C1c.  FIREMAN CLIMBED IN                                   

 

 

20404          C1d.  CHILDREN RESCUED                                     

 

 

20405          C1e.  MINOR INJURIES                                       

 

 

20406          C1f.  EVERYONE WELL                                        


20407          C2.   How old are you?                                     

 

Code # OF YEARS (40-95)

 

98.  DK

99.  NA

 

 

 

20408          C2a.  VERIFY ACCORDING TO DATE OF BIRTH, THEN MARK CORRECT OR                   OTHER                                                

1.  CORR

2.  OTHER

 

 

 

20409          C3.   What is the month, day and year of your birth? (USE TO                   VERIFY AGE)--MONTH                                   

 

Code MONTH (01-12)

 

98.  DK

99.  NA

 

 

 

20410          C3.   What is the month, day and year of your birth? (USE TO                   VERIFY AGE)--DAY                                     

 

Code DAY (01-31)

 

98.  DK

99.  NA

 

 

 

20411          C3.   What is the month, day and year of yoru birth? (USE TO                   VERIFY AGE)--YEAR                                    

 

Code last 2 digits of YEAR (00-40)

 

98.  DK

99.  NA

 


20412          C3a. IF DK/REFUSED, CODE "OTHER" [VERIFY WITH AGE AT C2]  

 

1.  CORR

2.  OTHER

 

 

 

20413          C4.   What is today's date?--MONTH                         

 

Code MONTH (01-12)

 

98.  DK

99.  NA

 

 

 

20414          C4.   What is today's date?--DAY                           

 

Code DAY (01-31)

 

98.  DK

99.  NA

 

 

 

20415          C4.   What is today's date?--YEAR                          

 

Code last 2 digits of YEAR (89-91)

 

98.  DK

99.  NA

 

 

 

20416          C4a. VERIFY DATE                                          

 

1.  CORR

2.  OTHER

 


20417          C5.   What is the day of the week?                         

 

1.  MON

2.  TUES

3.  WED

4.  THURS

5.  FRI

6.  SAT

7.  SUN

 

8.  DK

9.  NA

 

 

 

20418          C5a. VERIFY DAY:                                          

 

1.  CORR

2.  OTHER

 

 

 

20419          C6.   What was your mother's maiden name - just her last name?         

 

1.  DIFFERENT NAME FROM R

2.  SAME NAME AS R

 

3.  DK/NA

 

 

 

20420          C7.   Who is the President of the United States?           

 

1.  CORR

2.  OTHER

 

 

 

20421          C8.   Who was the President before him?                    

 

1.  CORR

2.  OTHER


20422          C9.   (17) Please subtract 3 from 20 and keep subtracting 3 from each new number all the way down.

CORRECT RESPONSE IS: 17, 14, 11, 8, 5, 2             

 

Code # given (00-50)               ┌─────────────────────┐

                                 Use same code for   

98.  DK                          V20423-20427.  If DK

99.  NA                          to entire question, 

                                 code all vars as 98.

                                 Otherwise, code any 

                                 blank line as 99,    

                                 not 00.             

                    └─────────────────────┘

 

20423          C9.   (14)

 

20424          C9.   (11)

 

20425          C9.   (8)

 

20426          C9.   (5)

 

20427          C9.   (2)

 

 

20428          C9a.                                                       

 

1.  ALL CORR

2.  OTHER

 


C10.  DELAYED RECALL OF STORY

 

Remember I told you a short story a few minutes ago?  Can you tell me as much as you remember of the story?

 

20429          C10a. THREE CHILDREN                                       

 

1.  PRESENT                      ┌────────────────┐

2.  ABSENT                       USE SAME CODE  

                                 FOR V20430-20434

9.  NA                           └────────────────┘

 

 

20430          C10b. HOUSE ON FIRE                                        

 

 

20431          C10c. FIREMAN CLIMBED IN                                   

 

 

20432          C10d. CHILDREN RESCUED                                     

 

 

20433          C10e. MINOR INJURIES                                       

 

 

20434          C10f. EVERYONE WELL                                        

 

 

 


C11.  HAND SIGNATURE

 

When I say, "Begin," I'd like you to pick up this pencil from the table, sign your name on the paper and put the pencil back on the table.  Begin.

 

20435          (C11). # OF SECONDS                                        

 

Code # OF SECONDS (001-300), except:

┌──────────┐

0 in 20436├──────── 993.  TRIED, UNABLE

└──────────┘

999.  NA

 

 

 

20436          C11a. HAND USED:                                           

 

1.  RIGHT

2.  LEFT

 

9.  NA

 

0.  Inap, 993 in 20435

 

 

 

Now I would like to take your pulse and blood pressure.

 

20437          C12.  PULSE FOR 15 SECONDS (RECORD ACTUAL COUNT, DON'T                     MULTIPLY)                                                  

 

Code number (10-50), except:

 

97.  UNSUCCESSFUL

 

99.  NA

 

 

C13.  SITTING, BLOOD PRESSURE READING (CHECK ARM CIRCUMFERENCE FOR CORRECT CUFF SIZE.)

20438          C13a. SYSTOLIC                                             

 

Code number (050-250), except:

 

997.  UNSUCCESSFUL

 

999.  NA

 

 


20439          C13b. DIASTOLIC                                            

 

Code number (050-250), except:

 

997.  UNSUCCESSFUL

 

999.  NA


C14.  NAMING:  I am going to show you some pictures, and I would like you to tell me the name of each picture. 

 

20440          C14a. BROOM -- Correct?                                    

 

1.  YES                          ┌────────────────┐

5.  NO                           USE SAME CODE  

                                 FOR V20441-20457

8.  DK                           └────────────────┘

9.  NA

 

20441          C14b. FUNNEL

 

20442          C14c. BENCH

 

20443          C14d. WHEELCHAIR

 

20444          C14e. TREE

 

20445          C14f. HANGER

 

20446          C14g. STETHOSCOPE

 

20447          C14h. FLOWER

 

20448          C14j. PLUG

 

20449          C14k. COMB

 

20450          C14m. ACCORDION

 

20451          C14n. SAW

 

20452          C14p. HAMMOCK

 

20453          C14q. SCISSORS

 

20454          C14r. TOOTHBRUSH

 

20455          C14s. HOUSE

 

20456          C14t. FAUCET

 

20457          C14u. HARP

 

 

20458          [BUILD VAR:  SUM OF "PRESENT" RESPONSES, C1a-C1f (V20401-20406)]

 

 

20459          [BUILD VAR:  SUM OF "PRESENT" RESPONSES, C10a-C10f (V20429-20434)]


 

 

VAR #

 

C15.  DELAYED RECOGNITION

 

What we're going to do next is something like a guessing game.  This is how we play it.  Here I have some discs (HOLD UP DISC AND SHOW IT TO R).  What I'm going to do is put 1 of these down on this board (DEMONSTRATE).  Next, I'll give you some time to look at the disc and its position on the board.  I will want you to take a good look because then I'll tip the board up like this, and add another disc (DEMONSTRATE).  When I lay the board down on the table (DEMONSTRATE), I'll want you to point to the new disc.  As you can see, to do that you will have to remember where the discs were in the beginning.  That's why I want you to look carefully before I put each new disc down.

 

SPATIAL SERIES A:  8  23  21  11  19  20  4  1  16  6

                   26  3  17  13  30  9  14

 

20501          C15a. TOTAL CORRECT                                        

 

Code TOTAL (00-17), except:

 

93.  TRIED, UNABLE

 

99.  NA

 

 

 

20502          C15b. INTERVIEWER CHECKPOINT  [SPATIAL SERIES A]           

┌──────────┐

0 in 20503├──────── 1.  R GOT 10 OR MORE DISCS CORRECT

└──────────┘

2.  ALL OTHERS


20503          C15c. Now, let's try it with the discs in different places.  As before I'll start with one disc and when I add  each new one, I want you to tell me where the new disc is.

 

SPATIAL SERIES B:  9  22  2  5  20  17  7  11  27  6 

                   14  29  24  3  25  8  16          

                                                                                 Code TOTAL (00-17), except:

 

93.  TRIED, UNABLE

 

99.  NA

 

00.  Inap, 1 in 20502

 

 

 

C16.  SIMILARITIES

 

Now, we're going to do something different.  I'm going to  name two things that are alike in some way and ask you to  tell me how they are alike.  (START WITH ITEM C16a).  Can  you tell me in what way an orange and a banana are alike?

 

20504          C16a. ORANGE-BANANA                                        

 

1.  ABSTRACT                     ┌────────────────┐

2.  CONCRETE                     USE SAME CODE  

3.  INCORRECT                    FOR V20505-20507

                                 └────────────────┘

8.  DK

9.  NA

 

 

20505          C16b. In what way are a boat and an automobile alike?      

 

 

20506          C16c. In what way are north and west alike?                

 

 

20507          C16d. In what way are work and play alike?                 


C17.  COPYING FIGURE 1

 

Now I have a drawing I would like you to copy.  Please copy this drawing down here as best you can.  GIVE R SHEET WITH DRAWING OF DIAMOND.  POINT TO A BLANK SECTION OF PAPER.  PROVIDE 2 SHARPENED PENCILS WITH ERASERS.  DO NOT NAME SHAPE IN THE DRAWING.

 

20508          C17a. 4 SIDES PRESENT AND ABOUT THE SAME LENGTH (NOT DIFFERENT BY

MORE THAN 1/4 INCH IN LENGTH).                       

 

1.  PRESENT                      ┌────────────────┐

2.  ABSENT                       USE SAME CODE  

                                 FOR V20509-20511

9.  NA                           └────────────────┘

 

 

20509          C17b. 3 OF 4 CORNERS RELATIVELY CLOSED (WITHIN 1/4 INCH).  

 

 

20510          C17c. 3 OF 4 ANGLES CLEARLY DEFINED (IF CLOSURE WITHIN 1/4 INCH,

ANGLE CAN BE CLEARLY DEFINED).                       

 

 

20511          C17d. DIAMOND PLACED ON ITS TIP (SO THAT A VERTICAL LINE DRAWN THROUGH THE TIP AND THE OPPOSING CORNER AND A HORIZONTAL LINE DRAWN PARALLEL TO THE BASE OF PAGE FORM AN ANGLE BETWEEN 80

AND 110 DEGREES).                                    

 

 

 

20512          C18.  INTERVIEWER CHECKPOINT [FIGURE 1]                    

┌────────────────┐

0 in 20513-20515├─1.  TWO OR MORE CRITERIA MARKED PRESENT

└────────────────┘

┌────────────────┐

0 in 20516-20532├─2.  ALL OTHERS

└────────────────┘

                   3.  NOT ADMINISTERED


C19.  COPYING FIGURE 2

 

Can you copy this drawing? GIVE R SHEET WITH DRAWING OF CIRCLE.

 

20513          C19a. LINE CONTINUOUS (NO GAP LONGER THAN 1/4 INCH)        

 

1.  PRESENT                      ┌────────────────┐

2.  ABSENT                       USE SAME CODE  

                                 FOR V20514-20515

9.  NA                           └────────────────┘

 

0.  Inap, 1 in 20512

 

20514          C19b. APPROXIMATELY CIRCULAR (DIAMETERS NOT DIFFERENT BY MORE THAN

1/4 INCH)                                            

 

 

20515          C19c. FAIRLY SMOOTH CIRCUMFERENCE (NO MORE THAN 1 POINT OR                       ANGLE)                                               

 

 

 


C20.  COPYING FIGURE 3

 

Can you copy this drawing?  GIVE R DRAWING WITH DIAMOND INSIDE SQUARE.

 

[DIAMOND]

 

20516          C20a. 4 SIDES PRESENT AND ABOUT THE SAME LENGTH (NOT DIFFERENT BY

MORE THAN 1/4 INCH IN LENGTH).                       

 

1.  PRESENT                      ┌────────────────┐

2.  ABSENT                       USE SAME CODE  

                                 FOR V20517-20526

9.  NA                           └────────────────┘

 

0.  Inap, 2 in 20512

 

 

20517          C20b. 3 OF 4 CORNERS RELATIVELY CLOSED (WITHIN 1/4 INCH)   

 

 

20518          C20c.  3 OF 4 ANGLES CLEARLY DEFINED (IF CLOSURE WITHIN 1/4 INCH,

ANGLE CAN BE CLEARLY DEFINED.)                       

 

 

20519          C20d. DIAMOND PLACED ON ITS TIP (SO THAT A VERTICAL LINE DRAWN THROUGH THE TIP AND THE OPPOSING CORNER AND A HORIZONTAL LINE DRAWN PARALLEL TO THE BASE OF PAGE FORM AN ANGLE BETWEEN 80

AND 110 DEGREES).                                    

 

 

[SQUARE]

 

 

20520          C20e. 4 SIDES PRESENT AND ABOUT THE SAME LENGTH (NOT DIFFERENT BY

MORE THAN 1/4 INCH IN LENGTH).                       

 

 

20521          C20f. 3 OF 4 CORNERS RELATIVELY CLOSED (WITHIN 1/4 INCH).  

 

 

20522          C20g. 3 OF 4 ANGLES CLEARLY DEFINED (IF CLOSURE WITHIN 1/4 INCH,

ANGLE CAN BE CLEARLY DEFINED).                       

 

 

20523          C20h. SQUARE PLACED ON SIDE (SO THAT ANGLE OF EACH VERTICAL SIDE                 AND A HORIZONTAL LINE DRAWN PARALLEL TO THE BASE OFPAGE FORM          ANGLE BETWEEN 80 AND 110 DEGREES).                   

 

 


[ALIGNMENT]

 

 

20524          C20j. DIAMOND INSIDE SQUARE (WITH NO MORE THAN 1/8 INCH OVERLAP

BETWEEN TWO SHAPES).                                 

 

 

 

20525          C20k. POINTS OF DIAMOND AND SIDES OF SQUARE TOUCHING (WITHIN 1/8

INCH).                                               

 

 

20526          C20m. PLACE OF CONTACT OF POINTS OF DIAMOND GENERALLY TOUCHING CENTER OF SIDES OF SQUARE (WITHIN MIDDLE THIRD OF EACH SIDE

      OF SQUARE).                                          

 

 

20527          C21.  INTERVIEWER CHECKPOINT  [FIGURE 3]                   

 

1. TWO OR MORE CRITERIA MARKED "PRESENT" FOR EACH OF 3                                                        DOMAINS

┌────────────────┐

0 in 20528-20532├─  2. ALL OTHERS

└────────────────┘

0. Inap, 2 in 20512

 

 

 

C22.  COPYING FIGURE 4

 

Can you copy this drawing?  GIVE R SHEET OF DRAWING WITH CUBE.

 

20528          C22a. 12 SIDES PRESENT AND ABOUT THE SAME LENGTH (NOT DIFFERENT            BY MORE THAN 1/4 INCH IN LENGTH).                    

 

1.  PRESENT                      ┌────────────────┐

2.  ABSENT                       USE SAME CODE  

                                 FOR V20529-20532

9.  NA                           └────────────────┘

 

0.  Inap, 2 in 20512 or 20527

 

 

20529          C22b. 7 OF 8 CORNERS RELATIVELY CLOSED (WITHIN 1/4 INCH).  

 

 

20530          C22c. 7 OF 8 CORNERS CLEARLY DEFINED (IF CLOSURE IS WITHIN 1/4                  INCH ANGLE CAN BE CLEARLY DEFINED).                  

 


20531          C22d. 3 DIMENSIONAL                                        

 

 

20532          C22e. PERSPECTIVE ACCURATE (FRONT FACE AT LOWER LEFT AND BACK FACE

AT UPPER RIGHT OF CUBE).                             

 

 

C23.  INCIDENTAL RECALL

 

There is another thing I would like you to try to do.  Do you remember that awhile ago I showed you pictures of some objects and asked you to tell me their names?  Can you tell me any of the pictures you can recall?

 

20533          C24.  TOTAL NUMBER OF RESPONSES TO C23                     

 

Code # (01-18), except:

 

00.  NONE

 


C25.  INITIAL STIMULUS; RECORD INCORRECT INITIAL NAMING RESPONSES FROM C14

 

20534          C25a. ACCORDION                                            

 

1. STIMULUS RECALLED BY CORRECT NAME                                                                        ┌─────────────────┐                          (INCLUDING ALTERNATE RESPONSE)USE SAME CODE   

FOR V20535-20551

2. RECALLED RESPONSE AGREES      └─────────────────┘

   EXACTLY W/INITIAL INCORRECT

   NAMING RESPONSE

 

3. NOT RECALLED

 

 

20535          C25b. BENCH

 

20536          C25c. BROOM

 

20537          C25d. COMB

 

20538          C25e. FAUCET

 

20539          C25f. FLOWER

 

20540          C25g. FUNNEL

 

20541          C25h. HAMMOCK

 

20542          C25j. HANGER

 

20543          C25k. HARP

 

20544          C25m. HOUSE

 

20545          C25n. PLUG

 

20546          C25p. SAW

 

20547          C25q. SCISSORS

 

20548          C25r. STETHOSCOPE

 

20549          C25s. TOOTHBRUSH

 

20550          C25t. TREE

 

20551          C25u. WHEELCHAIR


20552          C26.  # CORRECT RECALL RESPONSES (TOTAL OF COLUMN 1):      

 

Code # (00-18)

 

 

 

20553          C27.  # RECALL RESPONSES WHICH AGREE EXACTLY W/ INCORRECT INITIAL

NAMING RESPONSES (TOTAL OF COLUMN 2):                

 

Code # (00-18)

 

 

 

20554          [BUILD VAR: C28.  # RECALL RESPONSES NOT ON LIST AND NOT IN       COLUMN 2:  TO BE BUILT BY DDE.]

 

 

 

20555          [BUILD VAR:  C28 TOTAL # OF RESPONSES TO C23 LESS # CORRECT RECALL

 RESPONSES AT C26]

 

 

 

20556          [BUILD VAR:  C28 TOTAL # OF RESPONSES TO C23 LESS # RESPONSES AT    C27]

 

 


 

 

                  SECTION D: BLOOD PRESSURE AND LUNG FUNCTION

 

 

VAR #

 

Now I would like to take your blood pressure again.  To begin I would like to check your pulse and take three blood pressure measures while you're seated.

 

20601          D1.   PULSE FOR 15 SECONDS (RECORD ACTUAL COUNT, DON'T                            MULTIPLY.)                                           

 

Code number (10-50), except:

 

97.  UNSUCCESSFUL

 

99.  NA

 

 

 

20602          D2.   PULSE OBLITERATION PRESSURE (RECORD ACTUAL PRESSURE.  PUMP

MERCURY TO 30mmHg HIGHER FOR BLOOD PRESSURE READINGS.)    

 

Code number (050-250), except:

 

997.  UNSUCCESSFUL

 

999.  NA

 

 

 

D3.   FIRST SITTING BLOOD PRESSURE READING (CHECK ARM CIRCUMFERENCE FOR CORRECT CUFF SIZE.)

 

20603          D3a.  SYSTOLIC                                             

 

Code number (050-250), except:   ┌─────────────┐

                                 USE SAME CODE

997.  UNSUCCESSFUL               FOR V20604  

                                 └─────────────┘

999.  NA

 

 

20604          D3b.  DIASTOLIC                                            

 

D4.   SECOND SITTING BLOOD PRESSURE READING

 


20605          D4a.  SYSTOLIC                                             

 

Code number (050-250), except:   ┌─────────────┐

                                 USE SAME CODE

997.  UNSUCCESSFUL               FOR V20606  

                                 └─────────────┘

999.  NA

 

 

20606          D4b.  DIASTOLIC                                            

 

 

 

D5.   THIRD SITTING BLOOD PRESSURE READING

 

20607          D5a.  SYSTOLIC                                             

 

Code number (050-250), except:   ┌─────────────┐

                                 USE SAME CODE

997.  UNSUCCESSFUL               FOR V20608  

                                 └─────────────┘

999.  NA

 

 

20608          D5b.  DIASTOLIC                                            

 

 

 

               Now I would like you to stand up and I'll take two more blood pressure readings.  Begin timing when R stands up.

 

HAVE R REST ARM ON TOP OF CHAIR.  BEGIN TAKING PULSE 15 SECONDS AFTER R STANDS UP.

 

 

20609          D6.   PULSE FOR 15 SECONDS (RECORD ACTUAL COUNT, DON'T                            MULTIPLY.)                                           

 

Code number (10-50), except:

 

97.  UNSUCCESSFUL

 

99.  NA

 

 

 

 


D7.   FIRST STANDING BLOOD PRESSURE READING (1 MINUTE AFTER STANDING).

 

20610          D7a.  SYSTOLIC                                             

 

Code number (050-250), except:   ┌─────────────┐

                                 USE SAME CODE

997.  UNSUCCESSFUL               FOR V20611  

                                 └─────────────┘

999.  NA

 

 

20611          D7b.  DIASTOLIC                                            

 

 

 

20612          D8.   PULSE FOR 15 SECONDS (2 MINUTES 30 SECONDS AFTER                     STANDING).                                                 

 

Code number (10-50), except:

 

97.  UNSUCCESSFUL

 

99.  NA

 

 

 

D9.   SECOND STANDING BLOOD PRESSURE READING (3 MINUTES AFTER STANDING).

 

20613          D9a.  SYSTOLIC                                             

 

Code number (050-250), except:   ┌─────────────┐

                                 USE SAME CODE

997.  UNSUCCESSFUL               FOR V20614  

                                 └─────────────┘

999.  NA

 

 

20614          D9b.  DIASTOLIC                                            

 

 

 

20615          D10.  CUFF SIZE                                            

 

1.  REGULAR

2.  PEDIATRIC

3.  LARGE ARM

 

9.  NA


 

 

20616          D11.  WHAT DID YOU TELL THE RESPONDENT?                    

 

1.  NORMAL

2.  SOMEWHAT ELEVATED

3.  ELEVATED

4.  CRITICAL

5.  NOTHING, UNSUCCESSFUL

 

7.  OTHER

 

9.  NA

 

 

 

D12.  PEAK EXPIRATORY FLOW RATE

 

Next, I'm going to ask you to perform a simple test that will measure how fast you can expel air from your lungs.  When you blow into this instrument (SHOW INSTRUMENT TO RESPONDENT) the value of the biggest, fastest "huff" of air that you can expel will be recorded.  It is important that you blow as hard and as fast as you can.  I would like you to perform the test three times.

 

20617          D12a. FIRST READING                                        

 

Code number (030-800), except:   ┌─────────────────┐

                                 USE SAME CODE   

993.  TRIED, UNABLE              FOR V20618-20619

995.  NOT TRIED, HEALTH          └─────────────────┘

 

999.  NA

 

 

20618          D12b. SECOND READING                                       

 

 

20619          D12c. THIRD READING                                        

 

20620          D12d. METER SERIAL NUMBER                                  

 

Code 6-digit number

 

999 999.  NA

 

 

 


D13.  INTERVIEWER QUESTIONS

 

20621          D13a. INTERVIEWER OPINION OF UNDERSTANDING OF LUNG TEST    

 

1.  EXCELLENT

2.  GOOD

3.  FAIR

4.  POOR

5.  NOT DONE

 

9.  NA

 

 

 

20622          D13b. INTERVIEWER OPINION OF COMPLIANCE WITH LUNG TEST     

 

1.  EXCELLENT

2.  GOOD

3.  FAIR

4.  POOR

5.  NOT DONE

 

9.  NA

 

 

 

20623          D13c. POSITION FOR LUNG TEST                               

 

1.  STANDING

2.  SITTING

3.  LYING

 

5.  NOT DONE

 

9.  NA


 

 

 

                      SECTION X: INTERVIEWER OBSERVATIONS

 

 

VAR #

 

20701          X1.   Does respondent have to climb more than 3 stairs to get to

living quarters?                                     

 

1.  YES

5.  NO

 

8.  DK

9.  NA

 

 

 

20702          X2.   Condition of apartment walls, ceilings, windows,                     fixtures.                                                  

 

1.  In good condition

2.  Needs some repair

3.  Needs a lot of repair

 

9.  NA

 

 

 

20703          X3.   Condition of furnishings in apartment:               

 

1.  In good condition

2.  In fair condition

3.  In poor condition

 

9.  NA

 

 

 

20704          X4.   Cleanliness of apartment:                            

 

1.  Very neat and clean

2.  Fairly neat and clean

3.  Not too neat and clean

4.  Not at all neat and clean

 

9.  NA

 

 


20705          X5.   Any other remarkable thing about the dwelling?       

 

1.  YES

5.  NO

 

9.  NA

 

 

 

[X5a. not coded.]

 

 

 

20706          X6.   Respondent's grooming:                               

 

1.  Very neat and clean

2.  Fairly neat and clean

3.  Not too neat and clean

4.  Not at all neat and clean

 

9.  NA

 

 

 

20707          X7.   Was Respondent disturbed or upset by any part of the

interview?                                           

 

                     1.  YES

┌────────────────┐

0 in 20708-20710├─ 5.  NO

└────────────────┤

                 └─ 9.  NA

                  

 

 

20708(1)       X7a.  For what parts of the interview?  If disturbed more often,

20709(2)             select 3 most upsetting pages.                       

20710(3)

Code Page number (01-42)

 

00.  Inap, 5 or 9 in 20707; no further mention


20711          X8.   Language:                                            

 

1.  No language problem

2.  Has some difficulty speaking English

3.  Has great difficulty speaking English

 

9.  NA

 

 

 

20712          X9.   What was the Respondent's overall attitude toward the

interview?                                           

 

1.  Friendly and eager

2.  Cooperative but not particularly eager

3.  Indifferent

4.  Suspicious

5.  Hostile

 

9.  NA

 

 

 

20713          X10.  Impression of affect, mood                           

 

1.  Excited

2.  Alert

3.  Normal

4.  Apathetic (monotonic lack of affect)

5.  Mildly depressed (sadness, underlying non-sad facade)

6.  Moderately depressed (perceptible overt sadness)

7.  Severely depressed (pronounced overt sadness)

 

9.  NA

 

 

 

20714          X11.  Was the research interview perceived as helpful by the

respondent?                                          

 

1.  Very

2.  Moderately

3.  Little

 

5.  No

 

8.  DK

9.  NA

 


20715          X12.  Please rate your confidence in the ability of the respondent           to give an accurate history.                         

 

1.  Very confident

2.  Fairly confident

3.  Confident

4.  Somewhat confident

5.  Little or no confidence

 

9.  NA

 

 

 

20716          X13.  Was anyone else present during the interview?        

 

1.  YES

┌────────────────┐

0 in 20717-20722├─  5.  NO

└────────────────┤

                 └─  9.  NA

 

 

X13a. Who was present?  (CODE ALL THAT APPLY)

20717          X13a. A.  Spouse                                           

 

1.  Circled                      ┌────────────────┐

5.  Not circled                  USE SAME CODE  

                                 FOR V20718-20721

9.  NA to entire question        └────────────────┘

 

0.  Inap, 5 or 9 in 20716

 

 

20718          X13a.  B.  Child                                           

 

 

20719          X13a.  C.  Other relative                                  

 

 

20720          X13a.  D.  Friend                                          

 

 

20721          X13a.  E.  Neighbor                                        

 

 


 

20722          X13b. How long were they present?                          

 

1.  Entire interview

2.  More than half the interview

3.  Less than half the interview

 

9.  NA

 

0.  Inap, 5 or 9 in 20716

 

 

 

20723          X14.  Interview completed?                                 

 

1.  Yes, interview completed with very little or no missing                  information (missing information less than or equal to                 1/10)

 

2.  Yes, interview completed with a considerable amount of                missing information (missing information more than 1/10)

 

5.  No, interview terminated before completion; some           information obtained

 

9.  NA

 

 

X15.  Observed physical difficulties:

20724          X15a. Hearing impairment                                   

 

1.  YES                          ┌─────────────────┐

5.  NO                           USE SAME CODE   

                                 FOR V20725-20734

9.  NA                           └─────────────────┘

 

 

20725          X15b. Visual impairment                                    

 

20726          X15c.   Wheelchair                                         

 

 

20727          X15d.   Use cane, crutches, walker                         

 

 

20728          X15e. Walking difficulties                                 

 

 

20729          X15f. Crippled hands or legs                               

 


20730          X15g. Coughs continually                                   

 

 

20731          X15j. Shortness of breath                                  

 

 

20732          X15k. Skin problems                                        

 

 

20733          X15m. Speech problems --not language                       

 

20734          X15n. Other physical abnormalities                         


20735          X16.  Is it your impression that R is able to handle (cope with)

major problems which occur in (his/her) life?        

 

1.  YES

5.  NO

 

8.  DK

9.  NA

 

 

 

20736          X17.  Is it your impression that R finds life exciting and

enjoyable?                                           

 

1.  YES

5.  NO

 

8.  DK

9.  NA

 

 

 

20737          X18.  Is R either extremely overweight, or malnourished and

emaciated?                                           

 

1.  Yes, malnourished or emaciated

2.  Yes, extremely overweight

 

5.  No, neither

 

9.  NA

 

 

 

20738          X19.  How well do you think the participant understood the questions

in the tasks?                                        

 

1.  Quite well

2.  Fairly well

3.  Somewhat

4.  Very little

5.  Not at all

 

9.  NA


20739          X20.  How great an effort do you think the participant put into                 the cognitive function items?                        

 

1.  A great deal

2.  A considerable amount

3.  A moderate amount

4.  A little bit

5.  Hardly any

 

9.  NA

 

 

 

20740          X21.  How nervous do you think R was about the testing?    

 

1.  Very much

2.  A moderate amount

3.  A little

4.  Not at all

 

9.  NA

 

 

 

20741          X22.  How often was R's behavior toward the examiner and the                  testing situation appropriate?                       

 

1.  Always

2.  Often

3.  Sometimes

4.  Rarely

5.  Never

 

9.  NA