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pdfVariable Name
MR Screen Name
Question type
Question text/description
Code list
Routing
(01) excellent,
(02) very good,
(03) good,
(04) fair, or
(05) poor?
(-8) DON'T KNOW
(-9) REFUSED
HFA2 - COMPHLTH
(01) much better now than one year ago,
(02) somewhat better now than one year ago,
(03) about the same,
(04) somewhat worse now than one year ago, or
(05) much worse now than one year ago?
(-8) DON'T KNOW
(-9) REFUSED
HFA2B - FUTRHLTH
HEALTH STATUS AND FUNCTIONING QUESTIONNAIRE SPECIFICATIONS
CRITERIA
INTTYPE=C001, C002, C003, C004, C005, C006
SPALIVE=1
SEASON=FALL
SPPROXY=SP or PROXY
Other: N/A
PLACEMENT
If INTTYPE in(C001, C002, C003, C004, C005, C006), administer after PVQ.
BOX HFBEG
GENHELTH
HFA1
routing
code one
GO TO HFA1 - GENHELTH
In general, compared to other people [your/(SP's)] age, would you say that [your/his/her] health is . . .
SHOW CARD HF1
COMPHLTH
HFA2
code one
Compared to one year ago, how would you rate [your/(SP's)] health in general now?
Would you say [your/(SP's)] health is . . .
FUTRHLTH
HFA2B
code one
DISHEAR
DIS1
yes/no
DISSEE
DIS2
yes/no
DISDECISION
DIS3
yes/no
DISWALK
DIS4
yes/no
DISBATH
DIS5
yes/no
DISERRANDS
DIS6
yes/no
(01) it will get much better
(02) it will get somewhat better
(03) it will not change
SHOW CARD HF2
(04) it will get somewhat worse
In the next 6 months, what do you think will happen to [your/(SP's)] overall health?
(05) it will get much worse
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
Now, I would like to ask you about [your/(SP's)] health.
(02) NO
(-8) DON'T KNOW
[Are you/Is (SP)] deaf or [do you/does (SP)] have serious difficulty hearing?
(-9) REFUSED
(01) YES
(02) NO
[Are you/Is (SP)] blind or [do you/does (SP)] have serious difficulty seeing, even when wearing glasses?
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
Because of a physical, mental, or emotional condition, [do you/does (SP)] have serious difficulty
(-8) DON'T KNOW
concentrating, remembering, or making decisions?
(-9) REFUSED
(01) YES
(02) NO
[Do you/Does (SP)] have serious difficulty walking or climbing stairs?
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
[Do you/Does (SP)] have difficulty dressing or bathing?
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
Because of a physical, mental, or emotional condition, [do you/does (SP)] have difficulty doing errands alone (02) NO
(-8) DON'T KNOW
such as visiting a doctor's office or shopping?
(-9) REFUSED
DIS1 - DISHEAR
DIS2 - DISSEE
DIS3 - DISDECISION
DIS4 - DISWALK
DIS5 - DISBATH
DIS6 - DISERRANDS
HFA3 - HELMTACT
Variable Name
HELMTACT
MR Screen Name
HFA3
Question type
code one
Question text/description
How much of the time during the past month has [your/(SP's)] health limited [your/(SP's)] social activities,
like visiting with friends or close relatives?
Would you say . . .
Next we are going to ask some questions about your vision and hearing.
ECHELP
HFB1
yes/no
[Do you/Does (SP)] wear eyeglasses or contact lenses?
ECTROUB
HFB2
code one
Which statement best describes [your/(SP's)] vision [while wearing glasses or contact lenses]... no trouble
seeing, a little trouble, a lot of trouble, or no usable vision?
[Have you/Has (SP)] been told that [you are/he is/she is] legally blind?
ECLEGBLI
HFB2A
yes/no
[EXPLAIN IF NECESSARY: Informally, a person is legally blind when, even with corrective lenses, they cannot
see well enough to drive.]
Code list
(01) none of the time,
(02) some of the time,
(03) most of the time, or
(04) all of the time?
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(03) SP IS BLIND
(-8) DON'T KNOW
(-9) REFUSED
(01) NO TROUBLE SEEING
(02) A LITTLE TROUBLE SEEING
(03) A LOT OF TROUBLE SEEING
(04) NO USABLE VISION
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
Routing
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) HFB7A - EDOCTYPE
(02) HFB7 - EDOCLAST
(-8) BOX HFB1
(-9) BOX HFB1
(01) NEVER HAD EYE EXAM BY EYE DOCTOR
(02) 1 YEAR TO LESS THAN 2 YEARS
(03) 2 YEARS TO LESS THAN 5 YEARS
(04) 5 YEARS OR MORE
(-8) DON'T KNOW
(-9) REFUSED
(01) BOX HFB1
(02) HFB7A - EDOCTYPE
(03) HFB7A - EDOCTYPE
(04) HFB7A - EDOCTYPE
(-8) BOX HFB1
(-9) BOX HFB1
HFB1-ECHELP
(01) HFB2 - ECTROUB
(02) HFB2 - ECTROUB
(03) HFB6 - EDOCEXAM
(-8) HFB6 - EDOCEXAM
(-9) HFB6 - EDOCEXAM
(01) HFB6 - EDOCEXAM
(02) HFB6 - EDOCEXAM
(03) HFB2A - ECLEGBLI
(04) HFB6 - EDOCEXAM
(-8) HFB6 - EDOCEXAM
(-9) HFB6 - EDOCEXAM
HFB6 - EDOCEXAM
[Have you/Has (SP)] had an eye examination by an eye doctor since (LAST HF MONTH YEAR)?
EDOCEXAM
HFB6
yes/no
INCLUDE OPHTHALMOLOGISTS AND OPTOMETRISTS.
[IF NEEDED: Please include any eye exams that took place during a visit that you may have already told me
about.]
EDOCLAST
HFB7
code one
How long has it been since [your/(SP's)] last eye examination by an eye doctor?
I have a couple of questions about [your/(SP’s)] last eye examination.
EDOCTYPE
HFB7A
code one
EDOCTYOS
HFB7A
verbatim text
(01) OPTOMETRIST
Was the eye examination given by an optometrist, ophthalmologist or some other type of doctor or eye care
(02) OPHTHALMOLOGIST
professional?
(91) OTHER DOCTOR SPECIALTY
(-8) DON'T KNOW
[EXPLAIN IF NECESSARY: An optometrist is a doctor of optometry (O.D.) who diagnoses and treats visual
(-9) REFUSED
health problems. An ophthalmologist is a doctor of medicine (M.D.) who specializes in surgery and diseases
of the eye.]
OTHER (SPECIFY)
Again, thinking about [your/(SP’s)] last eye examination, were dilating drops used in [your/(SP)’s] eyes?
EDOCDLAT
ECATARAC
EGLAUCOM
HFB7B
HFB7C
HFB7C
yes/no
[EXPLAIN IF NECESSARY: Dilating drops are used to enlarge the pupil for eye examinations. The drops often
make your eyes more sensitive to bright light and may cause temporary blurry vision.]
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
yes/no
I am going to read a list of eye conditions. Please tell me if [you have/(SP) has] ever been told by a doctor or
(01) YES
other health professional that [you/he/she] had any of these conditions.
(02) NO
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…
(-8) DON'T KNOW
(-9) REFUSED
Cataracts?
yes/no
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
Glaucoma?
(01) H7B7B - EDOCDLAT
(02) H7B7B - EDOCDLAT
(91) HFB7 - EDOCTYOS
(-8) BOX HFB1
(-9) BOX HFB1
H7B7B - EDOCDLAT
HFB7C - ECATARAC
HFB7C - EGLAUCOM
HFB7C - ERETINOP
Variable Name
MR Screen Name
Question type
Question text/description
ERETINOP
HFB7C
yes/no
Diabetic retinopathy?
EMACULAR
HFB7C
yes/no
Macular degeneration or age-related macular degeneration, also called AMD?
BOX HFB1A
routing
IF ECATARAC=02/NO, GO TO BOX HFB1. ELSE GO TO HFB10 - ECCATOP.
ECCATOP
HFB10
yes/no
[Have you/Has (SP)] ever had an operation for cataracts?
BOX HFB1
routing
IF HFB7C - ERETINOP = 1/Yes OR HFB7C - EMACULAR = 1/Yes, GO TO HFB11 - ELASRSUR.
ELSE GO TO HFC1 - HCHELP.
Laser surgery to the back of the eye, or retina, is a commonly used treatment for diabetic retinopathy and
macular degeneration.
ELASRSUR
HFB11
yes/no
[Have you/Has (SP)] ever had laser surgery to the back of either eye for one of these conditions?
Code list
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
Routing
HFB7C - EMACULAR
BOX HFB1A
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
BOX HFB1
(01) YES
(02) NO
(-8) DON'T KNOW
(-9) REFUSED
HFC1 - HCHELP
[EXPLAIN IF NECESSARY: This does not include "Lasik" surgery to the front of the eye used to correct vision.]
HCHELP
HFC1
yes/no
HCTROUB
HFC2
code one
HCKNOWMC
HFC3
code one
HCCOMDOC
HFC4
code one
FOODTRBL
HFD1A
code one
HEIGHTFT
HFE1
numeric
HEIGHTIN
HFE1
numeric
WEIGHT
HFE1
numeric
(01) YES
(02) NO
[Do you/Does (SP)] use a hearing aid?
(03) SP IS DEAF
(-8) DON'T KNOW
(-9) REFUSED
(01) NO TROUBLE HEARING
(02) A LITTLE TROUBLE HEARING
Which statement best describes [your/(SP's)] hearing [with a hearing aid]: no trouble hearing, a little trouble, (03) A LOT OF TROUBLE HEARING
a lot of trouble, or deaf?
(04) DEAF
(-8) DON'T KNOW
(-9) REFUSED
(01) NO TROUBLE
How much trouble [do you/does (SP)] have finding out things [you need/he needs/she needs] to know about (02) A LITTLE TROUBLE
Medicare because [of (your/his/her) difficulty hearing/(you are/he is/she is) deaf]? Would you say [you
(03) A LOT OF TROUBLE
have/she has/he has] no trouble, a little trouble, or a lot of trouble?
(-8) DON'T KNOW
(-9) REFUSED
(01) NO TROUBLE
(02) A LITTLE TROUBLE
How much trouble [do you/does (SP)] have communicating with [your/his/her] doctor or other health
(03) A LOT OF TROUBLE
professional because [of (your/his/her) difficulty hearing/(you are/he is/she is) deaf]? Would you say [you
(-8) DON'T KNOW
have/she has/he has] no trouble, a little trouble, or a lot of trouble?
(-9) REFUSED
(01) NO TROUBLE
(02) A LITTLE TROUBLE
How much trouble [do you/does (SP)] have eating solid foods because of problems with [your/his/her]
(03) A LOT OF TROUBLE
mouth or teeth? Would you say [you have/she has/he has] no trouble, a little trouble, or a lot of trouble?
(-8) DON'T KNOW
(-9) REFUSED
(01) continuous answer
(-8) DON'T KNOW
How tall [are you/is (SP)]?
(-9) REFUSED
(01) continuous answer
How tall [are you/is (SP)]?
(-8) DON'T KNOW
(-9) REFUSED
How much [do you/does (SP)] weigh?
(01) continuous answer
(-8) DON'T KNOW
[WEIGHT SHOULD BE RECORDED IN POUNDS]
(-9) REFUSED
(01) HFC2 - HCTROUB
(02) HFC2 - HCTROUB
(03) HFC3 - HCKNOWMC
(-8) HFD1A - FOODTRBL
(-9) HFD1A - FOODTRBL
(01) HFD1A - FOODTRBL
(02) HFC3 - HCKNOWMC
(03) HFC3 - HCKNOWMC
(04) HFC3 - HCKNOWMC
(-8) HFD1A - FOODTRBL
(-9) HFD1A - FOODTRBL
HFC4 - HCCOMDOC
HFD1A - FOODTRBL
HFE1 - HEIGHTFT
HFE1 - HEIGHTIN
HFE1 - WEIGHT
HFHINTRO - DIFINTRO
Variable Name
DIFINTRO
MR Screen Name
HFHINTRO
Question type
Question text/description
Code list
Routing
no entry
Now, I'm going to ask about how difficult it is, on average, for [you/(SP)] to do certain kinds of activities.
Please tell me for each activity whether [you have/(SP) has] no difficulty at all, a little difficulty, some
difficulty, a lot of difficulty, or [is/are] not able to do it.
(01) CONTINUE
(-7) Empty
HFH1 - DIFSTOOP
(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
How much difficulty, if any, [do you/does (SP)] have stooping, crouching, or kneeling? Would you say [you
(04) A LOT OF DIFFICULTY
have/(SP) has] no difficulty at all, a little difficulty, some difficulty, a lot of difficulty, or [is/are] not able to do (05) NOT ABLE TO DO IT
it?
(-8) Don't Know
(-9) Refused
SHOW CARD HF3
(01) NO DIFFICULTY AT ALL
(02) A LITTLE DIFFICULTY
How much difficulty, if any, [do you/does (SP)] have lifting or carrying objects as heavy as 10 pounds, like a
(03) SOME DIFFICULTY
heavy bag of groceries?
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some
(-8) Don't Know
difficulty, a lot of difficulty, or [is/are] not able to do it?]
(-9) Refused
(01) NO DIFFICULTY AT ALL
SHOW CARD HF3
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
What about reaching or extending arms above shoulder level?
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some
(-8) Don't Know
difficulty, a lot of difficulty, or [is/are] not able to do it?]
(-9) Refused
(01) NO DIFFICULTY AT ALL
SHOW CARD HF3
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
How much difficulty, if any, [do you/does (SP)] have either writing or handling and grasping small objects?
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some
(-8) Don't Know
difficulty, a lot of difficulty, or [is/are] not able to do it?]
(-9) Refused
(01) NO DIFFICULTY AT ALL
SHOW CARD HF3
(02) A LITTLE DIFFICULTY
(03) SOME DIFFICULTY
What about walking a quarter of a mile - that is, about 2 or 3 blocks?
(04) A LOT OF DIFFICULTY
(05) NOT ABLE TO DO IT
[PROBE IF NECESSARY: Would you say [you have/(SP) has] no difficulty at all, a little difficulty, some
(-8) Don't Know
difficulty, a lot of difficulty, or [is/are] not able to do it?]
(-9) Refused
SHOW CARD HF3
DIFSTOOP
HFH1
code 1
DIFLIFT
HFH2
code 1
DIFREACH
HFH3
code 1
DIFWRITE
HFH4
code 1
DIFWALK
HFH5
code 1
PHYSACTINTRO
HFH10INT
no entry
VIGUNIT
HFH10
quantity unit
We are interested in two types of physical activity - vigorous and moderate. Vigorous activities cause large
(01) CONTINUE
increases in breathing or heart rate. Moderate activities cause small increases in breathing or heart rate. First
(-7) Empty
I will ask about the vigorous activities that [you do/(SP) does].
In a typical week, how much time [do you/does (SP)] spend doing vigorous activities, such as team sports,
running, aerobics, heavy house or yard work, or anything else that causes large increases in breathing or
heart rate?
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.
VIGNUM
HFH10
quantity unit
In a typical week, how much time [do you/does (SP)] spend doing vigorous activities, such as team sports,
running, aerobics, heavy house or yard work, or anything else that causes large increases in breathing or
heart rate?
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.
HFH2 - DIFLIFT
HFH3 - DIFREACH
HFH4 - DIFWRITE
HFH5 - DIFWALK
HFH10INT - PHYSACTINTRO
HFH10 - VIGUNIT
(01) NUMBER OF MINUTES PER DAY
(02) NUMBER OF HOURS PER DAY
(03) NUMBER OF HOURS PER WEEK
(04) NUMBER OF HOURS PER MONTH
(96) NONE
(-8) Don't Know
(-9) Refused
(01) HFH10 - VIGNUM
(02) HFH10 - VIGNUM
(03) HFH10 - VIGNUM
(04) HFH10 - VIGNUM
(96) HFH11 - MODUNIT
(-8) HFH11 - MODUNIT
(-9) HFH11 - MODUNIT
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
HFH11 - MODUNIT
Variable Name
MODUNIT
MR Screen Name
HFH11
Question type
quantity unit
Question text/description
Code list
(01) NUMBER OF MINUTES PER DAY
(02) NUMBER OF HOURS PER DAY
(03) NUMBER OF HOURS PER WEEK
(04) NUMBER OF HOURS PER MONTH
(96) NONE
(-8) Don't Know
(-9) Refused
Routing
(01) HFH11 - MODNUM
(02) HFH11 - MODNUM
(03) HFH11 - MODNUM
(04) HFH11 - MODNUM
(96) HFH12 - MUSUNIT
(-8) HFH12 - MUSUNIT
(-9) HFH12 - MUSUNIT
(01) continous answer
(01) HFH12 - MUSUNIT
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.
(01) NUMBER OF MINUTES PER DAY
(02) NUMBER OF HOURS PER DAY
(03) NUMBER OF HOURS PER WEEK
(04) NUMBER OF HOURS PER MONTH
(96) NONE
(-8) Don't Know
(-9) Refused
(01) HFH12 - MUSNUM
(02) HFH12 - MUSNUM
(03) HFH12 - MUSNUM
(04) HFH12 - MUSNUM
(96) HFJINTRO - MEDCONDINTRO
(-8) HFJINTRO - MEDCONDINTRO
(-9) HFJINTRO - MEDCONDINTRO
In a typical week, how much time [you/(SP)] spend doing exercises to increase [your/(SP)'s] muscle strength
or flexibility, such as lifting weights, push-ups, sit-ups, stretching, or yoga?
(01) Continunous answer
HFJINTRO - MEDCONDINTRO
(01) CONTINUE
(-7) Empty
BOX HFJ1
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ2 - OCHBP
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ2
(02) HFJ4 - OCMYOCAR
(-8) HFJ4 - OCMYOCAR
(-9) HFJ4 - OCMYOCAR
In a typical week, how much time [do you/does (SP)] spend doing moderate activities, such as brisk walking,
bicycling, gardening, golf, swimming, or vacuuming?
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.
MODNUM
MUSUNIT
MUSNUM
HFH11
HFH12
HFH12
numeric
quantity unit
numeric
In a typical week, how much time [do you/does (SP)] spend doing moderate activities, such as brisk walking,
bicycling, gardening, golf, swimming, or vacuuming?
Now I’m going to ask you about activities [you/(SP)] may do to increase [your/(SP)'s] muscle strength or
flexibility.
In a typical week, how much time [you/(SP)] spend doing exercises to increase [your/(SP)'s] muscle strength
or flexibility, such as lifting weights, push-ups, sit-ups, stretching, or yoga?
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO NEAREST HOUR.
Next, I'm going to read a list of medical conditions. [Since (LAST HF MONTH YEAR) has/Has] a doctor or other
health professional [ever] told [you/(SP)] that [you/he/she] had any of these conditions?
MEDCONDINTRO
HFJINTRO
no entry
[INTERVIEWER: IF THE SP IS CURRENTLY TAKING MEDICATION TO CONTROL A CONDITION, THE RESPONSE
RECORDED SHOULD BE "YES" TO INDICATE THAT THE SP HAS THE CONDITION.]
BOX HFJ1
OCARTERY
HFJ1
routing
yes/no
IF SP HAS EVER REPORTED HAVING HARDENING OF THE ARTERIES IN A PREVIOUS ROUND
(sample_person.P_OCHPB=1), GO TO HFJ2 - OCHBP.
ELSE GO TO HFJ1 - OCARTERY.
[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...
hardening of the arteries or arteriosclerosis?
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] [still has/still have/had/has/have...]
OCHBP
HFJ2
yes/no
hypertension, sometimes called high blood pressure?
[INTERVIEWER: IF THE RESPONDENT IS CURRENTLY TAKING MEDICATION TO CONTROL A CONDITION, THE
RESPONSE RECORDED SHOULD BE "YES" TO INDICATE THAT THE R HAS THE CONDITION.]
BOX HFJ2
YRHBP
OCMYOCAR
HFJ3
HFJ4
BOX HFJ3
YRMYOCAR
HFJ5
routing
IF SP IS IN THE SUPPLEMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ3 - YRHBP.
ELSE GO TO HFJ4 - OCMYOCAR.
yes/no
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] still
(01) YES
had hypertension or high blood pressure?
(02) NO
(-8) Don't Know
[INTERVIEWER: IF THE RESPONDENT IS CURRENTLY TAKING MEDICATION TO CONTROL A CONDITION, THE
(-9) Refused
RESPONSE RECORDED SHOULD BE "YES" TO INDICATE THAT THE R HAS THE CONDITION.]
yes/no
routing
yes/no
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
a myocardial infarction or heart attack?
IF SP IS IN THE SUPPLEMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ5 - YRMYOCAR.
ELSE GO TO HFJ6 - OCCHD.
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had (02) NO
(-8) Don't Know
a myocardial infarction or heart attack?
(-9) Refused
HFJ4 - OCMYOCAR
(01) BOX HFJ3
(02) HFJ6 - OCCHD
(-8) HFJ6 - OCCHD
(-9) HFJ6 - OCCHD
HFJ6 - OCCHD
Variable Name
MR Screen Name
Question type
OCCHD
HFJ6
yes/no
BOX HFJ4
YRCHD
OCCFAIL
YRCFAIL
HFJ7
routing
yes/no
HFJ8
yes/no
BOX HFJ5
routing
HFJ9
yes/no
Question text/description
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
[a new episode of] angina pectoris or coronary heart disease?
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ7 - YRCHD.
ELSE GO TO HFJ8 - OCCFAIL.
(01) YES
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had (02) NO
(-8) Don't Know
an episode of angina pectoris or coronary heart disease?
(-9) Refused
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
(01) YES
[you/he/she] had...]
(02) NO
(-8) Don't Know
[a new episode of] congestive heart failure?
(-9) Refused
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ9 - YRCFAIL.
ELSE GO TO HFJ14 - OCOTHHRT.
(01) YES
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had (02) NO
(-8) Don't Know
an episode of congestive heart failure?
(-9) Refused
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
[a new episode of] any other heart condition?
OCHRTCND
HFJ14
yes/no
[NOTE TO FI: This includes problems with the valves of the heart, such as aortic stenosis, and problems with
the rhythm of the heartbeat, such as atrial fibrillation.]
YRHRTCND
BOX HFJ8
routing
HFJ15
yes/no
HFJ16
yes/no
a stroke, a brain hemorrhage, or a cerebrovascular accident?
[NOTE: This includes transient ischemic attack (TIA) which is sometimes referred to as a ministroke.]
BOX HFJ9
YRSTROKE
HFJ17
HFJ17A
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
routing
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ17 - YRSTROKE.
ELSE GO TO HFJ17A - OCCHOLES.
yes/no
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had (01) YES
a stroke, a brain hemorrhage, or a cerebrovascular accident?
(02) NO
(-8) Don't Know
[NOTE: This includes transient ischemic attack (TIA) which is sometimes referred to as a ministroke.]
(-9) Refused
Has a doctor or other health professional ever told [you/(SP)] that [you/he/she] had high cholesterol?
OCCHOLES
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[DO NOT RECORD THE NAME OF THE CONDITION AT THIS QUESTION.]
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ15 - YRHRTCND.
ELSE GO TO HFJ16 - OCSTROKE.
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had
(01) YES
an episode of any other heart condition?
(02) NO
(-8) Don't Know
[NOTE TO FI: This includes problems with the valves of the heart, such as aortic stenosis, and problems with
(-9) Refused
the rhythm of the heartbeat, such as atrial fibrillation.]
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
OCSTROKE
Code list
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
yes/no
[INTERVIEWER: IF THE RESPONDENT IS CURRENTLY TAKING MEDICATION TO CONTROL A CONDITION, THE
RESPONSE RECORDED SHOULD BE "YES" TO INDICATE THAT THE R HAS THE CONDITION.]
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
Routing
(01) BOX HFJ4
(02) HFJ8 - OCCFAIL
(-8) HFJ8 - OCCFAIL
(-9) HFJ8 - OCCFAIL
HFJ8 - OCCFAIL
(01) BOX HFJ5
(02) HFJ14 - OCHRTCND
(-8) HFJ14 - OCHRTCND
(-9) HFJ14 - OCOTHHRT
HFJ14 - OCHRTCND
(01) BOX HFJ8
(02) HFJ16 - OCSTROKE
(-8) HFJ16 - OCSTROKE
(-9) HFJ16 - OCSTROKE
HFJ16 - OCSTROKE
(01) BOX HFJ9
(02) HFJ17A - OCCHOLES
(-8) HFJ17A - OCCHOLES
(-9) HFJ17A - OCCHOLES
HFJ17A - OCCHOLES
(01) HFJ17B - YRCHOLES
(02) BOX HFJ29
(-8) BOX HFJ29
(-9) BOX HFJ29
Variable Name
YRCHOLES
MR Screen Name
HFJ17B
Question type
Question text/description
yes/no
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had
(01) YES
high cholesterol?
(02) NO
(-8) Don't Know
[INTERVIEWER: IF THE RESPONDENT IS CURRENTLY TAKING MEDICATION TO CONTROL A CONDITION, THE
(-9) Refused
RESPONSE RECORDED SHOULD BE "YES" TO INDICATE THAT THE R HAS THE CONDITION.]
BLOSWGHT
HFJ45
yes/no
CLOSWGHT
HFJ46
yes/no
YRCSKIN
HFJ18
yes/no
BOX HFJ10
routing
HFJ19
yes/no
(01) YES
(02) NO
To lower risk for certain diseases, [have you/ has (SP)] ever been told by a doctor or health professional to
(-8) Don't Know
control weight or lose weight?
(-9) Refused
(01) YES
To lower risk for certain diseases, since (SAMPLE_PERSON.DATE_FALLRND) [have you/ has (SP)] been told by (02) NO
a doctor or health professional to control weight or lose weight?
(-8) Don't Know
(-9) Refused
[I've recorded that [you/(SP)] previously reported having had skin cancer.]
(01) YES
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
(02) NO
[you/he/she] had...]
(-8) Don't Know
(-9) Refused
[a new occurrence of] skin cancer?
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ19 - YRCSKIN.
ELSE GO TO HFJ20 - OCCANCER.
(01) YES
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had (02) NO
(-8) Don't Know
an occurrence of skin cancer?
(-9) Refused
[I've recorded that [you/(SP)] previously reported having had a tumor, growth, malignancy, or cancer of the
[READ RESPONSES BELOW].]
OCCANCER
HFJ20
Routing
BOX HFJ29
IF ROUND= FALL 2018 ROUND 82, GO TO HFJ45-BLOSWGHT.
ELSE IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3) GO TO HFJ45-BLOSWGHT. IF
P_EVRLOSWGHT=0 THEN GO TO HFJ46-CLOSWGHT. ELSE GO TO HFJ18 - OCCSKIN.
BOX HFJ29
OCCSKIN
Code list
yes/no
[Since (LAST HF MONTH YEAR), has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had any [other] kind of cancer, malignancy, or tumor other than skin cancer?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ18 - OCCSKIN
HFJ18 - OCCSKIN
(01) BOX HFJ10
(02) HFJ20 - OCCANCER
(-8) HFJ20 - OCCANCER
(-9) HFJ20 - OCCANCER
HFJ20 - OCCANCER
(01) BOX HFJ11
(02) BOX HFJ13
(-8) BOX HFJ13
(-9) BOX HFJ13
INCLUDE BENIGN OR NON-MALIGNANT TUMORS OR GROWTHS.
BOX HFJ11
YRCANCER
HFJ21
routing
IF SP IS IN THE SUPPLMENTAL SAMPLE [sample_person.INTTYPE=3], GO TO HFJ21 - YRCANCER.
ELSE GO TO HFJ22 - OCCCODE.
yes/no
(01) YES
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had (02) NO
(-8) Don't Know
any kind of cancer, malignancy, or tumor other than skin cancer?
(-9) Refused
HFJ22 - OCCCODE
Variable Name
MR Screen Name
Question type
Question text/description
SHOW CARD HF4
OCCCODE
HFJ22
code all
[Since the first time a doctor or other health professional told [you/(SP)] that [you/he/she] had a cancer,
malignancy, or tumor, on/On] what part or parts of [your/(SP's)] body was the cancer or tumor other than
skin cancer found?
[PROBE: Any other part?]
CHECK ALL THAT APPLY
OCCOS
OCARTHRH
HFJ22
verbatim text
BOX HFJ13
routing
HFJ24
BOX HFJ13B
OCOSARTH
OCARTH
YRARTHRD
HFJ24B
yes/no
routing
yes/no
BOX HFJ14
routing
HFJ25
yes/no
BOX HFJ15
routing
HFJ26
yes/no
BOX HFJ16
routing
Specify the part of parts of your body where the cancer or tumor was found.
IF SP HAS EVER REPORTED HAVING RHEUMATOID ARTHRITIS IN A PREVIOUS ROUND
(sample_person.P_OCARTHRH=1), GO TO BOX HFJ13B.
ELSE GO TO HFJ24 - OCARTHRH.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
rheumatoid arthritis?
IF SP HAS EVER REPORTED HAVING OSTEOARTHRITIS IN A PREVIOUS ROUND
(sample_person.P_OCOSARTH=1), GO TO BOX HFJ14.
ELSE GO TO HFJ24B-OCOSARTH.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
Code list
(01) LUNG
(02) COLON (BOWEL)
(03) BREAST
(04) UTERUS
(05) PROSTATE
(06) BLADDER
(07) OVARY
(08) STOMACH
(09) CERVIX
(10) BRAIN
(11) KIDNEY
(12) THROAT
(16) BLOOD
(17) BONE
(18) ESOPHAGUS
(19) GALL BLADDER
(20) LARYNX (WINDPIPE)
(21) LEUKOCYTES (LEUKEMIA)
(22) LIVER
(23) LYMPH NODES (LYMPHOMA)
(24) MOUTH/TONGUE/LIP
(25) PANCREAS
(26) RECTUM
(27) SOFT TISSUE/FAT
(28) TESTIS
(29) THYROID
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
Routing
(01) BOX HFJ13
(02) BOX HFJ13
(03) BOX HFJ13
(04) BOX HFJ13
(05) BOX HFJ13
(06) BOX HFJ13
(07) BOX HFJ13
(08) BOX HFJ13
(09) BOX HFJ13
(10) BOX HFJ13
(11) BOX HFJ13
(12) BOX HFJ13
(16) BOX HFJ13
(17) BOX HFJ13
(18) BOX HFJ13
(19) BOX HFJ13
(20) BOX HFJ13
(21) BOX HFJ13
(22) BOX HFJ13
(23) BOX HFJ13
(24) BOX HFJ13
(25) BOX HFJ13
(26) BOX HFJ13
(27) BOX HFJ13
(28) BOX HFJ13
(29) BOX HFJ13
(91) HFJ22 - OCCOS
(-8) BOX HFJ13
(-9) BOX HFJ13
BOX HFJ13
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ15
(02) BOX HFJ16
(-8) BOX HFJ16
(-9) BOX HFJ16
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFJ14
osteoarthritis?
IF SP HAS EVER REPORTED HAVING ARTHRITIS OTHER THAN RHEUMATOID ARTHRITIS IN A PREVIOUS ROUND
[sample_person.P_OCARTH=1], GO TO BOX HFJ16.
ELSE GO TO HFJ25 - OCARTH.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
(01) YES
(you/he/she) had...]
(02) NO
(-8) Don't Know
arthritis, other than rheumatoid or osteoarthritis?
(-9) Refused
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ26 - YRARTHRD.
ELSE GO TO BOX HFJ16A.
(01) YES
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had (02) NO
(-8) Don't Know
arthritis, other than rheumatoid or osteoarthritis, in any part of [your/his/her] body?
(-9) Refused
IF SP IS IN THE SUPPLMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ28 - OCMENTAL.
ELSE GO TO BOX HFJ16A.
BOX HFJ15
BOX HFJ16
Variable Name
OCMENTAL
MR Screen Name
HFJ28
BOX HFJ16A
OCALZMER
OCDEMENT
HFJ29A
Question type
yes/no
routing
yes/no
BOX HFJ16B
routing
HFJ29B
yes/no
BOX HFJ30
BASKDEPRS
HFJ47
yes/no
CASKDEPRS
HFJ48
yes/no
OCDEPRSS
YRDEPRSS
OCPSYCHO
YRPSYCHO
OCOSTEOP
HFJ30AA
yes/no
BOX HFJ17A
routing
HFJ30BB
yes/no
HFJ30A
yes/no
BOX HFJ17B
routing
HFJ31A
yes/no
BOX HFJ19
routing
HFJ32
yes/no
Question text/description
[Has a doctor or other health professional ever told [you/(SP)] that [you/he/she] had...]
an intellectual disability?
[EXPLAIN IF NECESSARY:] This is also known as intellectual development disorder or a general learning
disability. It was formerly known as mental retardation.
IF SP HAS EVER REPORTED HAVING ALZHEIMER’S DISEASE IN A PREVIOUS ROUND
(sample_person.P_OCALMER=1), GO TO BOX HFJ30.
ELSE GO TO HFJ29A - OCALZMER.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
Code list
Routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFJ16A
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFJ30AA - OCDEPRSS
(02) BOX HFJ16B
(-8) BOX HFJ16B
(-9) BOX HFJ16B
Alzheimer's disease?
IF SP HAS EVER REPORTED HAVING DEMENTIA IN A PREVIOUS ROUND (sample_person.P_OCDEMENT=1), GO
TO BOX HFJ30
ELSE GO TO HFJ29B - OCDEMENT.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
(01) YES
[you/he/she] had...]
(02) NO
(-8) Don't Know
any type of dementia other than Alzheimer's disease?
(-9) Refused
IF ROUND= FALL 2018 ROUND 82, GO TO HFJ47-BASKDEPRS.
ELSE IF SP IS IN THE BASELINE INTERIVEW (sample_person.INTTYPE=3) GO TO HFJ47-BASKDEPRS. IF
P_EVRASKDEPRESS=0 THEN GO TO HFJ48-CASKDEPRS. ELSE GO TO HFJ30AA - OCDEPRSS.
(01) YES
(02) NO
Has a doctor of other health professional ever asked [you/(SP)] if there was a period of time when
(-8) Don't Know
[you/he/she] felt sad, empty, or depressed?
(-9) Refused
(01) YES
Since (SAMPLE_PERSON.DATE_FALLRND), has a doctor of other health professional asked [you/(SP)] if there (02) NO
(-8) Don't Know
was a period of time when [you/he/she] felt sad, empty, or depressed?
(-9) Refused
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
(01) YES
[you/he/she] had...]
(02) NO
(-8) Don't Know
depression?
(-9) Refused
IF SP IS IN THE SUPPLEMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ30BB - YRDEPRSS.
ELSE GO TO HFJ30A - OCPSYCHO.
(01) YES
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had (02) NO
(-8) Don't Know
depression?
(-9) Refused
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
(01) YES
(02) NO
a mental or psychiatric disorder other than depression?
(-8) Don't Know
(-9) Refused
[INCLUDE ALCOHOLISM AS A MENTAL OR PSYCHIATRIC DISORDER.]
IF SP IS IN THE SUPPLEMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ31A - YRPSYCHO.
ELSE GO TO BOX HFJ19.
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had (01) YES
(02) NO
a mental or psychiatric disorder other than depression?
(-8) Don't Know
(-9) Refused
[INCLUDE ALCOHOLISM AS A MENTAL OR PSYCHIATRIC DISORDER.]
IF SP HAS EVER REPORTED HAVING OSTEOPOROSIS IN A PREVIOUS ROUND (sample_person.P_OCOSTEOP=1),
GO TO HFJ33 - OCBRKHIP.
ELSE GO TO HFJ32 - OCOSTEOP.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
(01) YES
[you/he/she] had...]
(02) NO
(-8) Don't Know
osteoporosis, sometimes called fragile or soft bones?
(-9) Refused
BOX HFJ30
HFJ30AA - OCDEPRSS
HFJ30AA - OCDEPRSS
(01) BOX HFJ17A
(02) HFJ30A - OCPSYCHO
(-8) HFJ30A - OCPSYCHO
(-9) HFJ30A - OCPSYCHO
HFJ30A - OCPSYCHO
(01) BOX HFJ17B
(02) BOX HFJ19
(-8) BOX HFJ19
(-9) BOX HFJ19
BOX HFJ19
HFJ33 - OCBRKHIP
Variable Name
OCBRKHIP
MR Screen Name
HFJ33
Question type
Question text/description
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]]
yes/no
a broken hip?
BOX HFJ20
YRBRKHIP
OCPARKIN
OCEMPHYS
OCPPARAL
YRPPARAL
OCAMPUTE
HAVEPROS
routing
HFJ34
yes/no
BOX HFJ21
routing
HFJ35
yes/no
BOX HFJ22
routing
HFJ36
yes/no
HFJ37
yes/no
BOX HFJ23
routing
HFJ38
yes/no
BOX HFJ24
routing
HFJ39
yes/no
BOX HFJ25
routing
HFJ40
yes/no
YRPROST
HFJ41
routing
yes/no
Routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ20
(02) BOX HFJ21
(-8) BOX HFJ21
(-9) BOX HFJ21
IF SP IS IN THE SUPPLMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFJ34 - YRBRKHIP.
ELSE GO TO BOX HFJ21.
(01) YES
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had (02) NO
(-8) Don't Know
a broken hip?
(-9) Refused
IF SP HAS EVER REPORTED HAVING PARKINSON’S DISEASE IN A PREVIOUS ROUND
(sample_person.P_OCPARKIN=1), GO TO BOX HFJ22.
ELSE GO TO HFJ35 - OCPARKIN.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
(01) YES
[you/he/she] had...]
(02) NO
(-8) Don't Know
Parkinson's disease?
(-9) Refused
IF SP HAS EVER REPORTED HAVING EMPHYSEMA, ASTHMA OR COPD IN A PREVIOUS ROUND
(sample_person.P_OCEMPHYS=1), GO TO HFJ37 - OCPPARAL.
ELSE GO TO HFJ36 - OCEMPHYS.
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
[you/he/she] had...]
(01) YES
(02) NO
emphysema, asthma, or COPD?
(-8) Don't Know
(-9) Refused
COPD=CHRONIC OBSTRUCTIVE PULMONARY DISEASE
IF SP IS OBVIOUSLY PARTIALLY OR COMPLETELY PARALYZED, SELECT "YES" AND DO NOT ASK. OTHERWISE,
ASK:
(01) YES
[[Since (LAST HF MONTH YEAR) has/Has] a doctor or other health professional [ever] told [you/(SP)] that
(02) NO
[you/he/she] had...]
(-8) Don't Know
(-9) Refused
complete or partial paralysis?
IF SP IS IN THE SUPPLMENTAL SAMPLE (sample_person.INTTYPE=3, GO TO HFJ38 - YRPPARAL.
ELSE GO TO BOX HFJ24.
(01) YES
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he/she] had (02) NO
(-8) Don't Know
complete or partial paralysis?
(-9) Refused
IF SP HAS EVER REPORTED AN ABSENCE OR LOSS OF ARM OR LEG IN A PREVIOUS ROUND
(sample_person.P_OCAMPUTE=1), GO TO BOX HFJ25.
ELSE GO TO HFJ39 - OCAMPUTE.
(01) YES
IF SP IS OBVIOUSLY MISSING ONE OR MORE LIMBS, SELECT "YES" AND DO NOT ASK. OTHERWISE, ASK:
(02) NO
(-8) Don't Know
What about absence or loss of an arm or a leg?
(-9) Refused
BOX HFJ21
BOX HFJ22
HFJ37 - OCPPARAL
(01) BOX HFJ23
(02) BOX HFJ24
(-8) BOX HFJ24
(-9) BOX HFJ24
BOX HFJ24
BOX HFJ25
IF SP IS FEMALE (ROSTSEX=2 or (roster.ROSTSEX=2 where ROSTNUM=1)), GO TO HFJ41A - OCBETES.
ELSE GO TO HFJ40 - HAVEPROS.
[[Before (you/[SP]) had prostate surgery, did a doctor or other health professional ever tell/Since (LAST HF
MONTH YEAR), has/Has] a doctor or other health professional [ever] told [you/(SP)] that [you/he] had...]
an enlarged prostate or benign prostatic hypertrophy (BPH)?
BOX HFJ26
Code list
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ26
(02) HFJ41A - OCBETES
(-8) HFJ41A - OCBETES
(-9) HFJ41A - OCBETES
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFJ41A - OCBETES
IF SP IS IN THE SUPPLMENTAL SAMPLE (sample_person.INTTYPE=3, GO TO HFJ41 - YRPROST.
ELSE GO TO HFJ41A - OCBETES.
Since (LAST HF MONTH YEAR), did a doctor or other health professional tell [you/(SP)] that [you/he] had an
enlarged prostate or benign prostatic hypertrophy (BPH)?
Variable Name
OCBETES
MR Screen Name
HFJ41A
Question type
Question text/description
Has a doctor or other health professional ever told [you/(SP)] that [you/he/she] had any type of diabetes,
including:
yes/no
sugar diabetes, high blood sugar, (borderline diabetes, pre-diabetes, or pregnancy-related
diabetes/borderline diabetes, or pre-diabetes)?
Code list
Routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFJ41B - OCDTYPE
(02) BOX HFJ27
(-8) BOX HFJ27
(-9) BOX HFJ27
SHOW CARD HF5
Looking at this card, please tell me which type of diabetes the doctor or other health professional said that
[you have/(SP) has].
OCDTYPE
HFJ41B
code 1
(01) TYPE 1
(02) TYPE 2
(03) BORDERLINE
[IF THE RESPONDENT REPORTS MORE THAN ONE TYPE OF DIABETES, PROBE FOR THE MOST RECENT TYPE OF (04) PRE-DIABETES
DIABETES THE DOCTOR TOLD THE RESPONDENT HE/SHE HAS.]
(05) GESTATIONAL (PREGNANCY-RELATED)
(91) SOME OTHER TYPE
[EXPLAIN IF NECESSARY: “Type 1” was formerly called “insulin dependent” or “juvenile-onset” diabetes. This (-8) Don't Know
type of diabetes usually develops during childhood or adolescence; but, it also can develop in adults.
(-9) Refused
“Type 2” was formerly called “non-insulin dependent” or “adult-onset” diabetes. Until recently, this type of
diabetes was found only in adults; but, now it is also occurring in children.]
(01) HFJ41C - OCDVISIT
(02) HFJ41C - OCDVISIT
(03) HFJ41C - OCDVISIT
(04) HFJ41C - OCDVISIT
(05) HFJ41C - OCDVISIT
(91) HFJ41B - OCDTYPOS
(-8) HFJ41C - OCDVISIT
(-9) HFJ41C - OCDVISIT
SOME OTHER TYPE (SPECIFY)
OCDTYPOS
OCDVISIT
HFJ41B
HFJ41C
BOX HFJ27
verbatim text
[IF THE RESPONDENT REPORTS MORE THAN ONE TYPE OF DIABETES, PROBE FOR THE MOST RECENT TYPE OF
DIABETES THE DOCTOR TOLD THE RESPONDENT HE/SHE HAS.]
yes/no
[Were you/Was (SP)] told on two or more different visits that [you/he/she] had diabetes?
routing
IF SP IS IN THE SUPPLEMENTAL SAMPLE AND SP'S AGE AT TIME OF CURRENT MEDICARE ELIGIBILITY WAS
UNDER 65 (sample_person.INTTYPE=3 and sample_person.AGECUREL<65 and greater than 0) THEN
IF SP REPORTED “YES” TO AT LEAST ONE HFJ CONDITION, GO TO HFJ42 - EMCOND.
ELSE IF SP REPORTED “NO” TO ALL HFJ CONDITIONS , GO TO HFJ43 - EMCAUSEVB.
ELSE IF SP IS NOT IN THE SUPPLEMENTAL SAMPLE OR SP'S AGE AT TIME OF CURRENT MEDICARE ELIGIBILITY
WAS NOT UNDER 65 THEN GO TO HFPINTRO - HLTHCAREINTRO.
(01) [Continuous answer.]
HFJ41C - OCDVISIT
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFJ27
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) BOX HFJ28
(02) HFJ43 - EMCAUSEVB
(-8) HFPINTRO - HLTHCAREINTRO
(-9) HFPINTRO - HLTHCAREINTRO
(01) [Continuous answer.]
HFPINTRO - HLTHCAREINTRO
You told me that [you have/(SP) has] had [READ CONDITIONS LISTED BELOW]. [Was this/Were any of these]
the original cause of [your/(SP's)] becoming eligible for Medicare?
EMCOND
HFJ42
yes/no
[LIST ALL CONDITIONS WHERE "YES" ANSWER RECORDED AT HFJ1 THROUGH HFJ41C]
[NOTE THAT CONDITIONS MAY NOT BE DISPLAYED WITH THE EXACT CONDITION NAME THAT WAS USED
EARLIER IN THE INTERVIEW (E.G., HYPERTENSION CAN ALSO BE CALLED HIGH BLOOD PRESSURE AT
DIFFERENT QUESTIONS).]
EMCAUSEVB
HFJ43
verbatim text
BOX HFJ28
routing
What was the original cause of [your/(SP's)] becoming eligible for Medicare?
RECORD VERBATIM.
IF SP RESPONDED “YES” TO ONLY ONE HFJ CONDITION, GO TO HFPINTRO - HLTHCAREINTRO.
ELSE GO TO HFJ44 - EMCODE.
EMOS
HFJ44
verbatim text
OTHER (SPECIFY)
Code list
(01) ARTERIES HARDENING
(02) HYPERTENSION
(03) HEART ATTACK
(04) HEART DISEASE
(05) CONGESTIVE HEART FAILURE
(06) HEART VALVE PROBLEM
(07) HEART RHYTHM PROBLEM
(08) OTHER HEART PROBLEM
(09) STROKE OR HEMORRHAGE
(10) SKIN CANCER
(11) CANCER/TUMOR
(12) RHEUMATOID ARTHRITIS
(26) OSTEOARTHRITIS
(13) OTHER ARTHRITIS
(14) INTELLECTUAL DISABILITY
(15) ALZHEIMER'S
(16) DEMENTIA
(17) DEPRESSION
(18) MENTAL DISORDER
(19) OSTEOPOROSIS
(20) BROKEN HIP
(21) PARKINSON'S
(22) EMPHYSEMA/ASTHMA/COPD
(23) PARALYSIS
(24) LOSS OF LIMB
(25) DIABETES
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
HLTHCAREINTRO
HFPINTRO
no entry
Now I want to ask you about some things that [you/(SP)] may be doing to maintain [your/his/her] health,
either by getting tested for health problems or by taking care of conditions that [you have/she has/he has].
(01) CONTINUE
(-7) Empty
BOX HFP1A
routing
IF (HFJ41A – OCBETES = 1/Yes) AND (HFJ41B - OCDTYPE = 1/TypeOne, 2/TypeTwo, 3/Borderline,
4/PreDiabetes, 91/Other, DK, or RF), GO TO HFP1 - DIAAGE.
ELSE GO TO HFP21 - DIAEVERT.
(01) [Continuous answer.]
(-7) Empty
(-8) Don't Know
(-9) Refused
BOX HFP2
Variable Name
MR Screen Name
Question type
Question text/description
Which of these conditions was the cause of [your/(SP's)] becoming eligible for Medicare?
EMCODE
HFJ44
BOX HFP1A
DIAAGE
HFP1
code all
numeric
[PROBE: Any other condition?]
CHECK UP TO 8 CONDITIONS.
I recorded that [you were/(SP) was] told by a doctor or other health professional that [you have/she has/he
has] [Type 1 diabetes/Type 2 diabetes/borderline diabetes/pre-diabetes/diabetes].
How old [were you/was (SP)] when [you were/he was/she was] first told that [you/he/she] had diabetes?
BOX HFP2
routing
DIAPRGNT
HFP2
yes/no
DIAINSUL
HFP4
list
DIAMEDS
HFP4
list
DIATEST
HFP4
list
Routing
(01) HFPINTRO - HLTHCAREINTRO
(02) HFPINTRO - HLTHCAREINTRO
(03) HFPINTRO - HLTHCAREINTRO
(04) HFPINTRO - HLTHCAREINTRO
(05) HFPINTRO - HLTHCAREINTRO
(06) HFPINTRO - HLTHCAREINTRO
(07) HFPINTRO - HLTHCAREINTRO
(08) HFPINTRO - HLTHCAREINTRO
(09) HFPINTRO - HLTHCAREINTRO
(10) HFPINTRO - HLTHCAREINTRO
(11) HFPINTRO - HLTHCAREINTRO
(12) HFPINTRO - HLTHCAREINTRO
(13)HFPINTRO - HLTHCAREINTRO
(14) HFPINTRO - HLTHCAREINTRO
(15) HFPINTRO - HLTHCAREINTRO
(16) HFPINTRO - HLTHCAREINTRO
(17) HFPINTRO - HLTHCAREINTRO
(18) HFPINTRO - HLTHCAREINTRO
(19) HFPINTRO - HLTHCAREINTRO
(20) HFPINTRO - HLTHCAREINTRO
(21) HFPINTRO - HLTHCAREINTRO
(22) HFPINTRO - HLTHCAREINTRO
(23) HFPINTRO - HLTHCAREINTRO
(24) HFPINTRO - HLTHCAREINTRO
(25) HFPINTRO - HLTHCAREINTRO
(91) HFJ44 - EMOS
(-8) HFPINTRO - HLTHCAREINTRO
(-9) HFPINTRO - HLTHCAREINTRO
HFPINTRO - HLTHCAREINTRO
IF THE SP IS FEMALE (ROSTSEX=2) AND (HFP1 – DIAAGE is >= 12 and is <= 45) OR (HFP1 – DIAAGE = DK OR RF),
GO TO HFP2 - DIAPRGNT.
ELSE GO TO HFP4 - DIAINSUL.
(01) YES
(02) NO
Did [you/(SP)] have diabetes only during a pregnancy?
(-8) Don't Know
(-9) Refused
Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do (01) YES
you/Does (SP)]…
(02) NO
(-8) Don't Know
take insulin?
(-9) Refused
Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do (01) YES
you/Does (SP)]…
(02) NO
(-8) Don't Know
take prescription diabetes pills or oral diabetes medicine?
(-9) Refused
Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do (01) YES
you/Does (SP)]…
(02) NO
(-8) Don't Know
test [your/his/her] blood for sugar or glucose?
(-9) Refused
(01) HFP21 - DIAEVERT
(02) HFP4 - DIAINSUL
(-8) HFP21 - DIAEVERT
(-9) HFP21 - DIAEVERT
HFP4 - DIAMEDS
HFP4 - DIATEST
HFP4 - DIASORES
Variable Name
MR Screen Name
Question type
DIASORES
HFP4
list
DIAPRESS
HFP4
list
DIAASPRN
HFP4
list
BOX HFP3
routing
INSUTAKE
HFP5
quantity unit
INSUDAY
INSUWEEK
HFP5
HFP5
quantity unit
quantity unit
BOX HFP4
routing
MEDSTAKE
HFP6
quantity unit
MEDDAY
MEDWEEK
MEDMONTH
HFP6
HFP6
HFP6
quantity unit
quantity unit
quantity unit
BOX HFP5
routing
TESTTAKE
HFP7
quantity unit
TESTDAY
HFP7
quantity unit
TESTWEEK
HFP7
quantity unit
TESTMNTH
HFP7
quantity unit
TESTYEAR
HFP7
quantity unit
Question text/description
Code list
Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do (01) YES
you/Does (SP)]…
(02) NO
(-8) Don't Know
check for sores or irritations on [your/his/her] feet?
(-9) Refused
Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do (01) YES
you/Does (SP)]…
(02) NO
(-8) Don't Know
measure [your/his/her] blood pressure at home?
(-9) Refused
Please tell me whether [you use/(SP) uses] any of the following ways to manage [your/his/her] diabetes. [Do (01) YES
you/Does (SP)]…
(02) NO
(-8) Don't Know
take aspirin regularly for [your/his/her] diabetes?
(-9) Refused
IF HFP4 - DIAINSUL = 1/Yes, GO TO HFP5 - INSUTAKE.
ELSE IF HFP4 - DIAMEDS = 1/Yes, GO TO HFP6 - MEDSTAKE.
ELSE IF HFP4 - DIATEST = 1/Yes, GO TO HFP7 - TESTTAKE.
ELSE IF HFP4 - DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.
(01) NUMBER OF TIMES PER DAY
(02) NUMBER OF TIMES PER WEEK
How often [do you/does (SP)] take insulin?
(03) USE INSULIN PUMP
(-8) Don't Know
(-9) Refused
How often [do you/does (SP)] take insulin?
(01) [Continuous answer.]
How often [do you/does (SP)] take insulin?
(01) [Continuous answer.]
IF HFP4 – DIAMEDS = 1/Yes, GO TO HFP6 - MEDSTAKE.
ELSE IF HFP4 - DIATEST = 1/Yes, GO TO HFP7 - TESTTAKE.
ELSE IF HFP4 - DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.
(01) NUMBER OF TIMES PER DAY
(02) NUMBER OF TIMES PER WEEK
How often [do you/does (SP)] take prescription diabetes pills or oral diabetes medicine?
(03) NUMBER OF TIMES PER MONTH
(-8) Don't Know
(-9) Refused
How often [do you/does (SP)] take prescription diabetes pills or oral diabetes medicine?
(01) [Continuous answer.]
How often [do you/does (SP)] take prescription diabetes pills or oral diabetes medicine?
(01) [Continuous answer.]
How often [do you/does (SP)] take prescription diabetes pills or oral diabetes medicine?
(01) [Continuous answer.]
IF HFP4 – DIATEST = 1/Yes, GO TO HFP7 - TESTTAKE.
ELSE IF HFP4 – DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.
(01) NUMBER OF TIMES PER DAY
How often [do you/does (SP)] test [your/his/her] blood for sugar or glucose?
(02) NUMBER OF TIMES PER WEEK
(03) NUMBER OF TIMES PER MONTH
[PROBE: Include times when it is tested by a family member or friend, but do not include times when it is
(04) NUMBER OF TIMES PER YEAR
tested by a health professional.]
(-8) Don't Know
(-9) Refused
How often [do you/does (SP)] test [your/his/her] blood for sugar or glucose?
[PROBE: Include times when it is tested by a family member or friend, but do not include times when it is
tested by a health professional.]
How often [do you/does (SP)] test [your/his/her] blood for sugar or glucose?
[PROBE: Include times when it is tested by a family member or friend, but do not include times when it is
tested by a health professional.]
How often [do you/does (SP)] test [your/his/her] blood for sugar or glucose?
[PROBE: Include times when it is tested by a family member or friend, but do not include times when it is
tested by a health professional.]
How often [do you/does (SP)] test [your/his/her] blood for sugar or glucose?
[PROBE: Include times when it is tested by a family member or friend, but do not include times when it is
tested by a health professional.]
Routing
HFP4 - DIAPRESS
HFP4 - DIAASPRN
BOX HFP3
(01) HFP5 - INSUDAY
(02) HFP5 - INSUWEEK
(03) BOX HFP4
(-8) BOX HFP4
(-9) BOX HFP4
BOX HFP4
BOX HFP4
(01) HFP6 - MEDDAY
(02) HFP6 - MEDWEEK
(03) ) HFP6 - MEDMONTH
(-8) BOX HFP5
(-9) BOX HFP5
BOX HFP5
BOX HFP5
BOX HFP5
(01) HFP7 - TESTDAY
(02) HFP7 - TESTWEEK
(03) HFP7 - TESTMNTH
(04) HFP7 - TESTYEAR
(-8) BOX HFP6
(-9) BOX HFP6
(01) [Continuous answer.]
BOX HFP6
(01) [Continuous answer.]
BOX HFP6
(01) [Continuous answer.]
BOX HFP6
(01) [Continuous answer.]
BOX HFP6
Variable Name
MR Screen Name
Question type
BOX HFP6
routing
SORECHEK
HFP8
quantity unit
SOREDAY
HFP8
quantity unit
SOREWEEK
HFP8
quantity unit
SOREMNTH
HFP8
quantity unit
SOREYEAR
HFP8
quantity unit
Question text/description
IF HFP4 – DIASORES = 1/Yes, GO TO HFP8 - SORECHEK.
ELSE GO TO HFP10 - DIATENYR.
(01) NUMBER OF TIMES PER DAY
How often [do you/does (SP)] check [your/his/her] feet for sores or irritations?
(02) NUMBER OF TIMES PER WEEK
(03) NUMBER OF TIMES PER MONTH
[PROBE: Include times when they are checked by a family member or friend, but do not include times when (04) NUMBER OF TIMES PER YEAR
they are checked by a health professional.]
(-8) Don't Know
(-9) Refused
How often [do you/does (SP)] check [your/his/her] feet for sores or irritations?
[PROBE: Include times when they are checked by a family member or friend, but do not include times when
they are checked by a health professional.]
How often [do you/does (SP)] check [your/his/her] feet for sores or irritations?
[PROBE: Include times when they are checked by a family member or friend, but do not include times when
they are checked by a health professional.]
How often [do you/does (SP)] check [your/his/her] feet for sores or irritations?
[PROBE: Include times when they are checked by a family member or friend, but do not include times when
they are checked by a health professional.]
How often [do you/does (SP)] check [your/his/her] feet for sores or irritations?
[PROBE: Include times when they are checked by a family member or friend, but do not include times when
they are checked by a health professional.]
DIATENYR
HFP10
yes/no
In the past year has a doctor or other health professional examined [your/his/her] feet for sores or
irritations?
DIADRSAW
HFP11
numeric
About how many times in the past year [have you/has (SP)] seen a doctor or other health professional for
[your/his/her] diabetes?
numeric
A test of hemoglobin "A one C" measures the average level of blood sugar over the past three months. It is
usually done in a doctor's office. About how many times in the past year has a doctor or other health
professional checked [you/(SP)] for hemoglobin "A one C"?
DIAHEMOC
HFP13
SHOW CARD HF6
DIACTRLD
DIAHYPO
HFP14
HFP14A1
code 1
yes/no
Would you say that [your/(SP)'s] blood sugar is well controlled all of the time, most of the time, some of the
time, a little of the time, or none of the time? By "well controlled" we mean a recent hemoglobin "A one C"
result of 7.5 or less or an average fasting blood test of 140 or less.
In the past year, [have you/has (SP)] experienced hypoglycemia, sometimes called low blood sugar or an
insulin reaction?
Please think about the most serious episode of hypoglycemia that [you have/(SP) has] experienced in the
past year.
DIAHYPTR
HFP14A2
code 1
[Were you/Was (SP)] able to treat [yourself/himself/herself] by taking some form of sugar, did [you/he/she]
require treatment from others, or did [you/he/she] require treatment by a hospital?
[EXPLAIN IF NECESSARY: Treatment by a hospital includes being treated in the emergency room or
outpatient department of a hospital, or being admitted as an inpatient.]
DIAFTEVR
HFP14A3
yes/no
Code list
[Have you/Has (SP)] ever had any problems with [your/his/her] feet as a result of [your/his/her] diabetes?
Routing
(01) HFP8 - SOREDAY
(02) HFP8 - SOREWEEK
(03) HFP8 - SOREMNTH
(04) HFP8 - SOREYEAR
(-8) HFP10 - DIATENYR
(-9) HFP10 - DIATENYR
(01) [Continuous answer.]
HFP10 - DIATENYR
(01) [Continuous answer.]
HFP10 - DIATENYR
(01) [Continuous answer.]
HFP10 - DIATENYR
(01) [Continuous answer.]
HFP10 - DIATENYR
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
(01) ALL OF THE TIME
(02) MOST OF THE TIME
(03) SOME OF THE TIME
(04) A LITTLE OF THE TIME
(05) NONE OF THE TIME
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFP11 - DIADRSAW
HFP13 - DIAHEMOC
HFP14 - DIACTRLD
HFP14A1 - DIAHYPO
(01) HFP14A2 - DIAHYPTR
(02) HFP14A - DIAFEET
(-8) HFP14A - DIAFEET
(-9) HFP14A - DIAFEET
(01) SELF TREATMENT
(02) TREATMENT FROM OTHERS
(03) HOSPITAL TREATMENT
(-8) Don't Know
(-9) Refused
HFP14A3 - DIAFTEVR
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFP14A - DIAFEET
(02) HFP15 - DIAEYPRB
(-8) HFP15 - DIAEYPRB
(-9) HFP15 - DIAEYPRB
Variable Name
MR Screen Name
Question type
Question text/description
DIAFEET
HFP14A
yes/no
[Do you/Does (SP)] currently have any problems with [your/his/her] feet as a result of [your/his/her]
diabetes?
DIANEURO
HFP14B
list
Code list
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] ever
been told by a doctor or other health professional that [you/he/she] had any of the following problems with
(01) YES
[your/his/her] feet as a result of [your/his/her] diabetes.
(02) NO
(-8) Don't Know
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…
(-9) Refused
Routing
HFP14B - DIANEURO
HFP14B - DIACIRCF
Neuropathy or nerve damage, which may cause pain or numbness in the feet?
DIACIRCF
HFP14B
list
[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] ever
been told by a doctor or other health professional that [you/he/she] had any of the following problems with
(01) YES
[your/his/her] feet as a result of [your/his/her] diabetes.]
(02) NO
(-8) Don't Know
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…
(-9) Refused
HFP14B - DIAULCER
Poor circulation or blood flow in the feet?
DIAULCER
HFP14B
list
[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] ever
been told by a doctor or other health professional that [you/he/she] had any of the following problems with
(01) YES
[your/his/her] feet as a result of [your/his/her] diabetes.]
(02) NO
(-8) Don't Know
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…
(-9) Refused
HFP14B - DIASKINC
Foot ulcers?
DIASKINC
HFP14B
list
[People with diabetes can develop many different foot problems. Please tell me if [you have/(SP) has] ever
been told by a doctor or other health professional that [you/he/she] had any of the following problems with
(01) YES
[your/his/her] feet as a result of [your/his/her] diabetes.]
(02) NO
(-8) Don't Know
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you/he/she] had…
(-9) Refused
HFP15 - DIAEYPRB
Calluses, infections, or other skin changes affecting the feet?
DIAEYPRB
HFP15
yes/no
DIAKDPEV
HFP16A1
yes/no
DIAKDPRB
HFP16
yes/no
DIAKIDNY
HFP16A
yes/no
DIAMNGE
HFP17
yes/no
(01) YES
(02) NO
[Do you/Does (SP)] have any problems with [your/his/her] eyes as a result of [your/his/her] diabetes?
(-8) Don't Know
(-9) Refused
(01) YES
[Have you/Has (SP)] ever had any problems with [your/his/her] kidneys as a result of [your/his/her] diabetes?
(02) NO
(-8) Don't Know
[EXPLAIN IF NECESSARY: This is tested by looking for protein in the urine.]
(-9) Refused
(01) YES
(02) NO
[Do you/Does (SP)] currently have any problems with [your/his/her] kidneys as a result of [your/his/her]
(-8) Don't Know
diabetes?
(-9) Refused
(01) YES
[Have you/Has (SP)] ever been told by a doctor or other health professional that [you have/she has/he has] (02) NO
(-8) Don't Know
chronic kidney disease?
(-9) Refused
(01) YES
(02) NO
[Have you/Has (SP)] ever participated in a diabetes self-management course or class, or received special
(-8) Don't Know
training on how [you/he/she] can manage [your/his/her] diabetes?
(-9) Refused
HFP16A1 - DIAKDPEV
(01) HFP16 - DIAKDPRB
(02) HFP17 - DIAMNGE
(-8) HFP17 - DIAMNGE
(-9) HFP17 - DIAMNGE
(01) HFP16A - DIAKIDNY
(02) HFP17 - DIAMNGE
(-8) HFP17 - DIAMNGE
(-9) HFP17 - DIAMNGE
HFP17 - DIAMNGE
(01) HFP18 - DIATRAIN
(02) BOX HFP7
(-8) BOX HFP7
(-9) BOX HFP7
Variable Name
MR Screen Name
Question type
DIATRAIN
HFP18
code 1
BOX HFP7
routing
DIAKNOW
HFP19
code 1
DIASUPPS
HFP20
yes/no
DIAEVERT
HFP21
yes/no
DIARECNT
HFP22
code 1
BOX HFP8
routing
DIAAWARE
HFP23
yes/no
DIARISK
HFP24
yes/no
DIASIGNS
HFP25
yes/no
BOX HFR1
routing
Question text/description
Code list
(01) LESS THAN 1 YEAR AGO
When was the most recent time that [you/(SP)] participated in a diabetes self-management course or class or (02) 1 YEAR TO LESS THAN 2 YEARS AGO
received special training on how [you/he/she] can manage [your/his/her] diabetes?
(03) 2 YEARS TO LESS THAN 3 YEARS AGO
(04) 3 YEARS TO LESS THAN 5 YEARS AGO
[IF THE RESPONDENT HAS GONE TO MORE THAN ONE COURSE OR TRAINING, PROBE FOR THE MOST RECENT (05) 5 OR MORE YEARS AGO
TIME.]
(-8) Don't Know
(-9) Refused
IF THE SP IS THE RESPONDENT (SPPROXY=1), GO TO HFP19 - DIAKNOW.
ELSE GO TO BOX HFR1.
(01) just about everything you need to know,
(02) most of what you need to know,
(03) some of what you need to know,
SHOW CARD HF7
(04) a little of what you need to know, or
(05) almost none of what you need to know about
How much do you think you know about managing your diabetes? Do you know . . .
managing your diabetes?
(-8) Don't Know
(-9) Refused
(01) YES
Before today, did you know that Medicare now helps pay the cost of diabetic testing supplies and self(02) NO
management education for people with diabetes?
(-8) Don't Know
(-9) Refused
[I have recorded that [you have/(SP) has] never been told by a doctor or other health professional that [you (01) YES
have/she has/he has] diabetes.]
(02) NO
(-8) Don't Know
[Have you/Has (SP)] ever had a blood test to see if [you have/she has/he has] diabetes?
(-9) Refused
(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS AGO
(03) 2 YEARS TO LESS THAN 3 YEARS AGO
When was the most recent time [you were/(SP) was] tested for diabetes?
(04) 3 YEARS TO LESS THAN 5 YEARS AGO
(05) 5 OR MORE YEARS AGO
(-8) Don't Know
(-9) Refused
IF THE SP IS THE RESPONDENT (SPPROXY=1), GO TO HFP23 - DIAAWARE.
ELSE GO TO HFP24 - DIARISK.
(01) YES
(02) NO
Before today, were you aware that there is a blood test to determine if a person has diabetes?
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
Has a doctor or other health professional ever told [you/(SP)] that [you are/he is/she is] at high risk for
(-8) Don't Know
diabetes?
(-9) Refused
(01) YES
In the past year, [have you/has (SP)] received any information about the signs, symptoms, or risk factors for (02) NO
(-8) Don't Know
diabetes?
(-9) Refused
HFR1
BOX HFP7
HFP20 - DIASUPPS
BOX HFR1
(01) HFP22 - DIARECNT
(02) BOX HFP8
(-8) BOX HFP8
(-9) BOX HFP8
HFP24 - DIARISK
HFP24 - DIARISK
HFP25 - DIASIGNS
BOX HFR1
IF (SP HAS EVER HEARD ABOUT COLORECTAL OR COLON CANCER IS UNKNOWN P_COLHEAR=.) AND (SP HAS
NOT REPORTED HAVING COLON, RECTAL OR BOWEL CANCER IN THE CURRENT ROUND OR IN A PREVIOUS
ROUND (OCCCODE not in 02 and P_OCCCOLON^=1), GO TO HFR1 - COLHEAR.
ELSE GO TO BOX HFS1.
Now I'd like to talk about a different illness, colorectal or colon cancer, a disease of the lower intestines.
COLHEAR
Routing
yes/no
Before today, had you ever heard of colorectal or colon cancer?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFR3 - COLHTEST
Variable Name
COLHTEST
MR Screen Name
HFR3
Question type
yes/no
Question text/description
The fecal occult blood test is a simple test for early signs of colon cancer. It detects invisible traces of blood
found in the stool. The doctor or other health professional can give the patient a kit to collect stool samples
at the patient’s home. The test is then sent to a laboratory for the results to be determined.
Has a doctor or other health professional ever given [you/(SP)] a home testing kit to test for blood in the
stool?
COLHKIT
HFR4
yes/no
Have you ever heard of this home testing kit?
COLFDOC
HFR4A
yes/no
Has a doctor or other health professional ever performed a fecal occult blood test to test for blood in the
stool while [you/(SP)] [were/was] at the doctor’s office?
COLCARD
HFR5
yes/no
Did [you/(SP)] complete the samples and return them for [your/his/her] most recent test?
COLRECNT
HFR7
code 1
When did [you/(SP)] have [your/his/her] most recent blood stool test (using a home testing kit)?
COLSCOPY
HFR8
yes/no
Another test for early signs of colon cancer is performed in the doctor's office. The doctor uses a flexible
lighted tube to examine the colon and rectum directly. This is called a sigmoidoscopy or colonoscopy.
[Have you/Has (SP)] ever had this exam?
WHENSCOP
HEARSCOP
HFR9
code 1
When did [you/(SP)] have [your/his/her] most recent sigmoidoscopy or colonoscopy?
HFR10
yes/no
Before today, had you ever heard of a sigmoidoscopy or colonoscopy?
BOX HFR2
routing
IF HFR3 - COLHTEST = 1/Yes or HFR4 - COLHKIT = 1/Yes, GO TO HFR13 - COLSCRNS.
ELSE GO TO BOX HFS1.
Code list
Routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFR5 - COLCARD
(02) HFR4 - COLHKIT
(-8) HFR4 - COLHKIT
(-9) HFR4 - COLHKIT
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS AGO
(03) 2 YEARS TO LESS THAN 3 YEARS AGO
(04) 3 YEARS TO LESS THAN 5 YEARS AGO
(05) 5 OR MORE YEARS AGO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS AGO
(03) 2 YEARS TO LESS THAN 3 YEARS AGO
(04) 3 YEARS TO LESS THAN 5 YEARS AGO
(05) 5 OR MORE YEARS AGO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
COLDRREC
HFR11
yes/no
Has a doctor or other health professional ever recommended that [you/(SP)] have this test?
COLSCRNS
HFR13
yes/no
Before today, did you know that Medicare now pays the cost of screening tests for colorectal cancer?
BOX HFS1
routing
IF SP HAS EVER REPORTED HAVING OSTEPOPORIS IN THE CURRENT ROUND OR IN A PREVIOUS ROUND
(OCOSTEOP=1 or sample_person.P_OCOSTEOP-=1 GO TO HFS3 - OSTTEST.
ELSE GO TO HFSINTRO - OSTINTRO.
HFSINTRO
no entry
Now I'd like to talk about a disease called osteoporosis, which can be treated if found early. In osteoporosis, (01) CONTINUE
the bones lose their calcium and become fragile and more easily broken.
(-7) Empty
OSTINTRO
HFR4A - COLFDOC
(01) HFR7 - COLRECNT
(02) HFR8 - COLSCOPY
(-8) HFR8 - COLSCOPY
(-9) HFR8 - COLSCOPY
HFR7 - COLRECNT
HFR8 - COLSCOPY
(01) HFR9 - WHENSCOP
(02) HFR10 - HEARSCOP
(8) HFR10 - HEARSCOP
(9) HFR10 - HEARSCOP
HFR13 - COLSCRNS
(01) HFR11 - COLDRREC
(02) BOX HFR2
(-8) BOX HFR2
(-9) BOX HFR2
HFR13 - COLSCRNS
BOX HFS1
HFS1 - OSTEVERT
Variable Name
MR Screen Name
Question type
OSTEVERT
HFS1
yes/no
OSTHRISK
HFS2
yes/no
OSTFRACT
HFS2A
yes/no
OSTTEST
HFS3
yes/no
OSTHEAR
HFS4
yes/no
OSTRECNT
HFS5
code 1
OSTMASS
HFS6
yes/no
HCTROUBL
HFAC29
yes/no
Question text/description
Code list
(01) YES
(02) NO
[Have you/Has (SP)] ever talked with [your/his/her] doctor or other health professional about osteoporosis?
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
Has a doctor or other health professional ever told [you/(SP)] that [you are/he is/she is] at high risk for
(-8) Don't Know
osteoporosis?
(-9) Refused
(01) YES
(02) NO
Have [you/(SP)] ever experienced a fracture that [your/his/her] doctor or other health professional told
(-8) Don't Know
[you/him/her] was related to osteoporosis?
(-9) Refused
There is a test to detect osteoporosis at an early stage, called Bone Mass Measurement or Bone Density
(01) YES
Measurement, or DEXA scan.
(02) NO
(-8) Don't Know
[Have you/Has (SP)] ever had a Bone Mass or Bone Density Measurement test?
(-9) Refused
(01) YES
(02) NO
Before today, had you ever heard of this test?
(-8) Don't Know
(-9) Refused
(01) LESS THAN 1 YEAR AGO
(02) 1 YEAR TO LESS THAN 2 YEARS AGO
(03) 2 YEARS TO LESS THAN 3 YEARS AGO
When was the most recent time that [you/(SP)] had a Bone Mass or Bone Density Measurement test?
(04) 3 YEARS TO LESS THAN 5 YEARS AGO
(05) 5 OR MORE YEARS AGO
(-8) Don't Know
(-9) Refused
(01) YES
Before today, did you know that Medicare would pay for Bone Mass or Bone Density Measurement tests for (02) NO
(-8) Don't Know
Medicare beneficiaries who are at risk for osteoporosis?
(-9) Refused
Routing
(01) HFS2 - OSTHRISK
(02) HFS3 - OSTTEST
(-8) HFS3 - OSTTEST
(-9) HFS3 - OSTTEST
Next, we are going to ask some questions about [your/(SP's)] health care needs during the past year.
(01) HFAC30A - HCTCODE
(02) HFAC31 - HCDELAY
(-8) HFAC31 - HCDELAY
(-9) HFAC31 - HCDELAY
Since (LAST HF MONTH YEAR), [have you/has (SP)] had any trouble getting health care that [you/he/she]
wanted or needed?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFS2A - OSTFRACT
HFS3 - OSTTEST
(01) HFS5 - OSTRECNT
(02) HFS4 - OSTHEAR
(-8) HFS4 - OSTHEAR
(-9) HFS4 - OSTHEAR
(01) HFS6 - OSTMASS
(02) HFAC29 - HCTROUBL
(-8) HFAC29 - HCTROUBL
(-9) HFAC29 - HCTROUBL
HFS6 - OSTMASS
HFAC29 - HCTROUBL
Variable Name
MR Screen Name
Question type
Question text/description
Why was that?
HCTCODE
HFAC30A
code all
HCTOTHOS
HFAC30A
verbatim text
BOX HFF6
routing
CGETAPPT
HFAC30B
[PROBE: Any other reason?]
CHECK ALL THAT APPLY.
OTHER (SPECIFY)
IF RESPONSE TO HFAC30A - HCTCODE INCLUDES 8/DrDoesNotAcceptMedicare OR 10/DifficultyGettingAppt,
GO TO HFAC30D - OFFEXPLN.
ELSE GO TO HFAC30B - CGETAPPT.
Code list
Routing
(01) SP DOES NOT HAVE MONEY
(02) COST IS TOO HIGH
(03) SERVICES/SUPPLIES NOT COVERED
(04) NEEDED TRANSPORTATION TO
DOCTOR/HOSPITAL
(05) DIFFICULTY GETTING HOME HEALTH CARE
(06) NO TREATMENT AVAILABLE/DOCTOR WON’T
TREAT
(07) WAIT TOO LONG/DOCTOR TOO BUSY
(08) OWN DOCTOR DOESN’T ACCEPT
MEDICARE/COULDN’T FIND DOCTOR WHO ACCEPTS
MEDICARE
(09) NOT ELIGIBLE FOR PUBLIC COVERAGE
(10) DIFFICULTY GETTING APPOINTMENT/ DELAYS
BECAUSE SP ON MEDICARE
(11) DOCTOR REFERRED SP TO SPECIALIST OR OTHER
DOCTOR
(12) HMO REFERRAL PROCESS (DIFFICULTY GETTING)
(13) PROBLEMS WITH HMO DOCTORS NOT GOOD OR
AVAILABLE
(14) HMO WOULD NOT COVER OR PROVIDE SERVICE
(91) OTHER
(-8) Don't Know
(-9) Refused
(01) BOX HFF6
(02) BOX HFF6
(03) BOX HFF6
(04) BOX HFF6
(05) BOX HFF6
(06) BOX HFF6
(07) BOX HFF6
(08) BOX HFF6
(09) BOX HFF6
(10) BOX HFF6
(11) BOX HFF6
(12) BOX HFF6
(13) BOX HFF6
(14) BOX HFF6
(91) HFAC30A - HCTOTHOS
(-8) BOX HFF6
(-9) BOX HFF6
(01) [Continuous answer.]
BOX HFF6
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFAC30C - CGETCODE
(02) HFAC31 - HCDELAY
(-8) HFAC31 - HCDELAY
(-9) HFAC31 - HCDELAY
yes/no
Since (LAST HF MONTH YEAR), [have you/has (SP)] been told by a doctor’s office that they cannot schedule
an appointment with [you/(SP)]?
(01) DOCTOR DOES NOT ACCEPT INSURANCE PLAN
(02) ALL OF DOCTORS APPOINTMENTS WERE FULL
(03) DOCTOR IS NOT ACCEPTING ANY NEW PATIENTS
(04) DOCTOR IS NOT ACCEPTING NEW MEDICARE
PATIENTS
(05) DOCTRS HOURS CONFLICTED WITH
What were the reasons the doctor’s office offered as an explanation for not scheduling an appointment with
REQUIREMENTS OF SP
[you/(SP)]?
(06) DOCTOR DOES NOT ACCEPT MEDICAID
(07) DOCTOR DOES NOT ACCEPT MEDICARE AT ALL
[PROBE: Any other reason?]
(08) DOCTOR DOES NOT ACCEPT MEDICARE
CHECK ALL THAT APPLY
ASSIGNMENT
(09) DOCTOR FELT ANOTHER PROVIDER WOULD BE
BETTER FOR SP
(91) OTHER
(-8) Don't Know
(-9) Refused
CGETCODE
HFAC30C
code all
CGETOTOS
CGETOTOS
verbatim text
BOX HFF7
routing
Please specify the other reason.
(01) [Continuous answer.]
IF RESPONSE TO HFAC30C - CGETCODE INCLUDES 4/DocNotAcceptNewMedicare OR 7/DocNotAcceptMCAR,
GO TO HFAC30D - OFFEXPLN.
ELSE GO TO HFAC31 - HCDELAY.
(01) BOX HFF7
(02) BOX HFF7
(03) BOX HFF7
(04) BOX HFF7
(05) BOX HFF7
(06) BOX HFF7
(07) BOX HFF7
(08) BOX HFF7
(09) BOX HFF7
(91) HFAC30C - CGETOTOS
(-8) BOX HFF7
(-9) BOX HFF7
BOX HFF7
Variable Name
MR Screen Name
Question type
Question text/description
OFFEXPLN
HFAC30D
yes/no
Did the doctor’s office explain why [it is difficult for Medicare patients to get an appointment/Medicare is
not accepted] at that practice?
OFFEXVB
HFAC30E
verbatim text
What was that explanation?
RECORD VERBATIM.
yes/no
Since (LAST HF MONTH YEAR), [have you/has (SP)] delayed seeking medical care because (you were/he
was/she was) worried about the cost?
HCDELAY
HFAC31
Code list
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
Routing
(01) HFAC30E - OFFEXVB
(02) HFAC31 - HCDELAY
(-8) HFAC31 - HCDELAY
(-9) HFAC31 - HCDELAY
(01) [Continuous answer.]
HFAC31 - HCDELAY
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
PAYPROB
HFAC32A
yes/no
Since (LAST HF MONTH YEAR) [have you/has (SP)] had problems paying or were unable to pay any medical
bills?
COLLAGNCY
HFAC32
yes/no
Because of problems paying medical bills since (LAST HF MONTH YEAR), [have you/has (SP)] been contacted
by a collection agency?
PAYOVRTM
HFAC32B
yes/no
[Do you /Does (SP)] currently have any medical bills that are being paid off over time?
IADLINTRO
HFKINTRO
no entry
Health problems can include physical, mental, emotional, or memory problems. I'd now like to ask you about
(01) CONTINUE
how health problems may affect [your/(SP)'s] ability to perform some other everyday activities. I’d like to
(-7) Empty
know whether [you have/(SP) has] any difficulty doing each activity by [yourself/himself/herself].
Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty...
PRBTELE
HFKA1
code 1
using the telephone?
[You said that using the telephone is something that [you don't/(SP) doesn't] do.]
DONTTELE
HFKA2
yes/no
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
PRBLHWK
HFKB1
code 1
doing light housework (like washing dishes, straightening up, or light cleaning)?
DONTLHWK
HFKB2
yes/no
[You said that doing light housework (like washing dishes, straightening up, or light cleaning) is something
that [you don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
PRBHHWK
HFKC1
code 1
doing heavy housework (like scrubbing floors or washing windows)?
DONTHHWK
HFKC2
yes/no
[You said that doing heavy housework (like scrubbing floors or washing windows) is something that [you
don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
PRBMEAL
HFKD1
code 1
preparing [your/his/her] own meals?
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
HFAC32 A-PAYPROB
(01) HFAC32 - COLLAGNCY
(02) HFKINTRO - IADLINTRO
(-8) HFKINTRO - IADLINTRO
(-9) HFKINTRO - IADLINTRO
HFAC32B- PAYOVRMT
HFKINTRO - IADLINTRO
HFKA1 - PRBTELE
(01) HFKB1 - PRBLHWK
(02) HFKB1 - PRBLHWK
(03) HFKA2 - DONTTELE
(-8) HFKB1 - PRBLHWK
(-9) HFKB1 - PRBLHWK
HFKB1 - PRBLHWK
(01) HFKC1 - PRBHHWK
(02) HFKC1 - PRBHHWK
(03) HFKB2 - DONTLHWK
(-8) HFKC1 - PRBHHWK
(-9) HFKC1 - PRBHHWK
HFKC1 - PRBHHWK
(01) HFKD1 - PRBMEAL
(02) HFKD1 - PRBMEAL
(03) HFKC2 - DONTHHWK
(-8) HFKD1 - PRBMEAL
(-9) HFKD1 - PRBMEAL
HFKD1 - PRBMEAL
(01) HFKE1 - PRBSHOP
(02) HFKE1 - PRBSHOP
(03) HFKD2 - DONTMEAL
(-8) HFKE1 - PRBSHOP
(-9) HFKE1 - PRBSHOP
Variable Name
MR Screen Name
Question type
DONTMEAL
HFKD2
yes/no
Question text/description
[You said that preparing [your/his/her] own meals is something that [you don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
PRBSHOP
HFKE1
code 1
shopping for personal items (such as toilet items or medicines)?
DONTSHOP
HFKE2
yes/no
[You said that shopping for personal items (such as toilet items or medicines) is something that [you
don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
PRBBILS
HFKF1
code 1
managing money (like keeping track of expenses or paying bills)?
DONTBILS
HFKF2
BOX HFKA1
HELPTELE
HFKA3
yes/no
routing
yes/no
[You said that managing money (like keeping track of expenses or paying bills) is something that [you
don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?
IF HFKA1 - PRBTELE = 1/Yes OR HFKA2 – DONTTELE = 1/Yes, GO TO HFKA3 - HELPTELE.
ELSE GO TO BOX HFKB1.
[[You said that [your/(SP's)] health makes using the telephone difficult./You said that using the telephone is
something that [you don't do/(SP) doesn't do].]]
[Do you/Does (SP)] receive help from another person with...
Code list
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
Routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFKA4 - PERSON_HLPRTELE
(02) BOX HFKB1
(-8) BOX HFKB1
(-9) BOX HFKB1
(01) [Continuous answer.]
BOX HFKB1
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFKB4 - PERSON_HLPRLHWK
(02) BOX HFKC1
(-8) BOX HFKC1
(-9) BOX HFKC1
HFKE1 - PRBSHOP
(01) HFKF1 - PRBBILS
(02) HFKF1 - PRBBILS
(03) HFKE2 - DONTSHOP
(-8) HFKF1 - PRBBILS
(-9) HFKF1 - PRBBILS
HFKF1 - PRBBILS
(01) BOX HFKA1
(02) BOX HFKA1
(03) HFKF2 - DONTBILS
(-8) BOX HFKA1
(-9) BOX HFKA1
BOX HFKA1
using the telephone?
PERSON_HLPRTEL
HFKA4
E
BOX HFKB1
HELPLHWK
HFKB3
roster
routing
You mentioned that [you receive/(SP) receives] help with using the telephone. Who gives that help?
ENTER ALL HELPERS.
IF HFKB1 - PRBLHWK = 1/Yes or HFKB2 - DONTLHWK = 1/Yes, GO TO HFKB3 - HELPLHWK.
ELSE GO TO BOX HFKC1.
[[You said that [your/(SP's)] health makes doing light housework (like washing dishes, straightening up, or
light cleaning) difficult./You said that doing light housework (like washing dishes, straightening up, or light
cleaning) is something that [you don't do/(SP) doesn't do].]]
yes/no
[Do you/Does (SP)] receive help from another person with...
PERSON_HLPRLH
WK
HELPHHWK
HFKB4
roster
BOX HFKC1
routing
HFKC3
PERSON_HLPRHH
HFKC4
WK
BOX HFKD1
yes/no
roster
routing
doing light housework (like washing dishes, straightening up, or light cleaning)?
You mentioned that [you receive/(SP) receives] help with doing light housework (like washing dishes,
(01) [Continuous answer.]
straightening up, or light cleaning). Who gives that help?
IF HFKC1 - PRBHHWK = 1/Yes or HFKC2 - DONTHHWK = 1/Yes, GO TO HFKC3 - HELPHHWK.
ELSE GO TO BOX HFKD1
[[You said that [your/(SP's)] health makes doing heavy housework (like scrubbing floors or washing windows)
difficult./You said that heavy housework (like scrubbing floors or washing windows) is something that [you
(01) YES
don't do/(SP) doesn't do].]]
(02) NO
(-8) Don't Know
[Do you/Does (SP)] receive help from another person with...
(-9) Refused
doing heavy housework (like scrubbing floors or washing windows)?
You mentioned that [you receive/(SP) receives] help with doing heavy housework (like scrubbing floors or
washing windows). Who gives that help?
ENTER ALL HELPERS.
IF HFKD1 – PRBMEAL = 1/Yes or HFKD2 – DONTMEAL = 1/Yes, GO TO HFKD3 - HELPMEAL.
ELSE GO TO BOX HFKE1.
(01) [Continuous answer.]
BOX HFKC1
(01) HFKC4 - PERSON_HLPRHHWK
(02) BOX HFKD1
(-8) BOX HFKD1
(-9) BOX HFKD1
BOX HFKD1
Variable Name
HELPMEAL
MR Screen Name
HFKD3
PERSON_HLPRME
HFKD4
AL
BOX HFKE1
HELPSHOP
HFKE3
PERSON_HLPRSHO
HFKE4
P
BOX HFKF1
HELPBILS
HFKF3
PERSON_HLPRBILS HFKF4
ADLSINTRO
HFLINTRO
Question type
yes/no
roster
routing
yes/no
roster
routing
yes/no
roster
no entry
Question text/description
[[You said that [your/(SP's)] health makes preparing [your/his/her] own meals difficult./You said that
preparing [your/his/her] own meals is something that [you don't do/(SP) doesn't do].]]
[Do you/Does (SP)] receive help from another person with...
HFLA1
Remembering that health problems can include physical, mental, emotional, or memory problems, I'd now
like to ask you about how health problems may affect [your/(SP)'s] ability to perform some other everyday
activities. I’d like to know whether [you have/(SP) has] any difficulty doing each activity by
[yourself/himself/herself] and without special equipment.
code 1
yes/no
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
HPPDDRES
HFLB1
code 1
dressing?
[You said that dressing is something that [you don't/(SP) doesn't] do.]
DONTDRES
HFLB2
yes/no
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
HPPDEAT
HFLC1
(01) HFKD4 - PERSON_HLPRMEAL
(02) BOX HFKE1
(-8) BOX HFKE1
(-9) BOX HFKE1
managing money (like keeping track of expenses or paying bills)?
You mentioned that [you receive/(SP) receives] help with managing money (like keeping track of expenses or
paying bills). Who gives that help?
(01) [Continuous answer.]
ENTER ALL HELPERS.
[You said that bathing or showering is something that [you don't/(SP) doesn't] do.]
HFLA2
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
shopping for personal items (such as toilet items or medicines)?
You mentioned that [you receive/(SP) receives] help with shopping for personal items (such as toilet items or
medicines). Who gives that help?
(01) [Continuous answer.]
ENTER ALL HELPERS.
IF HFKF1- PRBBILS = 1/Yes or HFKF2 – DONTBILS = 1/Yes, GO TO HFKF3 - HELPBILS.
ELSE GO TO HFLINTRO - ADLSINTRO.
[[You said that [your/(SP's)] health makes managing money (like keeping track of expenses or paying bills)
difficult./You said that managing money (like keeping track of expenses or paying bills) is something that [you
(01) YES
don't do/(SP) doesn't do].]]
(02) NO
(-8) Don't Know
[Do you/Does (SP)] receive help from another person with...
(-9) Refused
bathing or showering?
DONTBATH
Routing
preparing [your/his/her] own meals?
You mentioned that [you receive/(SP) receives] help with preparing [your/his/her] own meals. Who gives
(01) [Continuous answer.]
that help?
ENTER ALL HELPERS.
IF HFKE1 – PRBSHOP = 1/Yes or HFKE2 – DONTSHOP = 1/Yes, GO TO HFKE3 - HELPSHOP.
ELSE GO TO BOX HFKF1.
[[You said that [your/(SP's)] health makes shopping for personal items (such as toilet items or medicines)
difficult./You said that shopping for personal items (such as toilet items or medicines) is something that [you
(01) YES
don't do/(SP) doesn't do].]]
(02) NO
(-8) Don't Know
[Do you/Does (SP)] receive help from another person with...
(-9) Refused
Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty...
HPPDBATH
Code list
code 1
eating?
(01) CONTINUE
(-7) Empty
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
BOX HFKE1
(01) HFKE4 - PERSON_HLPRSHOP
(02) BOX HFKF1
(-8) BOX HFKF1
(-9) BOX HFKF1
BOX HFKF1
(01) HFKF4 - PERSON_HLPRBILS
(02) HFLINTRO - ADLSINTRO
(-8) HFLINTRO - ADLSINTRO
(-9) HFLINTRO - ADLSINTRO
HFLINTRO - ADLSINTRO
HFLA1 - HPPDBATH
(01) HFLB1 - HPPDDRES
(02) HFLB1 - HPPDDRES
(03) HFLA2 - DONTBATH
(-8) HFLB1 - HPPDDRES
(-9) HFLB1 - HPPDDRES
HFLB1 - HPPDDRES
(01) HFLC1 - HPPDEAT
(02) HFLC1 - HPPDEAT
(03) HFLB2 - DONTDRES
(-8) HFLC1 - HPPDEAT
(-9) HFLC1 - HPPDEAT
HFLC1 - HPPDEAT
(01) HFLD1 - HPPDCHAR
(02) HFLD1 - HPPDCHAR
(03) HFLC2 - DONTEAT
(-8) HFLD1 - HPPDCHAR
(-9) HFLD1 - HPPDCHAR
Variable Name
MR Screen Name
Question type
DONTEAT
HFLC2
yes/no
Question text/description
[You said that eating is something that [you don't/(SP) doesn't] do.]
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
HPPDCHAR
HFLD1
code 1
getting in or out of bed or chairs?
[You said that getting in or out of bed or chairs is something that [you don't/(SP) doesn't] do.]
DONTCHAR
HFLD2
yes/no
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
HPPDWALK
HFLE1
code 1
walking?
[You said that walking is something that [you don't/(SP) doesn't] do.]
DONTWALK
HFLE2
code 1
Is this because of a physical, mental, emotional, or memory problem?
[Because of a physical, mental, emotional, or memory problem, [do you/does (SP)] have any difficulty…]
HPPDTOIL
HFLF1
code 1
using the toilet, including getting up and down?
[You said that using the toilet is something that [you don't/(SP) doesn't] do.]
DONTTOIL
HFLF2
yes/no
Is this because of a physical, mental, emotional, or memory problem?
BOX HFLA1
HELPBATH
HFLA3
routing
yes/no
IF HFLA1 – HPPDBATH = 1/Yes OR HFLA2 - DONTBATH = 1/Yes, GO TO HFLA3 - HELPBATH.
ELSE GO TO BOX HFLB1.
[[You said [your/(SP's)] health makes bathing or showering difficult./You said that bathing or showering is
something [you don't/(SP) doesn't] do.]]
LONGBATH
STILBATH
(01) HFLF1 - HPPDTOIL
(02) HFLF1 - HPPDTOIL
(03) HFLE2 - DONTWALK
(-8) HFLF1 - HPPDTOIL
(-9) HFLF1 - HPPDTOIL
HFLF1 - HPPDTOIL
(01) BOX HFLA1
(02) BOX HFLA1
(03) HFLF2 - DONTTOIL
(-8) BOX HFLA1
(-9) BOX HFLA1
BOX HFLA1
How long [have you/has (SP)] needed help with bathing or showering? Has it been . . .
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFLB1
yes/no
[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with bathing or showering?
BOX HFLA2
routing
IF HFLA3 – HELPBATH = 1/Yes, GO TO HFLA6 - LONGBATH.
ELSE GO TO BOX HFLB1.
code 1
HFLE1 - HPPDWALK
(01) HFLA7 - STILBATH
(02) BOX HFLB1
(03) BOX HFLB1
(-8) BOX HFLB1
(-9) BOX HFLB1
HFLA5
HFLA6
(01) HFLE1 - HPPDWALK
(02) HFLE1 - HPPDWALK
(03) HFLD2 - DONTCHAR
(-8) HFLE1 - HPPDWALK
(-9) HFLE1 - HPPDWALK
(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused
yes/no
[That is, does someone usually stay or come into the room to check on [you/him/her]?]
EQIPBATH
HFLD1 - HPPDCHAR
(01) HFLA5 - EQIPBATH
(02) HFLA4 - PCHKBATH
(-8) HFLA4 - PCHKBATH
(-9) HFLA4 - PCHKBATH
Does someone usually stay nearby just in case [you need/(SP) needs] help with bathing or showering?
HFLA4
Routing
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[Do you/Does (SP)] receive help from another person with bathing or showering?
PCHKBATH
Code list
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(03) DOESN'T DO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFLA7
yes/no
Do you expect that [you/(SP)] will still need help with bathing or showering three months from now?
BOX HFLB1
routing
IF HFLB1 - HPPDDRES = 1/Yes OR HFLB2 – DONTDRES = 1/Yes, GO TO HFLB3 - HELPDRES.
ELSE GO TO BOX HFLC1.
HFLA5 - EQIPBATH
BOX HFLA2
Variable Name
MR Screen Name
Question type
HELPDRES
HFLB3
yes/no
Question text/description
[[You said [your/(SP's)] health makes dressing difficult./You said that dressing is something [you don't/(SP)
doesn't] do.]]
Code list
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
Routing
(01) HFLB5 - EQIPDRES
(02) HFLB4 - PCHKDRES
(-8) HFLB4 - PCHKDRES
(-9) HFLB4 - PCHKDRES
How long [have you/has (SP)] needed help with dressing? Has it been . . .
(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused
(01) HFLB7 - STILDRES
(02) BOX HFLC1
(03) BOX HFLC1
(-8) BOX HFLC1
(-9) BOX HFLC1
Do you expect that [you/(SP)] will still need help with dressing three months from now?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFLC1
[Do you/Does (SP)] receive help from another person with dressing?
Does someone usually stay nearby just in case [you need/(SP) needs] help with dressing?
PCHKDRES
HFLB4
yes/no
[That is, does someone usually stay or come into the room to check on [you/him/her]?]
EQIPDRES
LONGDRES
STILDRES
HELPEAT
HFLB5
yes/no
[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with dressing?
BOX HFLB2
routing
IF HFLB3 – HELPDRES = 1/Yes, GO TO HFLB6 - LONGDRES.
ELSE GO TO BOX HFLC1.
HFLB6
code 1
HFLB7
yes/no
BOX HFLC1
routing
HFLC3
yes/no
IF HFLC1 - HPPDEAT = 1/Yes OR HFLC2 – DONTEAT = 1/Yes, GO TO HFLC3 - HELPEAT.
ELSE GO TO BOX HFLD1.
[[You said [your/(SP's)] health makes eating difficult./You said that eating is something [you don't/(SP)
doesn't] do.]]
(01) HFLC5 - EQIPEAT
(02) HFLC4 - PCHKEAT
(-8) HFLC4 - PCHKEAT
(-9) HFLC4 - PCHKEAT
How long [have you/has (SP)] needed help with eating? Has it been . . .
(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused
(01) HFLC7 - STILEAT
(02) BOX HFLD1
(03) BOX HFLD1
(-8) BOX HFLD1
(-9) BOX HFLD1
Do you expect that [you/(SP)] will still need help with eating three months from now?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFLD1
Does someone usually stay nearby just in case [you need/(SP) needs] help with eating?
HFLC4
yes/no
[That is, does someone usually stay or come into the room to check on [you/him/her]?]
EQIPEAT
LONGEAT
STILEAT
HFLC5
yes/no
[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with eating?
BOX HFLC2
routing
IF HFLC3 - HELPEAT = 1/Yes, GO TO HFLC6 - LONGEAT.
ELSE GO TO BOX HFLD1.
HFLC6
code 1
HFLC7
yes/no
BOX HFLD1
routing
HELPCHAR
HFLD3
yes/no
PCHKCHAR
HFLD4
yes/no
BOX HFLB2
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[Do you/Does (SP)] receive help from another person with eating?
PCHKEAT
HFLB5 - EQIPDRES
IF HFLD1 – HPPDCHAR = 1/Yes OR HFLD2 - DONTCHAR = 1/Yes, GO TO HFLD3 - HELPCHAR.
ELSE GO TO BOX HFLE1.
[[You said [your/(SP's)] health makes getting in or out of bed or chairs difficult./You said that getting in or out (01) YES
of bed or chairs is something [you don't/(SP) doesn't] do.]]
(02) NO
(-8) Don't Know
[Do you/Does (SP)] receive help from another person with getting in or out of bed or chairs?
(-9) Refused
Does someone usually stay nearby just in case [you need/(SP) needs] help with getting in or out of bed or
(01) YES
chairs?
(02) NO
(-8) Don't Know
[That is, does someone usually stay or come into the room to check on (you/him/her)?]
(-9) Refused
HFLC5 - EQIPEAT
BOX HFLC2
(01) HFLD5 - EQIPCHAR
(02) HFLD4 - PCHKCHAR
(-8) HFLD4 - PCHKCHAR
(-9) HFLD4 - PCHKCHAR
HFLD5 - EQIPCHAR
Variable Name
MR Screen Name
Question type
Question text/description
EQIPCHAR
HFLD5
yes/no
[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with getting in or out of bed or
chairs?
BOX HFLD2
routing
IF HFLD3 – HELPCHAR = 1/Yes, GO TO HFLD6 - LONGCHAR.
ELSE GO TO BOX HFLE1.
LONGCHAR
STILCHAR
HELPWALK
HFLD6
code 1
HFLD7
yes/no
BOX HFLE1
routing
HFLE3
yes/no
Code list
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
Routing
How long [have you/has (SP)] needed help with getting in or out of bed or chairs? Has it been . . .
(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused
(01) HFLD7 - STILCHAR
(02) BOX HFLE1
(03) BOX HFLE1
(-8) BOX HFLE1
(-9) BOX HFLE1
Do you expect that [you/(SP)] will still need help with getting in or out of bed or chairs three months from
now?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFLE1
IF HFLE1- HPPDWALK = 1/Yes OR HFLE2 – DONTWALK = 1/Yes, GO TO HFLE3 - HELPWALK.
ELSE GO TO BOX HFLF1.
[[You said [your/(SP's)] health makes walking difficult./You said that walking is something [you don't/(SP)
doesn't] do.]]
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFLE5 - EQIPWALK
(02) HFLE4 - PCHKWALK
(-8) HFLE4 - PCHKWALK
(-9) HFLE4 - PCHKWALK
How long [have you/has (SP)] needed help with walking? Has it been . . .
(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused
(01) HFLE7 - STILWALK
(02) BOX HFLF1
(03) BOX HFLF1
(-8) BOX HFLF1
(-9) BOX HFLF1
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFLF1
[Do you/Does (SP)] receive help from another person with walking?
Does someone usually stay nearby just in case [you need/(SP) needs] help with walking?
PCHKWALK
HFLE4
yes/no
[That is, does someone usually stay or come into the room to check on (you/him/her)?]
EQIPWALK
LONGWALK
STILWALK
HELPTOIL
PCHKTOIL
HFLE5
yes/no
[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with walking?
BOX HFLE2
routing
IF HFLE3 - HELPWALK = 1/Yes, GO TO HFLE6 - LONGWALK.
ELSE GO TO BOX HFLF1.
HFLE6
code 1
HFLE7
yes/no
Do you expect that [you/(SP)] will still need help with walking three months from now?
BOX HFLF1
routing
IF HFLF1 – HPPDTOIL = 1/Yes OR HFLF2 – DONTTOIL = 1/Yes, GO TO HFLF3 - HELPTOIL.
ELSE GO TO BOX HFLA3.
yes/no
[[You said [your/(SP's)] health makes using the toilet difficult./You said that using the toilet is something [you (01) YES
don't/(SP) doesn't] do.]]
(02) NO
(-8) Don't Know
[Do you/Does (SP)] receive help from another person with using the toilet, including getting up and down?
(-9) Refused
HFLF3
HFLF4
yes/no
Does someone usually stay nearby just in case [you need/(SP) needs] help with using the toilet, including
getting up and down?
[That is, does someone usually stay or come into the room to check on [you/him/her]?]
EQIPTOIL
BOX HFLD2
HFLF5
yes/no
[Do you/Does (SP)] use special equipment or aids to help [you/him/her] with using the toilet, including
getting up and down?
BOX HFLF2
routing
IF HFLF3 - HELPTOIL = 1/Yes, GO TO HFLF6 - LONGTOIL.
ELSE GO TO BOX HFLA3.
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
HFLE5 - EQIPWALK
BOX HFLE2
(01) HFLF5 - EQIPTOIL
(02) HFLF4 - PCHKTOIL
(-8) HFLF4 - PCHKTOIL
(-9) HFLF4 - PCHKTOIL
HFLF5 - EQIPTOIL
BOX HFLF2
Variable Name
LONGTOIL
STILTOIL
MR Screen Name
HFLF6
Question type
code 1
Question text/description
Code list
Routing
How long [have you/has (SP)] needed help with using the toilet? Has it been . . .
(01) less than three months,
(02) three months or more but less than one year, or
(03) one year or more?
(-8) Don't Know
(-9) Refused
(01) HFLF7 - STILTOIL
(02) BOX HFLA3
(03) BOX HFLA3
(-8) BOX HFLA3
(-9) BOX HFLA3
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
BOX HFLA3
(01) [Continuous answer.]
BOX HFLB3
(01) [Continuous answer.]
BOX HFLC3
(01) [Continuous answer.]
BOX HFLD3
(01) [Continuous answer.]
BOX HFLE3
(01) [Continuous answer.]
BOX HFLF3
(01) [Continuous answer.]
BOX HFL4
(01) [Continuous answer.]
HFM1 - FALLANY
HFLF7
yes/no
Do you expect that [you/(SP)] will still need help with using the toilet three months from now?
BOX HFLA3
routing
IF HFLA3 - HELPBATH = 1/Yes, GO TO HFLA9 - PERSON_HLPRBATH.
ELSE GO TO BOX HFLB3.
PERSON_HLPRBAT
HFLA9
H
BOX HFLB3
PERSON_HLPRDRE
HFLB9
S
BOX HFLC3
PERSON_HLPREAT HFLC9
BOX HFLD3
PERSON_HLPRCHA
HFLD9
R
BOX HFLE3
PERSON_HLPRWA
HFLE9
LK
BOX HFLF3
PERSON_HLPRTOI
HFLF9
L
BOX HFL4
PERSON_HLPRMO
HFL10
ST
You mentioned that [you receive/(SP) receives] help with bathing and showering. Who gives that help?
roster
ENTER ALL HELPERS.
routing
IF HFLB3 - HELPDRES = 1/Yes, GO TO HFLB9 - PERSON_HLPRDRES.
ELSE GO TO BOX HFLC3.
You mentioned that [you receive/(SP) receives] help with dressing. Who gives that help?
roster
routing
ENTER ALL HELPERS.
IF HFLC3 – HELPEAT = 1/Yes, GO TO HFLC9 - PERSON_HLPREAT.
ELSE GO TO BOX HFLD3.
You mentioned that [you receive/(SP) receives] help with eating. Who gives that help?
roster
routing
roster
routing
ENTER ALL HELPERS.
IF HFLD3 – HELPCHAR = 1/Yes, GO TO HFLD9 - PERSON_HLPRCHAR.
ELSE GO TO BOX HFLE3.
You mentioned that [you receive/(SP) receives] help with getting in or out of bed or chairs. Who gives that
help?
ENTER ALL HELPERS.
IF HFLE3 – HELPWALK = 1/Yes, GO TO HFLE9 - PERSON_HLPRWALK.
ELSE GO TO BOX HFLF3.
You mentioned that [you receive/(SP) receives] help with walking. Who gives that help?
roster
routing
ENTER ALL HELPERS.
IF HFLF3 – HELPTOIL = 1/Yes, GO TO HFLF9 - PERSON_HLPRTOIL.
ELSE GO TO BOX HFL4.
You mentioned that [you receive/(SP) receives] help with using the toilet. Who gives that help?
roster
routing
ENTER ALL HELPERS.
IF MORE THAN ONE PERSON SELECTED AT HFLA9, HFLB9, HFLC9, HFLD9, HFLE9, AND/OR HFLF9, GO TO HFL10
- PERSON_HLPRMOST.
ELSE GO TO HFM1 - FALLANY.
Which of these persons gives [you/(SP)] the most help with these things?
roster
SELECT ONLY ONE.
FALLANY
HFM1
yes/no
FALLTIME
HFM2
numeric
Since (LAST HF MONTH YEAR), [have you/has (SP)] fallen down?
Since (LAST HF MONTH YEAR), how many times [have you/has (SP)] fallen down?
ENTER "95" IF 95 OR MORE FALLS REPORTED.
FALLHELP
HFM3A
yes/no
Thinking about the [most recent) time that [you/(SP)] fell, did [you/he/she] hurt [yourself/himself/herself]
badly enough to get medical help?
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[Continuous answer.]
Don't Know
Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) HFM2 - FALLTIME
HFM3A - FALLHELP
HFM3B - FALCODE
Variable Name
MR Screen Name
Question type
FALCODE
HFM3B
code all
FALOTHOS
HFM3B
verbatim text
FALLIMIT
HFM3C
yes/no
FALLBACK
HFM3D
code 1
FALLFEAR
HFM3E
numeric
BOX MH1
routing
HFGAD1
HFN1
list
HFGAD2
HFN2
list
HFPHQ1
HFN3
list
HFPHQ2
HFN4
list
HFPHQ3
HFN5
list
Question text/description
Code list
(01) BROKEN BONE/FRACTURE
(02) SPRAIN/STRAIN
(03) BRUISE
What kind of injury did [you/(SP)] have in that [most recent] fall?
(04) CUT/WOUND/LACERATION
(05) CONCUSSION
[PROBE: Anything else?]
(06) DISLOCATION
(91) OTHER
CHECK ALL THAT APPLY.
(96) NO INJURY
(-8) Don't Know
(-9) Refused
OTHER (SPECIFY)
(01) [Continuous answer.]
(01) YES
(02) NO
Did [your/(SP's)] [most recent] fall cause [you/him/her] to limit [your/his/her] regular acivities?
(-8) Don't Know
(-9) Refused
(01) LESS THAN ONE WEEK
(02) ONE WEEK OR MORE
How long did it take [you/(SP)] to get back to regular activities after [your/his/her] [most recent] fall?
(03) NEVER RESUMED REGULAR ACTIVITIES
(-8) Don't Know
(-9) Refused
(01) [Continuous answer.]
How would you rate [your/(SP's)] fear of falling on a scale of 1 to 6, where 1 is "Not at all afraid of falling" and
(-8) Don't Know
6 is "Extremely afraid of falling"?
(-9) Refused
If the respondent is a proxy (SPPROXY=2), go to HFQ1 - LOSTURIN.
Else go to HFN1 - HFGAD1.
The next few questions ask about the last two weeks.
(01) NOT AT ALL
(02) SEVERAL DAYS
SHOW CARD HF8
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
Over the last 2 weeks, how often have you been bothered by the following problems?
(-8) REFUSED
(-9) DON’T KNOW
Feeling nervous, anxious, or on edge
(01) NOT AT ALL
SHOW CARD HF8
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems?]
(04) NEARLY EVERY DAY
(-8) REFUSED
Not being able to stop or control worrying.
(-9) DON’T KNOW
(01) NOT AT ALL
SHOW CARD HF8
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(04) NEARLY EVERY DAY
(-8) REFUSED
little interest or pleasure in doing things? Would you say…
(-9) DON’T KNOW
(01) NOT AT ALL
SHOW CARD HF8
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(04) NEARLY EVERY DAY
(-8) REFUSED
feeling down, depressed, or hopeless?
(-9) DON’T KNOW
(01) NOT AT ALL
SHOW CARD HF8
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(04) NEARLY EVERY DAY
(-8) REFUSED
trouble falling or staying asleep, or sleeping too much?
(-9) DON’T KNOW
Routing
(01) HFM3C - FALLIMIT
(02) HFM3C - FALLIMIT
(03) HFM3C - FALLIMIT
(04) HFM3C - FALLIMIT
(05) HFM3C - FALLIMIT
(06) HFM3C - FALLIMIT
(91) HFM3B - FALOTHOS
(96) HFM3C - FALLIMIT
(-8) HFM3C - FALLIMIT
(-9) HFM3C - FALLIMIT
HFM3C - FALLIMIT
(01) HFM3D - FALLBACK
(02) HFM3E - FALLFEAR
(-8) HFM3E - FALLFEAR
(-9) HFM3E - FALLFEAR
HFM3E - FALLFEAR
BOX MH1
HFN2 - HFGAD2
HFN3 - HFPHQ1
HFN4 - HFPHQ2
HFN5 - HFPHQ3
HFN6 - HFPHQ4
Variable Name
MR Screen Name
Question type
HFPHQ4
HFN6
list
HFPHQ5
HFN7
list
HFPHQ6
HFN8
list
HFPHQ7
HFN9
list
HFPHQ8
HFN10
list
HFPHQ10
HFN11
code one
LOSTURIN
HFQ1
code 1
TALKURIN
HFQ2
yes/no
FEELURIN
HFQ3
yes/no
REASURIN
HFQ4
yes/no
Question text/description
Code list
(01) NOT AT ALL
SHOW CARD HF8
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(04) NEARLY EVERY DAY
(-8) REFUSED
feeling tired or having little energy?
(-9) DON’T KNOW
(01) NOT AT ALL
SHOW CARD HF8
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(04) NEARLY EVERY DAY
(-8) REFUSED
poor appetite or overeating?
(-9) DON’T KNOW
(01) NOT AT ALL
SHOW CARD HF8
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(04) NEARLY EVERY DAY
(-8) REFUSED
feeling bad about yourself – or that you are a failure or have let yourself or your family down?
(-9) DON’T KNOW
(01) NOT AT ALL
SHOW CARD HF8
(02) SEVERAL DAYS
(03) MORE THAN HALF THE DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(04) NEARLY EVERY DAY
(-8) REFUSED
trouble concentrating on things, such as reading the newspaper or watching TV?
(-9) DON’T KNOW
SHOW CARD HF8
(01) NOT AT ALL
(02) SEVERAL DAYS
[Over the last 2 weeks, how often have you been bothered by the following problems:]
(03) MORE THAN HALF THE DAYS
(04) NEARLY EVERY DAY
moving or speaking so slowly that other people could have noticed? Or the opposite – being so fidgety or
(-8) REFUSED
restless that you have been moving around a lot more than usual?
(-9) DON’T KNOW
(01) Not at all difficult,
SHOW CARD HF9
(02) Somewhat difficult,
(03) Very difficult,
How difficult have these problems made it for you to do your work, take care of things at home, or get along (04) Extremely difficult?
with people?
(-8) REFUSED
(-9) DON’T KNOW
(01) MORE THAN ONCE A WEEK
(02) ABOUT ONCE A WEEK
(03) 2-3 TIMES A MONTH
SHOW CARD HF10
(04) ABOUT ONCE A MONTH
(05) EVERY 2-3 MONTHS
I'd like to ask about a health problem that is more common than people think. Please look at this card and
(06) ONCE OR TWICE A YEAR
tell me how often, if at all, since (LAST HF MONTH YEAR) [you have/(SP) has] lost urine because [you/he/she] (07) NOT AT ALL
could not control [your/his/her] bladder.
(08) SP IS ON DIALYSIS OR CATHETERIZATION OR
UROSTOMY OR BLADDER BAG
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
[Have you/Has (SP)] talked about this problem with [your/(SP’s)] doctor or other health professional?
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
Has [your/(SP’s)] doctor or other health professional asked [you/him/her] about how [you/he/she] feel[s]
(-8) Don't Know
about this problem?
(-9) Refused
(01) YES
Has [your/(SP’s)] doctor or other health professional examined [you/him/her] to figure out why [you/he/she] (02) NO
[lose/loses] urine?
(-8) Don't Know
(-9) Refused
Routing
HFN7 - HFPHQ5
HFN8 - HFPHQ6
HFN9 - HFPHQ7
HFN10 - HFPHQ8
HFN11 - HFPHQ10
HFQ1 - LOSTURIN
(01) HFQ2 - TALKURIN
(02) HFQ2 - TALKURIN
(03) HFQ2 - TALKURIN
(04) HFQ2 - TALKURIN
(05) HFQ2 - TALKURIN
(06) HFQ2 - TALKURIN
(07) BOX HFT1
(08) BOX HFT1
(-8) BOX HFT1
(-9) BOX HFT1
(01) HFQ3 - FEELURIN
(02) BOX HFT1
(-8) BOX HFT1
(-9) BOX HFT1
HFQ4 - REASURIN
HFQ5 - SURGURIN
Variable Name
MR Screen Name
Question type
Question text/description
SURGURIN
HFQ5
yes/no
Has [your/(SP’s)] doctor or other health professional talked with [you/him/her] about taking medicine or
having surgery for this problem?
BOX HFT1
routing
HYPETOLD
HFT1
code 1
HYPEAGE
HFT2
numeric
HYPEAGE_LESSON
HFT2
E
numeric
HYPEHOME
HFT6D
yes/no
HYPEMEDS
HFT6G
yes/no
HYPEDRNK
HFT6J
yes/no
BOX HFT2
routing
HFT7
numeric
HYPELONG_LESSO
HFT7
NE
numeric
HYPELONG
BOX HFT3
routing
IF HFJ2 - OCHBP = 1/Yes, GO TO HFT1 - HYPETOLD.
ELSE GO TO BOX HFEND.
We have recorded that [you were/(SP) was] told by a doctor or other health professional that [you had/he
had/she had] hypertension, also called high blood pressure.
(01) YES
(02) NO
[Were you/Was (SP)] told on two or more different medical visits that [you/he/she] had high blood pressure (03) SP NEVER HAD HIGH BLOOD
or hypertension?
PRESSURE/PREVIOUS RESPONSE ENTERED IN ERROR
(-8) Don't Know
[EXPLAIN IF NECESSARY: We are interested in knowing whether [your/(SP’s)] blood pressure was high for
(-9) Refused
more than one reading.]
(01) [Continuous answer.]
How old [were you/was (SP)] when [you were/he was/she was] first told that [you/he/she] had high blood
(-8) Don't Know
pressure?
(-9) Refused
How old [were you/was (SP)] when (you were/he was/she was) first told that [you/he/she] had high blood
(01) LESS THAN ONE YEAR OLD
pressure?
(-7) Empty
(01) YES
Because of [your/his/her] high blood pressure, [are you/is (SP)] now measuring [your/his/her] blood pressure (02) NO
at home?
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
Because of [your/his/her] high blood pressure, [are you/is (SP)] now taking prescribed medicine for
(-8) Don't Know
[your/his/her] high blood pressure?
(-9) Refused
(01) YES
(02) NO
[Have you/Has (SP)] cut down on drinking alcoholic beverages because of [your/his/her] high blood
(-8) Don't Know
pressure?]
(-9) Refused
IF HFT6G - HYPEMEDS = 1/Yes, GO TO HFT7 - HYPELONG.
ELSE GO TO HFT12A - HYPECTRL.
(01) [Continuous answer.]
How long [have you/has (SP)] been treated with prescribed medicines for [your/his/her] high blood
(-8) Don't Know
pressure?
(-9) Refused
How long [have you/has (SP)] been treated with prescribed medicines for [your/his/her] high blood
(01) LESS THAN ONE YEAR
pressure?
(-7) Empty
IF SP IS IN THE SUPPLEMENTAL SAMPLE (sample_person.INTTYPE=3), GO TO HFT8 - HYPEMANY.
ELSE GO TO HFT11A - HYPECOND.
How many different prescribed medicines [do you/does (SP)] take for [your/his/her] high blood pressure?
HYPEMANY
HYPECOND
HYPECTRL
HFT8
HFT11A
numeric
code 1
HFT12A
code 1
BOX HFT4
routing
Code list
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
[WE ARE ASKING ABOUT HOW MANY DIFFERENT PRESCRIBED MEDICINES FOR HIGH BLOOD PRESSURE ARE
TAKEN BY THE RESPONDENT, NOT THE NUMBER OF PILLS THEY MIGHT TAKE IN ONE DAY.]
(01) [Continuous answer.]
(-8) Don't Know
(-9) Refused
How often [do you/does (SP)] have trouble with side effects from [your/his/her] blood pressure
(01) ALWAYS
medicines[s]? Please tell me if [you/he/she] always, sometimes, or never [have/has] trouble with side effects. (02) SOMETIMES
(03) NEVER
[EXPLAIN IF NECESSARY: By "side effects", I mean that the medicine causes any condition such as fatigue,
(-8) Don't Know
headache, or coughing.]
(-9) Refused
(01) VERY CONFIDENT
Doctors and other health professionals often recommend changing your habits or lifestyle, such as changing
(02) CONFIDENT
your diet, or getting regular exercise in order to control blood pressure. How confident are you that
(03) SOMEWHAT CONFIDENT
[you/(SP)] can follow these recommendation?
(04) NOT AT ALL CONFIDENT
(-8) Don't Know
Would you say that you are very confident, confident, somewhat confident, or not at all confident?
(-9) Refused
IF HFT6G - HYPEMEDS = 1/Yes, GO TO HFT13 - HYPEPAY.
ELSE GO TO BOX HFEND.
Routing
BOX HFT1
(01) HFT2 - HYPEAGE
(02) HFT2 - HYPEAGE
(03) BOX HFEND
(-8) HFT2 - HYPEAGE
(-9) HFT2 - HYPEAGE
HFT2 - HYPEAGE_LESSONE
HFT6D - HYPEHOME
HFT6G - HYPEMEDS
HFT6J - HYPEDRNK
BOX HFT2
HFT7 - HYPELONG_LESSONE
BOX HFT3
HFT11A - HYPECOND
HFT12A - HYPECTRL
BOX HFT4
Variable Name
MR Screen Name
Question type
Question text/description
HYPEPAY
HFT13
yes/no
[Do you/Does (SP)] have difficulty paying for the medicine[s] [your/his/her] doctor or other health
professional prescribes for [your/his/her] high blood pressure?
HYPESKIP
HFT14
yes/no
[Do you/Does (SP)] ever skip taking [your/his/her] medicine, take less medicine than prescribed, or share
medicine because of the cost of the medicine?
BALINTRO
HFQX
no entry
Next I am going to ask you to do a few simple activities for me, starting with a balance measure. Let me first
demonstrate this measure. After I demonstrate the measure, please tell me if you cannot do a particular
movement or if you feel it would be unsafe to try and do it.
Code list
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
(01) YES
(02) NO
(-8) Don't Know
(-9) Refused
Routing
(1) CONTINUE
(2) R CANNOT PARTICIPATE
(-9) REFUSED
(1) BALPOS1
(2) WALINTRO
(-9) WALINTRO
HFT14 - HYPESKIP
BOX HFEND
SHOWCARD HF#
DEMONSTRATE FIRST POSITION WHILE EXPLAINING POSITION
STAND WITH FEET TOGETHER, SIDE-BY-SIDE FOR 10 SECONDS
TRY NOT TO MOVE YOUR FEET
TRY TO HOLD THIS POSITION UNTIL I TELL YOU TO STOP
ASK R TO STAND IN FIRST POSITION
ONCE R IS IN POSITION, SAY ‘BEGIN’ AND START TIMING
BALPOS1
HFQX
code one
TIME THE FIRST POSITION
PUSH ‘START/STOP’ BUTTON WHEN YOU SAY ‘BEGIN’
PUSH ‘START/STOP’ BUTTON AND SAY ‘STOP’ AFTER 10 SECONDS, OR
PUSH ‘START/STOP’ BUTTON IF RESPONDENT STEPS OUT OF THE POSITION BEFORE 10 SECONDS
(1) NUMBER OF SECONDS HELD: _____
(2) EQUIPMENT PROBLEM
(3) TRIED, UNABLE TO DO
(4) R COULD NOT HOLD POSITION UNASSISTED
(5) NOT ATTEMPTED, FI FELT IT WAS UNSAFE
(6) NOT ATTEMPTED, R FELT UNSAFE
(7) R UNABLE TO UNDERSTAND INSTRUCTIONS
(8) OTHER (SPECIFY): ________________
(-8) DON'T KNOW
(-9) REFUSED
If (1) >= 10, go to BALPOS2;
ELSE TO TO BALNOTES
WHEN R IS IN FIRST POSITION:
Are you ready?
WHEN R IS READY, PUSH ‘START/STOP’ AND SAY:
Begin
SHOWCARD HF#
DEMONSTRATE SECOND POSITION WHILE EXPLAINING POSITION
STAND WITH THE HEEL OF ONE FOOT TOUCHING THE SIDE OF THE BIG TOE OF THE OTHER FOOT FOR 10
SECONDS
TRY NOT TO MOVE YOUR FEET
TRY TO HOLD THIS POSITION UNTIL I TELL YOU TO STOP
ASK R TO STAND IN SECOND POSITION
BALPOS2
HFQX
code one
ONCE R IS IN POSITION, SAY ‘BEGIN’ AND START TIMING
TIME THE SECOND POSITION
PUSH ‘START/STOP’ BUTTON WHEN YOU SAY ‘BEGIN’
PUSH ‘START/STOP’ BUTTON AND SAY ‘STOP’ AFTER 10 SECONDS, OR
PUSH ‘START/STOP’ BUTTON IF RESPONDENT STEPS OUT OF THE POSITION BEFORE 10 SECONDS
WHEN R IS IN SECOND POSITION:
Are you ready?
WHEN R IS READY, PUSH ‘START/STOP’ AND SAY:
Begin
(1) NUMBER OF SECONDS HELD: _____
(2) EQUIPMENT PROBLEM
(3) TRIED, UNABLE TO DO
(4) R COULD NOT HOLD POSITION UNASSISTED
(5) NOT ATTEMPTED, FI FELT IT WAS UNSAFE
(6) NOT ATTEMPTED, R FELT UNSAFE
(7) R UNABLE TO UNDERSTAND INSTRUCTIONS
(8) OTHER (SPECIFY): ________________
(-8) DON'T KNOW
(-9) REFUSED
If (1) >= 10, go to BALPOS3;
ELSE TO TO BALNOTES
Variable Name
MR Screen Name
Question type
Question text/description
Code list
Routing
SHOWCARD HF#
DEMONSTRATE THIRD POSITION WHILE EXPLAINING POSITION
STAND WITH THE HEEL OF ONE FOOT IN FRONT OF AND TOUCHING THE TOES OF THE OTHER FOOT FOR
10 SECONDS
TRY NOT TO MOVE YOUR FEET
TRY TO HOLD THIS POSITION UNTIL I TELL YOU TO STOP
ASK R TO STAND IN THIRD POSITION
BALPOS3
HFQX
code one
ONCE R IS IN POSITION, SAY ‘BEGIN’ AND START TIMING
TIME THE THIRD POSITION
PUSH ‘START/STOP’ BUTTON WHEN YOU SAY ‘BEGIN’
PUSH ‘START/STOP’ BUTTON AND SAY ‘STOP’ AFTER 10 SECONDS, OR
PUSH ‘START/STOP’ BUTTON IF RESPONDENT STEPS OUT OF THE POSITION BEFORE 10 SECONDS
(1) NUMBER OF SECONDS HELD: _____
(2) EQUIPMENT PROBLEM
(3) TRIED, UNABLE TO DO
(4) R COULD NOT HOLD POSITION UNASSISTED
(5) NOT ATTEMPTED, FI FELT IT WAS UNSAFE
(6) NOT ATTEMPTED, R FELT UNSAFE
(7) R UNABLE TO UNDERSTAND INSTRUCTIONS
(8) OTHER (SPECIFY): ________________
(-8) DON'T KNOW
(-9) REFUSED
BALNOTES
WHEN R IS IN THIRD POSITION:
Are you ready?
WHEN R IS READY, PUSH ‘START/STOP’ AND SAY:
Begin
BALNOTES
WALINTRO
HFQX
HFQX
text
ENTER NOTES ABOUT THE BALANCE TEST
no entry
Now I am going to observe how you normally walk. If you use a cane or other walking aid and you feel you
need it to walk a short distance, then you may use it. First, let me demonstrate this measure.
(1) CONTINUOUS
(1) CONTINUE
(2) R CANNOT PARTICIPATE (IN WHEELCHAIR, CAN’T
STAND UNASSISTED)
(-9) REFUSED
WALINTRO
(1) ABLE TO DO (SPECIFY SECONDS): ______
(2) EQUIPMENT PROBLEM
(3) TRIED, UNABLE TO DO
(4) R COULD NOT WALK UNASSISTED
(5) NOT ATTEMPTED, FI FELT UNSAFE
(6) NOT ATTEMPTED, R FELT UNSAFE
(7) R UNABLE TO UNDERSTAND INSTRUCTIONS
(8) OTHER (SPECIFY): ___________
(-8) DON'T KNOW
(-9) REFUSED
(1) WALKTIM2
(2) WALNOTES
(3) WALNOTES
(4) WALNOTES
(5) WALNOTES
(6) WALNOTES
(7) WALNOTES
(8) WALNOTES
(-8) WALNOTES
(-9) WALNOTES
(1) ABLE TO DO (SPECIFY SECONDS): ______
(2) EQUIPMENT PROBLEM
(3) TRIED, UNABLE TO DO
(4) R COULD NOT WALK UNASSISTED
(5) NOT ATTEMPTED, FI FELT UNSAFE
(6) NOT ATTEMPTED, R FELT UNSAFE
(7) R UNABLE TO UNDERSTAND INSTRUCTIONS
(8) OTHER (SPECIFY): ___________
(-8) DON'T KNOW
(-9) REFUSED
(1) WALKPROB
(2) WALKPROB
(3) WALKPROB
(4) WALKPROB
(5) WALKPROB
(6) WALKPROB
(7) WALKPROB
(8) WALKPROB
(-8) WALKPROB
(-9) WALKPROB
(1) WALKTIM1
(2) WALNOTES
(3) WALNOTES
USE PRE-CUT STRING TO MEASURE DISTANCE ON THE FLOOR
DEMONSTRATE THE WALK WHILE PROVIDING INSTRUCTIONS
STAND WITH TOES TOUCHING THE BEGINNING OF THE STRING
START WALKING WHEN I SAY BEGIN
WALK AT YOUR USUAL PACE
WALK PAST THE END OF THE STRING BEFORE YOU STOP
WALKTIM1
HFQX
code one
ALLOW R TO USE HIS/HER WALKING AID (CANE OR WALKER)
ASK R TO STAND AT BEGINNING OF STRING
When I say “Begin” you may start walking.
PUSH ‘START/STOP’ AND SAY:
‘Begin’
PUSH ‘START/STOP’ WHEN ONE OF R’S FEET IS COMPLETELY ACROSS THE OTHER END OF THE STRING
ASK RESPONDENT TO REPEAT WALK, FROM THE END OF THE STRING BACK TO THE BEGINNING OF THE
STRING
When I say “Begin” you may start walking.
WALKTIM2
HFQX
code one
PUSH ‘START/STOP’ AND SAY:
‘Begin’
PUSH ‘START/STOP’ WHEN ONE OF R’S FEET IS COMPLETELY ACROSS THE OTHER END OF THE STRING
Variable Name
MR Screen Name
Question type
WALKPROB
HFQX
code all
WALNOTES
HFQX
text
CSINTRO
HFQX
no entry
SNGLCS
HFQX
code one
CSINTRO2
HFQX
no entry
Question text/description
Code list
(1) R WALKED UNSTEADILY
(2) R LIMPED, SHUFFLED OR DRAGGED A LEG
(3) R USED A CANE
CHECK ALL THAT APPLY
(4) R USED WALKER
(5) R STATED IT’S PAINFUL
(6) NOTHING APPLIES
ENTER NOTES ABOUT THE GAIT SPEED TEST
(1) CONTINUOUS
(1) CONTINUE
Now I am going to ask you to stand up from a chair without using your arms. First, let me demonstrate this
(2) R CANNOT PARTICIPATE (IN WHEELCHAIR, CAN’T
measure. After I demonstrate the measure, please tell me if you cannot do this movement or if you feel it
STAND UNASSISTED)
would be unsafe to try.
(-9) REFUSED
(1) R STOOD WITHOUT USING ARMS
(2) R USED ARMS TO STAND
DEMONSTRATE CHAIR STAND WHILE PROVIDING INSTRUCTIONS
SIT IN CHAIR WITH YOUR FEET ON THE FLOOR. SIT SO THAT YOU CAN PLACE THE WIDTH OF YOUR HANDS (3) EQUIPMENT PROBLEM
(4) TRIED, UNABLE TO DO
BETWEEN THE CHAIR AND YOUR KNEES.
(5) R COULD NOT STAND UNASSISTED
FOLD YOUR ARMS ACROSS YOUR CHEST
(6) NOT ATTEMPTED, FI FELT IT WAS UNSAFE
STAND UP, KEEPING YOUR ARMS FOLDED ACROSS YOUR CHEST
(7) NOT ATTEMPTED, R FELT UNSAFE
When I say ‘Begin’ you may stand up straight from the chair.
(8) R UNABLE TO UNDERSTAND INSTRUCTIONS
(9) OTHER (SPECIFY): __________
IF R CANNOT RISE WITHOUT USING ARMS, ASK R TO TRY TO STAND UP USING ARMS
(-8) DON'T KNOW
(-9) REFUSED
Now I'm going to ask you to stand up and sit down as quickly as you can five times, keeping your arms folded
(1) CONTINUE
across your chest. I'm going to demonstrate one for you.
DEMONSTRATE 1 CHAIR STAND WHILE PROVIDING INSTRUCTIONS
SIT IN CHAIR WITH YOUR FEET ON THE FLOOR
FOLD YOUR ARMS ACROSS YOUR CHEST
STAND UP AND SIT DOWN ONCE
TELL R TO REPEAT THAT 4 MORE TIMES
When I say “Begin” you may stand up.
RPTDCS
HFQX
code one
PUSH ‘START/STOP’ AND SAY ‘Begin’
COUNT OUT LOUD AS RESPONDENT ARISES EACH TIME
PUSH ‘START/STOP’ WHEN R HAS COMPLETELY STOOD UP FROM THE CHAIR FOR THE 5TH TIME
STOP THE EXERCISE EARLY IF R CANNOT RISE WITHOUT USING ARMS, R IS TOO TIRED TO CONTINUE, OR R
IS UNABLE TO COMPLETE AFTER 1 MINUTE
CSNOTES
HFQX
text
(1) TIME TO COMPLETE FIVE STANDS (SPECIFY
SECONDS): ______
(2) EQUIPMENT PROBLEM
(3) TRIED, UNABLE TO DO
(4) R COULD NOT STAND UNASSISTED
(5) NOT ATTEMPTED, FI FELT IT WAS UNSAFE
(6) NOT ATTEMPTED, R FELT UNSAFE
(7) R UNABLE TO UNDERSTAND INSTRUCTIONS
(8) OTHER (SPECIFY): __________
(-8) DON'T KNOW
(-9) REFUSED
ENTER NOTES ABOUT THE CHAIR STAND TEST
Routing
WALNOTES
CSINTRO
(1) SNGLCS
(2) CSNOTES
(-9) CSNOTES
(1) CSINTRO2
(2) CSNOTES
(3) CSNOTES
(4) CSNOTES
(5) CSNOTES
(6) CSNOTES
(7) CSNOTES
(8) CSNOTES
(9) CSNOTES
(-8) CSNOTES
(-9) CSNOTES
RPTDCS
CSNOTES
CNTTM20
Now I'd like to ask you some questions having to do with memory. For this next question, please try to count
backward as quickly as you can from the number I will give you. I will tell you when to stop.
CNTTM20
HFQX
numeric
ALLOW R TO START OVER IF S/HE WISHES TO DO SO
Please start with: 20
(1) CONTINUOUS
(-8) DON'T KNOW
(-9) REFUSED
(1) CNTOTCM1
(-8) TDYMTH
(-9) TDYMTH
(1) CORRECT
(2) INCORRECT
(3) WANTS TO START OVER
(-9) REFUSED
(1) TDYMTH
(2) TDYMTH
(3) CNTTMT2
(-9) TDYMTH
(1) CONTINUOUS
(-8) DON'T KNOW
(-9) REFUSED
CNTOTCM2
CORRECT RESPONSES INCLUDE COUNTING DOWN FROM 19 TO 10 OR FROM 20 TO 11
You may stop now. Thank you.
CNTOTCM1
HFQX
code one
CODE CORRECT IF R COUNTED BACKWARDS FROM 19 TO 10 OR FROM 20 TO 11 WITHOUT ERROR
ALLOW R TO START OVER IF S/HE WISHES TO DO SO
Let's try again.
CNTTMT2
HFQX
numeric
The number to count backward from is: 20
Variable Name
MR Screen Name
Question type
CNTOTCM2
HFQX
code one
Question text/description
You may stop now. Thank you.
CODE CORRECT IF R COUNTED BACKWARDS FROM 19 TO 10 OR FROM 20 TO 11 WITHOUT ERROR
Please tell me today's date.
TDYMTH
HFQX
code one
PROBE MONTH, DAY, YEAR, DAY OF WEEK
THE DATE IS: MONTH/DAY/YEAR
Please tell me today's date.
TDYDAY
HFQX
code one
PROBE MONTH, DAY, YEAR, DAY OF WEEK
THE DATE IS: MONTH/DAY/YEAR
Please tell me today's date.
TDYYEAR
HFQX
code one
PROBE MONTH, DAY, YEAR, DAY OF WEEK
THE DATE IS: MONTH/DAY/YEAR
What is the day of the week?
TDYDOW
HFQX
code one
THE DAY OF THE WEEK IS: DAY OF WEEK
SCISSOR
HFQX
code one
Now I'm going to ask you for the names of some people and things.
What do people usually use to cut paper?
CACTUS
HFQX
code one
What do you call the kind of prickly plant that grows in the desert?
Who is the President of the United States right now?
POTUS
HFQX
code one
ANSWER IS TRUMP
PROBE FOR LAST NAME
Who is Vice President?
VPOTUS
HFQX
BOX HFEND
code one
ANSWER IS PENCE
routing
PROBE FOR LAST NAME
GO TO NAQ.
Code list
(1) CORRECT
(2) INCORRECT
(-9) REFUSED
Routing
TDYMTH
(1) MONTH CORRECT
(2) MONTH NOT CORRECT
(-8) DON'T KNOW
(-9) REFUSED
TDYDAY
(1) DAY OF MONTH CORRECT
(2) DAY OF MONTH NOT CORRECT
(-8) DON'T KNOW
(-9) REFUSED
TDYYEAR
(1) YEAR CORRECT
(2) YEAR NOT CORRECT
(-8) DON'T KNOW
(-9) REFUSED
TDYDOW
(1) DAY CORRECT
(2) DAY NOT CORRECT
(-8) DON'T KNOW
(-9) REFUSED
(1) SCISSORS OR SHEARS
(2) NOT CORRECT
(-8) DON'T KNOW
(-9) REFUSED
(1) CACTUS OR NAME OF KIND OF CACTUS
(2) NOT CORRECT
(-8) DON'T KNOW
(-9) REFUSED
SCISSOR
CACTUS
POTUS
(1) LAST NAME CORRECT
(2) NOT CORRECT
(-8) DON'T KNOW
(-9) REFUSED
VPOTUS
(1) LAST NAME CORRECT
(2) NOT CORRECT
(-8) DON'T KNOW
(-9) REFUSED
BOX HFEND
| File Type | application/pdf |
| Author | SLA |
| File Modified | 2018-05-02 |
| File Created | 2018-05-02 |