Data Dictionary for rosintfu

Number of Blaise fields: 639

Seq # Var Question Data Type/Coding
1 projid ROS FOLLOW-UP Interview (v3.0 Rev 12/29/2020) Enter project ID number. String[8]
2 visit Enter curent visit code from face sheet: CODE F/U Year CODE F/U Year CODE F/U Year CODE F/U Year 00 = Baseline 08 = 8th F/U 16 = 16th F/U 24 = 24th F/U 01 = 1st F/U 09 = 9th F/U 17 = 17th F/U 25 = 25th F/U 02 = 2nd F/U 10 = 10th F/U 18 = 18th F/U 26 = 26th F/U 03 = 3rd F/U 11 = 11th F/U 19 = 19th F/U 27 = 27th F/U 04 = 4th F/U 12 = 12th F/U 20 = 20th F/U 28 = 28th F/U 05 = 5th F/U 13 = 13th F/U 21 = 21th F/U 29 = 29th F/U 06 = 6th F/U 14 = 14th F/U 22 = 22th F/U 30 = 30th F/U 07 = 7th F/U 15 = 15th F/U 23 = 23th F/U String[2]
3 dateint Date of interview Date type
4 baseyear Enter year of baseline from face sheet: 1993 .. 2025
5 formno INTRODUCTION Form Number String[8]
6 version version Number. String[4]
7 autodate Automatic Date. Date type
8 autotime Automatic Time. TimeType
9 autolog Automatic Logged Date. Date type
10 intid INTERVIEWER ID 100 .. 997
11 compid Laptop ID String[20]
12 datlas Date of previous ROS questionnaire Date type
13 sex 1. Record participant's sex. 1= Male 2= Female
14 autotm [COMPUTER CLOCK TIME] String[8]
15 phone Was this interview completed over the telephone or in person? 1= In-person 2= Telephone
16 ssnmedneeded Do we need to obtain SSN and/or Medicare# from this participant? [INTERVIEWER: Check the face sheet. Enter NO if both SSN and Medicare# have been collected. Enter NO if participant refuses to provide both SSN and Medicare#. Enter 'Yes, both' if participant is able to provide both SSN and Medicare#. Enter 'Yes, SSN only' if participant is able to provide only the SSN. Enter 'Yes, Medicare# only' if participant is able to provide only the Medicare#.] 2= No 1= Yes, both 3= Yes, SSN only 4= Yes, Medicare# only
17 q5loc What is your social security number? 0 .. 999999999
18 q5aloc [ENTER R. SOCIAL SECURITY NUMBER AGAIN] 0 .. 999999999
19 q6loc What is your medicare number? Please show me your card. String[11]
20 q6aloc [ENTER R. MEDICARE NUMBER AGAIN] String[11]
21 validated
22 validateerror
23 errorposition
24 validated_hicn_cms
25 validated_rrb_pre1964
26 validated_rrb_post1964
27 hicnformats
28 hicn_alpha
29 hicn_numbers
30 strlen
31 hicn_trimmed
32 ssn_br Do we need to obtain SSN from this participant? [INTERVIEWER: Check the face sheet. Enter YES if participant is able to provide the SSN. Enter NO if SSN is not to be collected.] 1= Yes 2= No, already collected 3= No, face sheet stated NOT to ask Pt 4= No, Pt does not have it available or is not eligible 5= No, Pt has mild reluctance 6= No, Pt has moderate reluctance 7= No, Pt has strong reluctance
33 ssn What is your social security number? [INTERVIEWER: Please enter the SSN in 000-00-0000 format.] String[11]
34 ssn_c [ENTER R. SOCIAL SECURITY NUMBER AGAIN] String[11]
35 hicn_br Do we need to obtain the old Medicare#(HICN) from this participant? [INTERVIEWER: Check the face sheet. Enter YES if participant is able to provide the HICN. Enter NO if HICN is not to be collected.] 1= Yes 2= No, already collected 3= No, face sheet stated NOT to ask Pt 4= No, Pt does not have it available or is not eligible 5= No, Pt has mild reluctance 6= No, Pt has moderate reluctance 7= No, Pt has strong reluctance
36 hicn What is your old medicare number(HICN) ? Please show me your card. [INTERVIEWER: valid HICN formats include 000000000A, 000000000C1, A000000000 or A000000.] String[11]
37 hicn_c [ENTER R. MEDICARE NUMBER(HICN) AGAIN] String[11]
38 hicn_type HICN Type: ^hicnFormats String[15]
39 mbi_br Do we need to obtain the new Medicare#(MBI) from this participant? [INTERVIEWER: Check the face sheet. Enter YES if participant is able to provide the MBI. Enter NO if MBI is not to be collected.] 1= Yes 2= No, already collected 3= No, face sheet stated NOT to ask Pt 4= No, Pt does not have it available or is not eligible 5= No, Pt has mild reluctance 6= No, Pt has moderate reluctance 7= No, Pt has strong reluctance
40 mbi What is your new medicare number(MBI) ? Please show me your card. [INTERVIEWER: Please enter the MBI in 01EG4-TE5-MK73 format.] String[13]
41 mbi_c [ENTER R. MEDICARE NUMBER(MBI) AGAIN] String[13]
42 q1qua QUALITY OF LIFE Now I have some general questions about your health. 1. As compared to other people your own age, would you say that your health is excellent, good, fair or poor? 1= Excellent 2= Good 3= Fair 4= Poor
43 q2qua 2. Now, thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good? [ENTER NUMBER OF DAYS] 0 .. 30
44 q3qua 3. Now, thinking about your mental health, which includes stress, depression, or problems with your emotions. For how many days during the past 30 days was your mental health not good? [ENTER NUMBER OF DAYS] 0 .. 30
45 q4qua 4. During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation? [ENTER NUMBER OF DAYS] 0 .. 30
46 heartfu MEDICAL HISTORY - CARDIOVASCULAR DISEASE Now, I have some questions about a number of specific medical conditions. 1. Since your last study interview on [last interview date], have you been told by a doctor, nurse or therapist that you had a heart attack or coronary, or coronary thrombosis, or coronary occlusion, or myocardial infarction? 1= Yes 2= Suspect or possible 3= No
47 multipfu 1a. Did you have only one or more than one? 1= Only one 2= More than one
48 inhospfu 1b Were you hospitalized overnight or longer for this (last one)? 1= Yes 2= No
49 hospnafu 1d. What was the name of the (last) hospital? [SPECIFY] String[40]
50 cancerfu CANCER OR MALIGNANCY 1. Since your last interview on [last interview date], have you been told by a doctor, nurse or therapist that you had ... Cancer, malignancy or tumor of any type? 1= Yes 2= Suspect or possible 3= No
51 ca1afu 1a. Where was it? [OR: Where was the most recent cancer that you had?] [SPECIFY] String[20]
52 ca1bfu 1b. Were you hospitalized overnight or longer for this? 1= Yes 2= No
53 ca1dfu 1c. What was the name of the (last) hospital? [SPECIFY] String[40]
54 diabetfu DIABETES 1. (Since your last interview on [last interview date], have you been told by a doctor, nurse or therapist that you had ...) 2. Diabetes, or sugar in the urine, or high blood sugar? 1= Yes 2= Suspect or possible 3= No
55 db1fu 2. Has a doctor, nurse or therapist, told you to take insulin or injections for your high blood sugar? 1= Yes 2= No
56 db1afu 2a Are you currently taking insulin or injections? 1= Yes 2= No
57 db3fu 3 Has a doctor, nurse, or therapist told you to take medicine by mouth for your high blood sugar? 1= Yes 2= No
58 db3afu 3a Are you currently doing this? 1= Yes 2= No
59 highbpfu HIGH BLOOD PRESSURE (Since your interview on [last interview date], have you been told by a doctor, nurse or therapist that you had ...) 1. High blood pressure? 1= Yes 2= Suspect or possible 3= No
60 bp30fu 2 Has a doctor, nurse, or therapist told you to take medicine by mouth for your high blood pressure? 1= Yes 2= No
61 bp3afu 2a Are you currently doing this? 1= Yes 2= No
62 herpesfu HERPES ZOSTER (Since your interview on [last interview date], have you been told by a doctor, nurse or therapist that you had ...) 1. Shingles or herpes zoster? 1= Yes 2= Suspect or possible 3= No
63 thyroifu THYROID DISEASE (Since your interview on [last interview date], have you been told by a doctor, nurse or therapist that you had ...) 1. Thyroid disease? 1= Yes 2= Suspect or possible 3= No
64 th5bfu 1b. Were you hospitalized overnight or longer for thyroid disease? 1= Yes 2= No
65 th5dfu 1c. What was the name of the (last) hospital? [SPECIFY] String[40]
66 brokenfu BROKEN HIP (Since your interview on [last interview date], have you been told by a doctor, nurse or therapist that you had ...) 1. A broken or fractured hip? 1= Yes 2= Suspect or possible 3= No
67 hip6afu 1a. Were you ever hospitalized overnight or longer for this? 1= Yes 2= No
68 hip6cfu 1b. What was the name of the (last) hospital? [SPECIFY] String[40]
69 arthritis Arthritis Since your last study interview on ^IntroBlock_datlas, have you been told by a doctor, nurse or therapist that you had osteoarthritis? 1= Yes 2= Suspect or possible 3= No
70 gout Since your last study interview on ^IntroBlock_datlas, have you been told by a doctor, nurse or therapist that you had gout? 1= Yes 2= Suspect or possible 3= No
71 osteoporosis Since your last study interview on ^IntroBlock_datlas, have you been told by a doctor, nurse or therapist that you had osteoporosis? 1= Yes 2= Suspect or possible 3= No
72 joint_disease Since your last study interview on ^IntroBlock_datlas, have you been told by a doctor, nurse or therapist that you had other joint disease (excluding cancer)? 1= Yes 2= Suspect or possible 3= No
73 chespafu CHEST PAIN Now some questions about pains in your chest. 1. Since [last interview date], have you had any pain or discomfort in your chest? 1= Yes 2= No
74 pressufu 1a. Have you had any pressure or heaviness in your chest? 1= Yes 2= No
75 uphil0fu 2. Do you get this pain or discomfort when you walk uphill or hurry? 1= Yes 2= No 3= Never walks uphill or hurries
76 level0fu 3. Do you get this pain or discomfort when you walk at an ordinary pace on the level? 1= Yes 2= No
77 dowha0fu 4. What do you do if you get this pain while you are walking? [IF CONTINUED AFTER TAKING NITROGLYCERIN,RECORD AS `Stop or slow down'] 1= Stop or slow down 2= Take a nitroglycerin 3= Continue at the same pace
78 stand0fu 5. If you stand still, what happens to the pain? 1= Relieved 2= Not relieved
79 howso0fu 5a. How soon is the pain relieved? 1= 10 minutes or less 2= More than 10 minutes
80 musterfu 6a. Will you show me where it was? Sternum (middle or upper) 1= Show 2= Not shown
81 lowstefu 6b. Sternum (lower) 1= Show 2= Not shown
82 lantchfu 6c. Left anterior chest 1= Show 2= Not shown
83 leftarfu 6d. Left arm 1= Show 2= Not shown
84 otherfu 7. Did you feel it anywhere else? 1= Yes 2= No
85 wherefu 7a. Where? [SPECIFY] String[30]
86 attackfu 8. Have you had a severe pain across the front of your chest lasting half an hour or more? 1= Yes 2= No
87 seedocfu 9. Did you see a doctor because of the pain? 1= Yes 2= No
88 docsaifu 9a. What did (s)he say it was? String[40]
89 howma0fu 10. How many of these attacks have you had? 1 .. 99
90 legpain CLAUDICATION Now some questions about pains in your legs 1. Do you get pain in either leg while walking? 1= Yes 2= No
91 standsit 2. Does this pain ever begin when you are standing still or sitting? 1= Yes 2= No
92 calf 3. In what part of your leg do you feel it? [IF CALVES NOT MENTIONED ASK: `Anywhere else?' IF STILL NOT MENTIONED, CODE 2] 1= Pain includes calf/calves 2= Pain does not include calf
93 uphill1 4. Do you get this pain when you walk uphill or hurry? 1= Yes 2= No 3= Never walks uphill or hurries
94 level1 5. Do you get this pain when you walk at an ordinary pace on the level? 1= Yes 2= No
95 disapp 6. Does this pain ever disappear while you are still walking? 1= Yes 2= No
96 dowhat1 7. What do you do if you get this pain while you are walking? 1= Stop/slacken the pace 2= Continue at the same pace
97 stand1 8. What happens to the pain if you stand still? 1= Relieved 2= Not relieved
98 howsoon1 8a. How soon is it relieved? 1= 10 minutes or less 2= More than 10 minutes
99 hormadm HORMONE REPLACEMENT Now I'd like to ask you about hormonal medications you may have used. Hormones are sometimes used by women around the time of their change of life, after surgery on their ovaries, to control heavy or irregular menstrual periods, or for prevention of disease such as bone loss. These medications include pills, injections, vaginal creams or suppositories, or skin patches. [Please enter c for first question.] String[1]
100 hormonfu 1. Since [last interview date], have you taken any type of estrogen hormonal medication, for example Premarin, Ogen or Estrace, or progesterone hormonal medication, for example, Provera? 1= Yes 2= Suspect 3= No
101 pillfu Were these estrogen or progesterone hormones in the form of a pill, injection, vaginal cream or suppository, or skin patch? 2. pill or other oral dosage form 1= Yes 2= Suspect 3= No
102 shotfu 3. injection (shot) 1= Yes 2= Suspect 3= No
103 cosfu 4. vaginal cream or suppository 1= Yes 2= Suspect 3= No
104 patchfu 5. skin patch 1= Yes 2= Suspect 3= No
105 currenfu 6. Are you currently taking this/these medications? 1= Yes 2= No
106 dizzyfu DIZZINESS Now some questions about dizziness or lightheadedness. 1. Have you had an episode of dizziness or lightheadedness since your last interview on [last interview date]? 1= Yes 2= Suspect 3= No
107 freq0fu 2. How often, on average, do they occur? Would you say that they occur about once a year or less, several times a year, once a month, several times a month, once a week, or several times a week? 1= once a year or less 2= several times a year 3= once a month 4= several times a month 5= once a week 6= several times a week
108 severifu 3. How severe, on average, are these episodes? Would you say they are usually not severe at all, slightly severe, somewhat severe, very severe, or extremely severe? 1= not severe at all 2= slightly severe 3= somewhat severe 4= very severe 5= extremely severe
109 spinfu 4. During any of these episodes, did you definitely feel as if either you or the room was actually spinning, turning or moving? 1= Yes 2= Suspect 3= No
110 numspifu 4a. How many episodes like this have you had? Would you say one, or two to five, six to ten, or more than ten? 1= One 2= two to five 3= six to ten 4= more than ten
111 timespfu 4b. How long, on average, does a typical episode last? Would you say less than 5 seconds, between 5 seconds and 5 minutes, between 5 minutes and 1 hour, between 1 hour and 2 days, or more than 2 days? 1= < 5 seconds 2= 5 seconds - 5 minutes 3= > 5 minutes - 1 hour 4= > 1 hour - 2 days 5= > 2 days
112 dzdoctfu 4c. Since your last interview on [last interview date], have you seen a doctor because of an episode of dizziness? 1= Yes 2= No
113 dzhospfu 4d. Were you hospitalized overnight or longer for this (last one)? 1= Yes 2= No
114 dzhonmfu 4f. What was the name of the (last) hospital? String[40]
115 jointsfu JOINTS Now a few questions about your joints. 1. Since your last interview on [last interview date] have you had pain or aching in any of your joints on most days for at least one month? 1= Yes 2= No
116 neckpafu 2. ...Pain in your neck or back on most days for at least one month? 1= Yes 2= No
117 hippaifu 3. ...Pain in or around either hip joint including the buttock, groin, and side of the upper thigh on most days for at least one month? 1= Yes 2= No
118 kneepafu 4. ...Pain in or around the knees including the back of the knee on most days for at least one month? 1= Yes 2= No
119 swellifu 5. ...Swelling at a joint, with pain present in the joint when touched, on most days for at least one month? 1= Yes 2= No
120 stifffu 6. ...Stiffness in the joints and muscles when getting out of bed in the morning lasting for at least 15 minutes? 1= Yes 2= No
121 feetpafu 7. ...Pain or aching in either of your feet on most days for at least one month? 1= Yes 2= No
122 handpafu 8. ...Pain or aching in either of your hands, wrists or fingers on most days for at least one month? 1= Yes 2= No
123 q1neurfu NEUROPATHY Now I have some questions about numbness and tingling. Since your last interview on [last interview date], have you had numbness or tingling [or asleep or burning] feeling of your feet or toes? 1= Yes 2= Suspect 3= No
124 q2neurfu Was this ___ on the right side, left side, or both sides? 1= Right 2= Left 3= Both
125 q3neurfu In the past month, have you had numbness or tingling [or asleep or burning] feeling of your hands or fingers? [This question was replaced by q3bneufu in this form because the time frame is not within the pasy year.] 1= Yes 2= Suspect 3= No
126 q4neurfu Was this ___ on the right side, left side, or both sides? [This question was replaced by q4bneufu in this form because the time frame is not within the pasy year.] 1= Right 2= Left 3= Both
127 q3bneufu Since your last interview on [last interview date], have you had numbness or tingling [or asleep or burning] feeling of your hands or fingers? 1= Yes 2= Suspect 3= No
128 q4bneufu Was this ___ on the right side, left side, or both sides? 1= Right 2= Left 3= Both
129 q5neurfu CERVICAL RADICULAPATHY Now I have some questions about neck pain. Since your last interview on [last interview date] have you had neck pain that lasted days weeks, or months? 1= Yes 2= Suspect 3= No
130 q6neurfu At a time while you were having pain in the neck, did you also have pain, numbness or tingling, or weakness in the arms or hands? 1= Yes 2= Suspect 3= No
131 q7neurf1 Which of these problems did you have, pain, numbness or tingling, or weakness? [LIST ALL THAT APPLY] 1= Pain 2= Numbness or tingling 3= Weakness
132 q7neurf2 Which of these problems did you have, pain, numbness or tingling, or weakness? [LIST ALL THAT APPLY] See previous question
133 q7neurf3 Which of these problems did you have, pain, numbness or tingling, or weakness? [LIST ALL THAT APPLY] See previous question
134 q8neurfu Did this ___ occur on the right side, left side, or both sides? 1= Right 2= Left 3= Both
135 q9neurfu Now, when you have neck pain, how long, on average, does the neck pain typically last? Would you say less than a week, between one week and one month, between one and two months, between two and six months, or greater than six months? 1= < a week 2= 1 week - 1 month 3= > 1 month - 2 months 4= > 2 months - 6 months 5= > 6 months
136 q10neufu How many different times have you had neck pain? 1 .. 50
137 q11neufu How severe, on average, is the neck pain? Would you say it is usually not severe at all, slightly severe, somewhat severe, very severe, or extremely severe? 1= Not severe at all 2= Slightly severe 3= Somewhat severe 4= Very severe 5= Extremely severe
138 q12neufu Since your last interview on [last interview date] have you seen a doctor because of neck pain? 1= Yes 2= No
139 q13neufu Since your last interview on [last interview date] have you had an x-ray or scan [CT or MRI] of the neck because of the pain? 1= Yes 2= No
140 q14neufu When was the last time? [ENTER YEAR] 1900 .. 2040
141 q15neufu What was the name of the place (doctor's office, hospital or other place) at which the scan was performed? [ENTER NAME] String[40]
142 q16neufu [ENTER LOCATION] String[40]
143 q17neufu LUMBAR RADICULOPATHY Now I have some questions about low back pain. Since your last interview on [last interview date] have you had low back pain that lasted days to months? 1= Yes 2= Suspect 3= No
144 q18neufu At a time while you were having low back pain, did you also have pain, numbness or tingling, or weakness in the legs or feet? 1= Yes 2= Suspect 3= No
145 q19neuf1 Which of these problems did you have, pain, numbness or tingling, or weakness? [LIST ALL THAT APPLY] 1= Pain 2= Numbness or tingling 3= Weakness
146 q19neuf2 Which of these problems did you have, pain, numbness or tingling, or weakness? [LIST ALL THAT APPLY] See previous question
147 q19neuf3 Which of these problems did you have, pain, numbness or tingling, or weakness? [LIST ALL THAT APPLY] See previous question
148 q20neufu Did this ___ occur on the right side, left side, or both sides? 1= Right 2= Left 3= Both
149 q21neufu Now, when you have low back pain, how long, on average, does the low back pain typically last? Would you say less than a week, between one week and one month, between one and two months, between two and six months, or greater than six months? 1= < a week 2= 1 week - 1 month 3= > 1 month - 2 months 4= > 2 months - 6 months 5= > 6 months
150 q22neufu How many different times have you had low back pain? 1 .. 50
151 q23neufu How severe, on average, is the low back pain? Would you say it is usually not severe at all, slightly severe, somewhat severe, very severe, or extremely severe? 1= Not severe at all 2= Slightly severe 3= Somewhat severe 4= Very severe 5= Extremely severe
152 q24neufu Since your last interview on [last interview date] have you seen a doctor because of low back pain? 1= Yes 2= No
153 q25neufu Since your last interview on [last interview date] have you had an x-ray or scan [CT or MRI] of the low back because of the pain? 1= Yes 2= No
154 q26neufu When was the last time? [ENTER YEAR] 1900 .. 2040
155 q27neufu What was the name of the place (doctor's office, hospital or other place) at which the scan was performed? [ENTER NAME] String[40]
156 q28neufu [ENTER LOCATION] String[40]
157 q1md The next few questions are about your feelings during the past week. For each of the following statements, please tell me if you felt that way much of the time during the past week. 1. I felt that everything I did was an effort. Have you felt this way much of the time during the past week? 1= Yes 2= No
158 q2md 2. My sleep was restless. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
159 q3md 3. I felt depressed. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
160 q4md 4. I was happy. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
161 q5md 5. I felt lonely. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
162 q6md 6. People were unfriendly. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
163 q7md 7. I enjoyed life. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
164 q8md 8. I felt sad. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
165 q9md 9. I felt that people disliked me. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
166 q10md 10. I could not get 'going'. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
167 q1slp SLEEP Now I would like to get some information about how well you sleep 1. How often you have trouble falling asleep? Would you say it is - most of the time, sometimes, or rarely or never? 1= Very Often 2= Often 3= Sometimes 4= Rarely 5= never
168 q2slp 2. How often are you troubled by waking up during the night? 1= Very Often 2= Often 3= Sometimes 4= Rarely 5= never
169 q4slp 3. How often do you get so sleepy during the day or evening that you have to take a nap? 1= Very Often 2= Often 3= Sometimes 4= Rarely 5= never
170 q5slp 4. How often do you feel really rested when you wake up in the morning? 1= Very Often 2= Often 3= Sometimes 4= Rarely 5= never
171 q6slp How many hours do you usually sleep at night? 0 .. 24
172 q1dep DEPRESSION Now I have few more questions about how you feel. 1. In the past month, has there been two weeks or more during which you felt sad, blue, depressed, or when you lost interest and pleasure in things you usually cared about or enjoyed? 1= Yes 2= No
173 q1adep During this period, did you experience any of the following problems? 1a. A change in your appetite 1= Yes 2= No
174 q1bdep 1b. A change in your pattern of sleeping 1= Yes 2= No
175 q1cdep 1c. A decrease in your energy level 1= Yes 2= No
176 q1ddep 1d. Trouble concentrating 1= Yes 2= No
177 q1edep 1e. Felt extremely guilty or worthless 1= Yes 2= No
178 q1fdep 1f. Felt extremely restless or agitated 1= Yes 2= No
179 q1gdep 1g. Lost your interest in favorite activities 1= Yes 2= No
180 q1hdep 1h. Felt that life was not worth living 1= Yes 2= No
181 q2dep 2. Did you tell a doctor or any other professional about it? 1= Yes 2= No
182 q3dep 3. In the past year, other than the past month, have you ever had two weeks or more during which you felt sad, blue, depressed, or when you lost interest and pleasure in things you usually cared about or enjoyed? 1= Yes 2= No
183 q3aadep During this period during which you felt depressed, did you experience any of the following problems? 3a. A change in your appetite 1= Yes 2= No
184 q3abdep 3ab. A change in your pattern of sleeping 1= Yes 2= No
185 q3acdep 3ac. A decrease in your energy level 1= Yes 2= No
186 q3addep 3ad. Trouble concentrating 1= Yes 2= No
187 q3aedep 3ae. Felt extremely guilty or worthless 1= Yes 2= No
188 q3afdep 3af. Felt extremely restless or agitated 1= Yes 2= No
189 q3agdep 3ag. Lost your interest in favorite activities 1= Yes 2= No
190 q3ahdep 3ah. Felt that life was not worth living 1= Yes 2= No
191 q3bdep 3b. In the past year, how many episodes like that have you had that lasted two weeks or more? [allow for two digits] [ENTER NUMBER] 1 .. 99
192 q3cdep 3c. Have you ever seen a doctor because this (one of these) episode(s)? 1= Yes 2= No
193 q3ddep 3d. Were you ever hospitalized overnight or longer for this (one of these) episode(s)? 1= Yes 2= No
194 q3edep 3e. When was the last time? [ENTER YEAR] 1996 .. 2040
195 q3fdep 3f. What was the name and location of the (last) hospital? String[40]
196 swall SWALLOWING Now I have some question about chewing and swallowing 1. How much difficulty, on average, do you have swallowing your food? Would you say you have - no difficulty at all, a little difficulty, some difficulty or a lot of difficulty? 1= No difficulty at all 2= A little difficulty 3= Some difficulty 4= A lot of difficulty
197 movi 2. How much difficulty, on average, do you have moving food out of your mouth into your throat to swallow? Would you say you have - no difficulty at all, a little difficulty, some difficulty or a lot of difficulty? 1= No difficulty at all 2= A little difficulty 3= Some difficulty 4= A lot of difficulty
198 cough 3. How often do you cough or choke when drinking or eating? Would you say never, rarely, sometimes, most of the time or almost always? 1= Never 2= Rarely 3= Sometimes 4= Most of the time 5= Almost always
199 bring 4. How often do you bring up food or liquid after you have swallowed it? 1= Never 2= Rarely 3= Sometimes 4= Most of the time 5= Almost always
200 headinfu HEAD INJURY Now I have some questions about injuries. 1. Since [last interview date], have you had a head injury? 1= Yes 2= No
201 lostcofu 3. Have you lost consciousness because of a head injury that occurred since [last interview date]? 1= Yes 2= Suspect or possible 3= No
202 howma1fu 3a. How many times? 1 .. 50
203 howlo0fu 3c. How long were you unconscious for this (last) head injury? Would you say less than 5 seconds, between 5 seconds and 5 minutes, between 5 minutes and 1 hour, between 1 hour and 2 days, or more than 2 days? 1= < 5 seconds 2= 5 seconds - 5 minutes 3= > 5 minutes - 1 hour 4= > 1 hour - 2 days 5= > 2 days
204 hihospfu 4. Since your interview on [last interview date], were you hospitalized overnight or longer for a head injury? 1= Yes 2= No
205 same1fu 4a. Was this the same event we just spoke about? 1= Yes 2= No
206 hihonmfu 4c. What was the name of the (last) hospital? [HOSPITAL NAME] String[40]
207 hihoslfu [LOCATION:] String[40]
208 memor0fu Were any of the following signs/symptoms associated with this (last) event? [INTERVIEWER: `Last' event refers to the most recent hospitalization event.] 1. Memory loss or forgetfulness? 1= Yes 2= Suspect 3= No
209 speec0fu 2. Language or speech change? 1= Yes 2= Suspect 3= No
210 weakn0fu 3. Weakness or paralysis of face, arms or legs? 1= Yes 2= Suspect 3= No
211 side0fu 3a. Which side(s)? 1= right only 2= left only 3= both
212 othsp0fu 4. Specify any other signs or symptoms associated with this (last) event? String[40]
213 hiscanfu 5. Since [last interview date], did you have a CT, MRI or other type of brain scan because of a head injury? 1= Yes 2= No
214 same2fu Was this the same event we just spoke about? 1= Yes 2= No
215 hiscnmfu 5b. What was the name of the place (doctor's office, hospital or other place) at which the scan was performed? [NAME:] String[40]
216 memor1fu Were any of the following signs/symptoms associated with this (last) event? [INTERVIEWER: `Last' event refers to the most recent hospitalization event.] 1. Memory loss or forgetfulness? 1= Yes 2= Suspect 3= No
217 speec1fu 2. Language or speech change? 1= Yes 2= Suspect 3= No
218 weakn1fu 3. Weakness or paralysis of face, arms or legs? 1= Yes 2= Suspect 3= No
219 side1fu 3a. Which side(s)? 1= right only 2= left only 3= both
220 othsp1fu 4. Specify any other signs or symptoms associated with this (last) event? String[40]
221 speciffu 6. Specify left over troubles from your head injury(s)? String[40]
222 hdrvehicle
223 hdrhitbyobject
224 hdrfalling
225 hdrsports
226 hdrabuse
227 hdrmilitary
228 hdrother
229 prevbisqdone BRAIN INJURY SCREENING QUESTIONNAIRE Have the BISQ questions been previously completed for this participant? ^prevBisqDoneText 1= Yes 2= No
230 bisqveh BRAIN INJURY SCREENING QUESTIONNAIRE Now I have some questions about head injuries. ^lastInterviewText0en 1. Vehicle accident?(ex: MVA, pedestrian accident, motorcycle/ATV crash) 1= Yes 2= No
231 bisqvehnum ^hdrVehicle How many times did you receive a blow to the head, in a vehicle accident? 1 .. 30
232 bisqvehloc ^hdrVehicle Did you lose consciousness? 1= Yes 2= No
233 bisqvehlocnum ^hdrVehicle How many times have you lost consciousness? 1 .. 30
234 bisqvehlocdur ^hdrVehicle What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
235 bisqvehlocyr1 ^hdrVehicle In what year did this occur (1)? 1900 .. 2050
236 bisqvehlocyr2 ^hdrVehicle In what year did this occur (2)? 1900 .. 2050
237 bisqvehlocyr3 ^hdrVehicle In what year did this occur (3)? 1900 .. 2050
238 bisqvehlocyr4 ^hdrVehicle In what year did this occur (4)? 1900 .. 2050
239 bisqvehlocyr5 ^hdrVehicle In what year did this occur (5)? 1900 .. 2050
240 bisqvehdaze ^hdrVehicle Were you dazed or confused? 1= Yes 2= No
241 bisqvehdazenum ^hdrVehicle How many times have you been dazed or confused? 1 .. 30
242 bisqvehdazedur ^hdrVehicle What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
243 bisqvehdazeyr1 ^hdrVehicle In what year did this occur (1)? 1900 .. 2050
244 bisqvehdazeyr2 ^hdrVehicle In what year did this occur (2)? 1900 .. 2050
245 bisqvehdazeyr3 ^hdrVehicle In what year did this occur (3)? 1900 .. 2050
246 bisqvehdazeyr4 ^hdrVehicle In what year did this occur (4)? 1900 .. 2050
247 bisqvehdazeyr5 ^^hdrVehicle In what year did this occur (5)? 1900 .. 2050
248 bisqhit ^lastInterviewText1en 2. Hit by an object?(ex: equipment, falling object) 1= Yes 2= No
249 bisqhitnum ^hdrHitByObject How many times did you receive a blow to the head, from a falling object? 1 .. 30
250 bisqhitloc ^hdrHitByObject Did you lose consciousness? 1= Yes 2= No
251 bisqhitlocnum ^hdrHitByObject How many times have you lost consciousness? 1 .. 30
252 bisqhitlocdur ^hdrHitByObject What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
253 bisqhitlocyr1 ^hdrHitByObject In what year did this occur (1)? 1900 .. 2050
254 bisqhitlocyr2 ^hdrHitByObject In what year did this occur (2)? 1900 .. 2050
255 bisqhitlocyr3 ^hdrHitByObject In what year did this occur (3)? 1900 .. 2050
256 bisqhitlocyr4 ^hdrHitByObject In what year did this occur (4)? 1900 .. 2050
257 bisqhitlocyr5 ^hdrHitByObject In what year did this occur (5)? 1900 .. 2050
258 bisqhitdaze ^hdrHitByObject Were you dazed or confused? 1= Yes 2= No
259 bisqhitdazenum ^hdrHitByObject How many times have you been dazed or confused? 1 .. 30
260 bisqhitdazedur ^hdrHitByObject What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
261 bisqhitdazeyr1 ^hdrHitByObject In what year did this occur (1)? 1900 .. 2050
262 bisqhitdazeyr2 ^hdrHitByObject In what year did this occur (2)? 1900 .. 2050
263 bisqhitdazeyr3 ^hdrHitByObject In what year did this occur (3)? 1900 .. 2050
264 bisqhitdazeyr4 ^hdrHitByObject In what year did this occur (4)? 1900 .. 2050
265 bisqhitdazeyr5 ^hdrHitByObject In what year did this occur (5)? 1900 .. 2050
266 bisqfall ^lastInterviewText2en 3. Falling? (ex: down stairs, during a fainting spell, from a high place) 1= Yes 2= No
267 bisqfallnum ^hdrFalling How many times did you receive a blow to the head, in a fall? 1 .. 30
268 bisqfallloc ^hdrFalling Did you lose consciousness? 1= Yes 2= No
269 bisqfalllocnum ^hdrFalling How many times have you lost consciousness? 1 .. 30
270 bisqfalllocdur ^hdrFalling What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
271 bisqfalllocyr1 ^hdrFalling In what year did this occur (1)? 1900 .. 2050
272 bisqfalllocyr2 ^hdrFalling In what year did this occur (2)? 1900 .. 2050
273 bisqfalllocyr3 ^hdrFalling In what year did this occur (3)? 1900 .. 2050
274 bisqfalllocyr4 ^hdrFalling In what year did this occur (4)? 1900 .. 2050
275 bisqfalllocyr5 ^hdrFalling In what year did this occur (5)? 1900 .. 2050
276 bisqfalldaze ^hdrFalling Were you dazed or confused? 1= Yes 2= No
277 bisqfalldazenum ^hdrFalling How many times have you been dazed or confused? 1 .. 30
278 bisqfalldazedur ^hdrFalling What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
279 bisqfalldazeyr1 ^hdrFalling In what year did this occur (1)? 1900 .. 2050
280 bisqfalldazeyr2 ^hdrFalling In what year did this occur (2)? 1900 .. 2050
281 bisqfalldazeyr3 ^hdrFalling In what year did this occur (3)? 1900 .. 2050
282 bisqfalldazeyr4 ^hdrFalling In what year did this occur (4)? 1900 .. 2050
283 bisqfalldazeyr5 ^hdrFalling In what year did this occur (5)? 1900 .. 2050
284 bisqsprt ^lastInterviewText3en 4. Sports/Leisure?(ex: sports, biking, skiing, on the playground) 1= Yes 2= No
285 bisqsprtnum ^hdrSports How many times did you receive a blow to the head, during a sports or leisure activity? 1 .. 30
286 bisqsprtloc ^hdrSports Did you lose consciousness? 1= Yes 2= No
287 bisqsprtlocnum ^hdrSports How many times have you lost consciousness? 1 .. 30
288 bisqsprtlocdur ^hdrSports What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
289 bisqsprtlocyr1 ^hdrSports In what year did this occur (1)? 1900 .. 2050
290 bisqsprtlocyr2 ^hdrSports In what year did this occur (2)? 1900 .. 2050
291 bisqsprtlocyr3 ^hdrSports In what year did this occur (3)? 1900 .. 2050
292 bisqsprtlocyr4 ^hdrSports In what year did this occur (4)? 1900 .. 2050
293 bisqsprtlocyr5 ^hdrSports In what year did this occur (5)? 1900 .. 2050
294 bisqsprtdaze ^hdrSports Were you dazed or confused? 1= Yes 2= No
295 bisqsprtdazenum ^hdrSports How many times have you been dazed or confused? 1 .. 30
296 bisqsprtdazedur ^hdrSports What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
297 bisqsprtdazeyr1 ^hdrSports In what year did this occur (1)? 1900 .. 2050
298 bisqsprtdazeyr2 ^hdrSports In what year did this occur (2)? 1900 .. 2050
299 bisqsprtdazeyr3 ^hdrSports In what year did this occur (3)? 1900 .. 2050
300 bisqsprtdazeyr4 ^hdrSports In what year did this occur (4)? 1900 .. 2050
301 bisqsprtdazeyr5 ^hdrSports In what year did this occur (5)? 1900 .. 2050
302 bisqphys ^lastInterviewText4en 5. Physical Abuse/Assault?(ex: mugged) 1= Yes 2= No
303 bisqphysnum ^hdrAbuse How many times did you receive a blow to the head, from abuse or assault? 1 .. 30
304 bisqphysloc ^hdrAbuse Did you lose consciousness? 1= Yes 2= No
305 bisqphyslocnum ^hdrAbuse How many times have you lost consciousness? 1 .. 30
306 bisqphyslocdur ^hdrAbuse What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
307 bisqphyslocyr1 ^hdrAbuse In what year did this occur (1)? 1900 .. 2050
308 bisqphyslocyr2 ^hdrAbuse In what year did this occur (2)? 1900 .. 2050
309 bisqphyslocyr3 ^hdrAbuse In what year did this occur (3)? 1900 .. 2050
310 bisqphyslocyr4 ^hdrAbuse In what year did this occur (4)? 1900 .. 2050
311 bisqphyslocyr5 ^hdrAbuse In what year did this occur (5)? 1900 .. 2050
312 bisqphysdaze ^hdrAbuse Were you dazed or confused? 1= Yes 2= No
313 bisqphysdazenum ^hdrAbuse How many times have you been dazed or confused? 1 .. 30
314 bisqphysdazedur ^hdrAbuse What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
315 bisqphysdazeyr1 ^hdrAbuse In what year did this occur (1)? 1900 .. 2050
316 bisqphysdazeyr2 ^hdrAbuse In what year did this occur (2)? 1900 .. 2050
317 bisqphysdazeyr3 ^hdrAbuse In what year did this occur (3)? 1900 .. 2050
318 bisqphysdazeyr4 ^hdrAbuse In what year did this occur (4)? 1900 .. 2050
319 bisqphysdazeyr5 ^hdrAbuse In what year did this occur (5)? 1900 .. 2050
320 bisqmil ^lastInterviewText5en 6. Military Service?(ex: training, blast injury) 1= Yes 2= No
321 bisqmilnum ^hdrMilitary How many times did you receive a blow to the head, during military service? 1 .. 30
322 bisqmilloc ^hdrMilitary Did you lose consciousness? 1= Yes 2= No
323 bisqmillocnum ^hdrMilitary How many times have you lost consciousness? 1 .. 30
324 bisqmillocdur ^hdrMilitary What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
325 bisqmillocyr1 ^hdrMilitary In what year did this occur (1)? 1900 .. 2050
326 bisqmillocyr2 ^hdrMilitary In what year did this occur (2)? 1900 .. 2050
327 bisqmillocyr3 ^hdrMilitary In what year did this occur (3)? 1900 .. 2050
328 bisqmillocyr4 ^hdrMilitary In what year did this occur (4)? 1900 .. 2050
329 bisqmillocyr5 ^hdrMilitary In what year did this occur (5)? 1900 .. 2050
330 bisqmildaze ^hdrMilitary Were you dazed or confused? 1= Yes 2= No
331 bisqmildazenum ^hdrMilitary How many times have you been dazed or confused? 1 .. 30
332 bisqmildazedur ^hdrMilitary What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
333 bisqmildazeyr1 ^hdrMilitary In what year did this occur (1)? 1900 .. 2050
334 bisqmildazeyr2 ^hdrMilitary In what year did this occur (2)? 1900 .. 2050
335 bisqmildazeyr3 ^hdrMilitary In what year did this occur (3)? 1900 .. 2050
336 bisqmildazeyr4 ^hdrMilitary In what year did this occur (4)? 1900 .. 2050
337 bisqmildazeyr5 ^hdrMilitary In what year did this occur (5)? 1900 .. 2050
338 bisqoth ^lastInterviewText6en 7. In any other circumstances? 1= Yes 2= No
339 bisqothsp ^hdrOther Please specify: String[255]
340 bisqothnum ^hdrOther How many times did you receive a blow to the head, in a situation I have not mentioned? 1 .. 30
341 bisqothloc ^hdrOther Did you lose consciousness? 1= Yes 2= No
342 bisqothlocnum ^hdrOther How many times have you lost consciousness? 1 .. 30
343 bisqothlocdur ^hdrOther What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
344 bisqothlocyr1 ^hdrOther In what year did this occur (1)? 1900 .. 2050
345 bisqothlocyr2 ^hdrOther In what year did this occur (2)? 1900 .. 2050
346 bisqothlocyr3 ^hdrOther In what year did this occur (3)? 1900 .. 2050
347 bisqothlocyr4 ^hdrOther In what year did this occur (4)? 1900 .. 2050
348 bisqothlocyr5 ^hdrOther In what year did this occur (5)? 1900 .. 2050
349 bisqothdaze ^hdrOther Were you dazed or confused? 1= Yes 2= No
350 bisqothdazenum ^hdrOther How many times have you been dazed or confused? 1 .. 30
351 bisqothdazedur ^hdrOther What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
352 bisqothdazeyr1 ^hdrOther In what year did this occur (1)? 1900 .. 2050
353 bisqothdazeyr2 ^hdrOther In what year did this occur (2)? 1900 .. 2050
354 bisqothdazeyr3 ^hdrOther In what year did this occur (3)? 1900 .. 2050
355 bisqothdazeyr4 ^hdrOther In what year did this occur (4)? 1900 .. 2050
356 bisqothdazeyr5 ^hdrOther In what year did this occur (5)? 1900 .. 2050
357 q1injfu OTHER INJURIES 1. Since [last interview date], have you had any other accidents or injuries? 1= Yes 2= No
358 q1ainjfu 1a. Did you have one injury or more than one injury? 1= One 2= More than one
359 q2injfu [INTERVIEWER: IF MORE THAN ONE INJURY, THE FOLLOWING QUESTIONS REFER TO THE MOST SEVERE INJURY.] 2. Can you tell me where you were when the injury occurred? For example, were you in your bedroom, bathroom, dining room, or on the stairs, sidewalk, street...? String[40]
360 q3injfu 3. What event directly led to the injury? For example, did you fall either off of something or while walking, or were you struck by an object...? String[40]
361 q4injfu 4. What object or exposure directly inflicted the injury? For example, was it furniture, stairs, a wall, fire, a car...? String[40]
362 q5injfu 5. How would you describe the nature of the injury? For example, was it a cut, bruise, sprain, fracture, burn...? String[40]
363 q6injfu 6. Which part of the body was directly affected by the injury? For example, was it your eyes, hands, back...? String[40]
364 q7injfu 7. Did you have to see a doctor or other medical practitioner? 1= Yes 2= No
365 q7ainjfu 7a. Were you hospitalized? 1= Yes 2= No
366 q7binjfu 7b. What was the name of the (last) hospital? String[40]
367 q1cc COGNITIVE COMPLAINTS Now I have some questions about your memory. 1. People find that they sometimes have more trouble remembering things as they get older. About how often do you have trouble remembering things? Would you say it is very often, often, sometimes, rarely or never? 1= Very often 2= Often 3= Sometimes 4= Rarely 5= Never
368 q2cc 2. Compared to 10 years ago, would you say that your memory is much worse, a little worse, the same, a little better or much better? 1= Much worse 2= A little worse 3= The same 4= A little better 5= Much better
369 q3cc 3. How often do you have any other problems with your thinking, such as trouble concentrating or finding words in conversations? Would you say it is very often, often, sometimes, rarely or never? 1= Very often 2= Often 3= Sometimes 4= Rarely 5= Never
370 q3acc 3a. Specify String[30]
371 q3bcc 3b. Compared to 10 years ago, would you say that these problems are much worse, a little worse, the same, a little better or much better? [INTERVIEWER: 'THESE' REFERS TO ALL OF THE PROBLEMS. IF SUBJECT INSISTS ON 'WHICH ONE' INSTRUCT HIM/HER TO REFER TO THE ONE WHICH MOST TROUBLES HIM/HER.] 1= Much worse 2= A little worse 3= The same 4= A little better 5= Much better
372 q1phy PHYSICAL ACTIVITIY We are also interested in any physical activities that you do. I have a list of different types of activities that we ask of everyone, but most people do only one or two. String[1]
373 q1aphy How many times in the past 14 days did you go walking for exercise? [ENTER NUMBER OF TIMES] 0 .. 87
374 q1bphy On average, about how many minutes did you actually spend on each occasion? [ENTER NUMBER OF MINUTES] [CODE 1 Hour=60 min; 1.5 Hour=90 min; 2 Hours=120 min; 2.5 Hours=150 min; 3 Hours=180 min; 3.5 Hours=210 min; 4 Hours=240 min] 1 .. 300
375 q3aphy How many times in the past 14 days did you do gardening or yard work? [ENTER NUMBER OF TIMES] 0 .. 87
376 q3bphy On average, about how many minutes did you actually spend on each occasion? [ENTER NUMBER OF MINUTES] [CODE 1 Hour=60 min; 1.5 Hour=90 min; 2 Hours=120 min; 2.5 Hours=150 min; 3 Hours=180 min; 3.5 Hours=210 min; 4 Hours=240 min] 1 .. 300
377 q5aphy How many times in the past 14 days did you do calisthenics or general exercise? [ENTER NUMBER OF TIMES] 0 .. 87
378 q5bphy On average, bout how many minutes did you actually spend on each occasion? [ENTER NUMBER OF MINUTES] [CODE 1 Hour=60 min; 1.5 Hour=90 min; 2 Hours=120 min; 2.5 Hours=150 min; 3 Hours=180 min; 3.5 Hours=210 min; 4 Hours=240 min] 1 .. 300
379 q8aphy How many times in the past 14 days did you go bicycle riding? [ENTER NUMBER OF TIMES] 0 .. 87
380 q8bphy On average, about how many minutes did you actually spend on each occasion? [ENTER NUMBER OF MINUTES] [CODE 1 Hour=60 min; 1.5 Hour=90 min; 2 Hours=120 min; 2.5 Hours=150 min; 3 Hours=180 min; 3.5 Hours=210 min; 4 Hours=240 min] 1 .. 300
381 q101phy [SPECIFY] any other exercise, sports, or physically active hobbies in the past 2 weeks String[40]
382 q10aphy How many times in the past 14 days did you do this? [ENTER NUMBER OF TIMES] 1 .. 87
383 q10bphy On average, about how many minutes did you actually spend on each occasion? [ENTER NUMBER OF MINUTES] [CODE 1 Hour=60 min; 1.5 Hour=90 min; 2 Hours=120 min; 2.5 Hours=150 min; 3 Hours=180 min; 3.5 Hours=210 min; 4 Hours=240 min] 1 .. 300
384 q1fs FUNCTIONAL STATUS We would also like to know how well you are able to do some physical activities that are important in day-to-day living but which many people have problems doing. First, I would like to know if you are able to do certain kinds of activities without help from another person. Are you ABLE to do heavy work around the house, like washing windows, walls, or floors without help? 1= Yes 2= No
385 q2fs Are you able to walk up and down stairs to the second floor without help? 1= Yes 2= No
386 q3fs Are you able to walk a half mile without help? 1= Yes 2= No
387 q4fs Now I'm going to ask you how difficult it is, on the average to do similar kinds of activities. For each thing, tell me whether you have: no difficulty at all, a little difficulty, some difficulty, a lot of difficulty, or just unable to do it. To begin, how much difficulty, if any, do you have pulling or pushing large objects like a living room chair? Would you say you have no difficulty at all, a little difficulty, some difficulty, a lot of difficulty or are you just unable to do it? 1= No difficulty at all 2= A little difficulty 3= Some difficulty 4= A lot of difficulty 5= Just unable to do it
388 q5fs What about stooping, crouching, or kneeling? (Do you have no difficulty at all, a little difficulty, some difficulty, a lot of difficulty, or are you just unable to do it?) 1= No difficulty at all 2= A little difficulty 3= Some difficulty 4= A lot of difficulty 5= Just unable to do it
389 q6fs Lifting or carrying weights over 10 pounds, like a very heavy bag of groceries? (Do you have no difficulty at all, a little difficulty, some difficulty, a lot of difficulty, or are you just unable to do it?) 1= No difficulty at all 2= A little difficulty 3= Some difficulty 4= A lot of difficulty 5= Just unable to do it
390 q7fs Reaching or extending arms above shoulder level? Do you have...? 1= No difficulty at all 2= A little difficulty 3= Some difficulty 4= A lot of difficulty 5= Just unable to do it
391 q8fs Either writing or handling or fingering small objects? Do you have...? 1= No difficulty at all 2= A little difficulty 3= Some difficulty 4= A lot of difficulty 5= Just unable to do it
392 q9fs Trimming, cutting or clipping your toenails? Do you have...? 1= No difficulty at all 2= A little difficulty 3= Some difficulty 4= A lot of difficulty 5= Just unable to do it
393 q10fs How much difficulty do you have finding shoes that are comfortable? Do you have...? 1= No difficulty at all 2= A little difficulty 3= Some difficulty 4= A lot of difficulty 5= Just unable to do it
394 q11fs Next, I would like to know if you need help do some different kinds of activities. At the present time, do you need help ... Walking across a small room? 1= No Help 2= Help 3= Unable to do
395 q12fs Bathing, either a sponge bath, tub bath or shower? 1= No Help 2= Help 3= Unable to do
396 q14fs Dressing, like putting on a shirt, buttoning and zipping, or putting on shoes? 1= No Help 2= Help 3= Unable to do
397 q15fs Eating like holding a fork, cutting food, or drinking from a glass? 1= No Help 2= Help 3= Unable to do
398 q16fs Getting from a bed to a chair? 1= No Help 2= Help 3= Unable to do
399 q17fs Using the toilet? 1= No Help 2= Help 3= Unable to do
400 q1fun Now I have a few more questions about activities people may or may not do. Although some things may actually be performed by someone else, just tell me whether you think you are able to do them. 1. Are you able to use the telephone - including looking up numbers and dialing - completely by yourself, or does someone else help you? 1= No Help 2= Help 3= Unable to do
401 q2fun 2. Are you able to shop for the groceries you need - either by going to the grocery store and picking them up or by having them delivered - completely by yourself, or does someone else help you? 1= No Help 2= Help 3= Unable to do
402 q3fun 3. Are you able to prepare your own meals completely by yourself, or does someone else help you? 1= No Help 2= Help 3= Unable to do
403 q4fun 4. Are you able to do the routine light housekeeping completely by yourself, or does someone else help you? 1= No Help 2= Help 3= Unable to do
404 q5fun 5. Are you able to do the periodic heavy housekeeping completely by yourself, or does someone else help you? 1= No Help 2= Help 3= Unable to do
405 q6fun 6. Are you able to do your own laundry completely by yourself, or does someone else help you? 1= No Help 2= Help 3= Unable to do
406 q7fun 7. Are you able to take your own prescribed medicines completely by yourself, or does someone else help you? 1= No Help 2= Help 3= Unable to do
407 q8fun 8. Are you able to take care of your own finances - including paying bills, writing checks, keeping track of income (but not necessarily preparing your own taxes) - completely by yourself, or does someone else help you? 1= No Help 2= Help 3= Unable to do
408 q9fun 9. Are you able to take care of your own social life - including talking to friends and relatives on the telephone, having people come in to visit, going to other people to visit - completely by yourself, or does someone else help you by making all the arrangements? 1= No Help 2= Help 3= Unable to do
409 q10fun 10. Are you able to take care of making your own doctors appointments and going to see your doctor and other health care providers completely by yourself, or does someone else help you by making the appointments or taking you there? 1= No Help 2= Help 3= Unable to do
410 q11fun 11. Are you able to do your own personal shopping, like for clothes, for personal things, or for household needs completely by yourself, or does someone else help you? 1= No Help 2= Help 3= Unable to do
411 q12fun 12. Are you able to travel around in your community to the places you might want to go, like to church or just to be outside completely by yourself, or does someone else help you? 1= No Help 2= Help 3= Unable to do
412 introd Next we would like to ask a few questions about common problems that people have as they grow older. We would appreciate your answers to these questions even though you may not have any problems. >>>>[HIT ENTER FOR NEXT QUESTION]<<<< String[1]
413 q1ur URINARY INCONTINENCE 1. How often during the last 12 months have you leaked urine or lost control of your urine - almost every day, several times a week, several times a month, once a month, less than once a month, or never? 1= Almost everyday 2= Several times a week 3= Several times a month 4= Once a month 5= Less than once a month 6= Never
414 q2ur 2. When you lose urine, how much usually leaks - a few drops, enough to wet your underwear, enough to wet your outer clothes, or enough to wet the floor? [PROBE IF PADS WORN:] Without the protection pads, how much urine would you lose?] 1= A few drops 2= Enough to wet underwear 3= Enough to wet outer clothes 4= Enough to wet the floor
415 q3ur 3. How much of a problem do you consider your urine loss to be - a big problem, a little problem, or no problem at all? 1= A big problem 2= A little problem 3= No problem
416 q4ur 4. In the past few months have you ever lost control of your bowels when you didn't want to? 1= Yes 2= No
417 currjob OCCUPATION 1. The kind of work we do can also affect our health, so we would like to get some information about your occupations. Because Nuns, Priests, and Brothers perform many different types of functions, we would like to know if you are currently working at a job? 1= Yes 2= No
418 ftpt 2. Full-time or part-time? 1= Part-time 2= Full-time
419 cjobname 3. What kind of work are you doing? (What is your job called?) (For example, registered nurse, personnel manager, supervisor, a teacher...) [JOB NAME] String[30]
420 spanishbr Is the participant of Spanish/Hispanic origin? [CHECK RELEASE SHEET] 1= Yes 2= No
421 description_acc Acculturation Although you may speak many languages, the following questions refer to only English and Spanish. [PRESS ENTER TO CONTINUE]
422 acc_langreadspeak Although you may speak many languages, the following questions refer to only English and Spanish. 1. In general, what language(s) do you read and speak? 1= Only Spanish 2= Spanish better 3= Both equally 4= English better than Spanish 5= Only English
423 acc_langchild 2. What was the language(s) you used as a child? 1= Only Spanish 2= More Spanish than English 3= Both equally 4= More English than Spanish 5= Only English
424 acc_langhome 3. What language(s) do you usually speak at home? 1= Only Spanish 2= More Spanish than English 3= Both equally 4= More English than Spanish 5= Only English
425 acc_langthink 4. In which language(s) do you usually think? 1= Only Spanish 2= More Spanish than English 3= Both equally 4= More English than Spanish 5= Only English
426 acc_langfriend 5. What language(s) do you usually speak with your friends? 1= Only Spanish 2= More Spanish than English 3= Both equally 4= More English than Spanish 5= Only English
427 acc_langmedia 6. In general, what language(s) are the movies, T.V. and radio programs you prefer to watch and listen to? 1= Only Spanish 2= More Spanish than English 3= Both equally 4= More English than Spanish 5= Only English
428 acc_friends 7. Your close friends are... 1= All Hispanic/Latino 2= More Hispanic/Latino than non-Hispanic/non-Latino 3= About half and half 4= More non-Hispanic/non-Latino than Hispanic/Latino 5= All non-Hispanic/non-Latino
429 acc_social 8. You prefer going to social gatherings/parties at which people are... 1= All Hispanic/Latino 2= More Hispanic/Latino than non-Hispanic/non-Latino 3= About half and half 4= More non-Hispanic/non-Latino than Hispanic/Latino 5= All non-Hispanic/non-Latino
430 acc_visitors 9. The persons you visit or who visit you are... 1= All Hispanic/Latino 2= More Hispanic/Latino than non-Hispanic/non-Latino 3= About half and half 4= More non-Hispanic/non-Latino than Hispanic/Latino 5= All non-Hispanic/non-Latino
431 acc_kidsfriend 10. If you could choose your children's friends you would want them to be... 1= All Hispanic/Latino 2= More Hispanic/Latino than non-Hispanic/non-Latino 3= About half and half 4= More non-Hispanic/non-Latino than Hispanic/Latino 5= All non-Hispanic/non-Latino
432 description_fam Familism Please indicate how much you agree or disagree with these statements by choosing the answer from 1 (disagree a lot) to 5 (agree a lot) which best shows how you feel about each statement. [PRESS ENTER TO CONTINUE]
433 fam_grandchild 1. One should have the hope of living long enough to see his/her grandchildren grow up. 1= Disagree a lot 2= Disagree 3= Don't disagree or agree 4= Agree 5= Agree a lot
434 fam_parliverel 2. Aging parents should live with relatives. 1= Disagree a lot 2= Disagree 3= Don't disagree or agree 4= Agree 5= Agree a lot
435 fam_helprel 3. When someone has problems he/she can count on help from his/her relatives. 1= Disagree a lot 2= Disagree 3= Don't disagree or agree 4= Agree 5= Agree a lot
436 fam_pleasepar 4. Much of what a son or daughter does should be done to please the parents. 1= Disagree a lot 2= Disagree 3= Don't disagree or agree 4= Agree 5= Agree a lot
437 fam_embrass 5. One should be embarrassed about the bad things done by his/her brothers and sisters. 1= Disagree a lot 2= Disagree 3= Don't disagree or agree 4= Agree 5= Agree a lot
438 fam_livepar 6. Children should live in their parents' house until they get married. 1= Disagree a lot 2= Disagree 3= Don't disagree or agree 4= Agree 5= Agree a lot
439 admin1 PURDUE PEGBOARD -- ADMINISTRATION: [PLACE PEGBOARD IN FRONT OF R, WITH WELLS AT TOP AND PEGS IN FIRST AND LAST WELLS. SAY:] `I want to see how quickly you can place these pegs [POINT] into these holes [POINT] - like this without skipping any holes. [EXAMINER PLACES 4 PEGS WITH RIGHT HAND IN RIGHT-HAND COLUMN.] Now for practice you try it with your right hand.' [ALLOW SUBJECT TO PLACE 4 PEGS IN RIGHT COLUMN; ENCOURAGE WITH `good;' REPEAT PROCESS IF SUBJECT DOES NOT COMPLETE PRACTICE ITEMS SATISFACTORILY. THEN REPLACE PEGS.] >>>>> PRESS ENTER TO CONTINUE <<<<< String[1]
440 admin2 [SAY: ]`Good. You have the idea. Now, when I tell you to begin, pick up the pegs one at a time and place them in this column [POINT TO RIGHT-HAND COLUMN] with your RIGHT HAND as quickly as you can. Again, please do not skip any holes. Ready? Begin. '[START TIMER AS YOU SAY `BEGIN;' EACH TRIAL IS *30 SECONDS*. WATCH R; PROMPT TO PICK UP ONLY ONE PEG AT A TIME, TO USE ONLY ONE HAND AT A TIME, AND NOT TO SKIPHOLES, AS NECESSARY; IF R MAKES SIGNIFICANT ERRORS DURING TRIAL (E.G., USING BOTH HANDS, PLACING PEGS IN WRONG COLUMN, SKIPPING HOLES, ETC.) **IT IS PERMISSIBLE TO REPEAT 1 TRIAL**. IF NECESSARY, COVER ONE COLUMN OF HOLES WITH THE PANEL THAT SLIDES OVER THE WELLS. ONLY VERBALLY REMIND BEYOND THIS, HOWEVER. AT 30 SECONDS SAY:] `stop'. >>>>> PRESS ENTER FOR FIRST TRIAL <<<<< String[1]
441 trial11 1. Trial 1, Right Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] 0 .. 25
442 trial21 [AT COMPLETION OF TRIAL 1, REPLACE PEGS AND SAY:] `Now I want you to do the same thing with your LEFT HAND. Pick up the pegs one at a time and place them in this column [POINT TO LEFT-HAND COLUMN] with your left hand. Work as quickly as you can and do not skip any holes. Ready? Begin.' [TRIAL IS 30 SECONDS WITH SAME PROCEDURES AS TRIAL 1.] 2. Trial 2, Left Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] 0 .. 25
443 trial301 [AT COMPLETION OF TRIAL 2, REPLACE PEGS AND SAY:] `Now I want you to do this again with your RIGHT HAND. Place the pegs one at a time in this column [POINT TO RIGHT-HAND COLUMN COLUMN] with your right hand. Work as quickly as you can and do not skip any holes. Ready? Begin.' [TRIAL IS 30 SECONDS WITH SAME PROCEDURES AS TRIAL 1.] 3. Trial 3, Right Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] 0 .. 25
444 trial4 [AT COMPLETION OF TRIAL 3, REPLACE PEGS AND SAY:] `Now I want you to do this again with your LEFT HAND. Place the pegs one at a time in this column [POINT TO LEFT-HAND COLUMN] with your left hand. Work as quickly as you can and do not skip any holes. Ready? Begin.' [TRIAL IS 30 SECONDS WITH SAME PROCEDURES AS TRIAL 1.] 4. Trial 4, Left Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] 0 .. 25
445 glasses VISION Now I have some questions about your eyesight and your hearing. 1. Do you wear eyeglasses, contact lenses or both? 1= Eyeglasses 2= Contact lenses 3= Both 4= Neither
446 reading 1a. Do you use ^eyes for reading and other close work? 1= Yes 2= No
447 distant 1b. Do you use ^eyes for seeing distant objects better? 1= Yes 2= No
448 testaid ^instruct 1c. Test taken with: 1= Glasses 2= Contact lenses 3= Neither
449 trial10 [INTERVIEWER: Visual acuity should be checked with both eyes open. Hold card 14 inches from subject and ask him/her to read the number on the card. Record number of correct responses.] 2. First trial: 20/70 1= All three correct 2= Two correct 3= One correct 4= None correct
450 trial1a 2a. Second trial: 20/100 1= All three correct 2= Two correct 3= One correct 4= None correct
451 trial1b 2b. Third trial: 20/200 1= All three correct 2= Two correct 3= One correct 4= None correct
452 trial1c 2c. Fourth trial: 20/400 1= All three correct 2= Two correct 3= One correct 4= None correct
453 trial20 3. Second trial: 20/50 1= All three correct 2= Two correct 3= One correct 4= None correct
454 trial300 3a. Third trial: 20/40 1= All three correct 2= Two correct 3= One correct 4= None correct
455 hearaid 4. Do you wear a hearing aid? 1= Yes 2= No
456 freq1 4a. How often do you usually wear a hearing aid these days: practically always, frequently, occasionally, or almost never? 1= Practically always 2= Frequently 3= Occasionally 4= Almost never
457 normal 5. ^aid you usually hear and understand what a person says without seeing his or her face if that person talks in a normal voice to you in a quiet room? 1= Yes 2= No
458 acrossrm 5a. ^aid you usually hear and understand what a person says without seeing his or her face if that person shouts to you from across a quiet room? 1= Yes 2= No
459 inear 5b. ^aid you usually hear and understand what a person says without seeing his or her face if that person shouts in your better ear? 1= Yes 2= No
460 htwt1fu HEIGHT AND WEIGHT Now I have some questions about your height and weight. 1. Since your interview on [last interview date], have you gained or lost more than 10 pounds? [PROBE IF YES: Did you gain more than 10 pounds or lose more than 10 pounds or both?] 1= Yes, lost >10 lbs 2= Yes, gained > 10 lbs 3= Yes, gained and lost > 10 lbs 4= No changes
461 midarm BLOODPRESSURE Now I would like to take some arm, height and weight measurements, and blood pressure readings. 1. MID-ARM CIRCUMFERENCE [IN cm] 15.0 .. 78.0
462 midfore 1a. MID FOREARM CIRCUMFERENCE [IN cm] 10.0 .. 78.0
463 midleg 1b. MID LEG CIRCUMFERENCE [IN cm] 15.0 .. 99.0
464 tricep1 2. FIRST TRICEPS SKINFOLD MEASUREMENT [IN mm] CODE 72 IF MEASUREMENT >= 67 mm] 1 .. 72
465 cuff 3. IS CUFF SIZE AVAILABLE? [IF CUFF NOT AVAILABLE, AT END OF INTERVIEW SET UP TIME TO RETURN FOR BLOOD PRESSURE MEASUREMENT] 1= Yes 2= No
466 tricep2 4. SECOND TRICEPS SKINFOLD MEASUREMENT [IN mm] [CODE 72 IF MEASUREMENT >=67mm] 1 .. 72
467 pulsept 5. PULSE OBLITERATION POINT [IN mmHg] 50 .. 270
468 pul THE PEAK INFLATION LEVEL IS ^pulse [HIT ENTER FOR NEXT QUESTION] 80 .. 300
469 bp1 6. FIRST SITTING BLOOD PRESSURE READING [INTERVIEWER: The subject should be seated for five minutes prior to obtaining the seated blood pressure readings. ENTER SYSTOLIC/DIASTOLIC] String[7]
470 bp2 7. SECOND SITTING BLOOD PRESSURE READING [INTERVIEWER: ENTER SYSTOLIC/DIASTOLIC] String[7]
471 bp31 8. STANDING BLOOD PRESSURE READING [INTERVIEWER: ASK THE SUBJECT TO STAND. WAIT 60 SECONDS THEN REPEAT BLOOD PRESSURE READING. ENTER SYSTOLIC/DIASTOLIC] String[7]
472 weight 9. MEASURED WEIGHT [IN LBS] [CODE 333 IF MEASUREMENT IS >=300 lbs. CODE 888 IF PHYSICALLY UNABLE TO WEIGH] 30 .. 888
473 height 10. MEASURED HEIGHT [IN FEET & INCHES] [CODE 888 IF PHYSICALLY UNABLE TO MEASURE HEIGHT] String[5]
474 introk PHYSICAL MEASUREMENTS Now I would like you to try to do different movements of your body that involve your arms and legs. I will first describe and show each movement to you. Then I'd like you to try it. Please be very careful and let me know if you need help. [INTERVIEWER: BOTH THE RESEARCH ASSISTANT AND NURSE SHOULD BE PRESENT IF THE SUBJECT NEEDS ASSISTANCE WITH THESE MEASUREMENTS. DEMONSTRATE AND DESCRIBE EACH POSITION. THEN ENTER NUMBER OF SECONDS THE SUBJECT HOLDS POSITION.] >>>>> PRESS ENTER FOR NEXT QUESTION <<<<</p String[1]
475 move1 1. SEMI-TANDEM STAND (Eyes Open) [UP TO 10 SECONDS] [INTERVIEWER: DESCRIBE THE POSITION WHILE DEMONSTRATING.] [ENTER NUMBER OF SECONDS R HOLDS POSITION] [CODE 55.5=tried but unable] 1.0 .. 55.5
476 move2 2. FULL TANDEM STAND (Eyes Open) [INTERVIEWER: DESCRIBE THE POSITION WHILE DEMONSTRATING.] [ENTER NUMBER OF SECONDS R HOLDS POSITION] [CODE 55.5=tried but unable] 1.0 .. 55.5
477 move3 3. SIDE BY SIDE STAND (Eyes Open) [INTERVIEWER: DESCRIBE THE POSITION WHILE DEMONSTRATING.] [ENTER NUMBER OF SECONDS R HOLDS POSITION] [CODE 55.5=tried but unable] 1.0 .. 55.5
478 move4 4. SIDE BY SIDE STAND (Eyes Closed) [INTERVIEWER: DESCRIBE THE POSITION WHILE DEMONSTRATING.] [ENTER NUMBER OF SECONDS R HOLDS POSITION] [CODE 55.5=tried but unable] 1.0 .. 55.5
479 move5 5. HEEL STAND (Eyes Open) [INTERVIEWER: DESCRIBE THE POSITION WHILE DEMONSTRATING.] [ENTER NUMBER OF SECONDS R HOLDS POSITION] [CODE 55.5=tried but unable] 1.0 .. 55.5
480 move6 6. TOE STAND (Eyes Open) [INTERVIEWER: DESCRIBE THE POSITION WHILE DEMONSTRATING.] [ENTER NUMBER OF SECONDS R HOLDS POSITION] [CODE 55.5=tried but unable] 1.0 .. 55.5
481 move6a 6a. STANDING ON RIGHT LEG (Eyes Open) [TRIAL ONE] [INTERVIEWER: DESCRIBE THE POSITION WHILE DEMONSTRATING.] [ENTER NUMBER OF SECONDS R HOLDS POSITION] [CODE 55.5=tried but unable] 1.0 .. 55.5
482 move6b 6b. STANDING ON RIGHT LEG (Eyes Open) [TRIAL TWO] [INTERVIEWER: DESCRIBE THE POSITION WHILE DEMONSTRATING.] [ENTER NUMBER OF SECONDS R HOLDS POSITION] [CODE 55.5=tried but unable] 1.0 .. 55.5
483 move6c 6c. STANDING ON LEFT LEG (Eyes Open) [TRIAL ONE] [INTERVIEWER: DESCRIBE THE POSITION WHILE DEMONSTRATING.] [ENTER NUMBER OF SECONDS R HOLDS POSITION] [CODE 55.5=tried but unable] 1.0 .. 55.5
484 move6d 6d. STANDING ON LEFT LEG (Eyes Open) [TRIAL TWO] [INTERVIEWER: DESCRIBE THE POSITION WHILE DEMONSTRATING.] [ENTER NUMBER OF SECONDS R HOLDS POSITION] [CODE 55.5=tried but unable] 1.0 .. 55.5
485 move6e 6e. TURNING (360 degrees) [TRIAL ONE] [INTERVIEWER: DESCRIBE THE POSITION WHILE DEMONSTRATING.] [ENTER NUMBER OF SECONDS R TAKES TO COMPLETE THE TURN] [CODE 555.5=tried but unable] 1.0 .. 555.5
486 move6f 6f. TURNING (360 degrees) [TRIAL ONE] [INTERVIEWER: DESCRIBE THE POSITION WHILE DEMONSTRATING.] [ENTER NUMBER OF STEPS R TAKES TO COMPLETE THE TURN] [CODE 55=tried but unable] 1 .. 55
487 move6g 6g. TURNING (360 degrees) [TRIAL TWO] [INTERVIEWER: DESCRIBE THE POSITION WHILE DEMONSTRATING.] [ENTER NUMBER OF SECONDS R TAKES TO COMPLETE THE TURN] [CODE 555.5=tried but unable] 1.0 .. 555.5
488 move6h 6h. TURNING (360 degrees) [TRIAL TWO] [INTERVIEWER: DESCRIBE THE POSITION WHILE DEMONSTRATING.] [ENTER NUMBER OF STEPS R TAKES TO COMPLETE THE TURN] [CODE 55=tried but unable] 1 .. 55
489 move6i 6i. [INTERVIEWER: RECORD AIDS USED FOR TURNING] 1= No aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other
490 move6i1 [SPECIFY] String[20]
491 move7 7. MEASURED WALK [INTERVIEWER: EXTEND THE RULE TO THE 8' LENGTH IN AN AREA WHICH OFFERS AT LEAST 11' AND IDEALLY 12' OF WALKING SPACE. MARK STARTING LINE AND ENDING LINE WITH 18 INCH PIECE OF TAPE. Count the number of steps required to complete the course.] Was the course 8 feet in length? 1= Yes 2= No
492 move7a 7a. [INTERVIEWER: RECORD AIDS USED IN MEASURED WALK] 1= No aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair as walking aid 6= Other
493 move7a1 7b1. [SPECIFY] String[20]
494 move7b 7b. [INTERVIEWER: RECORD TIME FOR FIRST WALK (in seconds)] [CODE 555.5=tried but unable] 1.0 .. 555.5
495 move7c 7c. How many steps were taken? 1 .. 55
496 move8 8. TANDEM WALK [INTERVIEWER: RECORD NUMBER OF ERRORS, e.g. SIDESTEPS] [CODE 55=TRIED BUT UNABLE] 0 .. 55
497 move9a 9a. CHAIR STAND. [INTERVIEWER: DESCRIBE THE CHAIR STAND AND DEMONSTRATE.] ENTER NUMBER OF ATTEMPTS TO RISE (INCLUDING ROCKING/WEIGHT SHIFTING) 0 .. 20
498 move9b 9b. ATTEMPT TO RISE. 1= Rises without using arms 2= Rises using arms 3= Not attempted (no suitable chair) 55= Tried but unable
499 move10a 10. REPEATED CHAIR STAND [INTERVIEWER: DESCRIBE REPEATED CHAIR STANDS WHILE DEMONSTRATING.] 10a. COMPLETION. 1= One completed 2= Two completed 3= Three completed 4= Four completed 5= Five completed 13= Not attempted, no suitable chair 55= Tried, but unable
500 move10b 10b. TIME IF 5 STANDS DONE SUCCESSFULLY [IN SECONDS] 1.0 .. 99.0
501 move9c 10c. [RECORD CHAIR HEIGHT] [ENTER INCHES FROM FLOOR TO LOWEST POINT OF SEAT] 3 .. 48
502 move9d 10d. Did the chair have arms? 1= Yes 2= No
503 move11a EXTERNAL SHOULDER ROTATION. [DESCRIBE EXERCISE WHILE DEMONSTRATING.] 11a. RIGHT SIDE: 1= Performed fully 2= Performed partially; hand behind head 3= Performed partially; arm raised 4= Unable to do
504 move11b 11b. LEFT SIDE: 1= Performed fully 2= Performed partially; hand behind head 3= Performed partially; arm raised 4= Unable to do
505 autendtm [COMPUTER CLOCK TIME] String[8]
506 comment Comments String[120]
511 vegsign 0 .. 8
512 mvegsign 0 .. 8
513 cesd 0 .. 10
514 mcesd 0 .. 10
515 formcode Please enter status code. 11 = COMPLETE 13 = COMPLETE, portion with proxy 12 = INCOMPLETE, refused 14 = INCOMPLETE, too impaired 21 = INCOMPLETE interim, complete later 73 = NOT TESTED, out of town 31 = NOT TESTED, moved 33 = NOT TESTED, refused 75 = NOT TESTED, hospitalized 76 = NOT TESTED, other 42 = DECEASED 43 = WITHDRAWN 44 = WITHDRAWN, Autopsy OK 11 .. 76
516 formpart Was participant reluctant, and/or does participant have special needs? 1= Yes 2= No
517 formcomm Please explain reluctance or any other factors which may have affected this data. [Press enter if no comment needed.] String[120]
518 statid Please enter you staff id. 100 .. 997
519 formch Has the form been modified? 1= Yes 2= No
520 revidate Enter the date that the form was modified. Date type
521 revintd Enter your staff id number. 100 .. 997
522 anydev Are there any protocol deviations or missing data items to enter? 1= Yes 2= No
523 numdev How many total protocol deviations and tests with missing items to enter? 1 .. 20
524 reas00 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
525 test00 Enter test or procedure. String[15]
526 item00 List items involved. [SEPARATE BY A COMMA] String[20]
527 code00 Enter data code used. 1= Don't Know 2= Refusal 3= other
528 oth00 Enter other code used. String[20]
529 expl00 Explain what happened String[100]
530 reas01 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
531 test01 Enter test or procedure. String[15]
532 item01 List items involved. [SEPARATE BY A COMMA] String[20]
533 code01 Enter data code used. 1= Don't Know 2= Refusal 3= other
534 oth01 Enter other code used. String[20]
535 expl01 Explain what happened String[100]
536 reas02 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
537 test02 Enter test or procedure. String[15]
538 item02 List items involved. [SEPARATE BY A COMMA] String[20]
539 code02 Enter data code used. 1= Don't Know 2= Refusal 3= other
540 oth02 Enter other code used. String[20]
541 expl02 Explain what happened String[100]
542 reas03 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
543 test03 Enter test or procedure. String[15]
544 item03 List items involved. [SEPARATE BY A COMMA] String[20]
545 code03 Enter data code used. 1= Don't Know 2= Refusal 3= other
546 oth03 Enter other code used. String[20]
547 expl03 Explain what happened String[100]
548 reas04 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
549 test04 Enter test or procedure. String[15]
550 item04 List items involved. [SEPARATE BY A COMMA] String[20]
551 code04 Enter data code used. 1= Don't Know 2= Refusal 3= other
552 oth04 Enter other code used. String[20]
553 expl04 Explain what happened String[100]
554 reas05 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
555 test05 Enter test or procedure. String[15]
556 item05 List items involved. [SEPARATE BY A COMMA] String[20]
557 code05 Enter data code used. 1= Don't Know 2= Refusal 3= other
558 oth05 Enter other code used. String[20]
559 expl05 Explain what happened String[100]
560 reas06 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
561 test06 Enter test or procedure. String[15]
562 item06 List items involved. [SEPARATE BY A COMMA] String[20]
563 code06 Enter data code used. 1= Don't Know 2= Refusal 3= other
564 oth06 Enter other code used. String[20]
565 expl06 Explain what happened String[100]
566 reas07 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
567 test07 Enter test or procedure. String[15]
568 item07 List items involved. [SEPARATE BY A COMMA] String[20]
569 code07 Enter data code used. 1= Don't Know 2= Refusal 3= other
570 oth07 Enter other code used. String[20]
571 expl07 Explain what happened String[100]
572 reas08 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
573 test08 Enter test or procedure. String[15]
574 item08 List items involved. [SEPARATE BY A COMMA] String[20]
575 code08 Enter data code used. 1= Don't Know 2= Refusal 3= other
576 oth08 Enter other code used. String[20]
577 expl08 Explain what happened String[100]
578 reas09 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
579 test09 Enter test or procedure. String[15]
580 item09 List items involved. [SEPARATE BY A COMMA] String[20]
581 code09 Enter data code used. 1= Don't Know 2= Refusal 3= other
582 oth09 Enter other code used. String[20]
583 expl09 Explain what happened String[100]
584 reas10 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
585 test10 Enter test or procedure. String[15]
586 item10 List items involved. [SEPARATE BY A COMMA] String[20]
587 code10 Enter data code used. 1= Don't Know 2= Refusal 3= other
588 oth10 Enter other code used. String[20]
589 expl10 Explain what happened String[100]
590 reas11 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
591 test11 Enter test or procedure. String[15]
592 item11 List items involved. [SEPARATE BY A COMMA] String[20]
593 code11 Enter data code used. 1= Don't Know 2= Refusal 3= other
594 oth11 Enter other code used. String[20]
595 expl11 Explain what happened String[100]
596 reas12 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
597 test12 Enter test or procedure. String[15]
598 item12 List items involved. [SEPARATE BY A COMMA] String[20]
599 code12 Enter data code used. 1= Don't Know 2= Refusal 3= other
600 oth12 Enter other code used. String[20]
601 expl12 Explain what happened String[100]
602 reas13 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
603 test13 Enter test or procedure. String[15]
604 item13 List items involved. [SEPARATE BY A COMMA] String[20]
605 code13 Enter data code used. 1= Don't Know 2= Refusal 3= other
606 oth13 Enter other code used. String[20]
607 expl13 Explain what happened String[100]
608 reas14 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
609 test14 Enter test or procedure. String[15]
610 item14 List items involved. [SEPARATE BY A COMMA] String[20]
611 code14 Enter data code used. 1= Don't Know 2= Refusal 3= other
612 oth14 Enter other code used. String[20]
613 expl14 Explain what happened String[100]
614 reas15 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
615 test15 Enter test or procedure. String[15]
616 item15 List items involved. [SEPARATE BY A COMMA] String[20]
617 code15 Enter data code used. 1= Don't Know 2= Refusal 3= other
618 oth15 Enter other code used. String[20]
619 expl15 Explain what happened String[100]
620 reas16 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
621 test16 Enter test or procedure. String[15]
622 item16 List items involved. [SEPARATE BY A COMMA] String[20]
623 code16 Enter data code used. 1= Don't Know 2= Refusal 3= other
624 oth16 Enter other code used. String[20]
625 expl16 Explain what happened String[100]
626 reas17 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
627 test17 Enter test or procedure. String[15]
628 item17 List items involved. [SEPARATE BY A COMMA] String[20]
629 code17 Enter data code used. 1= Don't Know 2= Refusal 3= other
630 oth17 Enter other code used. String[20]
631 expl17 Explain what happened String[100]
632 reas18 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
633 test18 Enter test or procedure. String[15]
634 item18 List items involved. [SEPARATE BY A COMMA] String[20]
635 code18 Enter data code used. 1= Don't Know 2= Refusal 3= other
636 oth18 Enter other code used. String[20]
637 expl18 Explain what happened String[100]
638 reas19 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
639 test19 Enter test or procedure. String[15]
640 item19 List items involved. [SEPARATE BY A COMMA] String[20]
641 code19 Enter data code used. 1= Don't Know 2= Refusal 3= other
642 oth19 Enter other code used. String[20]
643 expl19 Explain what happened String[100]

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