Data Dictionary for rosintfu

Number of Blaise fields: 643

Seq # Var Question Data Type/Coding
1 ivisit visit
2 projid ROS FOLLOW-UP Interview (v4.0 Rev 02/21/2022) Enter project ID number. String[8]
3 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 31 = 30th F/U ... 50 = 50th F/U String[2]
4 dateint Date of interview Date type
5 baseyear Enter year of baseline from face sheet: 1993 .. 2025
6 formno INTRODUCTION Form Number String[8]
7 version version Number. String[4]
8 autodate Automatic Date. Date type
9 autotime Automatic Time. TimeType
10 autolog Automatic Logged Date. Date type
11 intid INTERVIEWER ID 100 .. 997
12 compid Laptop ID String[20]
13 datlas Date of previous ROS questionnaire Date type
14 sex 1. Record participant's sex. 1= Male 2= Female
15 autotm [COMPUTER CLOCK TIME] String[8]
16 phone Was this interview completed over the telephone or in person? 1= In-person 2= Telephone
17 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
18 q5loc What is your social security number? 0 .. 999999999
19 q5aloc [ENTER R. SOCIAL SECURITY NUMBER AGAIN] 0 .. 999999999
20 q6loc What is your medicare number? Please show me your card. String[11]
21 q6aloc [ENTER R. MEDICARE NUMBER AGAIN] String[11]
22 validated
23 validateerror
24 errorposition
25 validated_hicn_cms
26 validated_rrb_pre1964
27 validated_rrb_post1964
28 hicnformats
29 hicn_alpha
30 hicn_numbers
31 strlen
32 hicn_trimmed
33 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
34 ssn What is your social security number? [INTERVIEWER: Please enter the SSN in 000-00-0000 format.] String[11]
35 ssn_c [ENTER R. SOCIAL SECURITY NUMBER AGAIN] String[11]
36 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
37 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]
38 hicn_c [ENTER R. MEDICARE NUMBER(HICN) AGAIN] String[11]
39 hicn_type HICN Type: ^hicnFormats String[15]
40 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
41 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]
42 mbi_c [ENTER R. MEDICARE NUMBER(MBI) AGAIN] String[13]
43 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
44 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
45 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
46 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
47 chf CONGESTIVE HEART FAILURE Since your last interview on [last interview date], have you been told by a doctor, nurse, or therapist that you had.....congestive heart failure? 1= Yes 2= Suspect or possible 3= No
48 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
49 multipfu 1a. Did you have only one or more than one? 1= Only one 2= More than one
50 inhospfu 1b Were you hospitalized overnight or longer for this (last one)? 1= Yes 2= No
51 hospnafu 1d. What was the name of the (last) hospital? [SPECIFY] String[40]
52 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
53 ca1afu 1a. Where was it? [OR: Where was the most recent cancer that you had?] [SPECIFY] String[20]
54 ca1bfu 1b. Were you hospitalized overnight or longer for this? 1= Yes 2= No
55 ca1dfu 1c. What was the name of the (last) hospital? [SPECIFY] String[40]
56 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
57 db1fu 2. Has a doctor, nurse or therapist, told you to take insulin or injections for your high blood sugar? 1= Yes 2= No
58 db1afu 2a Are you currently taking insulin or injections? 1= Yes 2= No
59 db3fu 3 Has a doctor, nurse, or therapist told you to take medicine by mouth for your high blood sugar? 1= Yes 2= No
60 db3afu 3a Are you currently doing this? 1= Yes 2= No
61 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
62 bp30fu 2 Has a doctor, nurse, or therapist told you to take medicine by mouth for your high blood pressure? 1= Yes 2= No
63 bp3afu 2a Are you currently doing this? 1= Yes 2= No
64 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
65 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
66 th5bfu 1b. Were you hospitalized overnight or longer for thyroid disease? 1= Yes 2= No
67 th5dfu 1c. What was the name of the (last) hospital? [SPECIFY] String[40]
68 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
69 hip6afu 1a. Were you ever hospitalized overnight or longer for this? 1= Yes 2= No
70 hip6cfu 1b. What was the name of the (last) hospital? [SPECIFY] String[40]
71 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
72 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
73 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
74 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
75 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
76 pressufu 1a. Have you had any pressure or heaviness in your chest? 1= Yes 2= No
77 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
78 level0fu 3. Do you get this pain or discomfort when you walk at an ordinary pace on the level? 1= Yes 2= No
79 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
80 stand0fu 5. If you stand still, what happens to the pain? 1= Relieved 2= Not relieved
81 howso0fu 5a. How soon is the pain relieved? 1= 10 minutes or less 2= More than 10 minutes
82 musterfu 6a. Will you show me where it was? Sternum (middle or upper) 1= Show 2= Not shown
83 lowstefu 6b. Sternum (lower) 1= Show 2= Not shown
84 lantchfu 6c. Left anterior chest 1= Show 2= Not shown
85 leftarfu 6d. Left arm 1= Show 2= Not shown
86 otherfu 7. Did you feel it anywhere else? 1= Yes 2= No
87 wherefu 7a. Where? [SPECIFY] String[30]
88 attackfu 8. Have you had a severe pain across the front of your chest lasting half an hour or more? 1= Yes 2= No
89 seedocfu 9. Did you see a doctor because of the pain? 1= Yes 2= No
90 docsaifu 9a. What did (s)he say it was? String[40]
91 howma0fu 10. How many of these attacks have you had? 1 .. 99
92 legpain CLAUDICATION Now some questions about pains in your legs 1. Do you get pain in either leg while walking? 1= Yes 2= No
93 standsit 2. Does this pain ever begin when you are standing still or sitting? 1= Yes 2= No
94 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
95 uphill1 4. Do you get this pain when you walk uphill or hurry? 1= Yes 2= No 3= Never walks uphill or hurries
96 level1 5. Do you get this pain when you walk at an ordinary pace on the level? 1= Yes 2= No
97 disapp 6. Does this pain ever disappear while you are still walking? 1= Yes 2= No
98 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
99 stand1 8. What happens to the pain if you stand still? 1= Relieved 2= Not relieved
100 howsoon1 8a. How soon is it relieved? 1= 10 minutes or less 2= More than 10 minutes
101 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]
102 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
103 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
104 shotfu 3. injection (shot) 1= Yes 2= Suspect 3= No
105 cosfu 4. vaginal cream or suppository 1= Yes 2= Suspect 3= No
106 patchfu 5. skin patch 1= Yes 2= Suspect 3= No
107 currenfu 6. Are you currently taking this/these medications? 1= Yes 2= No
108 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
109 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
110 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
111 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
112 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
113 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
114 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
115 dzhospfu 4d. Were you hospitalized overnight or longer for this (last one)? 1= Yes 2= No
116 dzhonmfu 4f. What was the name of the (last) hospital? String[40]
117 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
118 neckpafu 2. ...Pain in your neck or back on most days for at least one month? 1= Yes 2= No
119 neckpafu2 2. ...Pain in your neck on most days for at least one month? 1= Yes 2= No
120 backpafu 2. ...Pain in your back on most days for at least one month? 1= Yes 2= No
121 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
122 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
123 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
124 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
125 feetpafu 7. ...Pain or aching in either of your feet on most days for at least one month? 1= Yes 2= No
126 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
127 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
128 q2neurfu Was this ___ on the right side, left side, or both sides? 1= Right 2= Left 3= Both
129 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
130 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
131 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
132 q4bneufu Was this ___ on the right side, left side, or both sides? 1= Right 2= Left 3= Both
133 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
134 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
135 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
136 q7neurf2 Which of these problems did you have, pain, numbness or tingling, or weakness? [LIST ALL THAT APPLY] See previous question
137 q7neurf3 Which of these problems did you have, pain, numbness or tingling, or weakness? [LIST ALL THAT APPLY] See previous question
138 q8neurfu Did this ___ occur on the right side, left side, or both sides? 1= Right 2= Left 3= Both
139 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
140 q10neufu How many different times have you had neck pain? 1 .. 50
141 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
142 q12neufu Since your last interview on [last interview date] have you seen a doctor because of neck pain? 1= Yes 2= No
143 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
144 q14neufu When was the last time? [ENTER YEAR] 1900 .. 2040
145 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]
146 q16neufu [ENTER LOCATION] String[40]
147 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
148 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
149 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
150 q19neuf2 Which of these problems did you have, pain, numbness or tingling, or weakness? [LIST ALL THAT APPLY] See previous question
151 q19neuf3 Which of these problems did you have, pain, numbness or tingling, or weakness? [LIST ALL THAT APPLY] See previous question
152 q20neufu Did this ___ occur on the right side, left side, or both sides? 1= Right 2= Left 3= Both
153 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
154 q22neufu How many different times have you had low back pain? 1 .. 50
155 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
156 q24neufu Since your last interview on [last interview date] have you seen a doctor because of low back pain? 1= Yes 2= No
157 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
158 q26neufu When was the last time? [ENTER YEAR] 1900 .. 2040
159 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]
160 q28neufu [ENTER LOCATION] String[40]
161 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
162 q2md 2. My sleep was restless. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
163 q3md 3. I felt depressed. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
164 q4md 4. I was happy. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
165 q5md 5. I felt lonely. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
166 q6md 6. People were unfriendly. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
167 q7md 7. I enjoyed life. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
168 q8md 8. I felt sad. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
169 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
170 q10md 10. I could not get 'going'. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
171 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
172 q2slp 2. How often are you troubled by waking up during the night? 1= Very Often 2= Often 3= Sometimes 4= Rarely 5= never
173 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
174 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
175 q6slp How many hours do you usually sleep at night? 0 .. 24
176 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
177 q1adep During this period, did you experience any of the following problems? 1a. A change in your appetite 1= Yes 2= No
178 q1bdep 1b. A change in your pattern of sleeping 1= Yes 2= No
179 q1cdep 1c. A decrease in your energy level 1= Yes 2= No
180 q1ddep 1d. Trouble concentrating 1= Yes 2= No
181 q1edep 1e. Felt extremely guilty or worthless 1= Yes 2= No
182 q1fdep 1f. Felt extremely restless or agitated 1= Yes 2= No
183 q1gdep 1g. Lost your interest in favorite activities 1= Yes 2= No
184 q1hdep 1h. Felt that life was not worth living 1= Yes 2= No
185 q2dep 2. Did you tell a doctor or any other professional about it? 1= Yes 2= No
186 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
187 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
188 q3abdep 3ab. A change in your pattern of sleeping 1= Yes 2= No
189 q3acdep 3ac. A decrease in your energy level 1= Yes 2= No
190 q3addep 3ad. Trouble concentrating 1= Yes 2= No
191 q3aedep 3ae. Felt extremely guilty or worthless 1= Yes 2= No
192 q3afdep 3af. Felt extremely restless or agitated 1= Yes 2= No
193 q3agdep 3ag. Lost your interest in favorite activities 1= Yes 2= No
194 q3ahdep 3ah. Felt that life was not worth living 1= Yes 2= No
195 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
196 q3cdep 3c. Have you ever seen a doctor because this (one of these) episode(s)? 1= Yes 2= No
197 q3ddep 3d. Were you ever hospitalized overnight or longer for this (one of these) episode(s)? 1= Yes 2= No
198 q3edep 3e. When was the last time? [ENTER YEAR] 1996 .. 2040
199 q3fdep 3f. What was the name and location of the (last) hospital? String[40]
200 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
201 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
202 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
203 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
204 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
205 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
206 howma1fu 3a. How many times? 1 .. 50
207 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
208 hihospfu 4. Since your interview on [last interview date], were you hospitalized overnight or longer for a head injury? 1= Yes 2= No
209 same1fu 4a. Was this the same event we just spoke about? 1= Yes 2= No
210 hihonmfu 4c. What was the name of the (last) hospital? [HOSPITAL NAME] String[40]
211 hihoslfu [LOCATION:] String[40]
212 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
213 speec0fu 2. Language or speech change? 1= Yes 2= Suspect 3= No
214 weakn0fu 3. Weakness or paralysis of face, arms or legs? 1= Yes 2= Suspect 3= No
215 side0fu 3a. Which side(s)? 1= right only 2= left only 3= both
216 othsp0fu 4. Specify any other signs or symptoms associated with this (last) event? String[40]
217 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
218 same2fu Was this the same event we just spoke about? 1= Yes 2= No
219 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]
220 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
221 speec1fu 2. Language or speech change? 1= Yes 2= Suspect 3= No
222 weakn1fu 3. Weakness or paralysis of face, arms or legs? 1= Yes 2= Suspect 3= No
223 side1fu 3a. Which side(s)? 1= right only 2= left only 3= both
224 othsp1fu 4. Specify any other signs or symptoms associated with this (last) event? String[40]
225 speciffu 6. Specify left over troubles from your head injury(s)? String[40]
226 hdrvehicle
227 hdrhitbyobject
228 hdrfalling
229 hdrsports
230 hdrabuse
231 hdrmilitary
232 hdrother
233 prevbisqdone BRAIN INJURY SCREENING QUESTIONNAIRE Have the BISQ questions been previously completed for this participant? ^prevBisqDoneText 1= Yes 2= No
234 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
235 bisqvehnum ^hdrVehicle How many times did you receive a blow to the head, in a vehicle accident? 1 .. 30
236 bisqvehloc ^hdrVehicle Did you lose consciousness? 1= Yes 2= No
237 bisqvehlocnum ^hdrVehicle How many times have you lost consciousness? 1 .. 30
238 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.
239 bisqvehlocyr1 ^hdrVehicle In what year did this occur (1)? 1900 .. 2050
240 bisqvehlocyr2 ^hdrVehicle In what year did this occur (2)? 1900 .. 2050
241 bisqvehlocyr3 ^hdrVehicle In what year did this occur (3)? 1900 .. 2050
242 bisqvehlocyr4 ^hdrVehicle In what year did this occur (4)? 1900 .. 2050
243 bisqvehlocyr5 ^hdrVehicle In what year did this occur (5)? 1900 .. 2050
244 bisqvehdaze ^hdrVehicle Were you dazed or confused? 1= Yes 2= No
245 bisqvehdazenum ^hdrVehicle How many times have you been dazed or confused? 1 .. 30
246 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.
247 bisqvehdazeyr1 ^hdrVehicle In what year did this occur (1)? 1900 .. 2050
248 bisqvehdazeyr2 ^hdrVehicle In what year did this occur (2)? 1900 .. 2050
249 bisqvehdazeyr3 ^hdrVehicle In what year did this occur (3)? 1900 .. 2050
250 bisqvehdazeyr4 ^hdrVehicle In what year did this occur (4)? 1900 .. 2050
251 bisqvehdazeyr5 ^^hdrVehicle In what year did this occur (5)? 1900 .. 2050
252 bisqhit ^lastInterviewText1en 2. Hit by an object?(ex: equipment, falling object) 1= Yes 2= No
253 bisqhitnum ^hdrHitByObject How many times did you receive a blow to the head, from a falling object? 1 .. 30
254 bisqhitloc ^hdrHitByObject Did you lose consciousness? 1= Yes 2= No
255 bisqhitlocnum ^hdrHitByObject How many times have you lost consciousness? 1 .. 30
256 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.
257 bisqhitlocyr1 ^hdrHitByObject In what year did this occur (1)? 1900 .. 2050
258 bisqhitlocyr2 ^hdrHitByObject In what year did this occur (2)? 1900 .. 2050
259 bisqhitlocyr3 ^hdrHitByObject In what year did this occur (3)? 1900 .. 2050
260 bisqhitlocyr4 ^hdrHitByObject In what year did this occur (4)? 1900 .. 2050
261 bisqhitlocyr5 ^hdrHitByObject In what year did this occur (5)? 1900 .. 2050
262 bisqhitdaze ^hdrHitByObject Were you dazed or confused? 1= Yes 2= No
263 bisqhitdazenum ^hdrHitByObject How many times have you been dazed or confused? 1 .. 30
264 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.
265 bisqhitdazeyr1 ^hdrHitByObject In what year did this occur (1)? 1900 .. 2050
266 bisqhitdazeyr2 ^hdrHitByObject In what year did this occur (2)? 1900 .. 2050
267 bisqhitdazeyr3 ^hdrHitByObject In what year did this occur (3)? 1900 .. 2050
268 bisqhitdazeyr4 ^hdrHitByObject In what year did this occur (4)? 1900 .. 2050
269 bisqhitdazeyr5 ^hdrHitByObject In what year did this occur (5)? 1900 .. 2050
270 bisqfall ^lastInterviewText2en 3. Falling? (ex: down stairs, during a fainting spell, from a high place) 1= Yes 2= No
271 bisqfallnum ^hdrFalling How many times did you receive a blow to the head, in a fall? 1 .. 30
272 bisqfallloc ^hdrFalling Did you lose consciousness? 1= Yes 2= No
273 bisqfalllocnum ^hdrFalling How many times have you lost consciousness? 1 .. 30
274 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.
275 bisqfalllocyr1 ^hdrFalling In what year did this occur (1)? 1900 .. 2050
276 bisqfalllocyr2 ^hdrFalling In what year did this occur (2)? 1900 .. 2050
277 bisqfalllocyr3 ^hdrFalling In what year did this occur (3)? 1900 .. 2050
278 bisqfalllocyr4 ^hdrFalling In what year did this occur (4)? 1900 .. 2050
279 bisqfalllocyr5 ^hdrFalling In what year did this occur (5)? 1900 .. 2050
280 bisqfalldaze ^hdrFalling Were you dazed or confused? 1= Yes 2= No
281 bisqfalldazenum ^hdrFalling How many times have you been dazed or confused? 1 .. 30
282 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.
283 bisqfalldazeyr1 ^hdrFalling In what year did this occur (1)? 1900 .. 2050
284 bisqfalldazeyr2 ^hdrFalling In what year did this occur (2)? 1900 .. 2050
285 bisqfalldazeyr3 ^hdrFalling In what year did this occur (3)? 1900 .. 2050
286 bisqfalldazeyr4 ^hdrFalling In what year did this occur (4)? 1900 .. 2050
287 bisqfalldazeyr5 ^hdrFalling In what year did this occur (5)? 1900 .. 2050
288 bisqsprt ^lastInterviewText3en 4. Sports/Leisure?(ex: sports, biking, skiing, on the playground) 1= Yes 2= No
289 bisqsprtnum ^hdrSports How many times did you receive a blow to the head, during a sports or leisure activity? 1 .. 30
290 bisqsprtloc ^hdrSports Did you lose consciousness? 1= Yes 2= No
291 bisqsprtlocnum ^hdrSports How many times have you lost consciousness? 1 .. 30
292 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.
293 bisqsprtlocyr1 ^hdrSports In what year did this occur (1)? 1900 .. 2050
294 bisqsprtlocyr2 ^hdrSports In what year did this occur (2)? 1900 .. 2050
295 bisqsprtlocyr3 ^hdrSports In what year did this occur (3)? 1900 .. 2050
296 bisqsprtlocyr4 ^hdrSports In what year did this occur (4)? 1900 .. 2050
297 bisqsprtlocyr5 ^hdrSports In what year did this occur (5)? 1900 .. 2050
298 bisqsprtdaze ^hdrSports Were you dazed or confused? 1= Yes 2= No
299 bisqsprtdazenum ^hdrSports How many times have you been dazed or confused? 1 .. 30
300 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.
301 bisqsprtdazeyr1 ^hdrSports In what year did this occur (1)? 1900 .. 2050
302 bisqsprtdazeyr2 ^hdrSports In what year did this occur (2)? 1900 .. 2050
303 bisqsprtdazeyr3 ^hdrSports In what year did this occur (3)? 1900 .. 2050
304 bisqsprtdazeyr4 ^hdrSports In what year did this occur (4)? 1900 .. 2050
305 bisqsprtdazeyr5 ^hdrSports In what year did this occur (5)? 1900 .. 2050
306 bisqphys ^lastInterviewText4en 5. Physical Abuse/Assault?(ex: mugged) 1= Yes 2= No
307 bisqphysnum ^hdrAbuse How many times did you receive a blow to the head, from abuse or assault? 1 .. 30
308 bisqphysloc ^hdrAbuse Did you lose consciousness? 1= Yes 2= No
309 bisqphyslocnum ^hdrAbuse How many times have you lost consciousness? 1 .. 30
310 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.
311 bisqphyslocyr1 ^hdrAbuse In what year did this occur (1)? 1900 .. 2050
312 bisqphyslocyr2 ^hdrAbuse In what year did this occur (2)? 1900 .. 2050
313 bisqphyslocyr3 ^hdrAbuse In what year did this occur (3)? 1900 .. 2050
314 bisqphyslocyr4 ^hdrAbuse In what year did this occur (4)? 1900 .. 2050
315 bisqphyslocyr5 ^hdrAbuse In what year did this occur (5)? 1900 .. 2050
316 bisqphysdaze ^hdrAbuse Were you dazed or confused? 1= Yes 2= No
317 bisqphysdazenum ^hdrAbuse How many times have you been dazed or confused? 1 .. 30
318 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.
319 bisqphysdazeyr1 ^hdrAbuse In what year did this occur (1)? 1900 .. 2050
320 bisqphysdazeyr2 ^hdrAbuse In what year did this occur (2)? 1900 .. 2050
321 bisqphysdazeyr3 ^hdrAbuse In what year did this occur (3)? 1900 .. 2050
322 bisqphysdazeyr4 ^hdrAbuse In what year did this occur (4)? 1900 .. 2050
323 bisqphysdazeyr5 ^hdrAbuse In what year did this occur (5)? 1900 .. 2050
324 bisqmil ^lastInterviewText5en 6. Military Service?(ex: training, blast injury) 1= Yes 2= No
325 bisqmilnum ^hdrMilitary How many times did you receive a blow to the head, during military service? 1 .. 30
326 bisqmilloc ^hdrMilitary Did you lose consciousness? 1= Yes 2= No
327 bisqmillocnum ^hdrMilitary How many times have you lost consciousness? 1 .. 30
328 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.
329 bisqmillocyr1 ^hdrMilitary In what year did this occur (1)? 1900 .. 2050
330 bisqmillocyr2 ^hdrMilitary In what year did this occur (2)? 1900 .. 2050
331 bisqmillocyr3 ^hdrMilitary In what year did this occur (3)? 1900 .. 2050
332 bisqmillocyr4 ^hdrMilitary In what year did this occur (4)? 1900 .. 2050
333 bisqmillocyr5 ^hdrMilitary In what year did this occur (5)? 1900 .. 2050
334 bisqmildaze ^hdrMilitary Were you dazed or confused? 1= Yes 2= No
335 bisqmildazenum ^hdrMilitary How many times have you been dazed or confused? 1 .. 30
336 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.
337 bisqmildazeyr1 ^hdrMilitary In what year did this occur (1)? 1900 .. 2050
338 bisqmildazeyr2 ^hdrMilitary In what year did this occur (2)? 1900 .. 2050
339 bisqmildazeyr3 ^hdrMilitary In what year did this occur (3)? 1900 .. 2050
340 bisqmildazeyr4 ^hdrMilitary In what year did this occur (4)? 1900 .. 2050
341 bisqmildazeyr5 ^hdrMilitary In what year did this occur (5)? 1900 .. 2050
342 bisqoth ^lastInterviewText6en 7. In any other circumstances? 1= Yes 2= No
343 bisqothsp ^hdrOther Please specify: String[255]
344 bisqothnum ^hdrOther How many times did you receive a blow to the head, in a situation I have not mentioned? 1 .. 30
345 bisqothloc ^hdrOther Did you lose consciousness? 1= Yes 2= No
346 bisqothlocnum ^hdrOther How many times have you lost consciousness? 1 .. 30
347 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.
348 bisqothlocyr1 ^hdrOther In what year did this occur (1)? 1900 .. 2050
349 bisqothlocyr2 ^hdrOther In what year did this occur (2)? 1900 .. 2050
350 bisqothlocyr3 ^hdrOther In what year did this occur (3)? 1900 .. 2050
351 bisqothlocyr4 ^hdrOther In what year did this occur (4)? 1900 .. 2050
352 bisqothlocyr5 ^hdrOther In what year did this occur (5)? 1900 .. 2050
353 bisqothdaze ^hdrOther Were you dazed or confused? 1= Yes 2= No
354 bisqothdazenum ^hdrOther How many times have you been dazed or confused? 1 .. 30
355 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.
356 bisqothdazeyr1 ^hdrOther In what year did this occur (1)? 1900 .. 2050
357 bisqothdazeyr2 ^hdrOther In what year did this occur (2)? 1900 .. 2050
358 bisqothdazeyr3 ^hdrOther In what year did this occur (3)? 1900 .. 2050
359 bisqothdazeyr4 ^hdrOther In what year did this occur (4)? 1900 .. 2050
360 bisqothdazeyr5 ^hdrOther In what year did this occur (5)? 1900 .. 2050
361 q1injfu OTHER INJURIES 1. Since [last interview date], have you had any other accidents or injuries? 1= Yes 2= No
362 q1ainjfu 1a. Did you have one injury or more than one injury? 1= One 2= More than one
363 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]
364 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]
365 q4injfu 4. What object or exposure directly inflicted the injury? For example, was it furniture, stairs, a wall, fire, a car...? String[40]
366 q5injfu 5. How would you describe the nature of the injury? For example, was it a cut, bruise, sprain, fracture, burn...? String[40]
367 q6injfu 6. Which part of the body was directly affected by the injury? For example, was it your eyes, hands, back...? String[40]
368 q7injfu 7. Did you have to see a doctor or other medical practitioner? 1= Yes 2= No
369 q7ainjfu 7a. Were you hospitalized? 1= Yes 2= No
370 q7binjfu 7b. What was the name of the (last) hospital? String[40]
371 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
372 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
373 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
374 q3acc 3a. Specify String[30]
375 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
376 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. [PRESS ENTER TO CONTINUE.] String[1]
377 q1aphy How many times in the past 14 days did you go walking for exercise? [ENTER NUMBER OF TIMES] 0 .. 87
378 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
379 q3aphy How many times in the past 14 days did you do gardening or yard work? [ENTER NUMBER OF TIMES] 0 .. 87
380 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
381 q5aphy How many times in the past 14 days did you do calisthenics or general exercise? [ENTER NUMBER OF TIMES] 0 .. 87
382 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
383 q8aphy How many times in the past 14 days did you go bicycle riding? [ENTER NUMBER OF TIMES] 0 .. 87
384 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
385 q101phy [SPECIFY] any other exercise, sports, or physically active hobbies in the past 2 weeks String[40]
386 q10aphy How many times in the past 14 days did you do this? [ENTER NUMBER OF TIMES] 1 .. 87
387 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
388 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
389 q2fs Are you able to walk up and down stairs to the second floor without help? 1= Yes 2= No
390 q3fs Are you able to walk a half mile without help? 1= Yes 2= No
391 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
392 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
393 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
394 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
395 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
396 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
397 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
398 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
399 q12fs Bathing, either a sponge bath, tub bath or shower? 1= No Help 2= Help 3= Unable to do
400 q14fs Dressing, like putting on a shirt, buttoning and zipping, or putting on shoes? 1= No Help 2= Help 3= Unable to do
401 q15fs Eating like holding a fork, cutting food, or drinking from a glass? 1= No Help 2= Help 3= Unable to do
402 q16fs Getting from a bed to a chair? 1= No Help 2= Help 3= Unable to do
403 q17fs Using the toilet? 1= No Help 2= Help 3= Unable to do
404 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
405 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
406 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
407 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
408 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
409 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
410 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
411 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
412 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
413 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
414 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
415 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
416 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]
417 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
418 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
419 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
420 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
421 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
422 ftpt 2. Full-time or part-time? 1= Part-time 2= Full-time
423 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]
424 spanishbr Is the participant of Spanish/Hispanic origin? [CHECK RELEASE SHEET] 1= Yes 2= No
425 description_acc Acculturation Although you may speak many languages, the following questions refer to only English and Spanish. [PRESS ENTER TO CONTINUE]
426 acc_langreadspeak 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
427 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
428 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
429 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
430 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
431 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
432 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
433 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
434 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
435 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
436 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]
437 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
438 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
439 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
440 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
441 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
442 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
443 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]
444 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]
445 trial11 1. Trial 1, Right Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] 0 .. 25
446 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
447 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
448 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
449 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
450 reading 1a. Do you use ^eyes for reading and other close work? 1= Yes 2= No
451 distant 1b. Do you use ^eyes for seeing distant objects better? 1= Yes 2= No
452 testaid ^instruct 1c. Test taken with: 1= Glasses 2= Contact lenses 3= Neither
453 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
454 trial1a 2a. Second trial: 20/100 1= All three correct 2= Two correct 3= One correct 4= None correct
455 trial1b 2b. Third trial: 20/200 1= All three correct 2= Two correct 3= One correct 4= None correct
456 trial1c 2c. Fourth trial: 20/400 1= All three correct 2= Two correct 3= One correct 4= None correct
457 trial20 3. Second trial: 20/50 1= All three correct 2= Two correct 3= One correct 4= None correct
458 trial300 3a. Third trial: 20/40 1= All three correct 2= Two correct 3= One correct 4= None correct
459 hearaid 4. Do you wear a hearing aid? 1= Yes 2= No
460 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
461 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
462 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
463 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
464 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
465 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
466 midfore 1a. MID FOREARM CIRCUMFERENCE [IN cm] 10.0 .. 78.0
467 midleg 1b. MID LEG CIRCUMFERENCE [IN cm] 15.0 .. 99.0
468 tricep1 2. FIRST TRICEPS SKINFOLD MEASUREMENT [IN mm] CODE 72 IF MEASUREMENT >= 67 mm] 1 .. 72
469 cuff BLOODPRESSURE Now I would like to take some height and weight measurements, and blood pressure readings. 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
470 tricep2 4. SECOND TRICEPS SKINFOLD MEASUREMENT [IN mm] [CODE 72 IF MEASUREMENT >=67mm] 1 .. 72
471 pulsept 5. PULSE OBLITERATION POINT [IN mmHg] 50 .. 270
472 pul THE PEAK INFLATION LEVEL IS ^pulse [HIT ENTER FOR NEXT QUESTION] 80 .. 300
473 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]
474 bp2 7. SECOND SITTING BLOOD PRESSURE READING [INTERVIEWER: ENTER SYSTOLIC/DIASTOLIC] String[7]
475 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]
476 weight 9. MEASURED WEIGHT [IN LBS] [CODE 333 IF MEASUREMENT IS >=300 lbs. CODE 888 IF PHYSICALLY UNABLE TO WEIGH] 30 .. 888
477 height 10. MEASURED HEIGHT [IN FEET & INCHES] [CODE 888 IF PHYSICALLY UNABLE TO MEASURE HEIGHT] String[5]
478 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]
479 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
480 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
481 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
482 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
483 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
484 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
485 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
486 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
487 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
488 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
489 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
490 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
491 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
492 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
493 move6i 6i. [INTERVIEWER: RECORD AIDS USED FOR TURNING] 1= No aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other
494 move6i1 [SPECIFY] String[20]
495 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
496 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
497 move7a1 7b1. [SPECIFY] String[20]
498 move7b 7b. [INTERVIEWER: RECORD TIME FOR FIRST WALK (in seconds)] [CODE 555.5=tried but unable] 1.0 .. 555.5
499 move7c 7c. How many steps were taken? 1 .. 55
500 move8 8. TANDEM WALK [INTERVIEWER: RECORD NUMBER OF ERRORS, e.g. SIDESTEPS] [CODE 55=TRIED BUT UNABLE] 0 .. 55
501 move9a 9a. CHAIR STAND. [INTERVIEWER: DESCRIBE THE CHAIR STAND AND DEMONSTRATE.] ENTER NUMBER OF ATTEMPTS TO RISE (INCLUDING ROCKING/WEIGHT SHIFTING) 0 .. 20
502 move9b 9b. ATTEMPT TO RISE. 1= Rises without using arms 2= Rises using arms 3= Not attempted (no suitable chair) 55= Tried but unable
503 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
504 move10b 10b. TIME IF 5 STANDS DONE SUCCESSFULLY [IN SECONDS] 1.0 .. 99.0
505 move9c 10c. [RECORD CHAIR HEIGHT] [ENTER INCHES FROM FLOOR TO LOWEST POINT OF SEAT] 3 .. 48
506 move9d 10d. Did the chair have arms? 1= Yes 2= No
507 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
508 move11b 11b. LEFT SIDE: 1= Performed fully 2= Performed partially; hand behind head 3= Performed partially; arm raised 4= Unable to do
509 autendtm [COMPUTER CLOCK TIME] String[8]
510 comment Comments String[120]
515 vegsign 0 .. 8
516 mvegsign 0 .. 8
517 cesd 0 .. 10
518 mcesd 0 .. 10
519 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
520 formpart Was participant reluctant, and/or does participant have special needs? 1= Yes 2= No
521 formcomm Please explain reluctance or any other factors which may have affected this data. [Press enter if no comment needed.] String[120]
522 statid Please enter you staff id. 100 .. 997
523 formch Has the form been modified? 1= Yes 2= No
524 revidate Enter the date that the form was modified. Date type
525 revintd Enter your staff id number. 100 .. 997
526 anydev Are there any protocol deviations or missing data items to enter? 1= Yes 2= No
527 numdev How many total protocol deviations and tests with missing items to enter? 1 .. 20
528 reas00 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
529 test00 Enter test or procedure. String[15]
530 item00 List items involved. [SEPARATE BY A COMMA] String[20]
531 code00 Enter data code used. 1= Don't Know 2= Refusal 3= other
532 oth00 Enter other code used. String[20]
533 expl00 Explain what happened String[100]
534 reas01 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
535 test01 Enter test or procedure. String[15]
536 item01 List items involved. [SEPARATE BY A COMMA] String[20]
537 code01 Enter data code used. 1= Don't Know 2= Refusal 3= other
538 oth01 Enter other code used. String[20]
539 expl01 Explain what happened String[100]
540 reas02 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
541 test02 Enter test or procedure. String[15]
542 item02 List items involved. [SEPARATE BY A COMMA] String[20]
543 code02 Enter data code used. 1= Don't Know 2= Refusal 3= other
544 oth02 Enter other code used. String[20]
545 expl02 Explain what happened String[100]
546 reas03 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
547 test03 Enter test or procedure. String[15]
548 item03 List items involved. [SEPARATE BY A COMMA] String[20]
549 code03 Enter data code used. 1= Don't Know 2= Refusal 3= other
550 oth03 Enter other code used. String[20]
551 expl03 Explain what happened String[100]
552 reas04 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
553 test04 Enter test or procedure. String[15]
554 item04 List items involved. [SEPARATE BY A COMMA] String[20]
555 code04 Enter data code used. 1= Don't Know 2= Refusal 3= other
556 oth04 Enter other code used. String[20]
557 expl04 Explain what happened String[100]
558 reas05 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
559 test05 Enter test or procedure. String[15]
560 item05 List items involved. [SEPARATE BY A COMMA] String[20]
561 code05 Enter data code used. 1= Don't Know 2= Refusal 3= other
562 oth05 Enter other code used. String[20]
563 expl05 Explain what happened String[100]
564 reas06 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
565 test06 Enter test or procedure. String[15]
566 item06 List items involved. [SEPARATE BY A COMMA] String[20]
567 code06 Enter data code used. 1= Don't Know 2= Refusal 3= other
568 oth06 Enter other code used. String[20]
569 expl06 Explain what happened String[100]
570 reas07 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
571 test07 Enter test or procedure. String[15]
572 item07 List items involved. [SEPARATE BY A COMMA] String[20]
573 code07 Enter data code used. 1= Don't Know 2= Refusal 3= other
574 oth07 Enter other code used. String[20]
575 expl07 Explain what happened String[100]
576 reas08 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
577 test08 Enter test or procedure. String[15]
578 item08 List items involved. [SEPARATE BY A COMMA] String[20]
579 code08 Enter data code used. 1= Don't Know 2= Refusal 3= other
580 oth08 Enter other code used. String[20]
581 expl08 Explain what happened String[100]
582 reas09 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
583 test09 Enter test or procedure. String[15]
584 item09 List items involved. [SEPARATE BY A COMMA] String[20]
585 code09 Enter data code used. 1= Don't Know 2= Refusal 3= other
586 oth09 Enter other code used. String[20]
587 expl09 Explain what happened String[100]
588 reas10 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
589 test10 Enter test or procedure. String[15]
590 item10 List items involved. [SEPARATE BY A COMMA] String[20]
591 code10 Enter data code used. 1= Don't Know 2= Refusal 3= other
592 oth10 Enter other code used. String[20]
593 expl10 Explain what happened String[100]
594 reas11 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
595 test11 Enter test or procedure. String[15]
596 item11 List items involved. [SEPARATE BY A COMMA] String[20]
597 code11 Enter data code used. 1= Don't Know 2= Refusal 3= other
598 oth11 Enter other code used. String[20]
599 expl11 Explain what happened String[100]
600 reas12 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
601 test12 Enter test or procedure. String[15]
602 item12 List items involved. [SEPARATE BY A COMMA] String[20]
603 code12 Enter data code used. 1= Don't Know 2= Refusal 3= other
604 oth12 Enter other code used. String[20]
605 expl12 Explain what happened String[100]
606 reas13 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
607 test13 Enter test or procedure. String[15]
608 item13 List items involved. [SEPARATE BY A COMMA] String[20]
609 code13 Enter data code used. 1= Don't Know 2= Refusal 3= other
610 oth13 Enter other code used. String[20]
611 expl13 Explain what happened String[100]
612 reas14 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
613 test14 Enter test or procedure. String[15]
614 item14 List items involved. [SEPARATE BY A COMMA] String[20]
615 code14 Enter data code used. 1= Don't Know 2= Refusal 3= other
616 oth14 Enter other code used. String[20]
617 expl14 Explain what happened String[100]
618 reas15 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
619 test15 Enter test or procedure. String[15]
620 item15 List items involved. [SEPARATE BY A COMMA] String[20]
621 code15 Enter data code used. 1= Don't Know 2= Refusal 3= other
622 oth15 Enter other code used. String[20]
623 expl15 Explain what happened String[100]
624 reas16 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
625 test16 Enter test or procedure. String[15]
626 item16 List items involved. [SEPARATE BY A COMMA] String[20]
627 code16 Enter data code used. 1= Don't Know 2= Refusal 3= other
628 oth16 Enter other code used. String[20]
629 expl16 Explain what happened String[100]
630 reas17 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
631 test17 Enter test or procedure. String[15]
632 item17 List items involved. [SEPARATE BY A COMMA] String[20]
633 code17 Enter data code used. 1= Don't Know 2= Refusal 3= other
634 oth17 Enter other code used. String[20]
635 expl17 Explain what happened String[100]
636 reas18 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
637 test18 Enter test or procedure. String[15]
638 item18 List items involved. [SEPARATE BY A COMMA] String[20]
639 code18 Enter data code used. 1= Don't Know 2= Refusal 3= other
640 oth18 Enter other code used. String[20]
641 expl18 Explain what happened String[100]
642 reas19 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
643 test19 Enter test or procedure. String[15]
644 item19 List items involved. [SEPARATE BY A COMMA] String[20]
645 code19 Enter data code used. 1= Don't Know 2= Refusal 3= other
646 oth19 Enter other code used. String[20]
647 expl19 Explain what happened String[100]

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