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Cambridge City Over 75 Cohort Survey 5 Year 13 (1999) interview

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Cambridge City Over 75 Cohort Survey 5 Year 13 (1999) interview ...

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    8/88/888 = Donot know, won’t answer

    9/99/999 = Not applicable

    Hughes Hall Project for Later Life

    Follow up survey

     Name: __________

     Address: __________

    Card [1] Project number [ ] Date [ / / ] List [ ] Age [ ] Sex Male…….1 [ ]

    Female…..2

    Interview code [ ] Observer code: If no observer, code = 00 [ ] GP Code [ ]

    Introduction and explanation of visit

First of all, I'd like to ask you for some personal details.

    0. Error [ ] 1. What is your full name?

     1. Right

    0. Error [ ] 2 Date of Birth?

     1. Right

    0. Error [ ] 3 Age?

    1. Right

    Code 9 if prompted by relative.

    4. Could you tell me how thinks have been for you in the past year?

Has anything important happened?

Have there been any changes in your family?

How has your health been?

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    9/99/999 = Not applicable

    5. Marital Status?

    No..0 [ ] a. Has your marital status

    Yes..1 changed in the last 12 month?

    1. Married [ ] b. Current marital status:

    2. Widowed

    3. Separated/Divorced

    4. Single

    5. Other (specify)

    6. Residency

    No..0 [ ] a. Have you moved house in

    Yes..1 the last 12 months?

    If still in same accommodation code 9 from (b) - (e)

    If move in last 12 month:

    To be near relative(s) [ ] b. Why did you move to this

    Bereavement [ ] address?

    Ill health/disability [ ]

    Smaller/more convenient house [ ]

    Other reason (specify) [ ]

     Code: no=0, yes=1

    1. House/flat/granny flat [ ] c What type of

    2. Warden controlled accommodation is this?

    3. Council residential home

    4. Private residential home

    5. Long stay hospital

    6. Other (Specify) __________

1. Owned [ ] d. Is this house/flat owned

    2. Council rented or rented?

    3. Private rented

    4. Other (Specify) __________ 1. Respondent or spouse [ ] e Who is head of the

    2. Sibling household?

    3. Child

    4. Other (specify) __________

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Ask all:

    0. Alone [ ] f Does anyone live here with you?

    1. With others

    If lives alone, code 0 here,

    Code 9 for (e) and (f) and proceed to Q15.

    Spouse [ ] g. Who lives here with you?

     Siblings [ ] Record numbers in each category. Children [ ]

     In laws [ ]

     Grandchildren [ ]

    Others (specify) __________ [ ]

    Add up numbers [ ]

    0. No [ ] h. Is there anyone who lives with you who is

    1. Yes frail and unwell and needs your help with

    day-to-day tasks?

    0. No [ ] di Do you have a telephone?

    1. Yes 7. Children if applicable:

     a. At the last interview you told us that you

     had children of whom where living in

     or near Cambridge. Is this correct or have

     there been changes?

    [ ] Code number of living children

    [ ] Code number living in Cambridge

If no children code 9 or 99 from (b)-(e)

    Single dgtrs…. [ ] b. Can you tell me that present marital

    Married dgtrs.. [ ] status of your children living locally?

    Single sons… [ ]

    Married sons… [ ] Code numbers.

    No change….0 [ ] c. Has there been any change in the amount

    Less contact overall….1 of contact you have with your children?

    More contact overall….2

    Single dgtr…1 [ ] d. Of all your children, which one do you

    Married dgtr..2 [ ] have the most contact with?

    Single son….3 [ ]

    Married son…4 [ ] Code: 0=no, 1=yes

If no contact with any children code 0 and 9 for (e)

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    No contact……………0 [ ] e. How often are you in contact with him/her?

    Daily…………..…….1

    At least twice weekly..2

    Weekly……………….3

    At least fortnightly……4

    monthly…………….....5

    Less frequently……….6

    8. Grandchildren

    Number……….. [ ] a. How many grandchildren do you have living

     or near Cambridge at present?

If no local adult GC, code 00 here, code 9 for

    (b) (c).

    No change….0 [ ] b. Has there been any change in the amount of

    Less contact overall….1 contact you have with your grandchildren in

    More contact overall….2 Cambridge?

    No contact…………..0 [ ] c. Of all your grown-up grandchildren, which

    Daily…………..…….1 one do you have most contact with? How often

    At least twice weekly..2 are you in contact with him/her?

    Weekly……………….3

     At least fortnightly……4

    At least monthly……...5

    Less frequently……….6

    10. Other Relatives

    Brothers……….. [ ] a. What about contact with other adult relatives

    Sisters…………. [ ] living in or near Cambridge?

    Nephews……… [ ]

    Nieces………… [ ] Code numbers where there has been contact in

    Others(specify)… [ ] last 12 months..

If no adult relatives code 9 for (b).

    No contact…………..0 [ ] b. Of all your relatives, which one do you have

    Daily…………..…….1 most contact with? How often are you in

    At least twice weekly..2 contact with him/her?

    Weekly……………….3

     At least twice monthly..4

    At least monthly……...5

    Less frequently……….6

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    Card [5]

    10. Friends

    No change….0 [ ] a. Have there been any changes in the amount of

    Less contact overall….1 contact you have with friends living in or near

    More contact overall….2 Cambridge?

If no local friends, code 9.

    No contact…………..0 [ ] b. Of all your friends in Cambridge or elsewhere,

    Daily…………..…….1 which one do you have most contact with? How

    At least twice weekly..2 often are you in contact with him/her?

    Weekly……………….3

    At least fortnightly……4 If no friends anywhere, code 9.

     monthly………….…...5

    Less frequently……….6

    11. Social contact in previous week

    a. I would like to get an idea of how you have spent the last week, what you have done,

    who you have seen, spoken to on the phone or been in correspondence with.

For example, were you in contact with any of your children/friends/neighbours last

    week?

Ask about each of the previous 7 days or each category of people according to which

    is most appropriate. Prompt as necessary.

    If no children, grandchildren, friends, Etc, code 99. If no telephone code 99 for phone calls.

    Visits…… [ ] Children:

    Phone call…….. [ ]

    Visits…… [ ] Grandchildren:

    Phone call…….. [ ]

    Visits…… [ ] Other relatives:

    Phone call…….. [ ]

    Visits…… [ ] Friends:

    Phone call…….. [ ]

    Visits…… [ ] Neighbours:

    Phone call…….. [ ]

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     b. Did you have any contact with any clubs or organisations in the past week?

     [ ] Over 60's Club

     [ ] Other social club

     [ ] Church

     [ ] Church group

     [ ] Voluntary work

     Other (specify) __________ [ ] c. Home help [ ] Did you have any contact with any of the

    Community nurse [ ] services in the past week?

    Meals on wheels [ ]

    Day centre….. [ ] Code number of contacts during past 7 days

    Day hospital… [ ]

    Fewer…………..0 [ ] d. Was this a typical week? Would you

    Same……..…….1 normally see this number of people

    More…………...2 children, other relatives, friends or would

    you normally see more or fewer?

    13.Usual contact with neighbours, clubs, church and services Ask appropriately and code for all respondents whether or not previous week was typical.

    No contact………..0 [ ] a. How much contact do you normally have

    Occasional chats…1 with neighbours?

    Regular chats…….2

    Close/do favours….3

     b. Do you normally attend any clubs or groups or do any voluntary work?

If yes: Have you participated in the past month?

Code no=0, yes=1.

     [ ] Over 60's Club

     [ ] Other social club

     [ ] Church group

     [ ] Voluntary work

     Other (specify) __________ [ ]

    Not at all………..0 [ ] c. Have you attended church in the last year?

    Occasionally……1

    Regularly….…….2

     [ ] d. Have you seen a community nurse in the past

     month?

    Code number of visits in last month

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    9/99/999 = Not applicable None= 0, Maximum = 6.

    Day centre….. [ ] e. Do attend a day centre or day hospital?

    Day hospital… [ ]

    13. PHYSICAL HEALTH

    1. Very good [ ] a. How would you rate your physical health

    2. Good at present?

    3. Fair

    4. Poor

    5. Very poor

     b. What particular difficulties do you have?

    Poor vision (with spectacles) [ ] c. In particular, have you suffered from any

    Poor hearing (with hearing aid) [ ] of the following difficulties in the last

    Arthritis/ rheumatism [ ] month?

    Back pain [ ]

    Chest pain [ ]

    Shortness of breath [ ] Code No=0, Yes = 1.

    Weakness in arm or leg [ ]

    Unsteady on feet [ ] Code “Yes” only if disability present for

    Falls [ ] one month and has interfered with daily

    tasks.

    Months [ ] d. Have you seen your G.P in the last year? Round up to nearest month last visit.

    No…0 [ ] e. Were you admitted to any hospital in last

    Yes…1 year?

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     14. ACTIVITIES OF DAILY LIVING

     Now I'd like to ask you some questions about how you cope with day-to-

    day tasks.

     (a) How do you manage with using a telephone i.e. looking up numbers,

    dialling etc?

     0 Telephones independently looks up numbers, dials etc. [ ]

    1 Dials a few well-known numbers only.

    2 Answers telephone but does not dial.

    3 Cannot use telephone at all.

    9 No telephone within easy access.

     (b) How do you manage with shopping?

     0 Takes care of all or nearly all shopping independently [ ]

    1 Shops independently for small purchases only.

    2 Needs to be accompanied on any shopping trip.

    3 Does not shop at all

     [ ] Who helps?

     (c) How do you manage with preparing meals?

     0 Prepares all or nearly all meals independently. [ ]

    1 Prepares snacks only or heats up meals prepared by others.

    2 All meals and snacks must be prepared by others.

    9 Meals have always been prepared by spouse or others.

     [ ] Who helps?

     (d) How do you manage with housework?

     0 Independent apart from occasional help with heavy work. [ ]

    1 Performs only light daily tasks e.g. dish washing, dusting.

    2 All housework must be done by others.

    9 Housework has always been done by spouse or other.

     [ ] Who helps?

Code:

    Nobody/none required .. 00 Home help ………………08

    Spouse …………………01 Meals on wheels ………..09

    Daughter ……………….02 Community nurse ………10

    Daughter in law ……03 Chiropodist ……………..11

    Son ……………………..04 Warden …………………12

    Son in law ………….05 Other (specify) ………… 13

    Other relative …………..06

    Friend/Neighbour ……..07

    For “Who helps?”, use only these codes. Do not use 99.

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    9/99/999 = Not applicable

     (e) How do you manage with laundry?

     0 Independent apart from occasional help with heavy work. [ ]

     1 Lauders only small items, e.g. stockings, underwear

     2 All laundry must be done by others

    9 Laundry has always been done by spouse or others

     [ ] Who helps?

     (f) How do you manage with walking?

     0 Walks around town, suburb or village [ ]

     1 Walks no further than one block away

     2 Walks no further than gate

     3 Walks only within house

     4 Takes no more than a few steps

     (h) Do you use a walking stick or other aid?

     0 Independent [ ]

     1 Walking stick(s)

     2 Frame/tripod

     3 Wheelchair

    4 Other person

    (i) How do you manage with bathing or showering?

     0 Independent in bath, shower or sponge-wash [ ]

     1 Needs help getting in or out of bath or shower

     2 Can wash face and hands only

     3 Needs major assistance

     Who helps? [ ]

Code: Nobody/none required .. 00 Home help ………………08

    Spouse …………………01 Meals on wheels ………..09

    Daughter ……………….02 Community nurse ………10

    Daughter in law ……03 Chiropodist ……………..11

    Son ……………………..04 Warden …………………12

    Son in law ………….05 Other (specify) ………… 13

    Other relative …………..06

    Friend/Neighbour ……..07

    For “Who helps?”, use only these codes. Do not use 99.

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    7/77/777 Not asked

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     (j) How do you manage with reaching up to comb your hair (or shave) or down to

    cut your toenails?

     0 Attends to grooming independently [ ]

     1 Needs minor assistance, e.g. cutting toenails

     2 Needs moderate assistance, e.g. shaving, brushing hair

     3 Needs major assistance.

     [ ] Who helps?

     (k) How do you manage with dressing or undressing?

     0 Dresses and undresses independently [ ]

     1 Needs minor assistance, e.g. tying shoelaces, buttons

     2 Needs moderate assistance

     e.g. shoes, socks, arms in sleeves, selecting clothes

     3 Needs major assistance

     [ ] Who helps?

     (l) How do you manage with getting to the toilet on time?

     0 Always gets to the toilet on time [ ]

     1 Rare (weekly at most) accidents

     2 Accidents more than once a week

     3 No control of bladder or bowels

     [ ] Who helps?

     (m) How do you manage with taking medicines?

     0 Responsible for taking medicines in correct dose at correct time. [ ]

     1 Medication must be put out in advance by others

     2 Medication must be administered by others

     9 Takes no medication at present

     [ ] Who helps?

    [ ] (n) Do you think that you need more help than you are getting at the moment?

     0 No

     1 Yes

Code:

    Nobody/none required .. 00 Home help ………………08

    Spouse …………………01 Meals on wheels ………..09

    Daughter ……………….02 Community nurse ………10

    Daughter in law ……03 Chiropodist ……………..11

    Son ……………………..04 Warden …………………12

    Son in law ………….05 Other (specify) ………… 13

    Other relative …………..06

    Friend/Neighbour ……..07

    For “Who helps?”, use only these codes. Do not use 99.

    Card [3]

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