43
7/77/777 = Not asked
8/88/888 = Donot know/Refusal won’t answer
9/99/999 = Not applicable
CONFIDENTIALThis booklet is the property of
The Cambridge Project for Later Life
Department of Community Medicine
Institute of Public Health
For completion by interviewers
Project number / []
GP Practice / []
Subject initials ______
Interviewer Code Number / []
Date of interview / [//]
Number of approaches made / []
Was interview complete? / 1. Complete
2. Incomplete / []
Reason interview incomplete (code 9 for complete) / 1. Family refusal
2. Refusal
3. Frailty
4. Abandoned
5. Ill
6. Disturbed
7. Other (specify) / []
If Other, specify ......
If Proxy interview for non-cognitive section code as follows: (not applicable 9) / 1. Spouse
2. Child
3. Other relative
4. Friend
5. Care assistant, warden or Matron
6. Other / []
Thank you very much for seeing me. I would just like to explain what this study is about. I am in the team from the Cambridge Project for Later Life. You may remember seeing an interviewer some time ago who asked about your health and how you were getting along. We would like to ask you some of these questions again to see how things have been since the last time. The reason for asking these questions is that it will give us a better understanding of the ageing process and it will help in planning better services for the future.
At the end there is a section of questions about memory, concentration and the like. Some people find they do have problems with memory as they get older although this may not apply to you. We ask everyone the same questions and we would be very grateful if you felt able to answer them.
Everything you tell us is confidential, and I would like to stress that this study does not affect your medical care at all.
First of all, I'd like to ask you to remind me of some personal details.
** / 1. / What is your full name?
(not proxy) / 0. Error
1. Right / []
** / 2(a) / Age?
(not proxy) / Record age given / []
** / 2(b) / 0. Error
1. Right / []
** / 3(a) / Date of Birth?
(not proxy) / Record date of birth given / [//]
** / 3(b) / 0. Error
1. Right / []
4. / Marital Status? / 1. Married
2. Widowed
3. Separated/Divorced
4. Single
5. Other / []
If widowed, separated or divorced ask
5. / How long have you been widowed, separated/divorced?
If married/never married code 99 / In years / []
6. / Could you tell me how things have been for you in the past year?
Note any important comments
______
______
______
______
RESIDENCY
7. / Have you moved house in the last 4~years? / 0. No
1. Yes / []
8. / If moved in last 4 years
Why did you move to this address?
Code reason(s) if no move code 9’s
To be near relative(s) / 0. No
1. Yes / []
Bereavement / 0. No
1. Yes / []
Ill health/disability / 0. No
1. Yes / []
Smaller/more convenient house / 0. No
1. Yes / []
Other reason (specify) / 0. No
1. Yes / []
Specify ______
1. House/flat/granny flat
2. Warden controlled
3. Council residential home
4. Private residential home
5. Long stay hospital
6. Other (specify) / []
Specify ______
Omit question 10-14 if living in residential home or hospital.
10. / Is this house/flat owned or rented? / 1. Owned
2. Council rented
3. Private rented
4. Other (specify) / []
Specify ______
Only ask if relevant, otherwise code as appropriate.
11. / Who is head of the household? / 1. Respondent or spouse
2. Sibling
3. Child
4. Other (specify) / []
Specify ______
12. / Does anyone else live here? / 0. No
1. Yes / []
If yes, Record numbers of people in each category.
If no, code 9’s / Spouse / []
Siblings / []
Children / []
In laws / []
Grandchildren / []
Others (specify) / []
Specify ______
13. / Is there anyone who lives with you who is frail and unwell and needs your help with day-to-day tasks? / 0. No
1. Yes / []
14. / If yes establish whether due to / 1. Physical frailty
2. Mental frailty
3. Both / []
FAMILY CONTACT
15. / Do you have any children of your own? / 0. No
1. Yes / []
If No,omit question 16 and code 99.
16. / How many children?
Omit children who have died, but do not probe / Number / []
17. / Do any of your (children or other) relatives live in the area or within easy reach of the area?
(Cambridge City or nearby villages up to 7 miles). / 0. No relatives
1. None in area
2. Yes / []
If yes, record number living in the area.
Number of children / []
Number of grandchildren / []
Number of parents / []
Number of brothers/ sisters / []
Number of other relatives. / []
Omit 18, 19 if lives with relatives (code 9, 99).
18. / How often do you see any of your relatives to speak to? / 0. Never
1. Daily
2. 2-3 times a week
3. At least weekly
4. At least monthly
5. Less often / []
If never sees, omit 19 (code 99).
19. / Of all your relatives with which one do you have the most contact? / 1. Daughter
2. Son
3. Daughter-in-law
4. Son-in-law
5. Parent
6. Sister/Brother
7. Other female relative
8. Other male relative / []
20. / In the last year, have you been in contact with your relatives as much as usual? / 1. More
2. Same
3. Less / []
21. / If change record main reason.
1. Physical illness (subject)
2. Mood change (subject eg. says depressed)
3. Interpersonal problems
4. Change in circumstances (subject)
5. Other (specify) / []
Specify ______
FRIENDS AND NEIGHBOURS
22. / Do you have any friends locally? / 0. No
1. Yes / []
23. / In the last year, have you been in contact with your friends as much as usual? / 1. More
2. Same
3. Less / []
24. / If change record main reason. / 1. Physical illness (subject)
2. Mood change (subject eg. says depressed)
3. Interpersonal problems
4. Change in circumstances (subject)
5. Other (specify) / []
Specify ______
25. / In general, do you have as much contact with family and friends as you would like to?
1. Yes, satisfied
2. No, would like more contact
3. No, would like less contact / []
Omit question 26 if lives in institution (code 9)
26. / How often do you see any of your neighbours? / 1. Daily
2. 2-3 times a week
3. At least weekly
4. At least monthly
5. Less often
6. Never/no neighbours / []
I will read some comments people have made about their family and friends and I would like you to say how much each statement is true for you.
27. / There are members of my family (friends) who can be relied on no matter what happens. / 0. No
1. Yes to an extent
2. Yes, definitely / []
28. / There are members of my family (friends) who would see that I am taken care of if I needed to be. / 0. No
1. Yes to an extent
2. Yes, definitely / []
29. / Is there someone in whom you can confide about anything that might be worrying you? / 0. No
1. Yes to an extent
2. Yes, definitely / []
SOCIAL CONTACTS
30. / Have you had any contact with any clubs or organisations in the past week?
Ask each item
Over 60's Club / 0. No
1. Yes / []
Other social club / 0. No
1. Yes / []
Church / 0. No
1. Yes / []
Church group / 0. No
1. Yes / []
Voluntary work / 0. No
1. Yes / []
Other (specify) / 0. No
1. Yes / []
Specify ______
Record if mentions regular events less than weekly eg. monthly W.I. (specify) / 0. No
1. Yes / []
Specify ______
Omit question 31 if bedridden
31. / In general, do you get out and about as much as you would like to? / 0. No
1. Yes / []
32. / Do you manage to do any physical activity or exercise?
Ask each item (do not ask if inappropriate)
Keep fit / 0. No
1. Yes / []
Walking / 0. No
1. Yes / []
Gardening / 0. No
1. Yes / []
DIY / 0. No
1. Yes / []
Cycling / 0. No
1. Yes / []
Other (specify) / 0. No
1. Yes / []
Specify ______
33. / Have you been involved in any other activities in the last fortnight?
Read list, omit if housebound
Visited places of interest / 0. No
1. Yes / []
Amateur Music, Acting, Singing / 0. No
1. Yes / []
Been to a pub/restaurant / 0. No
1. Yes / []
Class or lecture / 0. No
1. Yes / []
Ask all
Knitting or sewing / 0. No
1. Yes / []
Hobbies such as painting, crafts or collecting things / 0. No
1. Yes / []
Games such as cards, board games or bingo / 0. No
1. Yes / []
Reading
Code 1 if reads magazines thoroughly and include talking books / 0. No
1. Yes / []
Other (specify) / 0. No
1. Yes / []
Specify ______
34. / Have you attended any kind of educational or training course in recent years? / 0. No
1. Yes (specify) / []
Specify ______
35. / Would you say that you enjoy your life? / 0. No
1. Some of the time
2. Most of the time / []
36. / Do you feel lonely? / 1. Very lonely
2. Lonely
3. Slightly lonely
4. Not at all lonely / []
I am going to read some statements about the way some people feel as they get older. Please tell me if they apply to you.
37. / As I grow older, things seem better than I thought they would be. / 0. No
1. Yes / []
38. / I am just as happy as when I was younger. / 0. No
1. Yes / []
39. / The things I do are as interesting to me as they ever were. / 0. No
1. Yes / []
SERVICE CONTACT
40. / Did you have any contact with any of these services in the past week? 6 or more contacts = 6
Home help / No. of contacts / []
Community nurse / No. of contacts / []
Meals on wheels / No. of contacts / []
Other community care
(specify type) / No. of contacts / []
Day centre / No. of contacts / []
Day hospital / No. of contacts / []
Other (specify) / No. of contacts / []
Specify ______
Only ask question 41 if applicable
41. / Do you think you are receiving enough of these services? / 0. No (specify)
1. Yes / []
If no, specify ______
Ask all
42. / Are there any services which you are not receiving which would be valuable to you? / 0. No
1. Yes (specify) / []
If yes specify ______
______
______
Only ask if relevant - otherwise code 9
43. / Have you ever received respite care/gone into a home or hospital to have a short break away from the family? / 0. No
1. Yes / []
If ``YES'' , where?______
44. / Do you receive any allowances such as invalidity or attendance allowance? / 0. No
1. Yes (specify) / []
Specify ______
Ask proxies only:
45. / Is “X” exempt from the community charge? / 0. No
1. Yes / []
MOOD AND RECENT EVENTS
The next questions are about recent events that may have happened to you and about how you feel.
46. / Have you lost anyone close to you in the last year - such as someone close to you dying or moving away, or losing a cherished pet?
Bereavement / 0. No
1. Yes / []
Close friend or relative moving away or becoming ill / 0. No
1. Yes / []
Loss of pet / 0. No
1. Yes / []
47. / Have you been very worried about anything in the last year, for example, money worries? / 0. No
1. Worried
2. Very worried / []
Specify ______
______
______
48. / Do you feel more tense and worry more than usual about little things? / 0. No
1. Yes / []
49. / Have you felt more irritable lately (eg. intolerant of noise)? / 0. No
1. Yes / []
50. / Do you consider yourself a nervous person? / 0. No
1. Yes / []
51. / Do you often feel like crying? / 0. No
1. Sometimes
2. Often / []
52. / Have you lost or gained a lot of weight in the last six months? / 0. No
1. Some loss
2. Considerable loss
3. Some gain
4. Considerable gain / []
53. / Do you find it more difficult to make decisions than you used to? / 0. No
1. Yes / []
54. / Have you lost pleasure or interest in doing things you usually cared about or enjoyed? / 0. No
1. Sometimes
2. Most of the time / []
55. / Have you preferred to be more on your own recently? / 0. No
1. Yes / []
56. / Do you find it more difficult to concentrate than is normal for you? / 0. No
1. Yes / []
57. / Are there times when your thoughts come much more slowly than usual? / 0. No
1. Yes / []
58. / Do you feel sad or depressed or miserable? / 0. No
1. Occasionally
2. Most of the time / []
59. / How do you feel about the future? How do you think things will work out for you? / 0. Neutral/Positive/Optimistic
1. Pessimistic/Negative / []
60. / Do you sometimes feel that life isn't worth living? / 0. No
1. Yes / []
61. / Have you ever had an emotional or nervous illness requiring treatment? / 0. No
1. Yes / []
Episodes requiring treatment by psychiatrist.
Record number of episodes. IF MORE THAN 5 CODE 6 / []
Episodes requiring treatment by general practitioner.
Record number of episodes. IF MORE THAN 5 CODE 6 / []
PHYSICAL HEALTH
I would like to move on to some questions about your health now.
62. / Would you say you have more or less energy than most people your age? / 1. More
2. Same
3. Less / []
63. / Would you say you have more or less energy at the moment than you did a year ago? / 1. More
2. Same
3. Less / []
64. / Have you had more trouble sleeping recently than is normal for you? / 0. No
1. Yes / []
65. / How would you rate your physical health at present compared to others of the same age? / 1. Very good
2. Good
3. Fair
4. Poor
5. Very poor / []
66. / How would you rate your physical health compared to a year ago? / 1. Better
2. Same
3. Worse / []
I would like to ask you about some special conditions you may have had.
67. / Have you ever had or has a doctor ever told you that you have had:
(a) / Angina? / 0. No
1. Yes / []
(b) / Heart attack? / 0. No
1. Yes / []
(c) / Problems with circulation in your legs? / 0. No
1. Yes / []
(d) / High blood pressure? / 0. No
1. Yes / []
(e) / Chronic bronchitis? / 0. No
1. Yes / []
(f) / A stroke? / 0. No
1. Yes / []
(g) / Have you ever had sudden weakness, or difficulty with speech, memory or vision which got better after a short time? / 0. No
1. Yes / []
(h) / Sugar diabetes? / 0. No
1. Yes / []
(i) / Thyroid problems? / 0. No
1. Yes / []
(j) / Severe headaches or migraine? / 0. No
1. Yes / []
(k) / Anything else (specify)? / 0. No
1. Yes / []