|
Help Bathing
|
Yes = 1, No = 0
|
|
Help Dressing
|
Yes = 1, No = 0
|
|
Help getting in/out of Chair
|
Yes = 1, No = 0
|
|
Help Walking around house
|
Yes = 1, No = 0
|
|
Help Eating
|
Yes = 1, No = 0
|
|
Help Grooming
|
Yes = 1, No = 0
|
|
Help Using Toilet
|
Yes = 1, No = 0
|
|
Help up/down Stairs
|
Yes = 1, No = 0
|
|
Help lifting 10 lbs
|
Yes = 1, No = 0
|
|
Help Shopping
|
Yes = 1, No = 0
|
|
Help with Housework
|
Yes = 1, No = 0
|
|
Help with meal Preparations
|
Yes = 1, No = 0
|
|
Help taking Medication
|
Yes = 1, No = 0
|
|
Help with Finances
|
Yes = 1, No = 0
|
|
Lost more than 10 lbs in last year
|
Yes = 1, No = 0
|
|
Self Rating of Health
|
Poor = 1, Fair = 0.75, Good = 0.5, V. Good = 0.25, Excellent = 0
|
|
How Health has changed in last year
|
Worse = 1, Better/Same = 0
|
|
Stayed in Bed at least half the day due to health (in last month)
|
Yes = 1, No = 0
|
|
Cut down on Usual Activity (in last month)
|
Yes = 1, No = 0
|
|
Walk outside
|
<3 days = 1, ≤ 3 days = 0
|
|
Feel Everything is an Effort
|
Most of time = 1, Some time = 0.5, Rarely = 0
|
|
Feel Depressed
|
Most of time = 1, Some time = 0.5, Rarely = 0
|
|
Feel Happy
|
Most of time = 0, Some time = 0.5, Rarely = 1
|
|
Feel Lonely
|
Most of time = 1, Some time = 0.5, Rarely = 0
|
|
Have Trouble getting going
|
Most of time = 1, Some time = 0.5, Rarely = 0
|
|
High blood pressure
|
Yes = 1, Suspect = 0.5, No = 0
|
|
Heart attack
|
Yes = 1, Suspect = 0.5, No = 0
|
|
CHF
|
Yes = 1, Suspect = 0.5, No = 0
|
|
Stroke
|
Yes = 1, Suspect = 0.5, No = 0
|
|
Cancer
|
Yes = 1, Suspect = 0.5, No = 0
|
|
Diabetes
|
Yes = 1, Suspect = 0.5, No = 0
|
|
Arthritis
|
Yes = 1, Suspect = 0.5, No = 0
|
|
Chronic Lung Disease
|
Yes = 1, Suspect = 0.5, No = 0
|
|
MMSE
|
<10 = 1, 11–17 = 0.75, 18–20 = 0.5, 20–24 = 0.25, >24 = 0
|
|
Peak Flow
|
See Table 2
|
|
Shoulder Strength
|
See Table 2
|
|
BMI
|
See Table 2
|
|
Grip Strength
|
See Table 2
|
|
Usual Pace
|
See Table 2
|
|
Rapid Pace
|
See Table 2
|
