XT020
Description:
difficulties doing activities
Item type: Question
Question text:
Because of a physical, mental, emotional or memory problem, did (Name of deceased) have difficulty doing any of the following activities during the last twelve months of [his/her] life? Please name only difficulties that lasted at least three months.
Answer type: Set of enumerated
Answer choices:
1 Dressing, including putting on shoes and socks
2 Walking across a room
3 Bathing or showering
4 Eating, such as cutting up your food
5 Getting in or out of bed
6 Using the toilet, including getting up or down
7 Preparing a hot meal
8 Shopping for groceries
9 Making telephone calls
10 Taking medication
97 None of these
Flowchart: locate in flowchart