I. Physical Measures (respondent)

I. Physical Measures (respondent) module of HRS 2006

item label type description
HHID System generated Household identification number
PN System generated Respondent person identification number
KSUBHH System generated 2006 sub household identification number
JSUBHH System generated 2004 sub household identification number
KPN_SP System generated 2006 spouse/partner person number
KCSR System generated 2006 whether coversheet respondent
KFAMR System generated 2006 whether family respondent
KFINR System generated 2006 whether financial respondent
KEFTF System generated Assign enhanced ftf assignment
KNURSHM System generated 2006 nursing home status-tracker
KPMELIG System generated 2006 physical measures eligibility
KI800 Question asked of interviewer Physical measures interview mode
KI802 Question Physical measures consent form
KI854 Question asked of interviewer Blood pressure complete
KI855 Question asked of interviewer Blood pressure not complete
KI857 Question asked of interviewer Bloodpressure time
KI859 Question asked of interviewer Bloodpressure 1 systolic
KI860 Question asked of interviewer Bloodpressure 1 diastolic
KI861 Question asked of interviewer Bloodpressure 1 pulse
KI862 Question asked of interviewer Blood pressure 2 time
KI864 Question asked of interviewer Bloodpressure 2 systolic
KI865 Question asked of interviewer Bloodpressure 2 diastolic
KI866 Question asked of interviewer Bloodpressure 2 pulse
KI867 Question asked of interviewer Bloodpressure 3 time
KI869 Question asked of interviewer Bloodpressure 3 systolic
KI870 Question asked of interviewer Bloodpressure 3 diastolic
KI871 Question asked of interviewer Bloodpressure 3 pulse
KFLAG_BP Added variable (weight, paradata, merged) Changes made to bp variables
KFLAG_PULSE Added variable (weight, paradata, merged) Changes made to pulse variables
KI872 Question asked of interviewer Bloodpressure arm
KI873 Question asked of interviewer Bloodpressure compliance
KI874 Question asked of interviewer Bloodpressure position
KI875 Question asked of interviewer Bloodpressure smoke etc
KI804 Question asked of interviewer Breath complete at least one trial
KI805 Question asked of interviewer Breath test reason not complete
KI807 Question asked of interviewer Puff test 1
KI808 Question Puff test 2
KI809 Question asked of interviewer Puff test 3
KFLAG_PUFF Added variable (weight, paradata, merged) Changes made to puff test variables
KI810 Question asked of interviewer R breathing test effort
KI811 Question asked of interviewer Breathing test r position
KI812 Question asked of interviewer Hand strength complete one trial
KI813 Question asked of interviewer Hand strength test reason not complete
KI815 Question asked of interviewer Grip dominant hand
KI816 Question asked of interviewer Left hand first
KI851 Question asked of interviewer Right hand first
KI852 Question asked of interviewer Left hand second
KI853 Question asked of interviewer Right hand second
KFLAG_LGRIP Added variable (weight, paradata, merged) Changes made to left grip strength vars
KFLAG_RGRIP Added variable (weight, paradata, merged) Changes made to right grip strength vars
KI817 Question asked of interviewer Grip r effort
KI818 Question asked of interviewer Hand strength test r position
KI819 Question asked of interviewer Hand strength rest arm
KI876 Question asked of interviewer Balance test - semi-tandem stand
KI877 Question asked of interviewer Balance semi-tandem reason not comp
KI879 Question Balance test semi-tandem hold full time
KI880 Question Balance test semi-tandem time
KI881 Question asked of interviewer Balance test semi-tandem compensatory
KI883 Question asked of interviewer Balance test s-b-s complete
KI884 Question asked of interviewer Balance test sbs stand reason not comp
KI886 Question asked of interviewer Balance test s-b-s hold full time
KI887 Question asked of interviewer Balance test side-by-side time
KI888 Question asked of interviewer Balance test side-by-side compensatory
KI889 Question asked of interviewer Balance test s-b-s floor surface
KI891 Question asked of interviewer Balance test s-b-s compliance
KI893 Question asked of interviewer Balance test full tandem complete
KI894 Question asked of interviewer Balance full tandem stand-not complete
KI896 Question asked of interviewer Balance test full tandem hold full time
KI897 Question asked of interviewer Balance test full tandem time
KI898 Question asked of interviewer Balance test full tandem compensatory
KI899 Question asked of interviewer Balance test full tandem floor surface
KI902 Question asked of interviewer Balance test full tandem compliance
KI820 Question asked of interviewer Walking test complete at least one trial
KI821 Question asked of interviewer Walking test reason not complete
KI823 Question asked of interviewer Walking test 1st trial time
KI824 Question asked of interviewer Walking test 2nd trial time
KFLAG_WALK Added variable (weight, paradata, merged) Changes made to walking trial variables
KI825 Question asked of interviewer Walking test floor surface
KI828 Question asked of interviewer Walking aid type
KI830 Question asked of interviewer Walking test r compliance
KI831 Question asked of interviewer Measure r height
KI832 Question asked of interviewer Height reason not complete
KI834 Question asked of interviewer Height measurment
KFLAG_HEIGHT Added variable (weight, paradata, merged) Changes made to height variable
KI835 Question asked of interviewer Height floor surface
KI837 Question asked of interviewer Height wearing shoes
KI903 Question asked of interviewer Height compliance
KI838 Question asked of interviewer Weight able to measure
KI839 Question asked of interviewer Weight reason not complete
KI841 Question asked of interviewer Weight pounds measurment
KFLAG_WEIGHT Added variable (weight, paradata, merged) Changes made to weight variable
KI842 Question asked of interviewer Weight floor surface
KI844 Question asked of interviewer Weight wearing shoes
KI947 Question asked of interviewer Weight compliance
KI904 Question asked of interviewer Waist complete
KI905 Question asked of interviewer Waist why not complete
KI907 Question asked of interviewer Waist measurment
KFLAG_WAIST Added variable (weight, paradata, merged) Changes made to waist meas variable
KI908 Question asked of interviewer Waist difficulties
KI910 Question asked of interviewer Waist compliance
KI911 Question asked of interviewer Waist who measured
KI912 Question asked of interviewer Waist bulky clothes
KI913 Question asked of interviewer Saliva consent
KI941 Question asked of interviewer Why no consent saliva
KI914 Question asked of interviewer Saliva sample eat drink etc
KI915 Question asked of interviewer Saliva sample complete
KI916 Question asked of interviewer Saliva why not complete
KI918 Question asked of interviewer Saliva fill vial
KI919 Question asked of interviewer Saliva problems
KI921 Question asked of interviewer Saliva compliance
KI922 Question asked of interviewer Blood sample consent
KI943 Question asked of interviewer Why no consent blood
KI923 Question asked of interviewer Blood sample complete
KI924 Question asked of interviewer Why blood sample not complete
KI926 Question asked of interviewer Blood sample what problems
KI928 Question asked of interviewer Blood who measured
KI929 Question asked of interviewer Amount of blood on first card
KI945 Question asked of interviewer Amount of blood on storage card
KI930 Question asked of interviewer How many blood pricks
KI931 Question asked of interviewer Blood sample compliance
KVDATE System generated 2006 data model version
KVERSION System generated 2006 data release version
Start of I. Physical Measures (respondent)
 
KI800

Physical measures interview mode

ENTER CURRENT MODE OF INTERVIEW
expand
 
If Prefered mode of iwer = ENHANCEDFTF »
 
   
 
If Physical measures interview mode = 2. F-t-f and R in nursing home = NO and LANGUAGE = SPANISH or ENGLISH »
 
     
   
KI802

Physical measures consent form

NOW I AM GOING TO ASK YOU TO DO A FEW SIMPLE ACTIVITIES FOR ME. RESEARCHERS ARE INTERESTED IN HOW PERFORMANCE ON THESE ACTIVITIES RELATES TO SOME OF THE OTHER FACTORS I HAVE ASKED YOU ABOUT IN THE INTERVIEW. I WILL ASK YOU TO DO THESE ACTIVITIES: A BREATHING TEST, A TEST OF HAND STRENGTH, [PHYSICAL MEASURES CONSENT FORM] A BALANCE TEST, AND BLOOD PRESSURE, HEIGHT, [PHYSICAL MEASURES CONSENT FORM] AND WAIST MEASUREMENTS. MY PRIMARY CONCERN IS FOR YOUR SAFETY, SO I WILL ASK YOU IF YOU FEEL IT WOULD BE SAFE FOR YOU TO COMPLETE EACH ACTIVITY. IF YOU HAVE ANY CONCERNS ABOUT THE ACTIVITY, PLEASE LET ME KNOW AND WE WILL SKIP IT. PLEASE DO NOT EAT, DRINK, SMOKE, OR BRUSH YOUR TEETH WHILE WE ARE CONDUCTING THE MEASUREMENTS. I WILL ALSO BE ASKING YOU TO REMOVE BULKY CLOTHING AND TO TAKE OFF YOUR SHOES DURING THE MEASUREMENTS. BEFORE WE BEGIN, I'D LIKE TO HAVE YOU READ AND SIGN A FORM EXPLAINING YOUR RIGHTS AS A PARTICIPANT IN THIS PART OF THE STUDY.

SHOW R THE FIRST CONSENT FORM IN THE PHYSICAL MEASURES
expand
     
   
If Physical measures consent form = 1. Continue »
 
       
     
KI854

Blood pressure complete

BLOOD PRESSURE

DID R COMPLETE AT LEAST ONE BLOOD PRESSURE MEASUREMENT?
expand
       
     
If Blood pressure complete = 5. No »
 
         
       
KI855

Blood pressure not complete

BLOOD PRESSURE

WHY DIDN'T R COMPLETE THE BLOOD PRESSURE MEASUREMENT? (SELECT ALL THAT APPLY)
expand
         
     
ElseIf Blood pressure complete = 1. Yes »
 
         
       
KI857

Bloodpressure time

BLOOD PRESSURE - 1ST TIME

FIRST READING TIME OF READING

USER NOTE: TIME OF DAY IS PRESENTED AS MILITARY TIME.

7441 00000000-23:51:00. ACTUAL VALUE
expand
         
       
KI859

Bloodpressure 1 systolic

BLOOD PRESSURE - 1ST SYSTOLIC

FIRST READING SYSTOLIC

ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 999 IF R CHOSE NOT TO DO IT.
expand
         
       
If Bloodpressure 1 systolic != 9993 and Bloodpressure 1 systolic != 999. R chose not to do it »
 
           
         
KI860

Bloodpressure 1 diastolic

BLOOD PRESSURE - 1ST DIASTOLIC

FIRST READING DIASTOLIC
expand
           
         
KI861

Bloodpressure 1 pulse

BLOOD PRESSURE - 1ST PULSE

FIRST READING PULSE
expand
           
         
KI862

Blood pressure 2 time

BLOOD PRESSURE - 2ND TIME

SECOND READING TIME OF READING

USER NOTE: TIME OF DAY IS PRESENTED AS MILITARY TIME.

7410 00000000-23:52:00. ACTUAL VALUE
expand
           
         
KI864

Bloodpressure 2 systolic

BLOOD PRESSURE - 2ND SYSTOLIC

SECOND READING SYSTOLIC

ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 999 IF R CHOSE NOT TO DO IT.
expand
           
         
If Bloodpressure 2 systolic != 9993 and Bloodpressure 2 systolic != 999. R chose not to do it »
 
             
           
KI865

Bloodpressure 2 diastolic

BLOOD PRESSURE - 2ND DIASTOLIC

SECOND READING DIASTOLIC
expand
             
           
KI866

Bloodpressure 2 pulse

BLOOD PRESSURE - 2ND PULSE

SECOND READING PULSE
expand
             
           
KI867

Bloodpressure 3 time

BLOOD PRESSURE - 3RD TIME

THIRD READING TIME OF READING

USER NOTE: TIME OF DAY IS PRESENTED AS MILITARY TIME.

7342 00000000-23:53:00. ACTUAL VALUE
expand
             
           
KI869

Bloodpressure 3 systolic

BLOOD PRESSURE - 3RD SYSTOLIC

THIRD READING SYSTOLIC

ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 999 IF R CHOSE NOT TO DO IT.
expand
             
           
If Bloodpressure 3 systolic != 9993 and Bloodpressure 3 systolic != 999. R chose not to do it »
 
               
             
KI870

Bloodpressure 3 diastolic

BLOOD PRESSURE - 3RD DIASTOLIC

THIRD READING DIASTOLIC
expand
               
             
KI871

Bloodpressure 3 pulse

BLOOD PRESSURE - 3RD PULSE

THIRD READING PULSE
expand
               
         
KI872

Bloodpressure arm

BLOOD PRESSURE - ARM

WHICH ARM WAS USED TO CONDUCT THE MEASUREMENTS?
expand
           
         
KI873

Bloodpressure compliance

BLOOD PRESSURE - COMPLIANCE

HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
expand
           
         
KI874

Bloodpressure position

BLOOD PRESSURE - POSITION

WHAT WAS R'S POSITION FOR THIS TEST?
expand
           
         
KI875

Bloodpressure smoke etc

BLOOD PRESSURE - SMOKE ETC.

DID R SMOKE, EXERCISE, CONSUME ALCOHOL OR FOOD WITHIN THE 30 MINUTES PRIOR TO COMPLETING THE BLOOD PRESSURE TEST?
expand
           
     
KI804

Breath complete at least one trial

BREATHING TEST

DID R COMPLETE AT LEAST ONE TRIAL OF THE BREATHING TEST?
expand
       
     
If Breath complete at least one trial != 1. Yes »
 
         
       
KI805

Breath test reason not complete

BREATHING TEST

WHY DIDN'T R COMPLETE THE BREATHING TEST? (SELECT ALL THAT APPLY)
expand
         
     
If Breath complete at least one trial = 1. Yes »
 
         
       
KI807

Puff test 1

BREATHING TEST

FIRST READING:

SECOND READING:

THIRD READING:

ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 999 IF R CHOSE NOT TO DO IT.
expand
         
       
KI808

Puff test 2

BREATHING TEST

FIRST READING: [PUFF TEST 1]

SECOND READING:

THIRD READING:

ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 999 IF R CHOSE NOT TO DO IT.
expand
         
       
KI809

Puff test 3

BREATHING TEST

FIRST READING: [PUFF TEST 1]

SECOND READING: [PUFF TEST 2]

THIRD READING:

ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 999 IF R CHOSE NOT TO DO IT.
expand
         
       
KI810

R breathing test effort

BREATHING TEST

HOW MUCH EFFORT DID THE R GIVE TO THIS TEST?
expand
         
       
KI811

Breathing test r position

BREATHING TEST

WHAT WAS THE R'S POSITION FOR THIS TEST?
expand
         
     
KI812

Hand strength complete one trial

HAND STRENGTH TEST

DID R COMPLETE AT LEAST ONE TRIAL OF THE HAND STRENGTH TEST?
expand
       
     
If Hand strength complete one trial != 1. Yes »
 
         
       
KI813

Hand strength test reason not complete

HAND STRENGTH TEST

WHY DIDN'T R COMPLETE THE HAND STRENGTH TEST? (SELECT ALL THAT APPLY)
expand
         
     
Else If Hand strength complete one trial = 1. Yes »
 
         
       
KI815

Grip dominant hand

HAND STRENGTH TEST

RECORD R'S DOMINANT HAND.
expand
         
       
KI816

Left hand first

HAND STRENGTH TEST

LEFT HAND, FIRST MEASUREMENT .

LEFT HAND, FIRST MEASUREMENT: RIGHT HAND, FIRST MEASUREMENT: LEFT HAND, SECOND MEASUREMENT: RIGHT HAND, SECOND MEASUREMENT:

ENTER THE RESULT TO THE NEAREST 0.5 KILOGRAM.

ENTER 993 IF R WAS UNABLE TO PERFORM THIS MEASUREMENT ENTER 999 IF R CHOSE NOT TO DO IT
expand
         
       
KI851

Right hand first

HAND STRENGTH TEST

RIGHT HAND, FIRST MEASUREMENT.

LEFT HAND, FIRST MEASUREMENT: [LEFT FIRST ] RIGHT HAND, FIRST MEASUREMENT: LEFT HAND, SECOND MEASUREMENT: RIGHT HAND, SECOND MEASUREMENT:

ENTER THE RESULT TO THE THE NEAREST 0.5 KILOGRAM.

ENTER 993 IF R WAS UNABLE TO PERFORM THIS MEASUREMENT ENTER 999 IF R CHOSE NOT TO DO IT
expand
         
       
KI852

Left hand second

HAND STRENGTH TEST

LEFT HAND, SECOND MEASUREMENT.

LEFT HAND, FIRST MEASUREMENT: [LEFT FIRST ] RIGHT HAND, FIRST MEASUREMENT: [RIGHT FIRST ] LEFT HAND, SECOND MEASUREMENT : RIGHT HAND, SECOND MEASUREMENT:

ENTER THE RESULT TO THE THE NEAREST 0.5 KILOGRAM.

ENTER 993 IF R WAS UNABLE TO PERFORM THIS MEASUREMENT ENTER 999 IF R CHOSE NOT TO DO IT
expand
         
       
KI853

Right hand second

HAND STRENGTH TEST

RIGHT HAND, SECOND MEASUREMENT.

LEFT HAND, FIRST MEASUREMENT: [LEFT FIRST ] RIGHT HAND, FIRST MEASUREMENT: [RIGHT FIRST ] LEFT HAND, SECOND MEASUREMENT: [LEFT SECOND] RIGHT HAND, SECOND MEASUREMENT :

ENTER THE RESULT TO THE THE NEAREST 0.5 KILOGRAM.

ENTER 993 IF R WAS UNABLE TO PERFORM THIS MEASUREMENT ENTER 999 IF R CHOSE NOT TO DO IT
expand
         
       
KI817

Grip r effort

HAND STRENGTH TEST

HOW MUCH EFFORT DID THE R GIVE TO THIS TEST?
expand
         
       
KI818

Hand strength test r position

HAND STRENGTH TEST

WHAT WAS THE R'S POSITION FOR THIS TEST?
expand
         
       
KI819

Hand strength rest arm

HAND STRENGTH TEST

DID THE R REST THEIR ARM ON A SUPPORT WHILE PERFORMING THIS TEST?
expand
         
     
KI876

Balance test - semi-tandem stand

BALANCE TEST - SEMI-TANDEM STAND

DID R COMPLETE THE SEMI-TANDEM STAND?
expand
       
     
If Balance test - semi-tandem stand != 1. Yes »
 
         
       
KI877

Balance semi-tandem reason not comp

BALANCE TEST - SEMI-TANDEM STAND

WHY DIDN'T R COMPLETE THE SEMI-TANDEM STAND? SELECT ALL THAT APPLY
expand
         
     
ElseIf Balance test - semi-tandem stand = 1. Yes »
 
         
       
KI879

Balance test semi-tandem hold full time

BALANCE TEST - SEMI-TANDEM STAND

DID R HOLD SEMI-TANDEM STAND FOR FULL 10 SECONDS WITHOUT STEPPING OUT OF PLACE OR GRABBING HOLD OF ANYTHING?
expand
         
       
If Balance test semi-tandem hold full time = 1. Yes »
 
           
         
KI880

Balance test semi-tandem time

BALANCE TEST - SEMI-TANDEM STAND

RECORD TIME IN SECONDS TO TWO DECIMAL PLACES
           
       
If Balance test semi-tandem hold full time != 999. R chose not to do it and Balance test semi-tandem hold full time != 993. R tried but was unable »
 
           
         
KI881

Balance test semi-tandem compensatory

BALANCE TEST - SEMI-TANDEM STAND

DID R USE ANY COMPENSATORY MOVEMENTS OF HIS/HER TRUNK, ARMS OR LEGS TO STEADY HIM/HERSELF DURING SEMI-TANDEM STAND?
expand
           
     
If Balance test - semi-tandem stand = 5. No or Balance test semi-tandem hold full time != 1. Yes »
 
         
       
KI883

Balance test s-b-s complete

BALANCE TEST - SIDE-BY-SIDE STAND

DID R COMPLETE THE SIDE-BY-SIDE STAND?
expand
         
       
If Balance test s-b-s complete != 1. Yes »
 
           
         
KI884

Balance test sbs stand reason not comp

BALANCE TEST - SIDE-BY-SIDE STAND

WHY DIDN'T R COMPLETE THE SIDE-BY-SIDE STAND? SELECT ALL THAT APPLY
expand
           
       
ElseIf Balance test s-b-s complete = 1. Yes »
 
           
         
KI886

Balance test s-b-s hold full time

BALANCE TEST - SIDE-BY-SIDE STAND

DID R HOLD SIDE-BY-SIDE STAND FOR FULL 10 SECONDS WITHOUT STEPPING OUT OF PLACE OR GRABBING HOLD OF ANYTHING?
expand
           
         
If Balance test s-b-s hold full time = 1. Yes »
 
             
           
KI887

Balance test side-by-side time

BALANCE TEST - SIDE-BY-SIDE STAND

RECORD TIME IN SECONDS TO TWO DECIMAL PLACES
             
         
If Balance test s-b-s hold full time != 993. R tried but was unable and Balance test s-b-s hold full time != 999. R chose not to do it »
 
             
           
KI888

Balance test side-by-side compensatory

BALANCE TEST - SIDE-BY-SIDE STAND

DID R USE ANY COMPENSATORY MOVEMENTS OF HIS/HER TRUNK, ARMS OR LEGS TO STEADY HIM/HERSELF DURING SIDE-BY-SIDE STAND?
expand
             
           
KI889

Balance test s-b-s floor surface

BALANCE TEST - SIDE-BY-SIDE STAND

RECORD TYPE OF FLOOR SURFACE
expand
             
           
KI891

Balance test s-b-s compliance

BALANCE TEST - SIDE-BY-SIDE STAND

HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
expand
             
     
Else
 
         
       
KI893

Balance test full tandem complete

BALANCE TEST - FULL TANDEM STAND

DID R COMPLETE THE FULL TANDEM STAND?
expand
         
       
If Balance test full tandem complete != 1. Yes »
 
           
         
KI894

Balance full tandem stand-not complete

BALANCE TEST - FULL TANDEM STAND

WHY DIDN'T R COMPLETE THE FULL -TANDEM STAND? SELECT ALL THAT APPLY
expand
           
       
Else
 
           
         
KI896

Balance test full tandem hold full time

BALANCE TEST - FULL TANDEM STAND

DID R HOLD FULL TANDEM STAND FOR FULL [30/60] SECONDS WITHOUT STEPPING OUT OF PLACE OR GRABBING HOLD OF ANYTHING?
expand
           
         
If Balance test full tandem hold full time = 1. Yes and R current age calculation > 70 »
 
             
           
KI897

Balance test full tandem time

BALANCE TEST - FULL TANDEM STAND

RECORD TIME IN SECONDS TO TWO DECIMAL PLACES
             
         
If Balance test full tandem hold full time != 993. R tried but was unable and Balance test full tandem hold full time != 999. R chose not to do it »
 
             
           
KI898

Balance test full tandem compensatory

BALANCE TEST - FULL TANDEM STAND

DID R USE ANY COMPENSATORY MOVEMENTS OF HIS/HER TRUNK, ARMS OR LEGS TO STEADY HIM/HERSELF DURING FULL TANDEM STAND?
expand
             
           
KI899

Balance test full tandem floor surface

BALANCE TEST - FULL TANDEM

RECORD TYPE OF FLOOR SURFACE
expand
             
           
KI902

Balance test full tandem compliance

BALANCE TEST - FULL TANDEM STAND

HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
expand
             
     
If R current age calculation > 64 »
 
         
       
KI820

Walking test complete at least one trial

WALKING TEST

DID R COMPLETE AT LEAST ONE TRIAL OF THE WALKING TEST?
expand
         
       
If Walking test complete at least one trial != 1. Yes »
 
           
         
KI821

Walking test reason not complete

WALKING TEST

WHY DIDN'T R COMPLETE THE WALKING TEST? (SELECT ALL THAT APPLY)
expand
           
       
Else
 
           
         
KI823

Walking test 1st trial time

WALKING TEST - TIME FROM FIRST TRIAL

RECORD TIME IN SECONDS TO TWO DECIMAL PLACES

FIRST TRIAL:

SECOND TRIAL:

ENTER 993 IF R WAS UNABLE TO DO IT ENTER 999 IF R CHOSE NOT TO DO IT
expand
           
         
If Walking test 1st trial time != 993. R unable to do it and Walking test 1st trial time != 999. R chose not to do it »
 
             
           
KI824

Walking test 2nd trial time

WALKING TEST - TIME FROM SECOND TRIAL

RECORD TIME IN SECONDS TO TWO DECIMAL PLACES

FIRST TRIAL: [T WALK 1ST TRIAL TIME]

SECOND TRIAL:

ENTER 993 IF R WAS UNABLE TO DO IT ENTER 999 IF R CHOSE NOT TO DO IT
expand
             
           
KI825

Walking test floor surface

WALKING TEST

RECORD TYPE OF FLOOR SURFACE
expand
             
           
KI828

Walking aid type

WALKING TEST

RECORD TYPE OF AID USED
expand
             
           
KI830

Walking test r compliance

WALKING TEST

HOW COMPLIANT WAS R DURING THIS MEASUREMENT
expand
             
     
KI831

Measure r height

HEIGHT

WERE YOU ABLE TO MEASURE R'S HEIGHT?
expand
       
     
If Measure r height != 1. Yes »
 
         
       
KI832

Height reason not complete

HEIGHT

WHY WEREN'T YOU ABLE TO MEASURE R'S HEIGHT? (SELECT ALL THAT APPLY)
expand
         
     
Else
 
         
       
KI834

Height measurment

HEIGHT

ENTER RESPONDENT'S HEIGHT IN INCHES. ROUND TO THE NEAREST QUARTER INCH.
expand
         
       
KI835

Height floor surface

HEIGHT

RECORD TYPE OF FLOOR SURFACE
expand
         
       
KI837

Height wearing shoes

HEIGHT

WAS R WEARING SHOES DURING MEASUREMENT?
expand
         
       
KI903

Height compliance

HEIGHT

HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
expand
         
     
If Weight in pounds < 300 »
 
         
       
KI838

Weight able to measure

WEIGHT

WERE YOU ABLE TO MEASURE R'S WEIGHT?
expand
         
       
If Weight able to measure != 1. Yes »
 
           
         
KI839

Weight reason not complete

WEIGHT

WHY WEREN'T YOU ABLE TO MEASURE R'S WEIGHT? (SELECT ALL THAT APPLY)
expand
           
       
Else
 
           
         
KI841

Weight pounds measurment

WEIGHT

ENTER RESPONDENT'S WEIGHT IN POUNDS AS RECORDED ON SCALE (TO THE NEAREST 1/2 POUND). ENTER 993 IF R TRIED BUT RECEIVED AN ERROR MESSAGE. ENTER 999 IF R CHOSE NOT TO DO IT.
expand
           
         
KI842

Weight floor surface

WEIGHT

RECORD TYPE OF FLOOR SURFACE
expand
           
         
KI844

Weight wearing shoes

WEIGHT

WAS R WEARING SHOES DURING MEASUREMENT?
expand
           
         
KI947

Weight compliance

WEIGHT

HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
expand
           
     
KI904

Waist complete

WAIST CIRCUMFERENCE

WERE YOU ABLE TO MEASURE R'S WAIST CIRCUMFERENCE?
expand
       
     
If Waist complete != 1. Yes »
 
         
       
KI905

Waist why not complete

WAIST CIRCUMFERENCE

WERE YOU ABLE TO MEASURE R'S WAIST CIRCUMFERENCE? (SELECT ALL THAT APPLY)
expand
         
     
Else
 
         
       
KI907

Waist measurment

WAIST CIRCUMFERENCE -MEASUREMENT

ENTER RESPONDENT'S WAIST MEASUREMENT TO THE NEAREST QUARTER INCH.

ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 999 IF R CHOSE NOT TO DO IT.
expand
         
       
If Waist measurment != 993. R tried but was unable to complete the test and Waist measurment != 999. R chose not to do it< »
 
           
         
KI908

Waist difficulties

WAIST CIRCUMFERENCE -MEASUREMENT

WHAT DIFFICULTIES OCCURRED DURING THIS MEASUREMENT?
expand
           
         
KI910

Waist compliance

WAIST CIRCUMFERENCE

HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
expand
           
         
KI911

Waist who measured

WAIST CIRCUMFERENCE

WHO COMPLETED THE MEASUREMENT?
expand
           
         
KI912

Waist bulky clothes

WAIST CIRCUMFERENCE

WAS R WEARING BULKY CLOTHING DURING THIS MEASUREMENT?
expand
           
   
KI913

Saliva consent

SALIVA SAMPLE

DID R SIGN THE CONSENT FORM FOR THE SALIVA SAMPLE?
expand
     
   
If Saliva consent = 5. No »
 
       
     
KI941

Why no consent saliva

SALIVA SAMPLE

WHY DIDN'T R SIGN THE SALIVA CONSENT FORM? (SELECT ALL THAT APPLY)
expand
       
   
Else
 
       
     
KI915

Saliva sample complete

SALIVA SAMPLE

DID R COMPLETE THE SALIVA SAMPLE?
expand
       
     
If Saliva sample complete != 1. Yes »
 
         
       
KI916

Saliva why not complete

SALIVA SAMPLE

WHY DIDN'T R COMPLETE THE SALIVA SAMPLE? (SELECT ALL THAT APPLY)
expand
         
     
Else
 
         
       
KI918

Saliva fill vial

SALIVA SAMPLE

DID R FILL THE VIAL UP TO THE MARKED LINE?
expand
         
       
KI919

Saliva problems

SALIVA SAMPLE

WHAT, IF ANY, PROBLEMS OCCURED? (SELECT ALL THAT APPLY)
expand
         
       
KI921

Saliva compliance

SALIVA SAMPLE

HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
expand
         
   
KI922

Blood sample consent

BLOOD SAMPLE

DID R SIGN THE BLOOD SAMPLE CONSENT FORM?
expand
     
   
If Blood sample consent = 5. No »
 
       
     
KI943

Why no consent blood

BLOOD SAMPLE

WHY DIDN'T R SIGN THE BLOOD CONSENT FORM? (SELECT ALL THAT APPLY)
expand
       
   
Else
 
       
     
KI923

Blood sample complete

BLOOD SAMPLE

DID R COMPLETE THE BLOOD SAMPLE?
expand
       
     
If Blood sample complete != 1. Yes »
 
         
       
KI924

Why blood sample not complete

BLOOD SAMPLE

WHY DIDN'T R COMPLETE THE BLOOD SAMPLE? (SELECT ALL THAT APPLY)
expand
         
     
Else
 
         
       
KI926

Blood sample what problems

BLOOD SAMPLE

WHAT, IF ANY, PROBLEMS OCCURRED DURING THE COLLECTION OF THE BLOOD SAMPLE? (SELECT ALL THAT APPLY)
expand
         
       
KI928

Blood who measured

BLOOD SAMPLE

WHO PRICKED THE R'S FINGER(S)?
expand
         
       
KI929

Amount of blood on first card

BLOOD SAMPLE

HOW MANY CIRCLES WERE FILLED ON THE FIRST CARD?
expand
         
       
KI945

Amount of blood on storage card

BLOOD SAMPLE

HOW MANY CIRCLES WERE FILLED ON THE STORAGE CARD?
expand
         
       
KI930

How many blood pricks

BLOOD SAMPLE

HOW MANY TIMES DID THE R'S FINGER NEED TO BE PRICKED IN ORDER TO FILL THE CIRCLES?
expand
         
       
KI931

Blood sample compliance

BLOOD SAMPLE

HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
expand
         
End of I. Physical Measures (respondent)
Start of I. Physical Measures (respondent)

========================================================================
KI800
Physical measures interview mode

ENTER CURRENT MODE OF INTERVIEW
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Phone
2. F-t-f
Blank. Inapplicable; partial interview

If Prefered mode of iwer (KX090_R) = ENHANCEDFTF »

If Physical measures interview mode (KI800) = 2. F-t-f and R in nursing home (KA028) = NO and LANGUAGE = SPANISH or ENGLISH »

| | ========================================================================
| | 
KI802
Physical measures consent form

NOW I AM GOING TO ASK YOU TO DO A FEW SIMPLE ACTIVITIES FOR ME. RESEARCHERS ARE INTERESTED IN HOW PERFORMANCE ON THESE ACTIVITIES RELATES TO SOME OF THE OTHER FACTORS I HAVE ASKED YOU ABOUT IN THE INTERVIEW. I WILL ASK YOU TO DO THESE ACTIVITIES: A BREATHING TEST, A TEST OF HAND STRENGTH, [PHYSICAL MEASURES CONSENT FORM] A BALANCE TEST, AND BLOOD PRESSURE, HEIGHT, [PHYSICAL MEASURES CONSENT FORM] AND WAIST MEASUREMENTS. MY PRIMARY CONCERN IS FOR YOUR SAFETY, SO I WILL ASK YOU IF YOU FEEL IT WOULD BE SAFE FOR YOU TO COMPLETE EACH ACTIVITY. IF YOU HAVE ANY CONCERNS ABOUT THE ACTIVITY, PLEASE LET ME KNOW AND WE WILL SKIP IT. PLEASE DO NOT EAT, DRINK, SMOKE, OR BRUSH YOUR TEETH WHILE WE ARE CONDUCTING THE MEASUREMENTS. I WILL ALSO BE ASKING YOU TO REMOVE BULKY CLOTHING AND TO TAKE OFF YOUR SHOES DURING THE MEASUREMENTS. BEFORE WE BEGIN, I'D LIKE TO HAVE YOU READ AND SIGN A FORM EXPLAINING YOUR RIGHTS AS A PARTICIPANT IN THIS PART OF THE STUDY.

SHOW R THE FIRST CONSENT FORM IN THE PHYSICAL MEASURES
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Continue
9. Refused
Blank. Inapplicable; partial interview

| | If Physical measures consent form (KI802) = 1. Continue »

| | | ========================================================================
| | | 
KI854
Blood pressure complete

BLOOD PRESSURE

DID R COMPLETE AT LEAST ONE BLOOD PRESSURE MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview

| | | If Blood pressure complete (KI854) = 5. No »

| | | | ========================================================================
| | | | 
KI855
Blood pressure not complete

BLOOD PRESSURE

WHY DIDN'T R COMPLETE THE BLOOD PRESSURE MEASUREMENT? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the test
4. R tried but was unable to complete the test
5. R did not understand the instructions
6. R had a rash, a cast, edema, open sores or wounds, or significant bruise where the blood cuff would contact r's arm; other health reason
11. Problem with equipment or supplies
14. Unsuitable location
97. Other (specify)
98. Don't know; not ascertained
Blank. Inapplicable; partial interview

| | | ElseIf Blood pressure complete (KI854) = 1. Yes »

| | | | ========================================================================
| | | | 
KI857
Bloodpressure time

BLOOD PRESSURE - 1ST TIME

FIRST READING TIME OF READING

USER NOTE: TIME OF DAY IS PRESENTED AS MILITARY TIME.

7441 00000000-23:51:00. ACTUAL VALUE
- - - - - - - - - - - - - - - - - - - - - - - - -
Blank. Inapplicable; partial interview

| | | | ========================================================================
| | | | 
KI859
Bloodpressure 1 systolic

BLOOD PRESSURE - 1ST SYSTOLIC

FIRST READING SYSTOLIC

ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 999 IF R CHOSE NOT TO DO IT.
- - - - - - - - - - - - - - - - - - - - - - - - -
993. R was unable to do it
996. Unknown
998. Don't know; not ascertained
999. R chose not to do it

| | | | If Bloodpressure 1 systolic (KI859) != 9993 and Bloodpressure 1 systolic (KI859) != 999. R chose not to do it »

| | | | | ========================================================================
| | | | | 
KI860
Bloodpressure 1 diastolic

BLOOD PRESSURE - 1ST DIASTOLIC

FIRST READING DIASTOLIC
- - - - - - - - - - - - - - - - - - - - - - - - -
996. Unknown
998. Don't know; not ascertained
999. Refused

| | | | | ========================================================================
| | | | | 
KI861
Bloodpressure 1 pulse

BLOOD PRESSURE - 1ST PULSE

FIRST READING PULSE
- - - - - - - - - - - - - - - - - - - - - - - - -
996. Unknown
998. Don't know; not ascertained
999. Refused

| | | | | ========================================================================
| | | | | 
KI862
Blood pressure 2 time

BLOOD PRESSURE - 2ND TIME

SECOND READING TIME OF READING

USER NOTE: TIME OF DAY IS PRESENTED AS MILITARY TIME.

7410 00000000-23:52:00. ACTUAL VALUE
- - - - - - - - - - - - - - - - - - - - - - - - -
Blank. Inapplicable; partial interview

| | | | | ========================================================================
| | | | | 
KI864
Bloodpressure 2 systolic

BLOOD PRESSURE - 2ND SYSTOLIC

SECOND READING SYSTOLIC

ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 999 IF R CHOSE NOT TO DO IT.
- - - - - - - - - - - - - - - - - - - - - - - - -
993. R was unable to do it
996. Unknown
998. Don't know; not ascertained
999. R chose not to do it

| | | | | If Bloodpressure 2 systolic (KI864) != 9993 and Bloodpressure 2 systolic (KI864) != 999. R chose not to do it »

| | | | | | ========================================================================
| | | | | | 
KI865
Bloodpressure 2 diastolic

BLOOD PRESSURE - 2ND DIASTOLIC

SECOND READING DIASTOLIC
- - - - - - - - - - - - - - - - - - - - - - - - -
996. Unknown
998. Don't know; not ascertained
999. Refused

| | | | | | ========================================================================
| | | | | | 
KI866
Bloodpressure 2 pulse

BLOOD PRESSURE - 2ND PULSE

SECOND READING PULSE
- - - - - - - - - - - - - - - - - - - - - - - - -
996. Unknown
998. Don't know; not ascertained
999. Refused

| | | | | | ========================================================================
| | | | | | 
KI867
Bloodpressure 3 time

BLOOD PRESSURE - 3RD TIME

THIRD READING TIME OF READING

USER NOTE: TIME OF DAY IS PRESENTED AS MILITARY TIME.

7342 00000000-23:53:00. ACTUAL VALUE
- - - - - - - - - - - - - - - - - - - - - - - - -
Blank. Inapplicable; partial interview

| | | | | | ========================================================================
| | | | | | 
KI869
Bloodpressure 3 systolic

BLOOD PRESSURE - 3RD SYSTOLIC

THIRD READING SYSTOLIC

ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 999 IF R CHOSE NOT TO DO IT.
- - - - - - - - - - - - - - - - - - - - - - - - -
993. R was unable to do it
996. Unknown
998. Don't know; not ascertained
999. R chose not to do it

| | | | | | If Bloodpressure 3 systolic (KI869) != 9993 and Bloodpressure 3 systolic (KI869) != 999. R chose not to do it »

| | | | | | | ========================================================================
| | | | | | | 
KI870
Bloodpressure 3 diastolic

BLOOD PRESSURE - 3RD DIASTOLIC

THIRD READING DIASTOLIC
- - - - - - - - - - - - - - - - - - - - - - - - -
996. Unknown
998. Don't know; not ascertained
999. Refused

| | | | | | | ========================================================================
| | | | | | | 
KI871
Bloodpressure 3 pulse

BLOOD PRESSURE - 3RD PULSE

THIRD READING PULSE
- - - - - - - - - - - - - - - - - - - - - - - - -
996. Unknown
998. Don't know; not ascertained
999. Refused

| | | | | ========================================================================
| | | | | 
KI872
Bloodpressure arm

BLOOD PRESSURE - ARM

WHICH ARM WAS USED TO CONDUCT THE MEASUREMENTS?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Left arm
2. Right arm
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview

| | | | | ========================================================================
| | | | | 
KI873
Bloodpressure compliance

BLOOD PRESSURE - COMPLIANCE

HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
Blank. Inapplicable; partial interview

| | | | | ========================================================================
| | | | | 
KI874
Bloodpressure position

BLOOD PRESSURE - POSITION

WHAT WAS R'S POSITION FOR THIS TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Standing
2. Sitting
3. Lying down
Blank. Inapplicable; partial interview

| | | | | ========================================================================
| | | | | 
KI875
Bloodpressure smoke etc

BLOOD PRESSURE - SMOKE ETC.

DID R SMOKE, EXERCISE, CONSUME ALCOHOL OR FOOD WITHIN THE 30 MINUTES PRIOR TO COMPLETING THE BLOOD PRESSURE TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
8. Don't know; not ascertained
Blank. Inapplicable; partial interview

| | | ========================================================================
| | | 
KI804
Breath complete at least one trial

BREATHING TEST

DID R COMPLETE AT LEAST ONE TRIAL OF THE BREATHING TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview

| | | If Breath complete at least one trial (KI804) != 1. Yes »

| | | | ========================================================================
| | | | 
KI805
Breath test reason not complete

BREATHING TEST

WHY DIDN'T R COMPLETE THE BREATHING TEST? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the test
4. R tried but was unable to complete the test
5. R did not understand the instructions
11. Problem with equipment or supplies
13. R had surgery, injury or other health condition that prevented r from completing the measurement
14. Unsuitable location
97. Other (specify)
98. Don't know; not ascertained
Blank. Inapplicable; partial interview

| | | If Breath complete at least one trial (KI804) = 1. Yes »

| | | | ========================================================================
| | | | 
KI807
Puff test 1

BREATHING TEST

FIRST READING:

SECOND READING:

THIRD READING:

ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 999 IF R CHOSE NOT TO DO IT.
- - - - - - - - - - - - - - - - - - - - - - - - -
993. R tried but was unable to complete the test
996. Uknown
998. Don't know; not ascertained
999. R chose not to do it

| | | | ========================================================================
| | | | 
KI808
Puff test 2

BREATHING TEST

FIRST READING: [PUFF TEST 1]

SECOND READING:

THIRD READING:

ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 999 IF R CHOSE NOT TO DO IT.
- - - - - - - - - - - - - - - - - - - - - - - - -
993. R tried but was unable to complete the test
996. Uknown
998. Don't know; not ascertained
999. R chose not to do it

| | | | ========================================================================
| | | | 
KI809
Puff test 3

BREATHING TEST

FIRST READING: [PUFF TEST 1]

SECOND READING: [PUFF TEST 2]

THIRD READING:

ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 999 IF R CHOSE NOT TO DO IT.
- - - - - - - - - - - - - - - - - - - - - - - - -
993. R tried but was unable to complete the test
998. Don't know; not ascertained
999. R chose not to do it

| | | | ========================================================================
| | | | 
KI810
R breathing test effort

BREATHING TEST

HOW MUCH EFFORT DID THE R GIVE TO THIS TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R gave full effort
2. Full effort prevented by illness, pain, or other symptoms or discomforts
3. Full effort not given, but no obvious reason for this
Blank. Inapplicable; partial interview

| | | | ========================================================================
| | | | 
KI811
Breathing test r position

BREATHING TEST

WHAT WAS THE R'S POSITION FOR THIS TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Standing
2. Sitting
3. Lying down
8. Don't know; not ascertained
Blank. Inapplicable; partial interview

| | | ========================================================================
| | | 
KI812
Hand strength complete one trial

HAND STRENGTH TEST

DID R COMPLETE AT LEAST ONE TRIAL OF THE HAND STRENGTH TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview

| | | If Hand strength complete one trial (KI812) != 1. Yes »

| | | | ========================================================================
| | | | 
KI813
Hand strength test reason not complete

HAND STRENGTH TEST

WHY DIDN'T R COMPLETE THE HAND STRENGTH TEST? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the test
4. R tried but was unable to complete the test
5. R did not understand the instructions
6. R had surgery, injury, swelling, etc. on both hands in past 6 months; other health reason
11. Problem with equipment or supplies
14. Unsuitable location
97. Other (specify)
98. Don't know; not ascertained
Blank. Inapplicable; partial interview

| | | Else If Hand strength complete one trial (KI812) = 1. Yes »

| | | | ========================================================================
| | | | 
KI815
Grip dominant hand

HAND STRENGTH TEST

RECORD R'S DOMINANT HAND.
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Right hand
2. Left hand
3. Both hands equally dominant
Blank. Inapplicable; partial interview

| | | | ========================================================================
| | | | 
KI816
Left hand first

HAND STRENGTH TEST

LEFT HAND, FIRST MEASUREMENT .

LEFT HAND, FIRST MEASUREMENT: RIGHT HAND, FIRST MEASUREMENT: LEFT HAND, SECOND MEASUREMENT: RIGHT HAND, SECOND MEASUREMENT:

ENTER THE RESULT TO THE NEAREST 0.5 KILOGRAM.

ENTER 993 IF R WAS UNABLE TO PERFORM THIS MEASUREMENT ENTER 999 IF R CHOSE NOT TO DO IT
- - - - - - - - - - - - - - - - - - - - - - - - -
993. R tried but was unable to complete the test
996. Uknown
998. Don't know; not ascertained
999. R chose not to do it

| | | | ========================================================================
| | | | 
KI851
Right hand first

HAND STRENGTH TEST

RIGHT HAND, FIRST MEASUREMENT.

LEFT HAND, FIRST MEASUREMENT: [LEFT FIRST ] RIGHT HAND, FIRST MEASUREMENT: LEFT HAND, SECOND MEASUREMENT: RIGHT HAND, SECOND MEASUREMENT:

ENTER THE RESULT TO THE THE NEAREST 0.5 KILOGRAM.

ENTER 993 IF R WAS UNABLE TO PERFORM THIS MEASUREMENT ENTER 999 IF R CHOSE NOT TO DO IT
- - - - - - - - - - - - - - - - - - - - - - - - -
993. R tried but was unable to complete the test
996. Uknown
998. Don't know; not ascertained
999. R chose not to do it

| | | | ========================================================================
| | | | 
KI852
Left hand second

HAND STRENGTH TEST

LEFT HAND, SECOND MEASUREMENT.

LEFT HAND, FIRST MEASUREMENT: [LEFT FIRST ] RIGHT HAND, FIRST MEASUREMENT: [RIGHT FIRST ] LEFT HAND, SECOND MEASUREMENT : RIGHT HAND, SECOND MEASUREMENT:

ENTER THE RESULT TO THE THE NEAREST 0.5 KILOGRAM.

ENTER 993 IF R WAS UNABLE TO PERFORM THIS MEASUREMENT ENTER 999 IF R CHOSE NOT TO DO IT
- - - - - - - - - - - - - - - - - - - - - - - - -
993. R tried but was unable to complete the test
996. Uknown
998. Don't know; not ascertained
999. R chose not to do it

| | | | ========================================================================
| | | | 
KI853
Right hand second

HAND STRENGTH TEST

RIGHT HAND, SECOND MEASUREMENT.

LEFT HAND, FIRST MEASUREMENT: [LEFT FIRST ] RIGHT HAND, FIRST MEASUREMENT: [RIGHT FIRST ] LEFT HAND, SECOND MEASUREMENT: [LEFT SECOND] RIGHT HAND, SECOND MEASUREMENT :

ENTER THE RESULT TO THE THE NEAREST 0.5 KILOGRAM.

ENTER 993 IF R WAS UNABLE TO PERFORM THIS MEASUREMENT ENTER 999 IF R CHOSE NOT TO DO IT
- - - - - - - - - - - - - - - - - - - - - - - - -
993. R tried but was unable to complete the test
996. Uknown
998. Don't know; not ascertained
999. R chose not to do it

| | | | ========================================================================
| | | | 
KI817
Grip r effort

HAND STRENGTH TEST

HOW MUCH EFFORT DID THE R GIVE TO THIS TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R gave full effort
2. Full effort prevented by illness, pain, or other symptoms or discomforts
3. Full effort not given, but no obvious reason for this
Blank. Inapplicable; partial interview

| | | | ========================================================================
| | | | 
KI818
Hand strength test r position

HAND STRENGTH TEST

WHAT WAS THE R'S POSITION FOR THIS TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Standing
2. Sitting
3. Lying down
Blank. Inapplicable; partial interview

| | | | ========================================================================
| | | | 
KI819
Hand strength rest arm

HAND STRENGTH TEST

DID THE R REST THEIR ARM ON A SUPPORT WHILE PERFORMING THIS TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview

| | | ========================================================================
| | | 
KI876
Balance test - semi-tandem stand

BALANCE TEST - SEMI-TANDEM STAND

DID R COMPLETE THE SEMI-TANDEM STAND?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview

| | | If Balance test - semi-tandem stand (KI876) != 1. Yes »

| | | | ========================================================================
| | | | 
KI877
Balance semi-tandem reason not comp

BALANCE TEST - SEMI-TANDEM STAND

WHY DIDN'T R COMPLETE THE SEMI-TANDEM STAND? SELECT ALL THAT APPLY
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the test
4. R tried but was unable to complete the test
5. R did not understand the instructions
6. R had surgery, injury or other health condition that prevented r from standing
14. Unsuitable location
97. Other (specify)
98. Don't know; not ascertained
Blank. Inapplicable; partial interview

| | | ElseIf Balance test - semi-tandem stand (KI876) = 1. Yes »

| | | | ========================================================================
| | | | 
KI879
Balance test semi-tandem hold full time

BALANCE TEST - SEMI-TANDEM STAND

DID R HOLD SEMI-TANDEM STAND FOR FULL 10 SECONDS WITHOUT STEPPING OUT OF PLACE OR GRABBING HOLD OF ANYTHING?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
993. R tried but was unable
999. R chose not to do it
Blank. Inapplicable; partial interview

| | | | If Balance test semi-tandem hold full time (KI879) = 1. Yes »

| | | | | ========================================================================
| | | | | 
KI880
Balance test semi-tandem time

BALANCE TEST - SEMI-TANDEM STAND

RECORD TIME IN SECONDS TO TWO DECIMAL PLACES

| | | | If Balance test semi-tandem hold full time (KI879) != 999. R chose not to do it and Balance test semi-tandem hold full time (KI879) != 993. R tried but was unable »

| | | | | ========================================================================
| | | | | 
KI881
Balance test semi-tandem compensatory

BALANCE TEST - SEMI-TANDEM STAND

DID R USE ANY COMPENSATORY MOVEMENTS OF HIS/HER TRUNK, ARMS OR LEGS TO STEADY HIM/HERSELF DURING SEMI-TANDEM STAND?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview

| | | If Balance test - semi-tandem stand (KI876) = 5. No or Balance test semi-tandem hold full time (KI879) != 1. Yes »

| | | | ========================================================================
| | | | 
KI883
Balance test s-b-s complete

BALANCE TEST - SIDE-BY-SIDE STAND

DID R COMPLETE THE SIDE-BY-SIDE STAND?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview

| | | | If Balance test s-b-s complete (KI883) != 1. Yes »

| | | | | ========================================================================
| | | | | 
KI884
Balance test sbs stand reason not comp

BALANCE TEST - SIDE-BY-SIDE STAND

WHY DIDN'T R COMPLETE THE SIDE-BY-SIDE STAND? SELECT ALL THAT APPLY
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the test
4. R tried but was unable to complete the test
5. R did not understand the instructions
6. R had surgery, injury or other health condition that prevented r from standing
14. Unsuitable location
97. Other (specify)
98. Don't know; not ascertained
Blank. Inapplicable; partial interview

| | | | ElseIf Balance test s-b-s complete (KI883) = 1. Yes »

| | | | | ========================================================================
| | | | | 
KI886
Balance test s-b-s hold full time

BALANCE TEST - SIDE-BY-SIDE STAND

DID R HOLD SIDE-BY-SIDE STAND FOR FULL 10 SECONDS WITHOUT STEPPING OUT OF PLACE OR GRABBING HOLD OF ANYTHING?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
993. R tried but was unable
999. R chose not to do it
Blank. Inapplicable; partial interview

| | | | | If Balance test s-b-s hold full time (KI886) = 1. Yes »

| | | | | | ========================================================================
| | | | | | 
KI887
Balance test side-by-side time

BALANCE TEST - SIDE-BY-SIDE STAND

RECORD TIME IN SECONDS TO TWO DECIMAL PLACES

| | | | | If Balance test s-b-s hold full time (KI886) != 993. R tried but was unable and Balance test s-b-s hold full time (KI886) != 999. R chose not to do it »

| | | | | | ========================================================================
| | | | | | 
KI888
Balance test side-by-side compensatory

BALANCE TEST - SIDE-BY-SIDE STAND

DID R USE ANY COMPENSATORY MOVEMENTS OF HIS/HER TRUNK, ARMS OR LEGS TO STEADY HIM/HERSELF DURING SIDE-BY-SIDE STAND?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview

| | | | | | ========================================================================
| | | | | | 
KI889
Balance test s-b-s floor surface

BALANCE TEST - SIDE-BY-SIDE STAND

RECORD TYPE OF FLOOR SURFACE
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Linoleum/tile/wood
2. Low-pile carpet
3. High-pile carpet
4. Concrete
5. Not sure
7. Other (specify)
Blank. Inapplicable; partial interview

| | | | | | ========================================================================
| | | | | | 
KI891
Balance test s-b-s compliance

BALANCE TEST - SIDE-BY-SIDE STAND

HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
Blank. Inapplicable; partial interview

| | | Else

| | | | ========================================================================
| | | | 
KI893
Balance test full tandem complete

BALANCE TEST - FULL TANDEM STAND

DID R COMPLETE THE FULL TANDEM STAND?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview

| | | | If Balance test full tandem complete (KI893) != 1. Yes »

| | | | | ========================================================================
| | | | | 
KI894
Balance full tandem stand-not complete

BALANCE TEST - FULL TANDEM STAND

WHY DIDN'T R COMPLETE THE FULL -TANDEM STAND? SELECT ALL THAT APPLY
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the test
4. R tried but was unable to complete the test
5. R did not understand the instructions
6. R had surgery, injury or other health condition that prevented r from standing
97. Other (specify)
98. Don't know; not ascertained
Blank. Inapplicable; partial interview

| | | | Else

| | | | | ========================================================================
| | | | | 
KI896
Balance test full tandem hold full time

BALANCE TEST - FULL TANDEM STAND

DID R HOLD FULL TANDEM STAND FOR FULL [30/60] SECONDS WITHOUT STEPPING OUT OF PLACE OR GRABBING HOLD OF ANYTHING?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
993. R tried but was unable
999. R chose not to do it
Blank. Inapplicable; partial interview

| | | | | If Balance test full tandem hold full time (KI896) = 1. Yes and R current age calculation (KA019) > 70 »

| | | | | | ========================================================================
| | | | | | 
KI897
Balance test full tandem time

BALANCE TEST - FULL TANDEM STAND

RECORD TIME IN SECONDS TO TWO DECIMAL PLACES

| | | | | If Balance test full tandem hold full time (KI896) != 993. R tried but was unable and Balance test full tandem hold full time (KI896) != 999. R chose not to do it »

| | | | | | ========================================================================
| | | | | | 
KI898
Balance test full tandem compensatory

BALANCE TEST - FULL TANDEM STAND

DID R USE ANY COMPENSATORY MOVEMENTS OF HIS/HER TRUNK, ARMS OR LEGS TO STEADY HIM/HERSELF DURING FULL TANDEM STAND?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
8. Don't know; not ascertained
Blank. Inapplicable; partial interview

| | | | | | ========================================================================
| | | | | | 
KI899
Balance test full tandem floor surface

BALANCE TEST - FULL TANDEM

RECORD TYPE OF FLOOR SURFACE
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Linoleum/tile/wood
2. Low-pile carpet
3. High-pile carpet
4. Concrete
5. Not sure
7. Other (specify)
Blank. Inapplicable; partial interview

| | | | | | ========================================================================
| | | | | | 
KI902
Balance test full tandem compliance

BALANCE TEST - FULL TANDEM STAND

HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
Blank. Inapplicable; partial interview

| | | If R current age calculation (KA019) > 64 »

| | | | ========================================================================
| | | | 
KI820
Walking test complete at least one trial

WALKING TEST

DID R COMPLETE AT LEAST ONE TRIAL OF THE WALKING TEST?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview

| | | | If Walking test complete at least one trial (KI820) != 1. Yes »

| | | | | ========================================================================
| | | | | 
KI821
Walking test reason not complete

WALKING TEST

WHY DIDN'T R COMPLETE THE WALKING TEST? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the test
4. R tried but was unable to complete the test
5. R did not understand the instructions
6. R had surgery, injury or other health condition that prevented r from walking
7. No suitable space available
11. Problem with equipment or supplies
97. Other (specify)
98. Don't know; not ascertained
Blank. Inapplicable; partial interview

| | | | Else

| | | | | ========================================================================
| | | | | 
KI823
Walking test 1st trial time

WALKING TEST - TIME FROM FIRST TRIAL

RECORD TIME IN SECONDS TO TWO DECIMAL PLACES

FIRST TRIAL:

SECOND TRIAL:

ENTER 993 IF R WAS UNABLE TO DO IT ENTER 999 IF R CHOSE NOT TO DO IT
- - - - - - - - - - - - - - - - - - - - - - - - -
993. R unable to do it
996. Unknown
998. Don't know; not ascertained
999. R chose not to do it

| | | | | If Walking test 1st trial time (KI823) != 993. R unable to do it and Walking test 1st trial time (KI823) != 999. R chose not to do it »

| | | | | | ========================================================================
| | | | | | 
KI824
Walking test 2nd trial time

WALKING TEST - TIME FROM SECOND TRIAL

RECORD TIME IN SECONDS TO TWO DECIMAL PLACES

FIRST TRIAL: [T WALK 1ST TRIAL TIME]

SECOND TRIAL:

ENTER 993 IF R WAS UNABLE TO DO IT ENTER 999 IF R CHOSE NOT TO DO IT
- - - - - - - - - - - - - - - - - - - - - - - - -
993. R was unable to do it
996. Unknown
998. Don't know; not ascertained
999. R chose not to do it

| | | | | | ========================================================================
| | | | | | 
KI825
Walking test floor surface

WALKING TEST

RECORD TYPE OF FLOOR SURFACE
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Linoleum/tile/wood
2. Low-pile carpet
3. High-pile carpet
4. Concrete
5. Not sure
7. Other (specify)
Blank. Inapplicable; partial interview

| | | | | | ========================================================================
| | | | | | 
KI828
Walking aid type

WALKING TEST

RECORD TYPE OF AID USED
- - - - - - - - - - - - - - - - - - - - - - - - -
1. None
2. Walking stick or cane
3. Elbow crutches
4. Walking frame
7. Other (specify)
Blank. Inapplicable; partial interview

| | | | | | ========================================================================
| | | | | | 
KI830
Walking test r compliance

WALKING TEST

HOW COMPLIANT WAS R DURING THIS MEASUREMENT
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R was fully compliant.
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
Blank. Inapplicable; partial interview

| | | ========================================================================
| | | 
KI831
Measure r height

HEIGHT

WERE YOU ABLE TO MEASURE R'S HEIGHT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview

| | | If Measure r height (KI831) != 1. Yes »

| | | | ========================================================================
| | | | 
KI832
Height reason not complete

HEIGHT

WHY WEREN'T YOU ABLE TO MEASURE R'S HEIGHT? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the measurement
4. R tried but was unable to complete the measurement
5. R did not understand the instructions
6. R too tall, interviewer could not reach
7. No suitable space available
11. Problem with equipment or supplies
13. R had surgery, injury or other health condition that prevented r from completing the measurement
97. Other (specify)
98. Don't know; not ascertained
Blank. Inapplicable; partial interview

| | | Else

| | | | ========================================================================
| | | | 
KI834
Height measurment

HEIGHT

ENTER RESPONDENT'S HEIGHT IN INCHES. ROUND TO THE NEAREST QUARTER INCH.
- - - - - - - - - - - - - - - - - - - - - - - - -
996. Unknown

| | | | ========================================================================
| | | | 
KI835
Height floor surface

HEIGHT

RECORD TYPE OF FLOOR SURFACE
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Linoleum/tile/wood
2. Low-pile carpet
3. High-pile carpet
4. Concrete
5. Not sure
7. Other (specify)
Blank. Inapplicable; partial interview

| | | | ========================================================================
| | | | 
KI837
Height wearing shoes

HEIGHT

WAS R WEARING SHOES DURING MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview

| | | | ========================================================================
| | | | 
KI903
Height compliance

HEIGHT

HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
Blank. Inapplicable; partial interview

| | | If Weight in pounds (KC139) < 300 »

| | | | ========================================================================
| | | | 
KI838
Weight able to measure

WEIGHT

WERE YOU ABLE TO MEASURE R'S WEIGHT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview

| | | | If Weight able to measure (KI838) != 1. Yes »

| | | | | ========================================================================
| | | | | 
KI839
Weight reason not complete

WEIGHT

WHY WEREN'T YOU ABLE TO MEASURE R'S WEIGHT? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the measurement
4. R tried but was unable to complete the measurement
5. R did not understand the instructions
6. R is not able to stand or balance on scale; other health reason
7. No suitable space available
8. Scale did not work
11. Problem with equipment or supplies
97. Other (specify)
98. Don't know; not ascertained
Blank. Inapplicable; partial interview

| | | | Else

| | | | | ========================================================================
| | | | | 
KI841
Weight pounds measurment

WEIGHT

ENTER RESPONDENT'S WEIGHT IN POUNDS AS RECORDED ON SCALE (TO THE NEAREST 1/2 POUND). ENTER 993 IF R TRIED BUT RECEIVED AN ERROR MESSAGE. ENTER 999 IF R CHOSE NOT TO DO IT.
- - - - - - - - - - - - - - - - - - - - - - - - -
993. R tried but received an error message
996. Unknown
999. R chose not to do it

| | | | | ========================================================================
| | | | | 
KI842
Weight floor surface

WEIGHT

RECORD TYPE OF FLOOR SURFACE
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Linoleum/tile/wood
2. Low-pile carpet
3. High-pile carpet
4. Concrete
5. Not sure
7. Other (specify)
Blank. Inapplicable; partial interview

| | | | | ========================================================================
| | | | | 
KI844
Weight wearing shoes

WEIGHT

WAS R WEARING SHOES DURING MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview

| | | | | ========================================================================
| | | | | 
KI947
Weight compliance

WEIGHT

HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
Blank. Inapplicable; partial interview

| | | ========================================================================
| | | 
KI904
Waist complete

WAIST CIRCUMFERENCE

WERE YOU ABLE TO MEASURE R'S WAIST CIRCUMFERENCE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview

| | | If Waist complete (KI904) != 1. Yes »

| | | | ========================================================================
| | | | 
KI905
Waist why not complete

WAIST CIRCUMFERENCE

WERE YOU ABLE TO MEASURE R'S WAIST CIRCUMFERENCE? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the measurement
4. R tried but was unable to complete the measurement
5. R did not understand the instructions
6. R is not able to stand; other health reason
7. No suitable space available
11. Problem with equipment or supplies
97. Other (specify)
98. Don't know; not ascertained
Blank. Inapplicable; partial interview

| | | Else

| | | | ========================================================================
| | | | 
KI907
Waist measurment

WAIST CIRCUMFERENCE -MEASUREMENT

ENTER RESPONDENT'S WAIST MEASUREMENT TO THE NEAREST QUARTER INCH.

ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT. ENTER 999 IF R CHOSE NOT TO DO IT.
- - - - - - - - - - - - - - - - - - - - - - - - -
993. R tried but was unable to complete the test
996. Unknown
999. R chose not to do it<

| | | | If Waist measurment (KI907) != 993. R tried but was unable to complete the test and Waist measurment (KI907) != 999. R chose not to do it< »

| | | | | ========================================================================
| | | | | 
KI908
Waist difficulties

WAIST CIRCUMFERENCE -MEASUREMENT

WHAT DIFFICULTIES OCCURRED DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. None
2. R had breathing difficulties
3. R was unable to hold breath at end of exhale
4. R was prevented from giving full effort by illness, pain, or other symptoms or discomforts
5. R did not appear to give full effort, but no obvious reason for this.
6. Had difficulty locating navel; unable to locate navel
97. Other (specify)
Blank. Inapplicable; partial interview

| | | | | ========================================================================
| | | | | 
KI910
Waist compliance

WAIST CIRCUMFERENCE

HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
Blank. Inapplicable; partial interview

| | | | | ========================================================================
| | | | | 
KI911
Waist who measured

WAIST CIRCUMFERENCE

WHO COMPLETED THE MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R completed the measurement
2. Iwer completed the measurement
Blank. Inapplicable; partial interview

| | | | | ========================================================================
| | | | | 
KI912
Waist bulky clothes

WAIST CIRCUMFERENCE

WAS R WEARING BULKY CLOTHING DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview

| | ========================================================================
| | 
KI913
Saliva consent

SALIVA SAMPLE

DID R SIGN THE CONSENT FORM FOR THE SALIVA SAMPLE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview

| | If Saliva consent (KI913) = 5. No »

| | | ========================================================================
| | | 
KI941
Why no consent saliva

SALIVA SAMPLE

WHY DIDN'T R SIGN THE SALIVA CONSENT FORM? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the measurement
4. R tried but was unable to complete the measurement
5. R did not understand the instructions
6. R ate, drank, smoked, or brushed teeth in last 30 minutes
13. R had surgery, injury or other health condition that prevented r from completing the measurement
14. Unsuitable location
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview

| | Else

| | | ========================================================================
| | | 
KI915
Saliva sample complete

SALIVA SAMPLE

DID R COMPLETE THE SALIVA SAMPLE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview

| | | If Saliva sample complete (KI915) != 1. Yes »

| | | | ========================================================================
| | | | 
KI916
Saliva why not complete

SALIVA SAMPLE

WHY DIDN'T R COMPLETE THE SALIVA SAMPLE? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the measurement
4. R tried but was unable to complete the measurement
5. R did not understand the instructions
6. R ate, drank, smoked, or brushed teeth in last 30 minutes
13. R had surgery, injury or other health condition that prevented r from completing the measurement
97. Other (specify)
98. Don't know; not ascertained
Blank. Inapplicable; partial interview

| | | Else

| | | | ========================================================================
| | | | 
KI918
Saliva fill vial

SALIVA SAMPLE

DID R FILL THE VIAL UP TO THE MARKED LINE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview

| | | | ========================================================================
| | | | 
KI919
Saliva problems

SALIVA SAMPLE

WHAT, IF ANY, PROBLEMS OCCURED? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. None
2. Scope spilled before administering; including partial spill at any point in the measurement
3. R did not swish for full 45 seconds
4. Collection container leaked
15. R swallowed mouthwash
97. Other (specify)
Blank. Inapplicable; partial interview

| | | | ========================================================================
| | | | 
KI921
Saliva compliance

SALIVA SAMPLE

HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
Blank. Inapplicable; partial interview

| | ========================================================================
| | 
KI922
Blood sample consent

BLOOD SAMPLE

DID R SIGN THE BLOOD SAMPLE CONSENT FORM?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview

| | If Blood sample consent (KI922) = 5. No »

| | | ========================================================================
| | | 
KI943
Why no consent blood

BLOOD SAMPLE

WHY DIDN'T R SIGN THE BLOOD CONSENT FORM? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the measurement
4. R tried but was unable to complete the measurement
5. R did not understand the instructions
6. R has hemophilia or is on medication that thins the blood (anticoagulant)
11. Problem with equipment or supplies
13. R had surgery, injury or other health condition that prevented r from completing the measurement
14. Unsuitable location
97. Other (specify)
98. Don't know; not ascertained
99. Refused
Blank. Inapplicable; partial interview

| | Else

| | | ========================================================================
| | | 
KI923
Blood sample complete

BLOOD SAMPLE

DID R COMPLETE THE BLOOD SAMPLE?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. Yes
5. No
Blank. Inapplicable; partial interview

| | | If Blood sample complete (KI923) != 1. Yes »

| | | | ========================================================================
| | | | 
KI924
Why blood sample not complete

BLOOD SAMPLE

WHY DIDN'T R COMPLETE THE BLOOD SAMPLE? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R felt it would not be safe
2. Iwer felt it would not be safe
3. R refused or was not willing to complete the measurement
4. R tried but was unable to complete the measurement
5. R did not understand the instructions
6. R has hemophilia or is on medication that thins the blood (anticoagulant)
11. Problem with equipment or supplies
13. R had surgery, injury or other health condition that prevented r from completing the measurement
97. Other (specify)
Blank. Inapplicable; partial interview

| | | Else

| | | | ========================================================================
| | | | 
KI926
Blood sample what problems

BLOOD SAMPLE

WHAT, IF ANY, PROBLEMS OCCURRED DURING THE COLLECTION OF THE BLOOD SAMPLE? (SELECT ALL THAT APPLY)
- - - - - - - - - - - - - - - - - - - - - - - - -
1. None
2. R became lightheaded, fainted, or became nauseous
3. R had difficulty getting finger to stop bleeding
11. Problem with equipment or supplies
16. Problems obtaining enough blood for the sample
97. Other (specify)
Blank. Inapplicable; partial interview

| | | | ========================================================================
| | | | 
KI928
Blood who measured

BLOOD SAMPLE

WHO PRICKED THE R'S FINGER(S)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R pricked own finger(s)
2. Iwer pricked r's finger(s)
3. Both r and iwer pricked r's finger(s)
4. Someone else pricked r's finger(s)
Blank. Inapplicable; partial interview

| | | | ========================================================================
| | | | 
KI929
Amount of blood on first card

BLOOD SAMPLE

HOW MANY CIRCLES WERE FILLED ON THE FIRST CARD?
- - - - - - - - - - - - - - - - - - - - - - - - -
0. Zero
1. One
2. Two
3. Three
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview

| | | | ========================================================================
| | | | 
KI945
Amount of blood on storage card

BLOOD SAMPLE

HOW MANY CIRCLES WERE FILLED ON THE STORAGE CARD?
- - - - - - - - - - - - - - - - - - - - - - - - -
0. Zero
1. One
2. Two
3. Three
Blank. Inapplicable; partial interview

| | | | ========================================================================
| | | | 
KI930
How many blood pricks

BLOOD SAMPLE

HOW MANY TIMES DID THE R'S FINGER NEED TO BE PRICKED IN ORDER TO FILL THE CIRCLES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. One time
2. Two times
3. Two times, but r was unable to fill all four circles with blood
8. Don't know; not ascertained
9. Refused
Blank. Inapplicable; partial interview

| | | | ========================================================================
| | | | 
KI931
Blood sample compliance

BLOOD SAMPLE

HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1. R was fully compliant
2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts
3. R was not fully compliant, but no obvious reason for this
Blank. Inapplicable; partial interview

End of I. Physical Measures (respondent)