I. Physical Measures

I. Physical Measures module of HRS 2010

item label type description
MI927 Question Blood Problem _ Specify
MI859 Question BLOODPRESSURE 1 SYSTOLIC (mmHg)
MI854 Question Blood Pressure Complete
MI855 Question Reason Blood Pressure Not Complete
MI856 Question BLOOD PRESSURE NOT COMPLETE_SPECIFY
MI861 Question BLOODPRESSURE 1 Pulse (bpm)
MI862 Question BLOODPRESSURE2 TIME
MI875 Question BLOODPRESSURE Smoke Etc
MI874 Question BLOODPRESSURE Position
MI873 Question BLOODPRESSURE Compliance
MI852 Question left second (kg)
MI915 Question Saliva Complete
MI819 Question HAND STRENGTH rest arm
MI818 Question HAND STRENGTH TEST R POSITION
MI811 Question BREATHING TEST R position
MI810 Question R BREATHING TEST effort
MI813 Question HAND STRENGTH TEST REASON NOT COMPLETE
MI812 Question HAND STRENGTH COMPLETE AT LEAST ONE TRIAL
MI815 Question grip dominant hand
MI814 Question HAND STRENGTH TEST REASON NOT COMPLETE -Specify
MI817 Question GRIP R EFFORT
MI816 Question Left first (kg)
MI935 Question Blood BarCode 2
MI857 Question BLOODPRESSURE TIME
MI842 Question WEIGHT floor surface
MI860 Question BLOODPRESSURE 1 DIASTOLIC (mmHg)
MI835 Question HEIGHT floor surface
MI844 Question WEIGHT wearing shoes
MI845 Question finish phy measures
MI806 Question Breath Test REASON NOT COMPLETE -Specify
MI923 Question Blood Complete
MI947 Question WEIGHT Compliance
MI920 Question Saliva Problem _ Specify
MI914 Question Saliva Eat Drank Etc
MI945 Question Blood Fill Spots
MI885 Question BALANCE TEST S-B-S REASON NOT COMPLETE -Specify
MI919 Question Saliva Problems
MI954 Question Why No Consent PHYSICAL MEASURES
MI926 Question Blood What Problems
MI820 Question WALKING TEST COMPLETE AT LEAST ONE TRIAL
MI821 Question WALKING TEST REASON NOT COMPLETE
MI822 Question WALKING TEST REASON NOT COMPLETE -Specify
MI823 Question T walk 1st trial time (seconds)
MI824 Question T walk 2nd trial time (seconds)
MI825 Question T walk floor surface
MI826 Question T walk floor surface -Specify
MI828 Question walking aid type
MI829 Question walking aid type -specify
MI950 Question SALIVA Did R sign the consent form
MI903 Question HEIGHT wearing shoes
MI938 Question Continue screen if REF physical measures
MI931 Question Blood Compliance
MI906 Question Waist Not Complete_Specify
MI887 Question BALANCE TEST SIDE-BY-SIDE Time
MI888 Question BALANCE TEST SIDE-BY-SIDE Compensatory
MI886 Question BALANCE TEST S-B-S Hold Full Time
MI891 Question BALANCE TEST S-B-S Compliance
MI846 Question PHYSICAL MEASURES INTRO
MI890 Question BALANCE TEST S-B-S Floor Surface -Specify
MI893 Question BALANCE TEST Full Tandem Complete
MI894 Question BALANCE TEST Full Tandem STAND REASON NOT COMPLETE
MI949 Question PHYSICAL MEASURES Did R sign - reason
MI803 Question LIST OF MEASURES R IS ASKED TO COMPLETE
MI940 Question Saliva BarCode 1
MI929 Question Blood Fill Spots
MI913 Question Saliva Consent
MI936 Question finish phy measures
MI925 Question Blood NotComplete_Specify
MI948 Question PHYSICAL MEASURES Did R sign the consent form
MI898 Question BALANCE TEST FULL TANDEM Compensatory
MI897 Question BALANCE TEST FULL TANDEM Time
MI896 Question BALANCE TEST FULL TANDEM Hold Full Time
MI895 Question BALANCE TEST Full Tandem REASON NOT COMPLETE -Specify
MI902 Question BALANCE TEST FULL TANDEM Compliance
MI901 Question BALANCE TEST FULL TANDEM Floor Surface -Specify
MI899 Question BALANCE TEST FULL TANDEM Floor Surface
MI916 Question Saliva Why Not Complete
MI833 Question HEIGHT REASON NOT COMPLETE -specify
MI832 Question HEIGHT REASON NOT COMPLETE
MI831 Question MEASURE R HEIGHT
MI830 Question walk R effort
MI837 Question HEIGHT wearing shoes
MI836 Question HEIGHT floor surface -Specify
MI834 Question HEIGHT MEASURMENT (inches)
MI839 Question WEIGHT REASON NOT COMPLETE
MI838 Question WEIGHT ABLE TO MEASURE
MI930 Question Blood Pricks
MI937 Question Blood Pressure Complete
MI952 Question BLOOD Did R sign the consent form
MI909 Question Waist Difficulties_Specify
MI876 Question BALANCE TEST - SEMI-TANDEM STAND
MI877 Question BALANCE TEST SEMI-TANDEM REASON NOT COMPLETE
MI878 Question BALANCE TEST SEMI-TANDEM REASON NOT COMPLETE -Specify
MI879 Question BALANCE TEST SEMI-TANDEM Hold Full Time
MI880 Question BALANCE TEST SEMI-TANDEM Time
MI881 Question BALANCE TEST SEMI-TANDEM Compensatory
MI883 Question BALANCE TEST S-B-S Complete
MI884 Question BALANCE TEST S-B-S STAND REASON NOT COMPLETE
MI951 Question SALIVA Did R sign - reason
MI953 Question BLOOD Did R sign - reason
MI918 Question Saliva Fill Vial
MI843 Question WEIGHT floor surface -Specify
MI802 Question PHYSICAL MEASURES CONSENT
MI840 Question WEIGHT REASON NOT COMPLETE -Specify
MI841 Question Weight Measurment (lbs)
MI921 Question Saliva Compliance
MI942 Question Why No Consent Saliva _Specify
MI928 Question Blood Who Measured
MI924 Question Blood Why Not Complete
MI934 Question Blood BarCode 1
MI808 Question Puff Test 2 (L/min)
MI809 Question Puff Test 3 (L/min)
MI807 Question Puff Test 1 (L/min)
MI804 Question Breath COMPLETE AT LEAST ONE TRIAL
MI805 Question Breath Test REASON NOT COMPLETE
MI917 Question Saliva Not Complete _Specify
MI944 Question Why No Consent Blood_Specify
MI851 Question RIGHT first (kg)
MI908 Question Waist Difficulties
MI941 Question Why No Consent Saliva
MI910 Question Waist Compliance
MI912 Question Waist Bulky Clothes
MI933 Question SalivaBarCode
MI871 Question BLOODPRESSURE 3 Pulse (bpm)
MI872 Question BLOODPRESSURE ARM
MI869 Question BLOODPRESSURE 3 Systolic (mmHg)
MI870 Question BLOODPRESSURE 3 DIASTOLIC (mmHg)
MI867 Question BLOODPRESSURE 3 TIME
MI865 Question BLOODPRESSURE 2 DIASTOLIC (mmHg)
MI866 Question BLOODPRESSURE 2 Pulse (bpm)
MI864 Question BLOODPRESSURE 2 SYSTOLIC (mmHg)
MI853 Question RIGHT Second (kg)
MI800 Question MODE OF INTERVIEW FOR PHYSICAL MEASURES
MI911 Question Waist Who Measured
MI904 Question WAIST Complete
MI932 Question SBookletID
MI905 Question Waist Why Not Complete
MI889 Question BALANCE TEST S-B-S Floor Surface
MI943 Question Why No Consent Blood
MI922 Question BLOOD Consent
MI907 Question Waist Measurment (inches)
Start of I. Physical Measures
 
MI800

MODE OF INTERVIEW FOR PHYSICAL MEASURES

» ENTER CURRENT MODE OF INTERVIEW
expand
 
If MX090_R = ENHANCEDFTF »
 
   
 
If MODE OF INTERVIEW FOR PHYSICAL MEASURES = 2 F-t-f and R IN NURSING HOME = NO and LANGUAGE = SPANISH or ENGMISH »
 
     
   
MI802

PHYSICAL MEASURES CONSENT

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 & BIOMARKER BOOKLET.
» DID R SIGN THE PHYSICAL MEASURES CONSENT FORM?
expand
     
   
If PHYSICAL MEASURES CONSENT = 1 Yes »
 
       
     
MI854

Blood Pressure Complete

BLOOD PRESSURE» DID R COMPLETE AT LEAST ONE BLOOD PRESSURE MEASUREMENT?
expand
       
     
If Blood Pressure Complete = 5 No »
 
         
       
MI855

Reason 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 »
 
         
       
MI857

BLOODPRESSURE TIME

BLOOD PRESSURE - 1ST TIME
»FIRST READING TIME OF READING
» ENTER HOUR, COLON, MINUTES, AND EITHER 'AM' OR 'PM'. E.G., FOR A
TIME OF 1:23PM, ENTER '1' FOLLOWED BY ':' FOLLOWED BY '23' FOLLOWED BY 'PM'.
PLEASE CHECK TO MAKE SURE ENTRY DISPLAYS CORRECTLY BEFORE PROCEEDING.

expand
         
       
MI859

BLOODPRESSURE 1 SYSTOLIC (mmHg)

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 (mmHg) != 9993 and BLOODPRESSURE 1 SYSTOLIC (mmHg) != 999 »
 
           
         
MI860

BLOODPRESSURE 1 DIASTOLIC (mmHg)

BLOOD PRESSURE - 1ST DIASTOLIC
»FIRST READING DIASTOLIC
expand
           
         
MI861

BLOODPRESSURE 1 Pulse (bpm)

BLOOD PRESSURE - 1ST PULSE
»FIRST READING PULSE
expand
           
         
MI862

BLOODPRESSURE2 TIME

BLOOD PRESSURE - 2ND TIME
»SECOND READING TIME OF READING
» ENTER HOUR, COLON, MINUTES, AND EITHER 'AM' OR 'PM'. E.G., FOR A TIME OF 1:23PM,
ENTER '1' FOLLOWED BY ':' FOLLOWED BY '23' FOLLOWED BY 'PM'. PLEASE CHECK TO MAKE SURE ENTRY
DISPLAYS CORRECTLY BEFORE PROCEEDING.

expand
           
         
MI864

BLOODPRESSURE 2 SYSTOLIC (mmHg)

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 (mmHg) != 9993 and BLOODPRESSURE 2 SYSTOLIC (mmHg) != 999 R CHOSE NOT TO DO IT »
 
             
           
MI865

BLOODPRESSURE 2 DIASTOLIC (mmHg)

BLOOD PRESSURE - 2ND DIASTOLIC
»SECOND READING DIASTOLIC
expand
             
           
MI866

BLOODPRESSURE 2 Pulse (bpm)

BLOOD PRESSURE - 2ND PULSE
»SECOND READING PULSE
expand
             
           
MI867

BLOODPRESSURE 3 TIME

BLOOD PRESSURE - 3RD TIME
»THIRD READING TIME OF READING
» ENTER HOUR, COLON, MINUTES, AND EITHER 'AM' OR 'PM'. E.G., FOR A TIME OF 1:23PM,
ENTER '1' FOLLOWED BY ':' FOLLOWED BY '23' FOLLOWED BY 'PM'. PLEASE CHECK TO MAKE SURE ENTRY
DISPLAYS CORRECTLY BEFORE PROCEEDING.

expand
             
           
MI869

BLOODPRESSURE 3 Systolic (mmHg)

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 (mmHg) != 9993 and BLOODPRESSURE 3 Systolic (mmHg) != 999 R CHOSE NOT TO DO IT »
 
               
             
MI870

BLOODPRESSURE 3 DIASTOLIC (mmHg)

BLOOD PRESSURE - 3RD DIASTOLIC
»THIRD READING DIASTOLIC
expand
               
             
MI871

BLOODPRESSURE 3 Pulse (bpm)

BLOOD PRESSURE - 3RD PULSE
»THIRD READING PULSE
expand
               
         
MI872

BLOODPRESSURE ARM

BLOOD PRESSURE - ARM
»WHICH ARM WAS USED TO CONDUCT THE MEASUREMENTS?
expand
           
         
MI873

BLOODPRESSURE Compliance

BLOOD PRESSURE - COMPLIANCE
»HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
expand
           
         
MI874

BLOODPRESSURE Position

BLOOD PRESSURE - POSITION
»WHAT WAS R'S POSITION FOR THIS TEST?
expand
           
         
MI875

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
           
     
MI804

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 »
 
         
       
MI805

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 »
 
         
       
MI807

Puff Test 1 (L/min)

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
         
       
MI808

Puff Test 2 (L/min)

BREATHING TEST
FIRST READING: Puff Test 1 (L/min)
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
         
       
MI809

Puff Test 3 (L/min)

BREATHING TEST
FIRST READING: Puff Test 1 (L/min)
SECOND READING: Puff Test 2 (L/min)
THIRD READING:
» ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT.
» ENTER 999 IF R CHOSE NOT TO DO IT.

expand
         
       
MI810

R BREATHING TEST effort

BREATHING TEST
» HOW MUCH EFFORT DID THE R GIVE TO THIS TEST?
expand
         
       
MI811

BREATHING TEST R position

BREATHING TEST
» WHAT WAS THE R'S POSITION FOR THIS TEST?
expand
         
     
MI812

HAND STRENGTH COMPLETE AT LEAST ONE TRIAL

HAND STRENGTH TEST
» DID R COMPLETE AT LEAST ONE TRIAL OF THE HAND STRENGTH TEST?
expand
       
     
If HAND STRENGTH COMPLETE AT LEAST ONE TRIAL != 1 Yes »
 
         
       
MI813

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 AT LEAST ONE TRIAL = 1 Yes »
 
         
       
MI815

grip dominant hand

HAND STRENGTH TEST
» RECORD R'S DOMINANT HAND.
expand
         
       
MI816

Left first (kg)

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
         
       
MI851

RIGHT first (kg)

HAND STRENGTH TEST
» RIGHT HAND, FIRST MEASUREMENT.
LEFT HAND, FIRST MEASUREMENT: Left first (kg)
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
         
       
MI852

left second (kg)

HAND STRENGTH TEST
» LEFT HAND, SECOND MEASUREMENT.
LEFT HAND, FIRST MEASUREMENT: Left first (kg)
RIGHT HAND, FIRST MEASUREMENT: RIGHT first (kg)
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
         
       
MI853

RIGHT Second (kg)

HAND STRENGTH TEST
» RIGHT HAND, SECOND MEASUREMENT.
LEFT HAND, FIRST MEASUREMENT: Left first (kg)
RIGHT HAND, FIRST MEASUREMENT: RIGHT first (kg)
LEFT HAND, SECOND MEASUREMENT: left second (kg)
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
         
       
MI817

GRIP R EFFORT

HAND STRENGTH TEST
» HOW MUCH EFFORT DID THE R GIVE TO THIS TEST?
expand
         
       
MI818

HAND STRENGTH TEST R POSITION

HAND STRENGTH TEST
» WHAT WAS THE R'S POSITION FOR THIS TEST?
expand
         
       
MI819

HAND STRENGTH rest arm

HAND STRENGTH TEST
» DID THE R REST THEIR ARM ON A SUPPORT WHILE PERFORMING THIS TEST?
expand
         
     
MI876

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 »
 
         
       
MI877

BALANCE TEST SEMI-TANDEM REASON NOT COMPLETE

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 »
 
         
       
MI879

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 »
 
           
         
MI880

BALANCE TEST SEMI-TANDEM Time

BALANCE TEST - SEMI-TANDEM STAND
» RECORD TIME IN SECONDS TO TWO DECIMAL PLACES
expand
           
       
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 »
 
           
         
MI881

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 »
 
         
       
MI883

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 »
 
           
         
MI884

BALANCE TEST S-B-S STAND REASON NOT COMPLETE

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 »
 
           
         
MI886

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 »
 
             
           
MI887

BALANCE TEST SIDE-BY-SIDE Time

BALANCE TEST - SIDE-BY-SIDE STAND
» RECORD TIME IN SECONDS TO TWO DECIMAL PLACES
expand
             
         
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 »
 
             
           
MI888

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
             
           
MI889

BALANCE TEST S-B-S Floor Surface

BALANCE TEST - SIDE-BY-SIDE STAND
» RECORD TYPE OF FLOOR SURFACE
expand
             
           
MI891

BALANCE TEST S-B-S Compliance

BALANCE TEST - SIDE-BY-SIDE STAND
» HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
expand
             
     
Else
 
         
       
MI893

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 »
 
           
         
MI894

BALANCE TEST Full Tandem STAND REASON NOT COMPLETE

BALANCE TEST - FULL TANDEM STAND
» WHY DIDN'T R COMPLETE THE FULL -TANDEM STAND?
» SELECT ALL THAT APPLY

expand
           
       
Else
 
           
         
MI896

BALANCE TEST FULL TANDEM Hold Full Time

BALANCE TEST - FULL TANDEM STAND
» DID R HOLD FULL TANDEM STAND FOR FULL 30 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 »
 
             
           
MI897

BALANCE TEST FULL TANDEM Time

BALANCE TEST - FULL TANDEM STAND
» RECORD TIME IN SECONDS TO TWO DECIMAL PLACES
expand
             
         
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 »
 
             
           
MI898

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
             
           
MI899

BALANCE TEST FULL TANDEM Floor Surface

BALANCE TEST - FULL TANDEM
» RECORD TYPE OF FLOOR SURFACE
expand
             
           
MI902

BALANCE TEST FULL TANDEM Compliance

BALANCE TEST - FULL TANDEM STAND
» HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
expand
             
     
If R CURRENT AGE CALCULATION > 64 »
 
         
       
MI820

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 »
 
           
         
MI821

WALKING TEST REASON NOT COMPLETE

WALKING TEST
» WHY DIDN`T R COMPLETE THE WALKING TEST? (SELECT ALL THAT APPLY)
expand
           
       
Else
 
           
         
MI823

T walk 1st trial time (seconds)

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 T walk 1st trial time (seconds) != 993 R UNABLE TO DO IT and T walk 1st trial time (seconds) != 999 R CHOSE NOT TO DO IT »
 
             
           
MI824

T walk 2nd trial time (seconds)

WALKING TEST - TIME FROM SECOND TRIAL
» RECORD TIME IN SECONDS TO TWO DECIMAL PLACES
FIRST TRIAL: T walk 1st trial time (seconds)
SECOND TRIAL:
ENTER 993 IF R WAS UNABLE TO DO IT
ENTER 999 IF R CHOSE NOT TO DO IT

expand
             
           
MI825

T walk floor surface

WALKING TEST
» RECORD TYPE OF FLOOR SURFACE
expand
             
           
MI828

walking aid type

WALKING TEST
» RECORD TYPE OF AID USED
expand
             
           
MI830

walk R effort

WALKING TEST
» HOW COMPLIANT WAS R DURING THIS MEASUREMENT
expand
             
     
MI831

MEASURE R HEIGHT

HEIGHT
» WERE YOU ABLE TO MEASURE R`S HEIGHT?
expand
       
     
If MEASURE R HEIGHT != 1 Yes »
 
         
       
MI832

HEIGHT REASON NOT COMPLETE

HEIGHT
» WHY WEREN'T YOU ABLE TO MEASURE R`S HEIGHT? (SELECT ALL THAT APPLY)
expand
         
     
Else
 
         
       
MI834

HEIGHT MEASURMENT (inches)

HEIGHT
» ENTER RESPONDENT'S HEIGHT IN INCHES. ROUND TO THE NEAREST QUARTER INCH.
expand
         
       
MI835

HEIGHT floor surface

HEIGHT
» RECORD TYPE OF FLOOR SURFACE
expand
         
       
MI837

HEIGHT wearing shoes

HEIGHT
» WAS R WEARING SHOES DURING MEASUREMENT?
expand
         
       
MI903

HEIGHT wearing shoes

HEIGHT
» HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
expand
         
     
If WEIGHT IN POUNDS < 300 »
 
         
       
MI838

WEIGHT ABLE TO MEASURE

WEIGHT
» WERE YOU ABLE TO MEASURE R`S WEIGHT?
expand
         
       
If WEIGHT ABLE TO MEASURE != 1 Yes »
 
           
         
MI839

WEIGHT REASON NOT COMPLETE

WEIGHT
» WHY WEREN'T YOU ABLE TO MEASURE R`S WEIGHT? (SELECT ALL THAT APPLY)
expand
           
       
Else
 
           
         
MI841

Weight Measurment (lbs)

WEIGHT
» ENTER RESPONDENT'S WEIGHT IN POUNDS AS RECORDED ON SCALE (TO THE NEAREST
expand
           
         
MI842

WEIGHT floor surface

WEIGHT
» RECORD TYPE OF FLOOR SURFACE
expand
           
         
MI844

WEIGHT wearing shoes

WEIGHT
» WAS R WEARING SHOES DURING MEASUREMENT?
expand
           
         
MI947

WEIGHT Compliance

WEIGHT
» HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
expand
           
     
MI904

WAIST Complete

WAIST CIRCUMFERENCE
» WERE YOU ABLE TO MEASURE R'S WAIST CIRCUMFERENCE?
expand
       
     
If WAIST Complete != 1 Yes »
 
         
       
MI905

Waist Why Not Complete

WAIST CIRCUMFERENCE
» WERE YOU ABLE TO MEASURE R'S WAIST CIRCUMFERENCE? (SELECT ALL THAT APPLY)
expand
         
     
Else
 
         
       
MI907

Waist Measurment (inches)

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 (inches) != 993 R TRIED BUT WAS UNABLE TO COMPLETE THE TEST and Waist Measurment (inches) != 999 R CHOSE NOT TO DO IT »
 
           
         
MI908

Waist Difficulties

WAIST CIRCUMFERENCE -MEASUREMENT
» WHAT DIFFICULTIES OCCURRED DURING THIS MEASUREMENT?
» SELECT ALL THAT APPLY
expand
           
         
MI910

Waist Compliance

WAIST CIRCUMFERENCE
» HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
expand
           
         
MI911

Waist Who Measured

WAIST CIRCUMFERENCE
» WHO COMPLETED THE MEASUREMENT?
expand
           
         
MI912

Waist Bulky Clothes

WAIST CIRCUMFERENCE
» WAS R WEARING BULKY CLOTHING DURING THIS MEASUREMENT?
expand
           
   
MI913

Saliva Consent

SALIVA SAMPLE
» DID R SIGN THE CONSENT FORM FOR THE SALIVA SAMPLE?
expand
     
   
If Saliva Consent = 5 No »
 
       
     
MI941

Why No Consent Saliva

SALIVA SAMPLE
» WHY DIDN'T R SIGN THE SALIVA CONSENT FORM? (SELECT ALL THAT APPLY)
expand
       
   
Else
 
       
     
MI915

Saliva Complete

SALIVA SAMPLE
» DID R COMPLETE THE SALIVA SAMPLE?
expand
       
     
If Saliva Complete != 1 Yes »
 
         
       
MI916

Saliva Why Not Complete

SALIVA SAMPLE
» WHY DIDN'T R COMPLETE THE SALIVA SAMPLE? (SELECT ALL THAT APPLY)
expand
         
     
Else
 
         
       
MI918

Saliva Fill Vial

SALIVA SAMPLE
» DID R FILL THE VIAL TO THE DESIRED LEVEL?
expand
         
       
MI919

Saliva Problems

SALIVA SAMPLE
» WHAT, IF ANY, PROBLEMS OCCURED?
(SELECT ALL THAT APPLY)

expand
         
       
MI921

Saliva Compliance

SALIVA SAMPLE
» HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
expand
         
   
MI922

BLOOD Consent

BLOOD SAMPLE
» DID R SIGN THE BLOOD SAMPLE CONSENT FORM?
expand
     
   
If BLOOD Consent = 5 No »
 
       
     
MI943

Why No Consent Blood

BLOOD SAMPLE
» WHY DIDN'T R SIGN THE BLOOD CONSENT FORM? (SELECT ALL THAT APPLY)
expand
       
   
Else
 
       
     
MI923

Blood Complete

BLOOD SAMPLE
» DID R COMPLETE THE BLOOD SAMPLE?
expand
       
     
If Blood Complete != 1 Yes »
 
         
       
MI924

Blood Why Not Complete

BLOOD SAMPLE
» WHY DIDN'T R COMPLETE THE BLOOD SAMPLE? (SELECT ALL THAT APPLY)
expand
         
     
Else
 
         
       
MI926

Blood What Problems

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

expand
         
       
MI928

Blood Who Measured

BLOOD SAMPLE
» WHO PRICKED THE R'S FINGER(S)?
expand
         
       
MI929

Blood Fill Spots

BLOOD SAMPLE
» HOW MANY CIRCLES WERE FILLED ON THE FIRST CARD?
expand
         
       
MI945

Blood Fill Spots

BLOOD SAMPLE
» HOW MANY CIRCLES WERE FILLED ON THE STORAGE CARD?
expand
         
       
MI930

Blood Pricks

BLOOD SAMPLE
» HOW MANY TIMES DID THE R'S FINGER HAVE TO BE PRICKED IN ORDER TO FILL THE CARDS?
expand
         
       
MI931

Blood Compliance

BLOOD SAMPLE
» HOW COMPLIANT WAS R DURING THIS MEASUREMENT?
expand
         
End of I. Physical Measures
Start of I. Physical Measures

========================================================================
MI800
MODE OF INTERVIEW FOR PHYSICAL MEASURES

@/@/@S@WW@W ENTER CURRENT MODE OF INTERVIEW@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Phone
2 F-t-f


If MX090_R = ENHANCEDFTF »

If MODE OF INTERVIEW FOR PHYSICAL MEASURES (MI800) = 2 F-t-f and R IN NURSING HOME (MA028) = NO and LANGUAGE = SPANISH or ENGMISH »

| | ========================================================================
| | 
MI802
PHYSICAL MEASURES CONSENT

@/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.

@/@/@S@WW@W SHOW R THE FIRST CONSENT FORM IN THE PHYSICAL MEASURES & BIOMARKER BOOKLET.
@/@/@S@WW@W DID R SIGN THE PHYSICAL MEASURES CONSENT FORM?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
9 RF

| | If PHYSICAL MEASURES CONSENT (MI802) = 1 Yes »

| | | ========================================================================
| | | 
MI854
Blood Pressure Complete

@/BLOOD PRESSURE@/@/@S@WW@W DID R COMPLETE AT LEAST ONE BLOOD PRESSURE MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | | If Blood Pressure Complete (MI854) = 5 No »

| | | | ========================================================================
| | | | 
MI855
Reason Blood Pressure Not Complete

@/BLOOD PRESSURE
@/@/@S@WW@W WHY DIDN'T R COMPLETE THE BLOOD PRESSURE MEASUREMENT?
@/@WW@W (SELECT ALL THAT APPLY)@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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 test
5 R did not understand the instructions
6 R had a rash, cast, edema, etc. on arm; other health reason
7 No suitable space
8 Problem with equipment or supplies
97 Other (specify)
98 DK
99 RF

| | | ElseIf Blood Pressure Complete (MI854) = 1 Yes »

| | | | ========================================================================
| | | | 
MI857
BLOODPRESSURE TIME

@/BLOOD PRESSURE - 1ST TIME
@/@/@WW@W@SFIRST READING TIME OF READING
@/@/@WW@W ENTER HOUR, COLON, MINUTES, AND EITHER 'AM' OR 'PM'. E.G., FOR A
TIME OF 1:23PM, ENTER '1' FOLLOWED BY ':' FOLLOWED BY '23' FOLLOWED BY 'PM'.
PLEASE CHECK TO MAKE SURE ENTRY DISPLAYS CORRECTLY BEFORE PROCEEDING.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
00000000-23:55:00 Actual Value
99999998 DK
99999999 RF

| | | | ========================================================================
| | | | 
MI859
BLOODPRESSURE 1 SYSTOLIC (mmHg)

@/BLOOD PRESSURE - 1ST SYSTOLIC
@/@/@WW@W@SFIRST READING SYSTOLIC
@/@/@WW@WENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT.
@/@WW@WENTER 999 IF R CHOSE NOT TO DO IT.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
-999999999..999999999

| | | | If BLOODPRESSURE 1 SYSTOLIC (mmHg) (MI859) != 9993 and BLOODPRESSURE 1 SYSTOLIC (mmHg) (MI859) != 999 »

| | | | | ========================================================================
| | | | | 
MI860
BLOODPRESSURE 1 DIASTOLIC (mmHg)

@/BLOOD PRESSURE - 1ST DIASTOLIC
@/@/@WW@W@SFIRST READING DIASTOLIC@S
- - - - - - - - - - - - - - - - - - - - - - - - -
-999999999..999999999

| | | | | ========================================================================
| | | | | 
MI861
BLOODPRESSURE 1 Pulse (bpm)

@/BLOOD PRESSURE - 1ST PULSE
@/@/@WW@W@SFIRST READING PULSE @S
- - - - - - - - - - - - - - - - - - - - - - - - -
-999999999..999999999

| | | | | ========================================================================
| | | | | 
MI862
BLOODPRESSURE2 TIME

@/BLOOD PRESSURE - 2ND TIME
@/@/@WW@W@SSECOND READING TIME OF READING
@/@/@WW@W ENTER HOUR, COLON, MINUTES, AND EITHER 'AM' OR 'PM'. E.G., FOR A TIME OF 1:23PM,
ENTER '1' FOLLOWED BY ':' FOLLOWED BY '23' FOLLOWED BY 'PM'. PLEASE CHECK TO MAKE SURE ENTRY
DISPLAYS CORRECTLY BEFORE PROCEEDING.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
00000000-23:57:00 Actual Value
99999998 DK
99999999 RF


| | | | | ========================================================================
| | | | | 
MI864
BLOODPRESSURE 2 SYSTOLIC (mmHg)

@/BLOOD PRESSURE - 2ND SYSTOLIC
@/@/@WW@W@SSECOND READING SYSTOLIC
@/@/@WW@WENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT.
@/@WW@WENTER 999 IF R CHOSE NOT TO DO IT.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
-999999999..999999999
993 R TRIED BUT WAS UNABLE TO DO IT
998 DK
999 R CHOSE NOT TO DO IT

| | | | | If BLOODPRESSURE 2 SYSTOLIC (mmHg) (MI864) != 9993 and BLOODPRESSURE 2 SYSTOLIC (mmHg) (MI864) != 999 R CHOSE NOT TO DO IT »

| | | | | | ========================================================================
| | | | | | 
MI865
BLOODPRESSURE 2 DIASTOLIC (mmHg)

@/BLOOD PRESSURE - 2ND DIASTOLIC
@/@/@WW@W@SSECOND READING DIASTOLIC@S
- - - - - - - - - - - - - - - - - - - - - - - - -
-999999999..999999999

| | | | | | ========================================================================
| | | | | | 
MI866
BLOODPRESSURE 2 Pulse (bpm)

@/BLOOD PRESSURE - 2ND PULSE
@/@/@WW@W@SSECOND READING PULSE @S
- - - - - - - - - - - - - - - - - - - - - - - - -
-999999999..999999999
998 DK
999 RF

| | | | | | ========================================================================
| | | | | | 
MI867
BLOODPRESSURE 3 TIME

@/BLOOD PRESSURE - 3RD TIME
@/@/@WW@W@STHIRD READING TIME OF READING
@/@/@WW@W ENTER HOUR, COLON, MINUTES, AND EITHER 'AM' OR 'PM'. E.G., FOR A TIME OF 1:23PM,
ENTER '1' FOLLOWED BY ':' FOLLOWED BY '23' FOLLOWED BY 'PM'. PLEASE CHECK TO MAKE SURE ENTRY
DISPLAYS CORRECTLY BEFORE PROCEEDING.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
00000000-23:59:00 Actual Value
99999998 DK
99999999 RF

| | | | | | ========================================================================
| | | | | | 
MI869
BLOODPRESSURE 3 Systolic (mmHg)

@/BLOOD PRESSURE - 3RD SYSTOLIC
@/@/@WW@W@STHIRD READING SYSTOLIC
@/@/@WW@WENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT.
@/@WW@WENTER 999 IF R CHOSE NOT TO DO IT.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
-999999999..999999999
993 R TRIED BUT WAS UNABLE TO DO IT
998 DK
999 R CHOSE NOT TO DO IT

| | | | | | If BLOODPRESSURE 3 Systolic (mmHg) (MI869) != 9993 and BLOODPRESSURE 3 Systolic (mmHg) (MI869) != 999 R CHOSE NOT TO DO IT »

| | | | | | | ========================================================================
| | | | | | | 
MI870
BLOODPRESSURE 3 DIASTOLIC (mmHg)

@/BLOOD PRESSURE - 3RD DIASTOLIC
@/@/@WW@W@STHIRD READING DIASTOLIC@S
- - - - - - - - - - - - - - - - - - - - - - - - -
-999999999..999999999
998 DK
999 RF

| | | | | | | ========================================================================
| | | | | | | 
MI871
BLOODPRESSURE 3 Pulse (bpm)

@/BLOOD PRESSURE - 3RD PULSE
@/@/@WW@W@STHIRD READING PULSE @S
- - - - - - - - - - - - - - - - - - - - - - - - -
-999999999..999999999
998 DK
999 RF


| | | | | ========================================================================
| | | | | 
MI872
BLOODPRESSURE ARM

@/BLOOD PRESSURE - ARM
@/@/@WW@W@SWHICH ARM WAS USED TO CONDUCT THE MEASUREMENTS?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Left arm
2 Right arm
8 DK
9 RF

| | | | | ========================================================================
| | | | | 
MI873
BLOODPRESSURE Compliance

@/BLOOD PRESSURE - COMPLIANCE
@/@/@WW@W@SHOW COMPLIANT WAS R DURING THIS MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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
8 DK
9 RF

| | | | | ========================================================================
| | | | | 
MI874
BLOODPRESSURE Position

@/BLOOD PRESSURE - POSITION
@/@/@WW@W@SWHAT WAS R'S POSITION FOR THIS TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Standing
2 Sitting
3 Lying down
8 DK
9 RF

| | | | | ========================================================================
| | | | | 
MI875
BLOODPRESSURE Smoke Etc

@/BLOOD PRESSURE - SMOKE ETC.
@/@/@WW@W@SDID R SMOKE, EXERCISE, CONSUME ALCOHOL OR FOOD WITHIN THE 30
MINUTES PRIOR TO COMPLETING THE BLOOD PRESSURE TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
8 DK
9 RF

| | | ========================================================================
| | | 
MI804
Breath COMPLETE AT LEAST ONE TRIAL

@/BREATHING TEST
@/@/@S@WW@W DID R COMPLETE AT LEAST ONE TRIAL OF THE BREATHING TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | | If Breath COMPLETE AT LEAST ONE TRIAL (MI804) != 1 Yes »

| | | | ========================================================================
| | | | 
MI805
Breath Test REASON NOT COMPLETE

@/BREATHING TEST
@/@/@S@WW@W WHY DIDN'T R COMPLETE THE BREATHING TEST? (SELECT ALL THAT APPLY)@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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 test
5 R did not understand the instructions
6 R could not participate due to health reasons
7 No suitable space
8 Problem with equipment or supplies
97 Other (specify)
98 DK
99 RF


| | | If Breath COMPLETE AT LEAST ONE TRIAL (MI804) = 1 Yes »

| | | | ========================================================================
| | | | 
MI807
Puff Test 1 (L/min)

@/BREATHING TEST
@/@/FIRST READING:
@/@/SECOND READING:
@/@/THIRD READING:
@/@/@S@WW@W ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT.
@/@WW@W ENTER 999 IF R CHOSE NOT TO DO IT.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
993 R TRIED BUT WAS UNABLE TO DO IT
998 DK
999 R CHOSE NOT TO DO IT

| | | | ========================================================================
| | | | 
MI808
Puff Test 2 (L/min)

@/BREATHING TEST
@/@/FIRST READING: Puff Test 1 (L/min)
@/@/SECOND READING:
@/@/THIRD READING:
@/@/@S@WW@W ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT.
@/@WW@W ENTER 999 IF R CHOSE NOT TO DO IT.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
993 R TRIED BUT WAS UNABLE TO DO IT
998 DK
999 R CHOSE NOT TO DO IT

| | | | ========================================================================
| | | | 
MI809
Puff Test 3 (L/min)

@/BREATHING TEST
@/@/FIRST READING: Puff Test 1 (L/min)
@/@/SECOND READING: Puff Test 2 (L/min)
@/@/THIRD READING:
@/@/@S@WW@W ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT.
@/@WW@W ENTER 999 IF R CHOSE NOT TO DO IT.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
993 R TRIED BUT WAS UNABLE TO DO IT
998 DK
999 R CHOSE NOT TO DO IT

| | | | ========================================================================
| | | | 
MI810
R BREATHING TEST effort

@/BREATHING TEST
@/@/@S@WW@W HOW MUCH EFFORT DID THE R GIVE TO THIS TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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
8 DK
9 RF

| | | | ========================================================================
| | | | 
MI811
BREATHING TEST R position

@/BREATHING TEST
@/@/@S@WW@W WHAT WAS THE R'S POSITION FOR THIS TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Standing
2 Sitting
3 Lying down
8 DK
9 RF

| | | ========================================================================
| | | 
MI812
HAND STRENGTH COMPLETE AT LEAST ONE TRIAL

@/HAND STRENGTH TEST
@/@/@S@WW@W DID R COMPLETE AT LEAST ONE TRIAL OF THE HAND STRENGTH TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | | If HAND STRENGTH COMPLETE AT LEAST ONE TRIAL (MI812) != 1 Yes »

| | | | ========================================================================
| | | | 
MI813
HAND STRENGTH TEST REASON NOT COMPLETE

@/HAND STRENGTH TEST
@/@/@S@WW@W WHY DIDN'T R COMPLETE THE HAND STRENGTH TEST? (SELECT ALL THAT APPLY)@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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 test
5 R did not understand the instructions
6 R could not participate due to surgery, swelling, etc.; other health reason
7 No suitable space
8 Problem with equipment or supplies
97 Other (specify)
98 DK
99 RF

| | | Else If HAND STRENGTH COMPLETE AT LEAST ONE TRIAL (MI812) = 1 Yes »

| | | | ========================================================================
| | | | 
MI815
grip dominant hand

@/HAND STRENGTH TEST
@/@/@S@WW@W RECORD R'S DOMINANT HAND.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Right hand
2 Left hand
3 Both hands equally dominant
8 DK
9 RF


| | | | ========================================================================
| | | | 
MI816
Left first (kg)

@/HAND STRENGTH TEST
@/@/@S@WW@W @ULEFT@U HAND, FIRST MEASUREMENT@S.
@/@/@S@ULEFT HAND, FIRST MEASUREMENT:@U@S
@/@SRIGHT HAND, FIRST MEASUREMENT:@S
@/@SLEFT HAND, SECOND MEASUREMENT:@S
@/@SRIGHT HAND, SECOND MEASUREMENT:@S
@/@/@WW@W ENTER THE RESULT TO THE NEAREST 0.5 KILOGRAM.
@/@/@WW@W ENTER 993 IF R WAS UNABLE TO PERFORM THIS MEASUREMENT
@/ENTER 999 IF R CHOSE NOT TO DO IT@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
993 R TRIED BUT WAS UNABLE TO COMPLETE THE TEST
998 DK
999 R CHOSE NOT TO DO IT

| | | | ========================================================================
| | | | 
MI851
RIGHT first (kg)

@/HAND STRENGTH TEST
@/@/@S@WW@W @URIGHT@U HAND, FIRST MEASUREMENT@S.
@/@/@SLEFT HAND, FIRST MEASUREMENT:@S Left first (kg)
@/@S@URIGHT HAND, FIRST MEASUREMENT:@U@S
@/@SLEFT HAND, SECOND MEASUREMENT:@S
@/@SRIGHT HAND, SECOND MEASUREMENT:@S
@/@/@WW@W ENTER THE RESULT TO THE THE NEAREST 0.5 KILOGRAM.
@/@/@WW@W ENTER 993 IF R WAS UNABLE TO PERFORM THIS MEASUREMENT
@/ENTER 999 IF R CHOSE NOT TO DO IT@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
993 R TRIED BUT WAS UNABLE TO COMPLETE THE TEST
998 DK
999 R CHOSE NOT TO DO IT

| | | | ========================================================================
| | | | 
MI852
left second (kg)

@/HAND STRENGTH TEST
@/@/@S@WW@W @ULEFT@U HAND, @USECOND@U MEASUREMENT@S.
@/@/@SLEFT HAND, FIRST MEASUREMENT:@S Left first (kg)
@/@SRIGHT HAND, FIRST MEASUREMENT:@S RIGHT first (kg)
@/@S@ULEFT HAND, SECOND MEASUREMENT@U:@S
@/@SRIGHT HAND, SECOND MEASUREMENT:@S
@/@/@WW@W 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@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
993 R TRIED BUT WAS UNABLE TO COMPLETE THE TEST
998 DK (Don't Know)
999 R CHOSE NOT TO DO IT


| | | | ========================================================================
| | | | 
MI853
RIGHT Second (kg)

@/HAND STRENGTH TEST
@/@/@S@WW@W @URIGHT@U HAND, @USECOND@U MEASUREMENT@S.
@/@/@SLEFT HAND, FIRST MEASUREMENT:@S Left first (kg)
@/@SRIGHT HAND, FIRST MEASUREMENT:@S RIGHT first (kg)
@/@SLEFT HAND, SECOND MEASUREMENT:@S left second (kg)
@/@S@URIGHT HAND, SECOND MEASUREMENT@U:@S
@/@/@WW@W 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@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000

993 R TRIED BUT WAS UNABLE TO COMPLETE THE TEST
998 DK
999 R CHOSE NOT TO DO IT


| | | | ========================================================================
| | | | 
MI817
GRIP R EFFORT

@/HAND STRENGTH TEST
@/@/@S@WW@W HOW MUCH EFFORT DID THE R GIVE TO THIS TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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


| | | | ========================================================================
| | | | 
MI818
HAND STRENGTH TEST R POSITION

@/HAND STRENGTH TEST
@/@/@S@WW@W WHAT WAS THE R'S POSITION FOR THIS TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Standing
2 Sitting
3 Lying down


| | | | ========================================================================
| | | | 
MI819
HAND STRENGTH rest arm

@/HAND STRENGTH TEST
@/@/@S@WW@W DID THE R REST THEIR ARM ON A SUPPORT WHILE PERFORMING THIS TEST?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | | ========================================================================
| | | 
MI876
BALANCE TEST - SEMI-TANDEM STAND

@/BALANCE TEST - SEMI-TANDEM STAND
@/@/@S@WW@W DID R COMPLETE THE SEMI-TANDEM STAND?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | | If BALANCE TEST - SEMI-TANDEM STAND (MI876) != 1 Yes »

| | | | ========================================================================
| | | | 
MI877
BALANCE TEST SEMI-TANDEM REASON NOT COMPLETE

@/BALANCE TEST - SEMI-TANDEM STAND
@/@/@S@WW@W WHY DIDN'T R COMPLETE THE SEMI-TANDEM STAND?
@/@WW@W SELECT ALL THAT APPLY@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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 test
5 R did not understand the instructions
6 R had surgery, injury, or other health condition that prevented R from completing the test
7 No suitable space
8 Problem with equipment or supplies
97 Other (specify)
98 DK
99 RF

| | | ElseIf BALANCE TEST - SEMI-TANDEM STAND (MI876) = 1 Yes »

| | | | ========================================================================
| | | | 
MI879
BALANCE TEST SEMI-TANDEM Hold Full Time

@/BALANCE TEST - SEMI-TANDEM STAND
@/@/@S@WW@W DID R HOLD SEMI-TANDEM STAND FOR FULL 10 SECONDS WITHOUT STEPPING OUT OF PLACE OR GRABBING HOLD OF ANYTHING?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
993 R tried but was unable
999 R chose not to do it


| | | | If BALANCE TEST SEMI-TANDEM Hold Full Time (MI879) = 1 Yes »

| | | | | ========================================================================
| | | | | 
MI880
BALANCE TEST SEMI-TANDEM Time

@/BALANCE TEST - SEMI-TANDEM STAND
@/@/@S@WW@W RECORD TIME IN SECONDS TO TWO DECIMAL PLACES@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
93 R TRIED BUT WAS UNABLE TO DO IT
98 DK
99 RF

| | | | If BALANCE TEST SEMI-TANDEM Hold Full Time (MI879) != 999 R chose not to do it and BALANCE TEST SEMI-TANDEM Hold Full Time (MI879) != 993 R tried but was unable »

| | | | | ========================================================================
| | | | | 
MI881
BALANCE TEST SEMI-TANDEM Compensatory

@/BALANCE TEST - SEMI-TANDEM STAND
@/@/@S@WW@W DID R USE ANY COMPENSATORY MOVEMENTS OF HIS/HER TRUNK, ARMS OR LEGS TO STEADY HIM/HERSELF DURING SEMI-TANDEM STAND?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
8 DK

| | | If BALANCE TEST - SEMI-TANDEM STAND (MI876) = 5 No or BALANCE TEST SEMI-TANDEM Hold Full Time (MI879) != 1 Yes »

| | | | ========================================================================
| | | | 
MI883
BALANCE TEST S-B-S Complete

@/BALANCE TEST - SIDE-BY-SIDE STAND
@/@/@S@WW@W DID R COMPLETE THE SIDE-BY-SIDE STAND? @S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | | | If BALANCE TEST S-B-S Complete (MI883) != 1 Yes »

| | | | | ========================================================================
| | | | | 
MI884
BALANCE TEST S-B-S STAND REASON NOT COMPLETE

@/BALANCE TEST - SIDE-BY-SIDE STAND
@/@/@S@WW@W WHY DIDN'T R COMPLETE THE SIDE-BY-SIDE STAND?
@/@WW@W SELECT ALL THAT APPLY@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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 test
5 R did not understand the instructions
6 R had surgery, injury, or other health condition that prevented R from completing the test
7 No suitable space
8 Problem with equipment or supplies
97 Other (specify)
98 DK
99 RF


| | | | ElseIf BALANCE TEST S-B-S Complete (MI883) = 1 Yes »

| | | | | ========================================================================
| | | | | 
MI886
BALANCE TEST S-B-S Hold Full Time

@/BALANCE TEST - SIDE-BY-SIDE STAND
@/@/@S@WW@W DID R HOLD SIDE-BY-SIDE STAND FOR FULL 10 SECONDS WITHOUT STEPPING OUT OF PLACE OR GRABBING HOLD OF ANYTHING?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
993 R tried but was unable
999 R chose not to do it


| | | | | If BALANCE TEST S-B-S Hold Full Time (MI886) = 1 Yes »

| | | | | | ========================================================================
| | | | | | 
MI887
BALANCE TEST SIDE-BY-SIDE Time

@/BALANCE TEST - SIDE-BY-SIDE STAND
@/@/@S@WW@W RECORD TIME IN SECONDS TO TWO DECIMAL PLACES@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
98 DK
99 RF

| | | | | If BALANCE TEST S-B-S Hold Full Time (MI886) != 993 R tried but was unable and BALANCE TEST S-B-S Hold Full Time (MI886) != 999 R chose not to do it »

| | | | | | ========================================================================
| | | | | | 
MI888
BALANCE TEST SIDE-BY-SIDE Compensatory

@/BALANCE TEST - SIDE-BY-SIDE STAND
@/@/@S@WW@W DID R USE ANY COMPENSATORY MOVEMENTS OF HIS/HER TRUNK, ARMS OR LEGS TO STEADY HIM/HERSELF DURING SIDE-BY-SIDE STAND?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
8 DK

| | | | | | ========================================================================
| | | | | | 
MI889
BALANCE TEST S-B-S Floor Surface

@/BALANCE TEST - SIDE-BY-SIDE STAND
@/@/@S@WW@W RECORD TYPE OF FLOOR SURFACE@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Linoleum/tile/wood
2 Low-pile carpet
3 High-pile carpet
4 Concrete
5 Not sure
7 Other (specify)


| | | | | | ========================================================================
| | | | | | 
MI891
BALANCE TEST S-B-S Compliance

@/BALANCE TEST - SIDE-BY-SIDE STAND
@/@/@S@WW@W HOW COMPLIANT WAS R DURING THIS MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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


| | | Else

| | | | ========================================================================
| | | | 
MI893
BALANCE TEST Full Tandem Complete

@/BALANCE TEST - FULL TANDEM STAND
@/@/@S@WW@W DID R COMPLETE THE FULL TANDEM STAND? @S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | | | If BALANCE TEST Full Tandem Complete (MI893) != 1 Yes »

| | | | | ========================================================================
| | | | | 
MI894
BALANCE TEST Full Tandem STAND REASON NOT COMPLETE

@/BALANCE TEST - FULL TANDEM STAND
@/@/@S@WW@W WHY DIDN'T R COMPLETE THE FULL -TANDEM STAND?
@/@WW@W SELECT ALL THAT APPLY@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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 test
5 R did not understand the instructions
6 R had surgery, injury, or other health condition that prevented R from completing the test
7 No suitable space
8 Problem with equipment or supplies
97 Other (specify)
98 DK
99 RF

| | | | Else

| | | | | ========================================================================
| | | | | 
MI896
BALANCE TEST FULL TANDEM Hold Full Time

@/BALANCE TEST - FULL TANDEM STAND
@/@/@S@WW@W DID R HOLD FULL TANDEM STAND FOR FULL 30 SECONDS WITHOUT STEPPING OUT OF PLACE OR GRABBING HOLD OF ANYTHING?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
993 R tried but was unable
999 R chose not to do it


| | | | | If BALANCE TEST FULL TANDEM Hold Full Time (MI896) = 1 Yes and R CURRENT AGE CALCULATION (MA019) > 70 »

| | | | | | ========================================================================
| | | | | | 
MI897
BALANCE TEST FULL TANDEM Time

@/BALANCE TEST - FULL TANDEM STAND
@/@/@S@WW@W RECORD TIME IN SECONDS TO TWO DECIMAL PLACES@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
99998 DK
99999 RF

| | | | | If BALANCE TEST FULL TANDEM Hold Full Time (MI896) != 993 R tried but was unable and BALANCE TEST FULL TANDEM Hold Full Time (MI896) != 999 R chose not to do it »

| | | | | | ========================================================================
| | | | | | 
MI898
BALANCE TEST FULL TANDEM Compensatory

@/BALANCE TEST - FULL TANDEM STAND
@/@/@S@WW@W DID R USE ANY COMPENSATORY MOVEMENTS OF HIS/HER TRUNK, ARMS OR LEGS TO STEADY HIM/HERSELF DURING FULL TANDEM STAND?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
8 DK

| | | | | | ========================================================================
| | | | | | 
MI899
BALANCE TEST FULL TANDEM Floor Surface

@/BALANCE TEST - FULL TANDEM
@/@/@S@WW@W RECORD TYPE OF FLOOR SURFACE@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Linoleum/tile/wood
2 Low-pile carpet
3 High-pile carpet
4 Concrete
5 Not sure
7 Other (specify)
8 DK
9 RF

| | | | | | ========================================================================
| | | | | | 
MI902
BALANCE TEST FULL TANDEM Compliance

@/BALANCE TEST - FULL TANDEM STAND
@/@/@S@WW@W HOW COMPLIANT WAS R DURING THIS MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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
8 DK
9 RF

| | | If R CURRENT AGE CALCULATION (MA019) > 64 »

| | | | ========================================================================
| | | | 
MI820
WALKING TEST COMPLETE AT LEAST ONE TRIAL

@/WALKING TEST
@/@/@S@WW@W DID R COMPLETE AT LEAST ONE TRIAL OF THE WALKING TEST? @S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | | | If WALKING TEST COMPLETE AT LEAST ONE TRIAL (MI820) != 1 Yes »

| | | | | ========================================================================
| | | | | 
MI821
WALKING TEST REASON NOT COMPLETE

@/WALKING TEST
@/@/@S@WW@W WHY DIDN`T R COMPLETE THE WALKING TEST? (SELECT ALL THAT APPLY)@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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 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
8 Problem with equipment or supplies
97 Other (specify)
98 DK
99 RF

| | | | Else

| | | | | ========================================================================
| | | | | 
MI823
T walk 1st trial time (seconds)

@/WALKING TEST - TIME FROM FIRST TRIAL
@/@/@S@WW@W RECORD TIME IN SECONDS TO TWO DECIMAL PLACES
@/@/@UFIRST TRIAL:@U
@/@/SECOND TRIAL:
@/@/ENTER 993 IF R WAS UNABLE TO DO IT
@/ENTER 999 IF R CHOSE NOT TO DO IT@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
993 R UNABLE TO DO IT
998 DK
999 R CHOSE NOT TO DO IT


| | | | | If T walk 1st trial time (seconds) (MI823) != 993 R UNABLE TO DO IT and T walk 1st trial time (seconds) (MI823) != 999 R CHOSE NOT TO DO IT »

| | | | | | ========================================================================
| | | | | | 
MI824
T walk 2nd trial time (seconds)

@/WALKING TEST - TIME FROM SECOND TRIAL
@/@/@S@WW@W RECORD TIME IN SECONDS TO TWO DECIMAL PLACES
@/@/FIRST TRIAL: T walk 1st trial time (seconds)
@/@/@USECOND TRIAL:@U
@/@/ENTER 993 IF R WAS UNABLE TO DO IT
@/ENTER 999 IF R CHOSE NOT TO DO IT@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
993 R was unable to do it
998 DK
999 R chose not to do it

| | | | | | ========================================================================
| | | | | | 
MI825
T walk floor surface

@/WALKING TEST
@/@/@S@WW@W RECORD TYPE OF FLOOR SURFACE@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Linoleum/tile/wood
2 Low-pile carpet
3 High-pile carpet
4 Concrete
5 Not sure
7 Other (specify)


| | | | | | ========================================================================
| | | | | | 
MI828
walking aid type

@/WALKING TEST
@/@/@S@WW@W RECORD TYPE OF AID USED@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 NONE
2 Walking stick or cane
3 Elbow crutches
4 Walking frame
7 Other (specify)
8 DK
9 RF

| | | | | | ========================================================================
| | | | | | 
MI830
walk R effort

@/WALKING TEST
@/@/@S@WW@W HOW COMPLIANT WAS R DURING THIS MEASUREMENT@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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


| | | ========================================================================
| | | 
MI831
MEASURE R HEIGHT

@/HEIGHT
@/@/@S@WW@W WERE YOU ABLE TO MEASURE R`S HEIGHT? @S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | | If MEASURE R HEIGHT (MI831) != 1 Yes »

| | | | ========================================================================
| | | | 
MI832
HEIGHT REASON NOT COMPLETE

@/HEIGHT
@/@/@S@WW@W WHY WEREN'T YOU ABLE TO MEASURE R`S HEIGHT? (SELECT ALL THAT APPLY)@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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 measurement
5 R did not understand the instructions
6 R is not able to stand; other health reason
7 No suitable space available
8 Problem with equipment or supplies
9 R too tall, interviewer could not reach
97 Other (specify)
98 DK
99 RF

| | | Else

| | | | ========================================================================
| | | | 
MI834
HEIGHT MEASURMENT (inches)

@/HEIGHT
@/@/@S@WW@W ENTER RESPONDENT'S HEIGHT IN INCHES. ROUND TO THE NEAREST QUARTER INCH.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..99
99998 DK
99999 RF

| | | | ========================================================================
| | | | 
MI835
HEIGHT floor surface

@/HEIGHT
@/@/@S@WW@W RECORD TYPE OF FLOOR SURFACE@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Linoleum/tile/wood
2 Low-pile carpet
3 High-pile carpet
4 Concrete
5 Not sure
7 Other (specify)


| | | | ========================================================================
| | | | 
MI837
HEIGHT wearing shoes

@/HEIGHT
@/@/@S@WW@W WAS R WEARING SHOES DURING MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | | | ========================================================================
| | | | 
MI903
HEIGHT wearing shoes

@/HEIGHT
@/@/@S@WW@W HOW COMPLIANT WAS R DURING THIS MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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


| | | If WEIGHT IN POUNDS (MC139) < 300 »

| | | | ========================================================================
| | | | 
MI838
WEIGHT ABLE TO MEASURE

@/WEIGHT
@/@/@S@WW@W WERE YOU ABLE TO MEASURE R`S WEIGHT? @S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | | | If WEIGHT ABLE TO MEASURE (MI838) != 1 Yes »

| | | | | ========================================================================
| | | | | 
MI839
WEIGHT REASON NOT COMPLETE

@/WEIGHT
@/@/@S@WW@W WHY WEREN'T YOU ABLE TO MEASURE R`S WEIGHT? (SELECT ALL THAT APPLY)@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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; other problem with equipment or supplies
97 Other (specify)
98 DK
99 RF

| | | | Else

| | | | | ========================================================================
| | | | | 
MI841
Weight Measurment (lbs)

@/WEIGHT
@/@/@S@WW@W ENTER RESPONDENT'S WEIGHT IN POUNDS AS RECORDED ON SCALE (TO THE NEAREST
- - - - - - - - - - - - - - - - - - - - - - - - -
0..1000
993 R TRIED BUT RECEIVED AN ERROR MESSAGE
998 DK
999 R CHOSE NOT TO DO IT

| | | | | ========================================================================
| | | | | 
MI842
WEIGHT floor surface

@/WEIGHT
@/@/@S@WW@W RECORD TYPE OF FLOOR SURFACE@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Linoleum/tile/wood
2 Low-pile carpet
3 High-pile carpet
4 Concrete
5 Not sure
7 Other (specify)


| | | | | ========================================================================
| | | | | 
MI844
WEIGHT wearing shoes

@/WEIGHT
@/@/@S@WW@W WAS R WEARING SHOES DURING MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | | | | ========================================================================
| | | | | 
MI947
WEIGHT Compliance

@/WEIGHT
@/@/@S@WW@W HOW COMPLIANT WAS R DURING THIS MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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


| | | ========================================================================
| | | 
MI904
WAIST Complete

@/WAIST CIRCUMFERENCE
@/@/@S@WW@W WERE YOU ABLE TO MEASURE R'S WAIST CIRCUMFERENCE?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | | If WAIST Complete (MI904) != 1 Yes »

| | | | ========================================================================
| | | | 
MI905
Waist Why Not Complete

@/WAIST CIRCUMFERENCE
@/@/@S@WW@W WERE YOU ABLE TO MEASURE R'S WAIST CIRCUMFERENCE? (SELECT ALL THAT APPLY)@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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 measurement
5 R did not understand the instructions
6 R is not able to stand; other health reason
7 No suitable space available
8 Problem with equipment or supplies
97 Other (specify)
98 DK
99 RF

| | | Else

| | | | ========================================================================
| | | | 
MI907
Waist Measurment (inches)

@/WAIST CIRCUMFERENCE -MEASUREMENT
@/@/@S@WW@W ENTER RESPONDENT'S WAIST MEASUREMENT TO THE NEAREST QUARTER INCH.
@/@/@WW@W ENTER 993 IF R TRIED BUT WAS UNABLE TO DO IT.
@/@WW@W ENTER 999 IF R CHOSE NOT TO DO IT.@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0..999
993 R TRIED BUT WAS UNABLE TO COMPLETE THE TEST
998 DK
999 R CHOSE NOT TO DO IT

| | | | If Waist Measurment (inches) (MI907) != 993 R TRIED BUT WAS UNABLE TO COMPLETE THE TEST and Waist Measurment (inches) (MI907) != 999 R CHOSE NOT TO DO IT »

| | | | | ========================================================================
| | | | | 
MI908
Waist Difficulties

@/WAIST CIRCUMFERENCE -MEASUREMENT
@/@/@S@WW@W WHAT DIFFICULTIES OCCURRED DURING THIS MEASUREMENT?@S
@/@S@WW@W SELECT ALL THAT APPLY@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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 or unable to locate navel
97 Other (specify)
98 DK
99 RF

| | | | | ========================================================================
| | | | | 
MI910
Waist Compliance

@/WAIST CIRCUMFERENCE
@/@/@S@WW@W HOW COMPLIANT WAS R DURING THIS MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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


| | | | | ========================================================================
| | | | | 
MI911
Waist Who Measured

@/WAIST CIRCUMFERENCE
@/@/@S@WW@W WHO COMPLETED THE MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 R completed the measurement
2 IWER completed the measurement
8 DK

| | | | | ========================================================================
| | | | | 
MI912
Waist Bulky Clothes

@/WAIST CIRCUMFERENCE
@/@/@S@WW@W WAS R WEARING BULKY CLOTHING DURING THIS MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | ========================================================================
| | 
MI913
Saliva Consent

@/SALIVA SAMPLE
@/@/@S@WW@W DID R SIGN THE CONSENT FORM FOR THE SALIVA SAMPLE?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | If Saliva Consent (MI913) = 5 No »

| | | ========================================================================
| | | 
MI941
Why No Consent Saliva

@/SALIVA SAMPLE
@/@/@S@WW@W WHY DIDN'T R SIGN THE SALIVA CONSENT FORM? (SELECT ALL THAT APPLY)@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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 measurement
5 R did not understand the instructions
6 R could not complete the measurement due to health reasons
7 No suitable space
8 R ate, drank, smoked, or brushed teeth in last 30 minutes
97 Other (specify)
98 DK
99 RF


| | Else

| | | ========================================================================
| | | 
MI915
Saliva Complete

@/SALIVA SAMPLE
@/@/@S@WW@W DID R COMPLETE THE SALIVA SAMPLE?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | | If Saliva Complete (MI915) != 1 Yes »

| | | | ========================================================================
| | | | 
MI916
Saliva Why Not Complete

@/SALIVA SAMPLE
@/@/@S@WW@W WHY DIDN'T R COMPLETE THE SALIVA SAMPLE? (SELECT ALL THAT APPLY)@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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 measurement
5 R did not understand the instructions
6 R could not complete the measurement due to health problems
7 No suitable space available
8 Problem with equipment or supplies
97 Other (specify)
98 DK
99 RF

| | | Else

| | | | ========================================================================
| | | | 
MI918
Saliva Fill Vial

@/SALIVA SAMPLE
@/@/@S@WW@W DID R FILL THE VIAL TO THE DESIRED LEVEL?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No
8 DK
9 RF

| | | | ========================================================================
| | | | 
MI919
Saliva Problems

@/SALIVA SAMPLE
@/@/@S@WW@W WHAT, IF ANY, PROBLEMS OCCURED?
@/(SELECT ALL THAT APPLY)@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 None
2 Solution in cover leaked before vial was sealed
3 Saliva spilled
4 R was unable to produce enough saliva
5 Collection container leaked; other problem with equipment or supplies
97 Other (specify)


| | | | ========================================================================
| | | | 
MI921
Saliva Compliance

@/SALIVA SAMPLE
@/@/@S@WW@W HOW COMPLIANT WAS R DURING THIS MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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


| | ========================================================================
| | 
MI922
BLOOD Consent

@/BLOOD SAMPLE
@/@/@S@WW@W DID R SIGN THE BLOOD SAMPLE CONSENT FORM?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | If BLOOD Consent (MI922) = 5 No »

| | | ========================================================================
| | | 
MI943
Why No Consent Blood

@/BLOOD SAMPLE
@/@/@S@WW@W WHY DIDN'T R SIGN THE BLOOD CONSENT FORM? (SELECT ALL THAT APPLY)@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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 measurement
5 R did not understand the instructions
6 R has hemophilia or is on medication that thins the blood (anticoagulant); other health reason
7 No suitable space
8 R ate, drank, smoked, or brushed teeth in last 30 minutes
97 Other (specify)
98 DK
99 RF

| | Else

| | | ========================================================================
| | | 
MI923
Blood Complete

@/BLOOD SAMPLE
@/@/@S@WW@W DID R COMPLETE THE BLOOD SAMPLE?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No


| | | If Blood Complete (MI923) != 1 Yes »

| | | | ========================================================================
| | | | 
MI924
Blood Why Not Complete

@/BLOOD SAMPLE
@/@/@S@WW@W WHY DIDN'T R COMPLETE THE BLOOD SAMPLE? (SELECT ALL THAT APPLY)@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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 measurement
5 R did not understand the instructions
6 R has hemophilia or is on medication that thins the blood (anticoagulant); other health reason
7 No suitable space
8 Problem with equipment or supplies
97 Other (specify)
98 DK

| | | Else

| | | | ========================================================================
| | | | 
MI926
Blood What Problems

@/BLOOD SAMPLE
@/@/@S@WW@W WHAT, IF ANY, PROBLEMS OCCURRED DURING THE COLLECTION OF THE BLOOD SAMPLE?
@/(SELECT ALL THAT APPLY)@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 None
2 R became lightheaded, fainted, or became nauseous
3 R had difficulty getting finger to stop bleeding
4 Unable to obtain enough blood
5 Problem with equipment or supplies
97 Other (specify)


| | | | ========================================================================
| | | | 
MI928
Blood Who Measured

@/BLOOD SAMPLE
@/@/@S@WW@W WHO PRICKED THE R'S FINGER(S)?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 R pricked own finger(s)
2 IWER pricked R's finger(s)
3 Both R and Iwer pricked R
4 SOMEONE ELSE PRICKED R'S FINGER(S)

| | | | ========================================================================
| | | | 
MI929
Blood Fill Spots

@/BLOOD SAMPLE
@/@/@S@WW@W HOW MANY CIRCLES WERE FILLED ON THE FIRST CARD? @S
- - - - - - - - - - - - - - - - - - - - - - - - -
0 Zero
1 One
2 Two
3 Three
8 DK
9 RF

| | | | ========================================================================
| | | | 
MI945
Blood Fill Spots

@/BLOOD SAMPLE
@/@/@S@WW@W HOW MANY CIRCLES WERE FILLED ON THE STORAGE CARD?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
0 Zero
1 One
2 Two
3 Three
8 DK
9 RF

| | | | ========================================================================
| | | | 
MI930
Blood Pricks

@/BLOOD SAMPLE
@/@/@S@WW@W HOW MANY TIMES DID THE R'S FINGER HAVE TO BE PRICKED IN ORDER TO FILL THE CARDS?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
1 One time
2 Two times
3 Two times but the R was unable to fill all of the collection areas
8 DK

| | | | ========================================================================
| | | | 
MI931
Blood Compliance

@/BLOOD SAMPLE
@/@/@S@WW@W HOW COMPLIANT WAS R DURING THIS MEASUREMENT?@S
- - - - - - - - - - - - - - - - - - - - - - - - -
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


End of I. Physical Measures