XT. End-of-Life Interview

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XT. End-of-Life Interview Module of SHARE 2013

item label	type	description
XT104		IWER:note sex of decedent (ask if unsure)
XT001		[{Name of the deceased}] has participated in the SHARE study before [his/her] death. [His/Her] contribution was very valuable. We would find it extremely helpful to havesome information about the final year of [{Name of the deceased}]'s life. All the information collected is strictly confidential, and will be held anonymously.
XT006		IWER:Code proxy respondent's sex.
XT002		Before we start ask ing questions about the last year of life of [{Name of the deceased}], would you please tell me what was your relationship to the deceased?
XT003		IWER:Specify other relative
XT004		IWER:Specify other non-relative
XT005		During the last twelve months of [his/her] life, how often did you have contact with [{Name of the deceased}], either personally, by phone, mail, email, or any other electronicmeans?
XT007		Can you tell me your year of birth?
XT101		Let us now talk about the deceased. Just to mak e sure that we have the correct information about [{Name of the deceased}], can I just confirm that [he/she] was born in[{Month and Year birth of deceased}]?
XT102		In which month and year was [{Name of the deceased}] born?MONTH:YEAR:
XT103		In which month and year were [{Name of the deceased}] born?MONTH: ______YEAR:
XT008		We would lik e to k now more about the circumstances of [{Name of the deceased}] 's death. In what month and year did [he/she] pass away?MONTH:YEAR:
XT009		In what month and YEAR did [he/she] pass away?MONTH: ______YEAR:
XT010		How old was [{Name of the deceased}] when [he/she] passed away?
XT109		Was [{Name of the deceased}] married at the time of [his/her] death?
XT039		How many children did [{Name of the deceased}] have that were still alive at the time of [his/her] death? Please include foster and adopted children.
XT011		What was the main cause of [his/her] death?
XT012		IWER:Specify other cause of death
XT013		How long had [{Name of the deceased}] been ill before [he/she] died?
XT014		Did [he/she] die ...
XT045		IWER:Specify other place of death
XT015		In the last year before [he/she] died, on how many different occasions did [{Name of the deceased}] stay in a hospital, hospice or nursing home?
XT016		During the last year of [his/her] life, for how long altogether did [{Name of the deceased}] stay at hospitals, hospices or nursing homes?
XT017		We would now lik e to ask you some questions about any expenses which [{Name of the deceased}] incurred as a result of the medical care [he/she] received in the last 12months before [he/she] died. For each of the types of care I will now read out, please indicate whether the deceased received the care and, if so, give your best estimate ofthe costs incurred from that care. Please include only costs not paid or reimbursed by the health insurance or the employer.
XT018		Has [{Name of the deceased}] had any [care from a general practitioner/care from specialist physicians/hospital stays/care in a nursing home/hospicestays/medication/aids and appliances/home care or home help due to disability] (in the last 12 months of [his/her] life)?
XT019		About how much did [his/her] [care from a general practitioner/care from specialist physicians/hospital stays/care in a nursing home/hospice stays/medication/aidsand appliances/home care or home help due to disability] cost (in the last 12 months of [his/her] life)?
XT105		We would lik e to k now more about the difficulties people have in their last year of life because of a physical, mental, emotional or memory problems. During the last year of[his/her] life, did [{Name of the deceased}] have any difficulty remembering where [he/she] was? Please name only difficulties that lasted at least three months?
XT106		During the last year of [his/her] life, did [{Name of the deceased}] have any difficulty rememberingwhat year it was? (Please name only difficulties that lasted at least three months?)
XT107		During the last year of [his/her] life, did [{Name of the deceased}] have any difficulty recognizingfamily members or good friends? (Please name only difficulties that lasted at least three months?)
XT020		Because of a physical, mental, emotional or memory problem, did [{Name of the deceased}] have difficulty doing any of the following activities during the last twelve monthsof [his/her] life? Please name only difficulties that lasted at least three months.
XT022		Think ing about the activities that the deceased had problems with during the last twelve months of [his/her] life, has anyone helped regularly with these activities?
XT023		Who, including yourself, has helped mainly with these activities? Please name at most three persons.
XT024		Overall, during the last twelve months of [his/her] life, for how long did the deceased receive help?
XT025		And about how many hours of help were necessary during a typical day?
XT026a		The next questions are about the assets and life insurance policies the deceased may have owned and what happened to those assets after [{Name of the deceased}] died.I appreciate that this may upset or distress you, but we would find it very helpful to have some information about the financial issues surrounding death. Before I continue,though, I'd lik e to assure you again that everything you have already told me and anything else you tell me will be k ept completely confidential.
XT026b		Some people mak e a will to determine who receives what parts of the estate.Did [{Name of the deceased}] have a will?
XT027		Who were the beneficiaries of the estate, including yourself?
XT028		IWER:Specify other relative
XT029		IWER:Specify other non-relative
XT030		Did the deceased own [his/her] home or apartment - either in total or a share of it?
XT031		After any outstanding mortgages, what was the value of the home or apartment or the share of it owned by the deceased?
XT051		IWER:Specify other relative
XT052		IWER:Specify other non-relative
XT053		IWER:First names of children who inherited home
XT033		Did the deceased own any life insurance policies?
XT034		In total, about what was the value of all life insurance policies owned by the deceased?
XT035		Who were the beneficiaries of the life insurance polices, including yourself.
XT054		IWER:Specify other relative
XT055		IWER:Specify other non-relative
XT056		IWER:First names of children who were beneficiaries
XT036		I will now read out a few types of assets people may have. For each item, please tell me whether the deceased owned them at the time of [his/her] death and, if so, pleasegive your best estimate of their value after any outstanding debts.
XT037		Did [he/she] own any [businesses, including land or premises/other real estate/cars/financial assets, e.g. cash, bonds or stock s/jewelry or antiquities]?
XT038		About what was the value of the [businesses, including land or premises/other real estate/cars/financial assets, e.g. cash, bonds or stock s/jewelry or antiquities] ownedby [{Name of the deceased}] at the time of [his/her] death?
XT040b		Would you say that some children received more than others to mak e up for previous gifts?
XT040c		Would you say that some children received more than others to give them financial support?
XT040d		Would you say that some children received more than others because they helped or cared for the deceased towards the end of [his/her] life?
XT040e		Would you say that some children received more than others because of other reasons?
XT040f		What other reasons do you mean?
XT041		Finally, we would lik e to k now about the deceased's funeral. Was the funeral accompanied by a religious ceremony?
XT108		We have ask ed you many questions about numerous aspects of [{Name of the deceased}]'s health and finances, and we want to thank you very much for your assistancewith them. Is there anything else you would lik e to add about the life circumstances of [{Name of the deceased}] in [his/her] last year of life?
XT042		This is the end of the interview. Thank you once again for all the information you have given us. It will prove extremely useful in helping us to understand how people fare atthe end of their lives
XT043		IWER:Please state mode of interview
XT044		IWER:Your interviewer id.
XT032		Who inherited the deceased's home or apartment, including yourself?

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Start of XT. End-of-Life Interview

XT104 IWER:note sex of decedent (ask if unsure) view item details » IWER:NOTE SEX OF DECEDENT (ASK IF UNSURE) 1 Male 2 Female

XT001 [{Name of the deceased}] has participated in the SHARE study before [his/her] death. [His/Her] contribution was very valuable. We would find it extremely helpful to havesome information about the final year of [{Name of the deceased}]'s life. All the information collected is strictly confidential, and will be held anonymously. view item details » [{NAME OF THE DECEASED}] HAS PARTICIPATED IN THE SHARE STUDY BEFORE [HIS/HER] DEATH. [HIS/HER] CONTRIBUTION WAS VERY VALUABLE. WE WOULD FIND IT EXTREMELY HELPFUL TO HAVESOME INFORMATION ABOUT THE FINAL YEAR OF [{NAME OF THE DECEASED}]'S LIFE. ALL THE INFORMATION COLLECTED IS STRICTLY CONFIDENTIAL, AND WILL BE HELD ANONYMOUSLY. 1 Continue

XT006 IWER:Code proxy respondent's sex. view item details » IWER:CODE PROXY RESPONDENT'S SEX. 1 Male 2 Female

XT002 Before we start ask ing questions about the last year of life of [{Name of the deceased}], would you please tell me what was your relationship to the deceased? view item details » BEFORE WE START ASK ING QUESTIONS ABOUT THE LAST YEAR OF LIFE OF [{NAME OF THE DECEASED}], WOULD YOU PLEASE TELL ME WHAT WAS YOUR RELATIONSHIP TO THE DECEASED? 1 Husband or wife or partner 2 Son or Daughter 3 Son- or Daughter-in-law 4 Son or Daughter of husband, wife or partner 5 Grandchild 6 Sibling 7 Other relative (specify) 8 Other non-relative (specify)

If Before we start ask ing questions about the last year of life of [{Name of the deceased}], would you please tell me what was your relationship to the deceased? view item details » = 7 »

	XT003 IWER:Specify other relative view item details » IWER:SPECIFY OTHER RELATIVE

If Before we start ask ing questions about the last year of life of [{Name of the deceased}], would you please tell me what was your relationship to the deceased? view item details » = 8 »

	XT004 IWER:Specify other non-relative view item details » IWER:SPECIFY OTHER NON-RELATIVE

XT005 During the last twelve months of [his/her] life, how often did you have contact with [{Name of the deceased}], either personally, by phone, mail, email, or any other electronicmeans? view item details » DURING THE LAST TWELVE MONTHS OF [HIS/HER] LIFE, HOW OFTEN DID YOU HAVE CONTACT WITH [{NAME OF THE DECEASED}], EITHER PERSONALLY, BY PHONE, MAIL, EMAIL, OR ANY OTHER ELECTRONICMEANS? 1 Daily 2 Several times a week 3 About once a week 4 About every two weeks 5 About once a month 6 Less than once a month 7 Never

If Before we start ask ing questions about the last year of life of [{Name of the deceased}], would you please tell me what was your relationship to the deceased? view item details » <> 1 Husband or wife or partner 2 Son or Daughter 3 Son- or Daughter-in-law 4 Son or Daughter of husband, wife or partner 5 Grandchild 6 Sibling 7 Other relative (specify) 8 Other non-relative (specify) »

	XT007 Can you tell me your year of birth? view item details » CAN YOU TELL ME YOUR YEAR OF BIRTH? 1900..1992

XT101 Let us now talk about the deceased. Just to mak e sure that we have the correct information about [{Name of the deceased}], can I just confirm that [he/she] was born in[{Month and Year birth of deceased}]? view item details » LET US NOW TALK ABOUT THE DECEASED. JUST TO MAK E SURE THAT WE HAVE THE CORRECT INFORMATION ABOUT [{NAME OF THE DECEASED}], CAN I JUST CONFIRM THAT [HE/SHE] WAS BORN IN[{MONTH AND YEAR BIRTH OF DECEASED}]? 1 Yes 5 No

If Let us now talk about the deceased. Just to mak e sure that we have the correct information about [{Name of the deceased}], can I just confirm that [he/she] was born in[{Month and Year birth of deceased}]? view item details » = 5 »

	XT102 In which month and year was [{Name of the deceased}] born?MONTH:YEAR: view item details » IN WHICH MONTH AND YEAR WAS [{NAME OF THE DECEASED}] BORN?MONTH:YEAR: 1 January 2 February 3 March 4 April 5 May 6 June 7 July 8 August 9 September 10 October 11 November 12 December

	XT103 In which month and year were [{Name of the deceased}] born?MONTH: ^XT102_DecMonthBirthYEAR: view item details » IN WHICH MONTH AND YEAR WERE [{NAME OF THE DECEASED}] BORN?MONTH: ______YEAR: 1900..2008

XT008 We would lik e to k now more about the circumstances of [{Name of the deceased}] 's death. In what month and year did [he/she] pass away?MONTH:YEAR: view item details » WE WOULD LIK E TO K NOW MORE ABOUT THE CIRCUMSTANCES OF [{NAME OF THE DECEASED}] 'S DEATH. IN WHAT MONTH AND YEAR DID [HE/SHE] PASS AWAY?MONTH:YEAR: 1 January 2 February 3 March 4 April 5 May 6 June 7 July 8 August 9 September 10 October 11 November 12 December

XT009 In what month and YEAR did [he/she] pass away?MONTH: ^XT008_MonthDiedYEAR: view item details » IN WHAT MONTH AND YEAR DID [HE/SHE] PASS AWAY?MONTH: ______YEAR: 1 2006 2 2007 3 2008 4 2009 5 2010 6 2011 7 2012 8 2013

XT010 How old was [{Name of the deceased}] when [he/she] passed away? view item details » HOW OLD WAS [{NAME OF THE DECEASED}] WHEN [HE/SHE] PASSED AWAY? 20..120

XT109 Was [{Name of the deceased}] married at the time of [his/her] death? view item details » WAS [{NAME OF THE DECEASED}] MARRIED AT THE TIME OF [HIS/HER] DEATH? 1 Yes 5 No

XT039 How many children did [{Name of the deceased}] have that were still alive at the time of [his/her] death? Please include foster and adopted children. view item details » HOW MANY CHILDREN DID [{NAME OF THE DECEASED}] HAVE THAT WERE STILL ALIVE AT THE TIME OF [HIS/HER] DEATH? PLEASE INCLUDE FOSTER AND ADOPTED CHILDREN.

XT011 What was the main cause of [his/her] death? view item details » WHAT WAS THE MAIN CAUSE OF [HIS/HER] DEATH? 1 Cancer 2 A heart attack 3 A stroke 4 Other cardiovascular related illness such as heart failure, arrhythmia 5 Respiratory disease 6 Disease of the digestive system such as gastrointestinal ulcer, inflammatory bowel disease 7 Severe infectious disease such as pneumonia, septicemia or flu 8 Accident 97 Other (Please specify)

If What was the main cause of [his/her] death? view item details » = 97 »

	XT012 IWER:Specify other cause of death view item details » IWER:SPECIFY OTHER CAUSE OF DEATH

If What was the main cause of [his/her] death? view item details » = 8 »

	XT013 How long had [{Name of the deceased}] been ill before [he/she] died? view item details » HOW LONG HAD [{NAME OF THE DECEASED}] BEEN ILL BEFORE [HE/SHE] DIED? 1 Less than one month 2 One month or more but less than 6 months 3 6 months or more but less than a year 4 One year or more

	XT014 Did [he/she] die ... view item details » DID [HE/SHE] DIE ... 1 at______ 2 at another person 3 in a hospital 4 in a nursing home 5 in a residential home or sheltered housing 6 in a hospice 97 at some other place (Please specify)

	If Did [he/she] die ... view item details » = 97 »

		XT045 IWER:Specify other place of death view item details » IWER:SPECIFY OTHER PLACE OF DEATH

	XT015 In the last year before [he/she] died, on how many different occasions did [{Name of the deceased}] stay in a hospital, hospice or nursing home? view item details » IN THE LAST YEAR BEFORE [HE/SHE] DIED, ON HOW MANY DIFFERENT OCCASIONS DID [{NAME OF THE DECEASED}] STAY IN A HOSPITAL, HOSPICE OR NURSING HOME? 1 Not at all 2 1 to 2 times 3 3 to 5 times 4 More than 5 times

	If In the last year before [he/she] died, on how many different occasions did [{Name of the deceased}] stay in a hospital, hospice or nursing home? view item details » > 1 Not at all 2 1 to 2 times 3 3 to 5 times 4 More than 5 times »

		XT016 During the last year of [his/her] life, for how long altogether did [{Name of the deceased}] stay at hospitals, hospices or nursing homes? view item details » DURING THE LAST YEAR OF [HIS/HER] LIFE, FOR HOW LONG ALTOGETHER DID [{NAME OF THE DECEASED}] STAY AT HOSPITALS, HOSPICES OR NURSING HOMES? 1 Less than one week 2 One week or more but less than one month 3 One month or more but less than 3 months 4 3 months or more but less than 6 months 5 6 months or more but less than a year 6 A full year

XT107 During the last year of [his/her] life, did [{Name of the deceased}] have any difficulty recognizingfamily members or good friends? (Please name only difficulties that lasted at least three months?) view item details » DURING THE LAST YEAR OF [HIS/HER] LIFE, DID [{NAME OF THE DECEASED}] HAVE ANY DIFFICULTY RECOGNIZINGFAMILY MEMBERS OR GOOD FRIENDS? (PLEASE NAME ONLY DIFFICULTIES THAT LASTED AT LEAST THREE MONTHS?) 1 Yes 5 No

As CNT goes from 1 to 8 »

	If ((CNT < 3) or (CNT > 5)) or (XT105 <> 1) »

		XT018 Has [{Name of the deceased}] had any [care from a general practitioner/care from specialist physicians/hospital stays/care in a nursing home/hospicestays/medication/aids and appliances/home care or home help due to disability] (in the last 12 months of [his/her] life)? view item details » HAS [{NAME OF THE DECEASED}] HAD ANY [CARE FROM A GENERAL PRACTITIONER/CARE FROM SPECIALIST PHYSICIANS/HOSPITAL STAYS/CARE IN A NURSING HOME/HOSPICESTAYS/MEDICATION/AIDS AND APPLIANCES/HOME CARE OR HOME HELP DUE TO DISABILITY] (IN THE LAST 12 MONTHS OF [HIS/HER] LIFE)? 1 Yes 5 No

		If Has [{Name of the deceased}] had any [care from a general practitioner/care from specialist physicians/hospital stays/care in a nursing home/hospicestays/medication/aids and appliances/home care or home help due to disability] (in the last 12 months of [his/her] life)? view item details » = 1 Yes 5 No »

			XT019 About how much did [his/her] [care from a general practitioner/care from specialist physicians/hospital stays/care in a nursing home/hospice stays/medication/aidsand appliances/home care or home help due to disability] cost (in the last 12 months of [his/her] life)? view item details » ABOUT HOW MUCH DID [HIS/HER] [CARE FROM A GENERAL PRACTITIONER/CARE FROM SPECIALIST PHYSICIANS/HOSPITAL STAYS/CARE IN A NURSING HOME/HOSPICE STAYS/MEDICATION/AIDSAND APPLIANCES/HOME CARE OR HOME HELP DUE TO DISABILITY] COST (IN THE LAST 12 MONTHS OF [HIS/HER] LIFE)? 0..980000

XT105 We would lik e to k now more about the difficulties people have in their last year of life because of a physical, mental, emotional or memory problems. During the last year of[his/her] life, did [{Name of the deceased}] have any difficulty remembering where [he/she] was? Please name only difficulties that lasted at least three months? view item details » WE WOULD LIK E TO K NOW MORE ABOUT THE DIFFICULTIES PEOPLE HAVE IN THEIR LAST YEAR OF LIFE BECAUSE OF A PHYSICAL, MENTAL, EMOTIONAL OR MEMORY PROBLEMS. DURING THE LAST YEAR OF[HIS/HER] LIFE, DID [{NAME OF THE DECEASED}] HAVE ANY DIFFICULTY REMEMBERING WHERE [HE/SHE] WAS? PLEASE NAME ONLY DIFFICULTIES THAT LASTED AT LEAST THREE MONTHS? 1 Yes 5 No

XT106 During the last year of [his/her] life, did [{Name of the deceased}] have any difficulty rememberingwhat year it was? (Please name only difficulties that lasted at least three months?) view item details » DURING THE LAST YEAR OF [HIS/HER] LIFE, DID [{NAME OF THE DECEASED}] HAVE ANY DIFFICULTY REMEMBERINGWHAT YEAR IT WAS? (PLEASE NAME ONLY DIFFICULTIES THAT LASTED AT LEAST THREE MONTHS?) 1 Yes 5 No

XT107 During the last year of [his/her] life, did [{Name of the deceased}] have any difficulty recognizingfamily members or good friends? (Please name only difficulties that lasted at least three months?) view item details » DURING THE LAST YEAR OF [HIS/HER] LIFE, DID [{NAME OF THE DECEASED}] HAVE ANY DIFFICULTY RECOGNIZINGFAMILY MEMBERS OR GOOD FRIENDS? (PLEASE NAME ONLY DIFFICULTIES THAT LASTED AT LEAST THREE MONTHS?) 1 Yes 5 No

XT020 Because of a physical, mental, emotional or memory problem, did [{Name of the deceased}] have difficulty doing any of the following activities during the last twelve monthsof [his/her] life? Please name only difficulties that lasted at least three months. view item details » BECAUSE OF A PHYSICAL, MENTAL, EMOTIONAL OR MEMORY PROBLEM, DID [{NAME OF THE DECEASED}] HAVE DIFFICULTY DOING ANY OF THE FOLLOWING ACTIVITIES DURING THE LAST TWELVE MONTHSOF [HIS/HER] LIFE? PLEASE NAME ONLY DIFFICULTIES THAT LASTED AT LEAST THREE MONTHS. 1 Dressing, including putting on shoes and socks 2 Walking across a room 3 Bathing or showering 4 Eating, such as cutting up your food 5 Getting in or out of bed 6 Using the toilet, including getting up or down 96 None of these

If (Because of a physical, mental, emotional or memory problem, did [{Name of the deceased}] have difficulty doing any of the following activities during the last twelve monthsof [his/her] life? Please name only difficulties that lasted at least three months. view item details » > 0) and NOT (96 includes XT020) »

	XT022 Think ing about the activities that the deceased had problems with during the last twelve months of [his/her] life, has anyone helped regularly with these activities? view item details » THINK ING ABOUT THE ACTIVITIES THAT THE DECEASED HAD PROBLEMS WITH DURING THE LAST TWELVE MONTHS OF [HIS/HER] LIFE, HAS ANYONE HELPED REGULARLY WITH THESE ACTIVITIES? 1 Yes 5 No

	If Think ing about the activities that the deceased had problems with during the last twelve months of [his/her] life, has anyone helped regularly with these activities? view item details » = 1 Yes 5 No »

		XT023 Who, including yourself, has helped mainly with these activities? Please name at most three persons. view item details » WHO, INCLUDING YOURSELF, HAS HELPED MAINLY WITH THESE ACTIVITIES? PLEASE NAME AT MOST THREE PERSONS. 1 Yourself (proxy respondent) 2 Husband or wife or partner of the deceased 3 Mother or father of the deceased 4 Son of the deceased 5 Son-in-law of the deceased 6 Daughter of the deceased 7 Daughter-in-law of the deceased 8 Grandson of the deceased 9 Granddaughter of the deceased 10 Sister of the deceased 11 Brother of the deceased 12 Other relative 13 Unpaid volunteer 14 Professional helper (e.g. nurse) 15 Friend or neighbor of the deceased 16 Other person

		XT024 Overall, during the last twelve months of [his/her] life, for how long did the deceased receive help? view item details » OVERALL, DURING THE LAST TWELVE MONTHS OF [HIS/HER] LIFE, FOR HOW LONG DID THE DECEASED RECEIVE HELP? 1 Less than one month 2 One month or more but less than 3 months 3 3 months or more but less than 6 months 4 6 months or more but less than a year 5 A full year

		XT025 And about how many hours of help were necessary during a typical day? view item details » AND ABOUT HOW MANY HOURS OF HELP WERE NECESSARY DURING A TYPICAL DAY? 0..24

XT026A The next questions are about the assets and life insurance policies the deceased may have owned and what happened to those assets after [{Name of the deceased}] died.I appreciate that this may upset or distress you, but we would find it very helpful to have some information about the financial issues surrounding death. Before I continue,though, I'd lik e to assure you again that everything you have already told me and anything else you tell me will be k ept completely confidential. view item details » THE NEXT QUESTIONS ARE ABOUT THE ASSETS AND LIFE INSURANCE POLICIES THE DECEASED MAY HAVE OWNED AND WHAT HAPPENED TO THOSE ASSETS AFTER [{NAME OF THE DECEASED}] DIED.I APPRECIATE THAT THIS MAY UPSET OR DISTRESS YOU, BUT WE WOULD FIND IT VERY HELPFUL TO HAVE SOME INFORMATION ABOUT THE FINANCIAL ISSUES SURROUNDING DEATH. BEFORE I CONTINUE,THOUGH, I'D LIK E TO ASSURE YOU AGAIN THAT EVERYTHING YOU HAVE ALREADY TOLD ME AND ANYTHING ELSE YOU TELL ME WILL BE K EPT COMPLETELY CONFIDENTIAL. 1 Continue

XT026B Some people mak e a will to determine who receives what parts of the estate.Did [{Name of the deceased}] have a will? view item details » SOME PEOPLE MAK E A WILL TO DETERMINE WHO RECEIVES WHAT PARTS OF THE ESTATE.DID [{NAME OF THE DECEASED}] HAVE A WILL? 1 Yes 5 No

XT027 Who were the beneficiaries of the estate, including yourself? view item details » WHO WERE THE BENEFICIARIES OF THE ESTATE, INCLUDING YOURSELF? 1 Yourself (proxy) 2 Husband or wife or partner of the deceased 3 Children of the deceased 4 Grandchildren of the deceased 5 Siblings of the deceased 6 Other relatives (specify) of the deceased 7 Other non-relatives (specify) 8 Church, foundation or charitable organization 9 Deceased did not leave anything at all (SPONTANEOUS)

If 6 includes XT027 »

	XT028 IWER:Specify other relative view item details » IWER:SPECIFY OTHER RELATIVE

If 7 includes XT027 »

	XT029 IWER:Specify other non-relative view item details » IWER:SPECIFY OTHER NON-RELATIVE

XT030 Did the deceased own [his/her] home or apartment - either in total or a share of it? view item details » DID THE DECEASED OWN [HIS/HER] HOME OR APARTMENT - EITHER IN TOTAL OR A SHARE OF IT? 1 Yes 5 No

If Did the deceased own [his/her] home or apartment - either in total or a share of it? view item details » = 1 Yes 5 No »

	XT031 After any outstanding mortgages, what was the value of the home or apartment or the share of it owned by the deceased? view item details » AFTER ANY OUTSTANDING MORTGAGES, WHAT WAS THE VALUE OF THE HOME OR APARTMENT OR THE SHARE OF IT OWNED BY THE DECEASED? 1 Yourself (proxy respondent) 2 Husband or wife or partner 3 Sons or daughters (ASK FOR FIRST NAMES) 4 Grandchildren 5 Siblings 6 Other relatives (specify) 7 Other non-relatives (specify)

	XT032 Who inherited the deceased's home or apartment, including yourself? view item details » WHO INHERITED THE DECEASED'S HOME OR APARTMENT, INCLUDING YOURSELF? IWER:CODE RELATIONSHIP TO DECEASED. 1 Yourself (proxy respondent) 2 Husband or wife or partner 3 Sons or daughters (ASK FOR FIRST NAMES) 4 Grandchildren 5 Siblings 6 Other relatives (specify) 7 Other non-relatives (specify)

	If 6 includes XT032 »

		XT051 IWER:Specify other relative view item details » IWER:SPECIFY OTHER RELATIVE

	If 7 includes XT032 »

		XT052 IWER:Specify other non-relative view item details » IWER:SPECIFY OTHER NON-RELATIVE

	If 3 includes XT032 »

		XT053 IWER:First names of children who inherited home view item details » IWER:FIRST NAMES OF CHILDREN WHO INHERITED HOME

XT033 Did the deceased own any life insurance policies? view item details » DID THE DECEASED OWN ANY LIFE INSURANCE POLICIES? 1 Yes 5 No

If Did the deceased own any life insurance policies? view item details » = 1 Yes 5 No »

	XT034 In total, about what was the value of all life insurance policies owned by the deceased? view item details » IN TOTAL, ABOUT WHAT WAS THE VALUE OF ALL LIFE INSURANCE POLICIES OWNED BY THE DECEASED? 1000..50000000

	XT035 Who were the beneficiaries of the life insurance polices, including yourself. view item details » WHO WERE THE BENEFICIARIES OF THE LIFE INSURANCE POLICES, INCLUDING YOURSELF. 1 Yourself (proxy respondent) 2 Husband or wife or partner 3 Sons or daughters (ASK FOR FIRST NAMES) 4 Grandchildren 5 Siblings 6 Other relatives (specify) 7 Other non-relatives (specify)

	If 6 includes XT035 »

		XT054 IWER:Specify other relative view item details » IWER:SPECIFY OTHER RELATIVE

	If 7 includes XT035 »

		XT055 IWER:Specify other non-relative view item details » IWER:SPECIFY OTHER NON-RELATIVE

	If 3 includes XT035 »

		XT056 IWER:First names of children who were beneficiaries view item details » IWER:FIRST NAMES OF CHILDREN WHO WERE BENEFICIARIES

XT036 I will now read out a few types of assets people may have. For each item, please tell me whether the deceased owned them at the time of [his/her] death and, if so, pleasegive your best estimate of their value after any outstanding debts. view item details » I WILL NOW READ OUT A FEW TYPES OF ASSETS PEOPLE MAY HAVE. FOR EACH ITEM, PLEASE TELL ME WHETHER THE DECEASED OWNED THEM AT THE TIME OF [HIS/HER] DEATH AND, IF SO, PLEASEGIVE YOUR BEST ESTIMATE OF THEIR VALUE AFTER ANY OUTSTANDING DEBTS. 1 Continue

As CNT goes from 1 to 5 »

	XT037 Did [he/she] own any [businesses, including land or premises/other real estate/cars/financial assets, e.g. cash, bonds or stock s/jewelry or antiquities]? view item details » DID [HE/SHE] OWN ANY [BUSINESSES, INCLUDING LAND OR PREMISES/OTHER REAL ESTATE/CARS/FINANCIAL ASSETS, E.G. CASH, BONDS OR STOCK S/JEWELRY OR ANTIQUITIES]? 1 Yes 5 No

	If Did [he/she] own any [businesses, including land or premises/other real estate/cars/financial assets, e.g. cash, bonds or stock s/jewelry or antiquities]? view item details » = 1 Yes 5 No »

		XT038 About what was the value of the [businesses, including land or premises/other real estate/cars/financial assets, e.g. cash, bonds or stock s/jewelry or antiquities] ownedby [{Name of the deceased}] at the time of [his/her] death? view item details » ABOUT WHAT WAS THE VALUE OF THE [BUSINESSES, INCLUDING LAND OR PREMISES/OTHER REAL ESTATE/CARS/FINANCIAL ASSETS, E.G. CASH, BONDS OR STOCK S/JEWELRY OR ANTIQUITIES] OWNEDBY [{NAME OF THE DECEASED}] AT THE TIME OF [HIS/HER] DEATH? 1 Some children received more than others 2 The estate was divided about equally among all children 3 The estate was distributed exactly among the children 4 The children have not received anything

If (How many children did [{Name of the deceased}] have that were still alive at the time of [his/her] death? Please include foster and adopted children. view item details » > 1) and NOT (9 includes XT027) »

	XT040A

	If XT040A = 1 »

		XT040B Would you say that some children received more than others to mak e up for previous gifts? view item details » WOULD YOU SAY THAT SOME CHILDREN RECEIVED MORE THAN OTHERS TO MAK E UP FOR PREVIOUS GIFTS? 1 Yes 5 No

		XT040C Would you say that some children received more than others to give them financial support? view item details » WOULD YOU SAY THAT SOME CHILDREN RECEIVED MORE THAN OTHERS TO GIVE THEM FINANCIAL SUPPORT? 1 Yes 5 No

		XT040D Would you say that some children received more than others because they helped or cared for the deceased towards the end of [his/her] life? view item details » WOULD YOU SAY THAT SOME CHILDREN RECEIVED MORE THAN OTHERS BECAUSE THEY HELPED OR CARED FOR THE DECEASED TOWARDS THE END OF [HIS/HER] LIFE? 1 Yes 5 No

		XT040E Would you say that some children received more than others because of other reasons? view item details » WOULD YOU SAY THAT SOME CHILDREN RECEIVED MORE THAN OTHERS BECAUSE OF OTHER REASONS? 1 Yes 5 No

		If Would you say that some children received more than others because of other reasons? view item details » = 1 Yes 5 No »

			XT040F What other reasons do you mean? view item details » WHAT OTHER REASONS DO YOU MEAN?

XT041 Finally, we would lik e to k now about the deceased's funeral. Was the funeral accompanied by a religious ceremony? view item details » FINALLY, WE WOULD LIK E TO K NOW ABOUT THE DECEASED'S FUNERAL. WAS THE FUNERAL ACCOMPANIED BY A RELIGIOUS CEREMONY? 1 Yes 5 No

XT108 We have ask ed you many questions about numerous aspects of [{Name of the deceased}]'s health and finances, and we want to thank you very much for your assistancewith them. Is there anything else you would lik e to add about the life circumstances of [{Name of the deceased}] in [his/her] last year of life? view item details » WE HAVE ASK ED YOU MANY QUESTIONS ABOUT NUMEROUS ASPECTS OF [{NAME OF THE DECEASED}]'S HEALTH AND FINANCES, AND WE WANT TO THANK YOU VERY MUCH FOR YOUR ASSISTANCEWITH THEM. IS THERE ANYTHING ELSE YOU WOULD LIK E TO ADD ABOUT THE LIFE CIRCUMSTANCES OF [{NAME OF THE DECEASED}] IN [HIS/HER] LAST YEAR OF LIFE?

XT042 This is the end of the interview. Thank you once again for all the information you have given us. It will prove extremely useful in helping us to understand how people fare atthe end of their lives view item details » THIS IS THE END OF THE INTERVIEW. THANK YOU ONCE AGAIN FOR ALL THE INFORMATION YOU HAVE GIVEN US. IT WILL PROVE EXTREMELY USEFUL IN HELPING US TO UNDERSTAND HOW PEOPLE FARE ATTHE END OF THEIR LIVES 1 Continue

XT043 IWER:Please state mode of interview view item details » IWER:PLEASE STATE MODE OF INTERVIEW 1 Face-to-face 2 Telephone

XT044 IWER:Your interviewer id. view item details » IWER:YOUR INTERVIEWER ID.

End of XT. End-of-Life Interview

Start of XT. End-of-Life Interview

========================================================================

XT104

IWER:note sex of decedent (ask if unsure)

IWER:NOTE SEX OF DECEDENT (ASK IF UNSURE)
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Male
2 Female

========================================================================

XT001

[{Name of the deceased}] has participated in the SHARE study before [his/her] death. [His/Her] contribution was very valuable. We would find it extremely helpful to havesome information about the final year of [{Name of the deceased}]'s life. All the information collected is strictly confidential, and will be held anonymously.

[{NAME OF THE DECEASED}] HAS PARTICIPATED IN THE SHARE STUDY BEFORE [HIS/HER] DEATH. [HIS/HER] CONTRIBUTION WAS VERY VALUABLE. WE WOULD FIND IT EXTREMELY HELPFUL TO HAVESOME INFORMATION ABOUT THE FINAL YEAR OF [{NAME OF THE DECEASED}]'S LIFE. ALL THE INFORMATION COLLECTED IS STRICTLY CONFIDENTIAL, AND WILL BE HELD ANONYMOUSLY.
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Continue

========================================================================

XT006

IWER:Code proxy respondent's sex.

IWER:CODE PROXY RESPONDENT'S SEX.
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Male
2 Female

========================================================================

XT002

Before we start ask ing questions about the last year of life of [{Name of the deceased}], would you please tell me what was your relationship to the deceased?

BEFORE WE START ASK ING QUESTIONS ABOUT THE LAST YEAR OF LIFE OF [{NAME OF THE DECEASED}], WOULD YOU PLEASE TELL ME WHAT WAS YOUR RELATIONSHIP TO THE DECEASED?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Husband or wife or partner
2 Son or Daughter
3 Son- or Daughter-in-law
4 Son or Daughter of husband, wife or partner
5 Grandchild
6 Sibling
7 Other relative (specify)
8 Other non-relative (specify)

If Before we start ask ing questions about the last year of life of [{Name of the deceased}], would you please tell me what was your relationship to the deceased? (XT002) = 7 »

| ========================================================================

XT003

IWER:Specify other relative

IWER:SPECIFY OTHER RELATIVE

If Before we start ask ing questions about the last year of life of [{Name of the deceased}], would you please tell me what was your relationship to the deceased? (XT002) = 8 »

| ========================================================================

XT004

IWER:Specify other non-relative

IWER:SPECIFY OTHER NON-RELATIVE

========================================================================

XT005

During the last twelve months of [his/her] life, how often did you have contact with [{Name of the deceased}], either personally, by phone, mail, email, or any other electronicmeans?

DURING THE LAST TWELVE MONTHS OF [HIS/HER] LIFE, HOW OFTEN DID YOU HAVE CONTACT WITH [{NAME OF THE DECEASED}], EITHER PERSONALLY, BY PHONE, MAIL, EMAIL, OR ANY OTHER ELECTRONICMEANS?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Daily
2 Several times a week
3 About once a week
4 About every two weeks
5 About once a month
6 Less than once a month
7 Never

If Before we start ask ing questions about the last year of life of [{Name of the deceased}], would you please tell me what was your relationship to the deceased? (XT002) <> 1 Husband or wife or partner 2 Son or Daughter 3 Son- or Daughter-in-law 4 Son or Daughter of husband, wife or partner 5 Grandchild 6 Sibling 7 Other relative (specify) 8 Other non-relative (specify) »

| ========================================================================

XT007

Can you tell me your year of birth?

CAN YOU TELL ME YOUR YEAR OF BIRTH?
- - - - - - - - - - - - - - - - - - - - - - - - -
1900..1992

========================================================================

XT101

Let us now talk about the deceased. Just to mak e sure that we have the correct information about [{Name of the deceased}], can I just confirm that [he/she] was born in[{Month and Year birth of deceased}]?

LET US NOW TALK ABOUT THE DECEASED. JUST TO MAK E SURE THAT WE HAVE THE CORRECT INFORMATION ABOUT [{NAME OF THE DECEASED}], CAN I JUST CONFIRM THAT [HE/SHE] WAS BORN IN[{MONTH AND YEAR BIRTH OF DECEASED}]?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No

If Let us now talk about the deceased. Just to mak e sure that we have the correct information about [{Name of the deceased}], can I just confirm that [he/she] was born in[{Month and Year birth of deceased}]? (XT101) = 5 »

| ========================================================================

XT102

In which month and year was [{Name of the deceased}] born?@bMONTH@b:YEAR:

IN WHICH MONTH AND YEAR WAS [{NAME OF THE DECEASED}] BORN?@BMONTH@B:YEAR:
- - - - - - - - - - - - - - - - - - - - - - - - -
1 January
2 February
3 March
4 April
5 May
6 June
7 July
8 August
9 September
10 October
11 November
12 December

| ========================================================================

XT103

In which month and year were [{Name of the deceased}] born?MONTH: ^XT102_DecMonthBirth@bYEAR@b:

IN WHICH MONTH AND YEAR WERE [{NAME OF THE DECEASED}] BORN?MONTH: ______@BYEAR@B:
- - - - - - - - - - - - - - - - - - - - - - - - -
1900..2008

========================================================================

XT008

We would lik e to k now more about the circumstances of [{Name of the deceased}] 's death. In what @bmonth@b and year did [he/she] pass away?@bMONTH@b:YEAR:

WE WOULD LIK E TO K NOW MORE ABOUT THE CIRCUMSTANCES OF [{NAME OF THE DECEASED}] 'S DEATH. IN WHAT @BMONTH@B AND YEAR DID [HE/SHE] PASS AWAY?@BMONTH@B:YEAR:
- - - - - - - - - - - - - - - - - - - - - - - - -
1 January
2 February
3 March
4 April
5 May
6 June
7 July
8 August
9 September
10 October
11 November
12 December

========================================================================

XT009

In what month and @bYEAR@b did [he/she] pass away?MONTH: ^XT008_MonthDied@bYEAR@b:

IN WHAT MONTH AND @BYEAR@B DID [HE/SHE] PASS AWAY?MONTH: ______@BYEAR@B:
- - - - - - - - - - - - - - - - - - - - - - - - -
1 2006
2 2007
3 2008
4 2009
5 2010
6 2011
7 2012
8 2013

========================================================================

XT010

How old was [{Name of the deceased}] when [he/she] passed away?

HOW OLD WAS [{NAME OF THE DECEASED}] WHEN [HE/SHE] PASSED AWAY?
- - - - - - - - - - - - - - - - - - - - - - - - -
20..120

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XT109

Was [{Name of the deceased}] married at the time of [his/her] death?

WAS [{NAME OF THE DECEASED}] MARRIED AT THE TIME OF [HIS/HER] DEATH?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No

========================================================================

XT039

How many children did [{Name of the deceased}] have that were still alive at the time of [his/her] death? Please include foster and adopted children.

HOW MANY CHILDREN DID [{NAME OF THE DECEASED}] HAVE THAT WERE STILL ALIVE AT THE TIME OF [HIS/HER] DEATH? PLEASE INCLUDE FOSTER AND ADOPTED CHILDREN.

========================================================================

XT011

What was the main cause of [his/her] death?

WHAT WAS THE MAIN CAUSE OF [HIS/HER] DEATH?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Cancer
2 A heart attack
3 A stroke
4 Other cardiovascular related illness such as heart failure, arrhythmia
5 Respiratory disease
6 Disease of the digestive system such as gastrointestinal ulcer, inflammatory bowel disease
7 Severe infectious disease such as pneumonia, septicemia or flu
8 Accident
97 Other (Please specify)

If What was the main cause of [his/her] death? (XT011) = 97 »

| ========================================================================

XT012

IWER:Specify other cause of death

IWER:SPECIFY OTHER CAUSE OF DEATH

If What was the main cause of [his/her] death? (XT011) = 8 »

| ========================================================================

XT013

How long had [{Name of the deceased}] been ill before [he/she] died?

HOW LONG HAD [{NAME OF THE DECEASED}] BEEN ILL BEFORE [HE/SHE] DIED?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Less than one month
2 One month or more but less than 6 months
3 6 months or more but less than a year
4 One year or more

| ========================================================================

XT014

Did [he/she] die ...

DID [HE/SHE] DIE ...
- - - - - - - - - - - - - - - - - - - - - - - - -
1 at______
2 at another person
3 in a hospital
4 in a nursing home
5 in a residential home or sheltered housing
6 in a hospice
97 at some other place (Please specify)

| If Did [he/she] die ... (XT014) = 97 »

| | ========================================================================

| |

XT045

IWER:Specify other place of death

IWER:SPECIFY OTHER PLACE OF DEATH

| ========================================================================

XT015

In the last year before [he/she] died, on how many different occasions did [{Name of the deceased}] stay in a hospital, hospice or nursing home?

IN THE LAST YEAR BEFORE [HE/SHE] DIED, ON HOW MANY DIFFERENT OCCASIONS DID [{NAME OF THE DECEASED}] STAY IN A HOSPITAL, HOSPICE OR NURSING HOME?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Not at all
2 1 to 2 times
3 3 to 5 times
4 More than 5 times

| If In the last year before [he/she] died, on how many different occasions did [{Name of the deceased}] stay in a hospital, hospice or nursing home? (XT015) > 1 Not at all 2 1 to 2 times 3 3 to 5 times 4 More than 5 times »

| | ========================================================================

| |

XT016

During the last year of [his/her] life, for how long altogether did [{Name of the deceased}] stay at hospitals, hospices or nursing homes?

DURING THE LAST YEAR OF [HIS/HER] LIFE, FOR HOW LONG ALTOGETHER DID [{NAME OF THE DECEASED}] STAY AT HOSPITALS, HOSPICES OR NURSING HOMES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Less than one week
2 One week or more but less than one month
3 One month or more but less than 3 months
4 3 months or more but less than 6 months
5 6 months or more but less than a year
6 A full year

========================================================================

XT107

During the last year of [his/her] life, did [{Name of the deceased}] have any difficulty recognizingfamily members or good friends? (Please name only difficulties that lasted at least three months?)

DURING THE LAST YEAR OF [HIS/HER] LIFE, DID [{NAME OF THE DECEASED}] HAVE ANY DIFFICULTY RECOGNIZINGFAMILY MEMBERS OR GOOD FRIENDS? (PLEASE NAME ONLY DIFFICULTIES THAT LASTED AT LEAST THREE MONTHS?)
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No

As CNT goes from 1 to 8 » »

| If (CNT < 3) or (CNT > 5)) or (We would lik e to k now more about the difficulties people have in their last year of life because of a physical, mental, emotional or memory problems. During the last year of[his/her] life, did [{Name of the deceased}] have any difficulty remembering where [he/she] was? Please name only difficulties that lasted at least three months? (XT105) <> 1 Yes 5 No ) »

| | ========================================================================

| |

XT018

Has [{Name of the deceased}] had any [care from a general practitioner/care from specialist physicians/hospital stays/care in a nursing home/hospicestays/medication/aids and appliances/home care or home help due to disability] (in the last 12 months of [his/her] life)?

HAS [{NAME OF THE DECEASED}] HAD ANY [CARE FROM A GENERAL PRACTITIONER/CARE FROM SPECIALIST PHYSICIANS/HOSPITAL STAYS/CARE IN A NURSING HOME/HOSPICESTAYS/MEDICATION/AIDS AND APPLIANCES/HOME CARE OR HOME HELP DUE TO DISABILITY] (IN THE LAST 12 MONTHS OF [HIS/HER] LIFE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No

| | If Has [{Name of the deceased}] had any [care from a general practitioner/care from specialist physicians/hospital stays/care in a nursing home/hospicestays/medication/aids and appliances/home care or home help due to disability] (in the last 12 months of [his/her] life)? (XT018) = 1 Yes 5 No »

| | | ========================================================================

| | |

XT019

About how much did [his/her] [care from a general practitioner/care from specialist physicians/hospital stays/care in a nursing home/hospice stays/medication/aidsand appliances/home care or home help due to disability] cost (in the last 12 months of [his/her] life)?

ABOUT HOW MUCH DID [HIS/HER] [CARE FROM A GENERAL PRACTITIONER/CARE FROM SPECIALIST PHYSICIANS/HOSPITAL STAYS/CARE IN A NURSING HOME/HOSPICE STAYS/MEDICATION/AIDSAND APPLIANCES/HOME CARE OR HOME HELP DUE TO DISABILITY] COST (IN THE LAST 12 MONTHS OF [HIS/HER] LIFE)?
- - - - - - - - - - - - - - - - - - - - - - - - -
0..980000

========================================================================

XT105

We would lik e to k now more about the difficulties people have in their last year of life because of a physical, mental, emotional or memory problems. During the last year of[his/her] life, did [{Name of the deceased}] have any difficulty remembering where [he/she] was? Please name only difficulties that lasted at least three months?

WE WOULD LIK E TO K NOW MORE ABOUT THE DIFFICULTIES PEOPLE HAVE IN THEIR LAST YEAR OF LIFE BECAUSE OF A PHYSICAL, MENTAL, EMOTIONAL OR MEMORY PROBLEMS. DURING THE LAST YEAR OF[HIS/HER] LIFE, DID [{NAME OF THE DECEASED}] HAVE ANY DIFFICULTY REMEMBERING WHERE [HE/SHE] WAS? PLEASE NAME ONLY DIFFICULTIES THAT LASTED AT LEAST THREE MONTHS?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No

========================================================================

XT106

During the last year of [his/her] life, did [{Name of the deceased}] have any difficulty rememberingwhat year it was? (Please name only difficulties that lasted at least three months?)

DURING THE LAST YEAR OF [HIS/HER] LIFE, DID [{NAME OF THE DECEASED}] HAVE ANY DIFFICULTY REMEMBERINGWHAT YEAR IT WAS? (PLEASE NAME ONLY DIFFICULTIES THAT LASTED AT LEAST THREE MONTHS?)
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No

========================================================================

XT107

========================================================================

XT020

Because of a physical, mental, emotional or memory problem, did [{Name of the deceased}] have difficulty doing any of the following activities during the last twelve monthsof [his/her] life? Please name only difficulties that lasted at least three months.

BECAUSE OF A PHYSICAL, MENTAL, EMOTIONAL OR MEMORY PROBLEM, DID [{NAME OF THE DECEASED}] HAVE DIFFICULTY DOING ANY OF THE FOLLOWING ACTIVITIES DURING THE LAST TWELVE MONTHSOF [HIS/HER] LIFE? PLEASE NAME ONLY DIFFICULTIES THAT LASTED AT LEAST THREE MONTHS.
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Dressing, including putting on shoes and socks
2 Walking across a room
3 Bathing or showering
4 Eating, such as cutting up your food
5 Getting in or out of bed
6 Using the toilet, including getting up or down
96 None of these

If (Because of a physical, mental, emotional or memory problem, did [{Name of the deceased}] have difficulty doing any of the following activities during the last twelve monthsof [his/her] life? Please name only difficulties that lasted at least three months. (XT020) > 0) and NOT (96 IN XT020) »

| ========================================================================

XT022

Think ing about the activities that the deceased had problems with during the last twelve months of [his/her] life, has anyone helped regularly with these activities?

THINK ING ABOUT THE ACTIVITIES THAT THE DECEASED HAD PROBLEMS WITH DURING THE LAST TWELVE MONTHS OF [HIS/HER] LIFE, HAS ANYONE HELPED REGULARLY WITH THESE ACTIVITIES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No

| If Think ing about the activities that the deceased had problems with during the last twelve months of [his/her] life, has anyone helped regularly with these activities? (XT022) = 1 Yes 5 No »

| | ========================================================================

| |

XT023

Who, including yourself, has helped mainly with these activities? Please name at most three persons.

WHO, INCLUDING YOURSELF, HAS HELPED MAINLY WITH THESE ACTIVITIES? PLEASE NAME AT MOST THREE PERSONS.
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yourself (proxy respondent)
2 Husband or wife or partner of the deceased
3 Mother or father of the deceased
4 Son of the deceased
5 Son-in-law of the deceased
6 Daughter of the deceased
7 Daughter-in-law of the deceased
8 Grandson of the deceased
9 Granddaughter of the deceased
10 Sister of the deceased
11 Brother of the deceased
12 Other relative
13 Unpaid volunteer
14 Professional helper (e.g. nurse)
15 Friend or neighbor of the deceased
16 Other person

| | ========================================================================

| |

XT024

Overall, during the last twelve months of [his/her] life, for how long did the deceased receive help?

OVERALL, DURING THE LAST TWELVE MONTHS OF [HIS/HER] LIFE, FOR HOW LONG DID THE DECEASED RECEIVE HELP?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Less than one month
2 One month or more but less than 3 months
3 3 months or more but less than 6 months
4 6 months or more but less than a year
5 A full year

| | ========================================================================

| |

XT025

And about how many hours of help were necessary during a typical day?

AND ABOUT HOW MANY HOURS OF HELP WERE NECESSARY DURING A TYPICAL DAY?
- - - - - - - - - - - - - - - - - - - - - - - - -
0..24

========================================================================

XT026A

The next questions are about the assets and life insurance policies the deceased may have owned and what happened to those assets after [{Name of the deceased}] died.I appreciate that this may upset or distress you, but we would find it very helpful to have some information about the financial issues surrounding death. Before I continue,though, I'd lik e to assure you again that everything you have already told me and anything else you tell me will be k ept completely confidential.

THE NEXT QUESTIONS ARE ABOUT THE ASSETS AND LIFE INSURANCE POLICIES THE DECEASED MAY HAVE OWNED AND WHAT HAPPENED TO THOSE ASSETS AFTER [{NAME OF THE DECEASED}] DIED.I APPRECIATE THAT THIS MAY UPSET OR DISTRESS YOU, BUT WE WOULD FIND IT VERY HELPFUL TO HAVE SOME INFORMATION ABOUT THE FINANCIAL ISSUES SURROUNDING DEATH. BEFORE I CONTINUE,THOUGH, I'D LIK E TO ASSURE YOU AGAIN THAT EVERYTHING YOU HAVE ALREADY TOLD ME AND ANYTHING ELSE YOU TELL ME WILL BE K EPT COMPLETELY CONFIDENTIAL.
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Continue

========================================================================

XT026B

Some people mak e a will to determine who receives what parts of the estate.Did [{Name of the deceased}] have a will?

SOME PEOPLE MAK E A WILL TO DETERMINE WHO RECEIVES WHAT PARTS OF THE ESTATE.DID [{NAME OF THE DECEASED}] HAVE A WILL?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No

========================================================================

XT027

Who were the beneficiaries of the estate, including yourself?

WHO WERE THE BENEFICIARIES OF THE ESTATE, INCLUDING YOURSELF?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yourself (proxy)
2 Husband or wife or partner of the deceased
3 Children of the deceased
4 Grandchildren of the deceased
5 Siblings of the deceased
6 Other relatives (specify) of the deceased
7 Other non-relatives (specify)
8 Church, foundation or charitable organization
9 Deceased did not leave anything at all (SPONTANEOUS)

If 6 IN XT027 »

| ========================================================================

XT028

IWER:Specify other relative

IWER:SPECIFY OTHER RELATIVE

If 7 IN XT027 »

| ========================================================================

XT029

IWER:Specify other non-relative

IWER:SPECIFY OTHER NON-RELATIVE

========================================================================

XT030

Did the deceased own [his/her] home or apartment - either in total or a share of it?

DID THE DECEASED OWN [HIS/HER] HOME OR APARTMENT - EITHER IN TOTAL OR A SHARE OF IT?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No

If Did the deceased own [his/her] home or apartment - either in total or a share of it? (XT030) = 1 Yes 5 No »

| ========================================================================

XT031

After any outstanding mortgages, what was the value of the home or apartment or the share of it owned by the deceased?

AFTER ANY OUTSTANDING MORTGAGES, WHAT WAS THE VALUE OF THE HOME OR APARTMENT OR THE SHARE OF IT OWNED BY THE DECEASED?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yourself (proxy respondent)
2 Husband or wife or partner
3 Sons or daughters (ASK FOR FIRST NAMES)
4 Grandchildren
5 Siblings
6 Other relatives (specify)
7 Other non-relatives (specify)

| ========================================================================

XT032

Who inherited the deceased's home or apartment, including yourself?

WHO INHERITED THE DECEASED'S HOME OR APARTMENT, INCLUDING YOURSELF?
IWER:CODE RELATIONSHIP TO DECEASED.
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yourself (proxy respondent)
2 Husband or wife or partner
3 Sons or daughters (ASK FOR FIRST NAMES)
4 Grandchildren
5 Siblings
6 Other relatives (specify)
7 Other non-relatives (specify)

| If 6 IN XT032 »

| | ========================================================================

| |

XT051

IWER:Specify other relative

IWER:SPECIFY OTHER RELATIVE

| If 7 IN XT032 »

| | ========================================================================

| |

XT052

IWER:Specify other non-relative

IWER:SPECIFY OTHER NON-RELATIVE

| If 3 IN XT032 »

| | ========================================================================

| |

XT053

IWER:First names of children who inherited home

IWER:FIRST NAMES OF CHILDREN WHO INHERITED HOME

========================================================================

XT033

Did the deceased own any life insurance policies?

DID THE DECEASED OWN ANY LIFE INSURANCE POLICIES?
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yes
5 No

If Did the deceased own any life insurance policies? (XT033) = 1 Yes 5 No »

| ========================================================================

XT034

In total, about what was the value of all life insurance policies owned by the deceased?

IN TOTAL, ABOUT WHAT WAS THE VALUE OF ALL LIFE INSURANCE POLICIES OWNED BY THE DECEASED?
- - - - - - - - - - - - - - - - - - - - - - - - -
1000..50000000

| ========================================================================

XT035

Who were the beneficiaries of the life insurance polices, including yourself.

WHO WERE THE BENEFICIARIES OF THE LIFE INSURANCE POLICES, INCLUDING YOURSELF.
- - - - - - - - - - - - - - - - - - - - - - - - -
1 Yourself (proxy respondent)
2 Husband or wife or partner
3 Sons or daughters (ASK FOR FIRST NAMES)
4 Grandchildren
5 Siblings
6 Other relatives (specify)
7 Other non-relatives (specify)

| If 6 IN XT035 »

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XT054

IWER:Specify other relative

IWER:SPECIFY OTHER RELATIVE

| If 7 IN XT035 »

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XT055

IWER:Specify other non-relative

IWER:SPECIFY OTHER NON-RELATIVE

| If 3 IN XT035 »

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XT056

IWER:First names of children who were beneficiaries

IWER:FIRST NAMES OF CHILDREN WHO WERE BENEFICIARIES

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XT036

I will now read out a few types of assets people may have. For each item, please tell me whether the deceased owned them at the time of [his/her] death and, if so, pleasegive your best estimate of their value after any outstanding debts.

I WILL NOW READ OUT A FEW TYPES OF ASSETS PEOPLE MAY HAVE. FOR EACH ITEM, PLEASE TELL ME WHETHER THE DECEASED OWNED THEM AT THE TIME OF [HIS/HER] DEATH AND, IF SO, PLEASEGIVE YOUR BEST ESTIMATE OF THEIR VALUE AFTER ANY OUTSTANDING DEBTS.
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1 Continue

As CNT goes from 1 to 5 » »

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XT037

Did [he/she] own any [businesses, including land or premises/other real estate/cars/financial assets, e.g. cash, bonds or stock s/jewelry or antiquities]?

DID [HE/SHE] OWN ANY [BUSINESSES, INCLUDING LAND OR PREMISES/OTHER REAL ESTATE/CARS/FINANCIAL ASSETS, E.G. CASH, BONDS OR STOCK S/JEWELRY OR ANTIQUITIES]?
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1 Yes
5 No

| If Did [he/she] own any [businesses, including land or premises/other real estate/cars/financial assets, e.g. cash, bonds or stock s/jewelry or antiquities]? (XT037) = 1 Yes 5 No »

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XT038

About what was the value of the [businesses, including land or premises/other real estate/cars/financial assets, e.g. cash, bonds or stock s/jewelry or antiquities] ownedby [{Name of the deceased}] at the time of [his/her] death?

ABOUT WHAT WAS THE VALUE OF THE [BUSINESSES, INCLUDING LAND OR PREMISES/OTHER REAL ESTATE/CARS/FINANCIAL ASSETS, E.G. CASH, BONDS OR STOCK S/JEWELRY OR ANTIQUITIES] OWNEDBY [{NAME OF THE DECEASED}] AT THE TIME OF [HIS/HER] DEATH?
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1 Some children received more than others
2 The estate was divided about equally among all children
3 The estate was distributed exactly among the children
4 The children have not received anything

If (How many children did [{Name of the deceased}] have that were still alive at the time of [his/her] death? Please include foster and adopted children. (XT039) > 1) and NOT (9 IN XT027) »

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XT040A

| If XT040A = 1 »

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XT040B

Would you say that some children received more than others to mak e up for previous gifts?

WOULD YOU SAY THAT SOME CHILDREN RECEIVED MORE THAN OTHERS TO MAK E UP FOR PREVIOUS GIFTS?
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1 Yes
5 No

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XT040C

Would you say that some children received more than others to give them financial support?

WOULD YOU SAY THAT SOME CHILDREN RECEIVED MORE THAN OTHERS TO GIVE THEM FINANCIAL SUPPORT?
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1 Yes
5 No

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XT040D

Would you say that some children received more than others because they helped or cared for the deceased towards the end of [his/her] life?

WOULD YOU SAY THAT SOME CHILDREN RECEIVED MORE THAN OTHERS BECAUSE THEY HELPED OR CARED FOR THE DECEASED TOWARDS THE END OF [HIS/HER] LIFE?
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1 Yes
5 No

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XT040E

Would you say that some children received more than others because of other reasons?

WOULD YOU SAY THAT SOME CHILDREN RECEIVED MORE THAN OTHERS BECAUSE OF OTHER REASONS?
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1 Yes
5 No

| | If Would you say that some children received more than others because of other reasons? (XT040E) = 1 Yes 5 No »

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XT040F

What other reasons do you mean?

WHAT OTHER REASONS DO YOU MEAN?

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XT041

Finally, we would lik e to k now about the deceased's funeral. Was the funeral accompanied by a religious ceremony?

FINALLY, WE WOULD LIK E TO K NOW ABOUT THE DECEASED'S FUNERAL. WAS THE FUNERAL ACCOMPANIED BY A RELIGIOUS CEREMONY?
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1 Yes
5 No

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XT108

We have ask ed you many questions about numerous aspects of [{Name of the deceased}]'s health and finances, and we want to thank you very much for your assistancewith them. Is there anything else you would lik e to add about the life circumstances of [{Name of the deceased}] in [his/her] last year of life?

WE HAVE ASK ED YOU MANY QUESTIONS ABOUT NUMEROUS ASPECTS OF [{NAME OF THE DECEASED}]'S HEALTH AND FINANCES, AND WE WANT TO THANK YOU VERY MUCH FOR YOUR ASSISTANCEWITH THEM. IS THERE ANYTHING ELSE YOU WOULD LIK E TO ADD ABOUT THE LIFE CIRCUMSTANCES OF [{NAME OF THE DECEASED}] IN [HIS/HER] LAST YEAR OF LIFE?

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XT042

This is the end of the interview. Thank you once again for all the information you have given us. It will prove extremely useful in helping us to understand how people fare atthe end of their lives

THIS IS THE END OF THE INTERVIEW. THANK YOU ONCE AGAIN FOR ALL THE INFORMATION YOU HAVE GIVEN US. IT WILL PROVE EXTREMELY USEFUL IN HELPING US TO UNDERSTAND HOW PEOPLE FARE ATTHE END OF THEIR LIVES
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1 Continue

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XT043

IWER:Please state mode of interview

IWER:PLEASE STATE MODE OF INTERVIEW
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1 Face-to-face
2 Telephone

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XT044

IWER:Your interviewer id.

IWER:YOUR INTERVIEWER ID.

End of XT. End-of-Life Interview

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XT. End-of-Life Interview