Section D: Functional Status

Section D: Functional Status Module of CRELES Wave 3

Label Type Description
D1 Question Are you able to walk?
D2 Question Do you have difficulty in walking a few blocks?
D3 Question Do you have difficulty in climbing stairs up a few floors without resting?
D4 Question Do you have difficulty in pushing or pulling a big object like a couch?
D5 Question Please lift and stretch your arms above your shoulders.
D6 Question Do you have difficulty in walking across from one side of a room to another?
D7 Question Do you use any kind of apparatus or instrument such as a cane wheelchair, walker, crutches, etc., to help you across a room?
D8 Question Do you have difficulty in bathing, including entering and exiting the bathtub?
D9 Question Have you evern used an apparatus or instrument (railing or stool) to bathe?
D10 Question Does someone help you bathe?
D11 Question Do you have difficulty in eating, including cutting food, filling glasses, etc.?
D12 Question Does someone help you to eat?
D13 Question Do you have difficulty in getting into bed or getting out of bed?
D14 Question Have you ever used an apparatus or instrument to help you get into or get out of bed?
D15 Question Does someone help you get into bed our to get out of bed?
D16 Question Do you have difficulty in using the restroom, including sitting and getting up from the toilet?
DN1 Question Does (NAME) use protective undergarments ( "diapers ")?
D17 Question Have you ever used an apparatus or instrument to help you use the restroom?
D18 Question Does someone help you use the restroom?
D19 Question Do you have difficulty in cutting your toenails?
D20 Question Does someone help you cut your toenails?
D21 Question Do you have difficulty in preparing warm food?
D22 Question Does someone help you prepare warm meals?
D23 Question Do you have difficulty in managing your own money?
D24 Question Does someone help you manage your money?
D25 Question Do you have difficulty in shopping (for example, groceries, clothes)?
D26 Question Does someone help you do the grocery shopping?
D27 Question Do you have difficulty in taking your medications?
D28 Question Does someone help you take your medications?
D29a Question Does the interviewee receive help with at least one of the above-mentioned activities?
D29b Question How many people help?
D30c Question Who is the person who mainly helps you?
D30a Question Who?______________________
D30b Question Who?________
D31 Question In the last month, about how many days did ____ help you?
D32 Question Is there another person who also helped you?
D33 Question In the last month, about how many days did ___ help you?