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BM001
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[Equipment needed: Omron HEM-780N Monitor, Batteries, Stopwatch] I would like to measure your blood pressure and pulse using this monitor and cuff which I will secure around your left arm. I would like to take three blood pressure measures. I will ask you to relax and remain seated and quiet, with legs uncrossed and feet flat on the floor, during the measurements. First, I will place the cuff on your left arm. Once the cuff is placed appropriately on your arm and we are ready to begin, I will ask you to lay your arm on a flat surface, palm facing up, so that the center of your upper arm is at the same height as your heart. I will then press the start button. The cuff will inflate and deflate automatically. It will squeeze your arm a bit, but won't hurt. After we have completed all three measures, I will give you your results. Do you understand these directions and are you willing to provide this measurement? |
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BM002
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Did you smoke, exercise, or consume alcohol or food within the 30 minutes prior the blood pressure test? |
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BM003
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Do you have a rash, a cast, edema (swelling) in the left arm, open sores or wounds, or a significant bruise where the blood pressure cuff will be in contact? |
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BM004
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[Ask only if BM003=1]Do you have a rash, a cast, edema (swelling) in the right arm, open sores or wounds, or a significant bruise where the blood pressure cuff will be in contact? |
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BM005_intro
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When the device is in the correct position and the R is relaxed, press the button to Start. Measure blood pressure and pulse three times with one minute gap between each of the measurements. No need to remove the cuffs and the device between the measurements. Record measurements in chart: (Enter 993 in first systolic reading if R tried but was unable to do it/if an unresolvable equipment problem occurs. Enter 999 if R chose not to do it.) If the lowest reading obtained is greater than 140 systolic or greater than 90 diastolic, fill out the High-Blood Pressure Card and leave it with the respondent. [Soft Check: Systolic: BM006=>90 or =<250; BM010=>90 or =<250; BM014=>90 or =<250] [Diastolic: BM007=>40 or =<150; BM011=>40 or =<150; BM015=>40 or<=150] [Pulse: BM008, BM012, BM016=>60 or <=150] [Hard check: BM006
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BM005
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Time of Reading __ __:__ __ am/pm |
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BM006
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Systolic Reading ___ mmHg |
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BM007
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Diastolic Reading ___ mmHg |
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BM008
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Pulse ___ Beats/min |
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BM009
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Time of Reading __ __:__ __ am/pm |
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BM010
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Systolic Reading___ mmHg |
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BM011
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Diastolic Reading___mmHg |
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BM012
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Pulse ___ Beats/min |
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BM013
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Time of Reading __ __:__ __ am/pm |
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BM014
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Systolic Reading___ mmHg |
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BM015
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Diastolic Reading___mmHg |
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BM016
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Pulse ___ Beats/min |
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BM017
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Systolic Reading ___mmHg |
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BM018
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Diastolic Reading ___mmHg |
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BM019
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Pulse __ Beats/min |
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BM020
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Which arm was used to conduct the measurements? |
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BM021
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What was R's position for this test? |
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BM022
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How compliant was R during this measurement? |
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BM023
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[Equipment needed: Dynamometer, Stopwatch] Now I would like to assess the strength of your hand in a gripping action. I will ask you to squeeze this handle as hard as you can, just for a couple of seconds and then let go. I will take alternately two measurements from your right and your left hand. Begin the test with the left hand. |
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BM024
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Before we begin, I would like to make sure it is safe for you to do this measurement. Have you had surgery or experienced any swelling, inflammation, severe pain, or injury in one or both hands within the last 6 months? |
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BM025
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In which hand (have you had surgery or experienced any swelling, inflammation, severe pain, or injury in the last 6 months)? |
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BM026
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Which is your dominant hand? |
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BM027_intro
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[Note: Conduct one practice with R's [right/left] hand]: We can practice with your [right/left] hand Start measurement from Left hand first. Take 30 second-rests between two measurements. Record measurements to the nearest 0.5 kilogram in the table below. Record 993 if R tried but was unable/if an irresolvable equipment problem occurs. Record 999 if R chose not to do it] [Soft check: BM028, BM029, BM030, BM031 =>5 or <= 60 kg][Hard check: There should be a 30 second gap between each reading] |
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BM028
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1st Left hand [(Ask if BM024=1 & BM025=3) or BM024=2] ____._ kg |
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BM029
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1st Right Hand [(Ask if BM024=1 & BM025=2) or BM024=2] ____._ kg |
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BM030
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2nd Left hand [(Ask if BM024=1 & BM025=3) or BM024=2] ____._ kg |
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BM031
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2nd Right Hand [(Ask if BM024=1 & BM025=2) or BM024=2] ____._ kg |
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BM032
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How much effort did R give to this test? |
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BM033
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What was R's position for this test? |
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BM034
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Did R rest their arm on a support while performing the test? |
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BM035
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[Equipment needed: Stopwatch, Show Card] I would now like you to try to stand in different positions. I will first describe and show each position to you. Then, I would like you to try to do it. If you cannot do a particular position, or if you feel it would be unsafe to try to do it, tell me and we will move on to the next one. Let me emphasize that I do not want you to try to do any activity that you feel might be unsafe. For the first one, I want you to try to stand with the side of the heel of one foot touching the big toe of the other foot for about 10 seconds. You may put either foot in front, whichever is more comfortable for you. Like this... Demonstrate the measurement. Stand and place the heel of one foot touching the big toe of the other foot. |
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BM036
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Before we begin, do you have any problems from recent surgery, injury or other health conditions that might prevent you from standing up from a chair and balancing? |
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BM037
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Discuss with him/her whether s/he should attempt each measurement given his/her physical problems after describing each measurement. Do not assume a respondent is too physically limited to attempt a measurement without discussing it with him/her. Do you understand these directions and are willing to provide this measurement? |
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BM038
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Did R hold semi-tandem stand for a full 10 seconds without stepping out of place or grabbing hold of anything? |
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BM040
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Did R use any compensatory movements of his/her trunk, arms or legs to steady him/herself during semi-tandem stand? |
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BM041
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[Equipment needed: Stopwatch, Show Card] Now I will show you next movement. I want you to try to stand with your feet together, side-by-side for about 10 seconds. You may use your arms, bend your knees, or move your body to maintain your balance, but try not to move your feet. Try to hold this position until I tell you to stop. Like this... Demonstrate the measurement Stand with feet together. Do you understand these directions and are you willing to do this test? |
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BM042
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Did R hold side-by-side stand for a full 10 seconds without stepping out of place or grabbing hold of anything? |
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BM044
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Did R use any compensatory movements of his/her trunk, arms or legs to steady him/herself during side-by-side stand? |
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BM045
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Record the type of floor surface that the balance measures were conducted on. |
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BM046
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How compliant was R during the balance measurement? |
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BM047
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[Equipment needed: Stopwatch, Show Card] Record eligible time If R's age is >=70, tandem time is 30 seconds. If R's age is <70, tandem time is 60 seconds. The full-tandem time for which R is eligible: |
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BM048
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Now I want you to try to stand with the heel of one foot in front of and touching the toes of the other foot for about [30/60] seconds. You may put either foot in front, whichever is more comfortable for you. You may use your arms, bend your knees, or move your body to maintain your balance, but try not to move your feet. Try to hold this position until I tell you to stop. Like this.. Demonstrate the measurement. Stand and place the heel of one foot touching the toes of the other foot. Do you understand these directions and are you willing to do this test? |
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BM049_IWER
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Did R hold full-tandem stand for a full [30/60] seconds without stepping out of place or grabbing hold of anything? |
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BM051_IWER
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Did R use any compensatory movements of his/her trunk, arms or legs to steady him/herself during the full-tandem stand? |
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BM052
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Record the type of floor surface that the balance measures were conducted on. |
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BM053_IWER
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How compliant was R during the balance measurements? |
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BM054
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Next, I would like to assess whether you can walk a very short distance comfortably (using a walking stick or other aid if necessary). First, I want to make sure it is safe to carry out the measurement. Do you have any problems from recent surgery, injury, or other health conditions that might prevent you from walking? |
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BM055
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Now let's find a place where we can conduct the measurement. We will need a clear space about 4 meters long in a non-carpeted area, if possible. I'm going to place the measuring tape alongside the space where the walk will take place. Set up the course (4meters) This is our walking course. I am going to time you as you walk the course. I will be asking you to walk the course two times. I will walk along side you the whole time during the measurement. Now, I would like to demonstrate how to do the measurement. You will start by lining your feet up at the starting point. Demonstrate the measurement Do you understand these directions and are you willing to do this test? |
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BM056_ intro
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I will be asking you to walk the course at your usual pace a total of two times. I will walk alongside you the whole time during the measurement. I would like you to stand here with your feet lined up. Start walking when I say ÒBeginÓ. Walk all the way past the other end of the tape before you stop. Are you ready to go now? Begin. [Repeat the measurement]: ÒNow I want you to repeat the walk. Remember to walk at your usual pace and go all the way past the other end of the course. I would like you to stand here with your feet lined up. Start walking when I say ÒBeginÓ. Are you ready to go now? Begin. [Instructions for Interviewer: Record measurements in table below. Record 993 if R tried but was unable. Record 999 if R chose not to do it.] [Record up to 2 decimal points: Example 10.15 seconds] |
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BM056
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1st Walking Speed Time ___.__ seconds |
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BM057
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2nd Walking Speed Time ___.__ seconds |
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BM058
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Record type of aid used |
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BM059
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How compliant was R during this measurement? |
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BM060
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[Equipment needed: CAPI, Flexible steel measuring tape, Sticky tape] We are now going to test your distance vision and near vision. Can you see light and count the fingers of hand held 2 feet in front of your face with one eye open and when wearing your glasses or contacts? |
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BM060a
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Left |
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BM060b
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Right |
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BM061_Intro
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[Distance vision] [Instructions for Interviewer: Start with using CAPI screen placed at 3 meters distance] We will start with your distance vision - and with your left eye. Would you please cover your Right eye with the palm of your Right- hand? Indicate if the "E" is facing Up, Down, Left or Right. Please read .. [Instructions for Interviewer: Set the Mini Laptop (CAPI Device) at eye level. For the displayed orientations, mark the responses given by 'R', as ÒcorrectÓ or ÒincorrectÓ. Once the test is completed the test results will be displayed on CAPI device & recorded automatically] Now please cover your left eye with your left-hand so we can test your right eye. Please read... [Instruction for CAPI: Record acuity in BM061-BM062 |
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BM061
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Distance Vision - Left Eye Distance Vision |
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BM062
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Distance Vision - Right Eye Distance Vision |
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BM063_Intro
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Okay, now we would like to test your near vision at 40cm - starting again with your Left eye - please cover your Right eye with your Right hand. Indicate if the "E" is facing up, down, left or right. Please read... Now cover your left eye with your left hand so I can test your right eye. Please read... [Ask respondent to stand or sit 40 centimetres from the monitor. Set the Mini Laptop (CAPI Device) at eye level. Then place the palm over the eye with the same hand. Responses will be verbal (Up, Down, Left, Right). Interviewer will mark correct or incorrect response] [Instruction for CAPI: Record acuity in BM063-BM064] |
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BM063
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Near Vision - Left Eye Near Vision |
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BM064
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Near Vision - Right Eye Near Vision |
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BM065
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How compliant was R during this measurement? |
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BM066
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[Equipment needed: Stadiometer] Can the respondent stand? |
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BM067
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Record R's height in centimetres __._ cm [Hard check: 50>=BM067>250] |
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BM068
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Was R wearing any artificial limbs or orthosis during the measurement? |
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BM069
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How compliant was R during this measurement? |
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BM070
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[Equipment needed: Weighing Scale] Next, I would like to measure your weight. To complete this measurement, I will be asking you to remove bulky clothing and to take off your shoes during weight measurements. Stand up and look straight ahead. [Instruction for Interviewer: Demonstrate the measurement] |
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BM071
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[Instruction for Interviewer: Record measurement in kilograms in table below: Enter 993 if R tried but received an error message. Record R's weight up to 2 decimal points] ___._ _ [Soft check: 25<=BM071<=250] |
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BM072
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Was R wearing an artificial limb or orthosis during the measurement? |
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BM074
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How compliant was R during this measurement? |
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BM075
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[Equipment needed: Soft tape measure] Next I am going to ask you to perform a simple measurement of your waist circumference. For this measurement it is important for you to be standing. I will ask you to identify where on your body your navel (belly button) is located. I will then ask you to place this soft measuring tape around your waist, over your clothing, holding it securely at the level of your navel. Once the tape measure is placed appropriately around your waist then we are ready to begin. I will ask you to take a normal breath and exhale, holding your breath at the end of the exhale. I will then record the measurement. |
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BM076_intro
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Record measurement in table below: Enter 999 if R chose not to do it. Record R's waist circumference to the nearest 0.1 cm |
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BM076
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Waist Measurement ______ [Soft check: BM076 >=50 or <150] |
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BM077
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Was R wearing bulky clothing during this measurement? |
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BM078
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[Equipment needed: Soft tape measure] Next I am going to ask you to perform a simple measurement of your hip circumference. For this measurement it is important for you to be standing. I will ask you to identify where the maximum circumference of your hip. I will then ask you to place this soft measuring tape around your hip, over your clothing, holding it securely. Once the tape measure is placed appropriately around your hip and parallel to floor then we are ready to begin. I will ask you to take a normal breath and exhale, holding your breath at the end of the exhale. I will then record the measurement. |
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BM079
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Record measurement in table below: Enter 999 if R chose not to do it. Record R's Hip Circumference to the nearest 0.1 cm ______ [BM079>=50 or <150] |
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BM080
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What difficulties occurred during this measurement? [Multiple answers are allowed][Instructions for CAPI: if BM080=a then freeze other options] |
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BM081
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Who conducted this measurement? |
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BM082
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Do you have any of the following condition? [Instruction for CAPI: If any of questions BM082a to BM082e=1, then skip to BM088] |
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BM082a
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Active Tb or Upper Respiratory tract infection (cough) |
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BM082b
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Eye surgery in last 3months |
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BM082c
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Abdominal Surgery in last 3 months |
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BM082d
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Myocardial Infarction in last 3 month |
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BM082e
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[If DM003 =2 & DM005 < 55] Pregnancy ( any trimester) |
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BM083
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Have you used any Inhalers in the last 6 hours? |
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BM084
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[Equipment needed: Spirometer, Disposable mouthpiece] Next I am going to ask you to perform a simple task of taking a deep breath and then blowing as long and hard as you can into a small tube attached to this machine. The machine measures how long it takes you to blow out all the air from your lungs. I would like you to perform the measurement few times. When we are ready to begin, I will ask you to sit up straight. Open your mouth and close your lips firmly around the outside of the mouthpiece. Take as deep a breath as possible and then blow as hard and as fast as you can into the mouth piece followed by deep inhalation again like this.... Demonstrate the measurement. Sit up, place lips around the outside of the mouth piece. Take a deep breath, and then blow as hard and as fast as you can. Do you understand these directions and are you willing to provide this measurement? |
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BM085
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[Instruction for Interviewer: CAPI should be connected with Spirometry instrument. Perform the test; and the spirometry readings will be automatically recorded in the CAPI] [Instruction for Interviewer: Step1: CAPI should be connected with Spirometry inst |
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BM086
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What was R's position for this test? |
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BM087
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How much effort did R give to this test? |
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BM088
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I would like to collect a small sample of your blood using just a finger prick. We would be very grateful if you would agree to provide us with a sample of blood. This is an important part of the study, as the analysis of blood samples will tell us a lot about the health of the population. Before we begin, I would like to read this consent form. Longitudinal Ageing Study in India (LASI) International Institute for Population Sciences (IIPS) Additional Consent Form for Blood Sample Collection for Storage and Future Use This is in continuation with your individual consent that you have already given. Further, we would like to inform you that as a part of this longitudinal ageing study, we want to collect few drops of your blood sample using finger prick. The blood sample will be used to test anemia, diabetes, and chronic infections. Your blood sample will be extremely useful to plan special health care services for the older population in the country. The test uses new, disposable sterile instruments that are clean and completely safe in use. I will prick your finger to draw few drops of blood. These drops will be soaked on a piece of filter paper. These pieces of paper will be used to check various health conditions. The blood sample will be sent to National AIDS Research Institute (NARI), which is a premier institute devoted to health research for analysis and storage. The information you will provide will be kept strictly confidential. The results of the blood test will only be used for research and planning purposes without any personal identification. However, if you decide not to provide a blood sample, it is your right and we will respect your decision. Should you have any question about the survey please feel free to ask me or contact the concerned authority (Interviewer: Provide Card). Director / Project Coordinators International Institute for Population Sciences (IIPS) Govandi Station Road, Deonar, Mumbai-400 088. Tel: 022-42372-682/ 401/ 682/ 417/ 422, Fax: 022-42372401. Do you agree to provide consent for giving few drops of blood sample? (Circle one of the response) |
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BM089_intro
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[Equipment needed: Black spread sheet, DBS Kit, Gloves, Small Biohazard Container, Barcode Scanner and Barcode label, drying rack with Box] |
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BM089
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Date ___date(dd/mm/yyyy) |
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BM090
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Time ____:____ am/pm(12hour clock |
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BM091
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Instructions for IWER:Step 1. Scan the barcode. Step 2. Enter the Barcode number twice: BM091a & BM091b CAPI will check BM091a=Bm091b If not, re-enter.BM091a Sample Barcode number:______BM091b Sample Barcode number:______[BM091 up to 14 digits] |
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BM092
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What, if any, problems occurred during the collection of the blood sample? [Multiple answers are allowed] [Instruction for CAPI: BM092=a then freeze other options] |
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BM093
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How many circles were filled on the DBS card? |
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BM094
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[For the Health Investigator]DBS quality assessment by the health investigator, which is to be completed after they have collected blood spots. What is the quality of the blood spots that have been collected? |
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BM095
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How many times did the R's finger need to be pricked in order to get 5 drops of blood? |
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BM096
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How compliant was R during this measurement? |
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BM097
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Thank you for your cooperation. This concludes the physical measure and biomarkers portion of the survey. |