Survey Text

1972
top
1972
Survey form view entire document:  text  image

Please look at this card (Hand respondent Card M)

Card M
Mobility


In terms of health:
1. Must stay in bed all or most of the time.
2. Must stay in the house all or most of the time.
3. Need the help of another person in getting around inside or outside the house.
4. Need the help of some special aid, such as a cane or wheelchair in getting around inside or outside the house.
5. Does not need the help of another person or a special aid but has trouble getting around freely.
6. Does not have trouble getting around freely.


Which one of these statements fits -- best in terms of health? (Circle appropriate number)
[] 1 (24a)
[] 2 (24a)
[] 3 (24a)
[] 4 (24a)
[] 5 (24a)
[] 6 (NP)


If respondent does not understand or is unable to read the card, ask questions 19-23 for each person.


[End section M]


19. In terms of health must -- stay IN BED all or most of the time?
1 [] Y (24a)
[] N


20. In terms of health must -- stay IN THE HOUSE all or most of the time?
2 [] Y (24a)
[] N


21. Does -- need the help of ANOTHER PERSON in getting around inside or outside the house?
3 [] Y (24a)
[] N


22. Does -- need help of some SPECIAL AID, such as a cane or wheelchair in getting around inside or outside the house?
4 [] Y (24a)
[] N


23. Although -- does not need the help of another person or a special aid, does he have trouble getting around freely?
5 [] Y (24a)
6 [] N (NP)