ID

40780

Beschrijving

This list contains questions about what this care means for you as a care receiver. Your answers will be used in research to improve care for the elderly. The more information there is about care for elderly people, the more this can be taken into consideration. For example, when changing the facilities, regulations or legislation for care and wellbeing. Therefore, your experiences are also valuable for other elderly people. Instructions for this questionnaire: - Completing this questionnaire will take approximately half an hour. - Read each question through completely before selecting an answer. - If you find it difficult to understand or answer the questions, ask your partner, a family member or a friend to help you. - Some questions may appear to be ‘repeated’, but please answer all questions. They are intended to view your situation again from a different angle. - When you are done, please check that you have not forgotten any questions. The Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS) is a public data repository which contains information on the physical and mental health and wellbeing of older persons and informal caregivers across the Netherlands. The database was developed in part to ensure uniform collection of outcomes measures, thus promoting comparability between studies. To date, 53 different research projects have contributed data to this initiative, resulting in a pooled dataset >44,000 older persons and >9,000 informal caregivers. Parts of the SF-36 (RAND/Version 1) are included in this form. More information about SF-36 can be found at https://www.rand.org/health-care/surveys_tools/mos/36-item-short-form.html This form contains the english version of TOPICS-MDS 2017. More information can be found at https://topics-mds.eu

Link

https://www.rand.org/health-care/surveys_tools/mos/36-item-short-form.html

Trefwoorden

Versies (5)
  1. 12-05-20 12-05-20 -
  2. 19-11-20 19-11-20 -
  3. 30-01-21 30-01-21 -
  4. 11-02-21 11-02-21 - Sarah Riepenhausen
  5. 27-09-21 27-09-21 -
Houder van rechten

Radboud University Medical Center, Department of Geriatric Medicine

Geüploaded op

12 mei 2020

DOI

Voor een aanvraag inloggen.

Licentie

Creative Commons BY-NC 4.0
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TOPICS-MDS

Engels Nederlands

TOPICS-MDS Care Receiver Baseline + Follow-up

1 Formulieren  
Distinction if this form is filled in at baseline or follow-up.
Beschrijving

Distinction if this form is filled in at baseline or follow-up.

Alias
UMLS CUI-1
C1522577
UMLS CUI-2
C1442488
Please tick, if you fill in this form at baseline or follow-up.
Beschrijving

Please pay attention to items which have to be filled in only at baseline.

Datatype

integer

Alias
UMLS CUI [1,1]
C1522577
UMLS CUI [1,2]
C1442488
Date of birth, gender and postal code
Beschrijving

Date of birth, gender and postal code

Alias
UMLS CUI-1
C1320722
Date of birth
Beschrijving

Assessment date

Datatype

date

Alias
UMLS CUI [1]
C2985720
Date of birth
Beschrijving

Date of birth

Datatype

date

Alias
UMLS CUI [1]
C0421451
Gender
Beschrijving

Gender

Datatype

text

Alias
UMLS CUI [1]
C0079399
Postal code (four numbers)
Beschrijving

Postal code

Datatype

integer

Alias
UMLS CUI [1]
C0421454
Personal information
Beschrijving

Personal information

Alias
UMLS CUI-1
C1955348
In which country were you born?
Beschrijving

Not filled in at follow-up.

Datatype

integer

Alias
UMLS CUI [1]
C1300001
If you ticked "Another country", in which country were you born?
Beschrijving

Not filled in at follow-up.

Datatype

text

Alias
UMLS CUI [1,1]
C0205394
UMLS CUI [1,2]
C1300001
In which country was your father born?
Beschrijving

Not filled in at follow-up.

Datatype

integer

Alias
UMLS CUI [1,1]
C1300001
UMLS CUI [1,2]
C0015671
If you ticked "Another country", in which country was your father born?
Beschrijving

Not filled in at follow-up.

Datatype

text

Alias
UMLS CUI [1,1]
C0205394
UMLS CUI [1,2]
C0015671
UMLS CUI [1,3]
C1300001
In which country was your mother born?
Beschrijving

Not filled in at follow-up.

Datatype

integer

Alias
UMLS CUI [1,1]
C1300001
UMLS CUI [1,2]
C0026591
If you ticked "Another country", in which country was your mother born?
Beschrijving

Not filled in at follow-up.

Datatype

text

Alias
UMLS CUI [1,1]
C0205394
UMLS CUI [1,2]
C1300001
UMLS CUI [1,3]
C0026591
What is the highest level of education that you have completed?
Beschrijving

Not filled in at follow-up.

Datatype

integer

Alias
UMLS CUI [1]
C4264309
What is your marital status?
Beschrijving

Marital status

Datatype

integer

Alias
UMLS CUI [1]
C0024819
Do you have children?
Beschrijving

Not filled in at follow-up.

Datatype

boolean

Alias
UMLS CUI [1]
C0008059
Living situation
Beschrijving

Living situation

Alias
UMLS CUI-1
C2184149
What is your living situation?
Beschrijving

Living situation

Datatype

integer

Alias
UMLS CUI [1]
C2184149
If "Another" was selected, please specify:
Beschrijving

Other Living situation

Datatype

text

Alias
UMLS CUI [1,1]
C0205394
UMLS CUI [1,2]
C2184149
Health and disease
Beschrijving

Health and disease

Alias
UMLS CUI-1
C0018759
UMLS CUI-2
C0012634
On a scale of 0 to 10: how do you rate your health in general TODAY? 0 indicates ‘completely unhealthy’ and 10 ‘completely healthy’.
Beschrijving

Health in general

Datatype

integer

Alias
UMLS CUI [1,1]
C0424575
UMLS CUI [1,2]
C0449438
UMLS CUI [1,3]
C0750526
Mobility
Beschrijving

Please tick the one box that best describes your health TODAY.

Datatype

integer

Alias
UMLS CUI [1,1]
C0547136
UMLS CUI [1,2]
C0750526
Self-care
Beschrijving

Please tick the one box that best describes your health TODAY.

Datatype

integer

Alias
UMLS CUI [1,1]
C0474417
UMLS CUI [1,2]
C0750526
Usual activities (e.g. work, study, housework, family or leisure activities)
Beschrijving

Please tick the one box that best describes your health TODAY.

Datatype

integer

Alias
UMLS CUI [1,1]
C0001288
UMLS CUI [1,2]
C0750526
Pain / discomfort
Beschrijving

Please tick the one box that best describes your health TODAY.

Datatype

integer

Alias
UMLS CUI [1,1]
C0030193
UMLS CUI [1,2]
C0750526
UMLS CUI [2,1]
C2364135
UMLS CUI [2,2]
C0750526
Anxiety / depression
Beschrijving

Please tick the one box that best describes your health TODAY.

Datatype

integer

Alias
UMLS CUI [1,1]
C0003467
UMLS CUI [1,2]
C0750526
UMLS CUI [2,1]
C0011581
UMLS CUI [2,2]
C0750526
Do you have complaints about your memory?
Beschrijving

Memory problems

Datatype

boolean

Alias
UMLS CUI [1,1]
C0233794
UMLS CUI [1,2]
C1254481
Did you consult a doctor about your memory problems?
Beschrijving

Medical consultation

Datatype

boolean

Alias
UMLS CUI [1,1]
C0233794
UMLS CUI [1,2]
C3826021
Did you fall in the past 12 months?
Beschrijving

Fall in past year

Datatype

boolean

Alias
UMLS CUI [1,1]
C0085639
UMLS CUI [1,2]
C3887293
Do you have or have you had diabetes in the past 12 months?
Beschrijving

Not filled in at follow-up.

Datatype

boolean

Alias
UMLS CUI [1,1]
C0521116
UMLS CUI [1,2]
C0011849
UMLS CUI [2,1]
C0011849
UMLS CUI [2,2]
C3887293
Do you have or have you had a stroke, cerebral haemorrhage (bleed in the brain), cerebral infarction (blocked blood vessel in the brain) or TIA in the past 12 months?
Beschrijving

Not filled in at follow-up.

Datatype

boolean

Alias
UMLS CUI [1,1]
C0521116
UMLS CUI [1,2]
C0038454
UMLS CUI [2,1]
C0038454
UMLS CUI [2,2]
C3887293
UMLS CUI [3,1]
C0007787
UMLS CUI [3,2]
C3887293
UMLS CUI [4,1]
C0521116
UMLS CUI [4,2]
C0007787
UMLS CUI [5,1]
C0007785
UMLS CUI [5,2]
C3887293
UMLS CUI [6,1]
C0007785
UMLS CUI [6,2]
C0521116
UMLS CUI [7,1]
C0521116
UMLS CUI [7,2]
C2937358
UMLS CUI [8,1]
C2937358
UMLS CUI [8,2]
C3887293
Do you have or have you had a heart failure, myocardial infarction (heart attack) or other heart condition in the past 12 months?
Beschrijving

Not filled in at follow-up.

Datatype

boolean

Alias
UMLS CUI [1,1]
C0521116
UMLS CUI [1,2]
C0018801
UMLS CUI [2,1]
C0018801
UMLS CUI [2,2]
C3887293
UMLS CUI [3,1]
C0027051
UMLS CUI [3,2]
C3887293
UMLS CUI [4,1]
C0521116
UMLS CUI [4,2]
C0027051
UMLS CUI [5,1]
C0205394
UMLS CUI [5,2]
C3842523
UMLS CUI [5,3]
C3887293
UMLS CUI [6,1]
C0205394
UMLS CUI [6,2]
C3842523
UMLS CUI [6,3]
C0521116
Do you have or have you had a type of cancer (malignant disease namely) in the past 12 months?
Beschrijving

Not filled in at follow-up.

Datatype

boolean

Alias
UMLS CUI [1,1]
C0521116
UMLS CUI [1,2]
C0006826
UMLS CUI [2,1]
C0006826
UMLS CUI [2,2]
C3887293
Please specify the type of cancer you have or had have:
Beschrijving

Not filled in at follow-up.

Datatype

text

Alias
UMLS CUI [1,1]
C0521116
UMLS CUI [1,2]
C0006826
UMLS CUI [2,1]
C0006826
UMLS CUI [2,2]
C3887293
Do you have or have you had asthma, chronic bronchitis, a pulmonary emphysema or COPD in the past 12 months?
Beschrijving

Not filled in at follow-up.

Datatype

boolean

Alias
UMLS CUI [1,1]
C0521116
UMLS CUI [1,2]
C0004096
UMLS CUI [2,1]
C0004096
UMLS CUI [2,2]
C3887293
UMLS CUI [3,1]
C0521116
UMLS CUI [3,2]
C0008677
UMLS CUI [4,1]
C0008677
UMLS CUI [4,2]
C3887293
UMLS CUI [5,1]
C0521116
UMLS CUI [5,2]
C0034067
UMLS CUI [6,1]
C0034067
UMLS CUI [6,2]
C3887293
UMLS CUI [7,1]
C0521116
UMLS CUI [7,2]
C0024117
UMLS CUI [8,1]
C0024117
UMLS CUI [8,2]
C3887293
Do you have or have you had an involuntary urinary loss (incontinence) in the past 12 months?
Beschrijving

Not filled in at follow-up.

Datatype

boolean

Alias
UMLS CUI [1,1]
C0521116
UMLS CUI [1,2]
C0021167
UMLS CUI [2,1]
C0021167
UMLS CUI [2,2]
C3887293
Do you have or have you had a wearing of the joints (arthrosis, osteoarthritis / degenerative arthritis) in the past 12 months?
Beschrijving

Not filled in at follow-up.

Datatype

boolean

Alias
UMLS CUI [1,1]
C0521116
UMLS CUI [1,2]
C0029408
UMLS CUI [2,1]
C0029408
UMLS CUI [2,2]
C3887293
Do you have or have you had a chronic joint inflammation (arthritis) in the past 12 months?
Beschrijving

Not filled in at follow-up.

Datatype

boolean

Alias
UMLS CUI [1,1]
C0521116
UMLS CUI [1,2]
C0003864
UMLS CUI [2,1]
C0003864
UMLS CUI [2,2]
C3887293
Do you have or have you had a loss of bone tissue (osteoporosis) in the past 12 months?
Beschrijving

Not filled in at follow-up.

Datatype

boolean

Alias
UMLS CUI [1,1]
C0521116
UMLS CUI [1,2]
C0029456
UMLS CUI [2,1]
C0029456
UMLS CUI [2,2]
C3887293
Do you have or have you had a hip fracture or other bone fractures in the past 12 months?
Beschrijving

Not filled in at follow-up.

Datatype

boolean

Alias
UMLS CUI [1,1]
C0521116
UMLS CUI [1,2]
C0019557
UMLS CUI [2,1]
C0019557
UMLS CUI [2,2]
C3887293
UMLS CUI [3,1]
C0521116
UMLS CUI [3,2]
C0205394
UMLS CUI [3,3]
C0016658
UMLS CUI [4,1]
C0205394
UMLS CUI [4,2]
C0016658
UMLS CUI [4,3]
C3887293
Do you have or have you had a dizziness in the past 12 months?
Beschrijving

Not filled in at follow-up.

Datatype

boolean

Alias
UMLS CUI [1,1]
C0521116
UMLS CUI [1,2]
C0012833
UMLS CUI [2,1]
C0012833
UMLS CUI [2,2]
C3887293
Do you have or have you had a Neurological disease (Parkinson’s disease, multiple sclerosis, epilepsy) in the past 12 months?
Beschrijving

Not filled in at follow-up.

Datatype

boolean

Alias
UMLS CUI [1,1]
C0521116
UMLS CUI [1,2]
C0027765
UMLS CUI [2,1]
C0027765
UMLS CUI [2,2]
C3887293
UMLS CUI [3,1]
C0521116
UMLS CUI [3,2]
C0030567
UMLS CUI [4,1]
C0030567
UMLS CUI [4,2]
C3887293
UMLS CUI [5,1]
C0521116
UMLS CUI [5,2]
C0026769
UMLS CUI [6,1]
C0026769
UMLS CUI [6,2]
C3887293
UMLS CUI [7,1]
C0521116
UMLS CUI [7,2]
C0014544
UMLS CUI [8,1]
C0014544
UMLS CUI [8,2]
C3887293
Do you have or have you had a depression in the past 12 months?
Beschrijving

Not filled in at follow-up.

Datatype

boolean

Alias
UMLS CUI [1,1]
C0521116
UMLS CUI [1,2]
C0011581
UMLS CUI [2,1]
C0011581
UMLS CUI [2,2]
C3887293
Do you have or have you had anxiety / panic disorder in the past 12 months?
Beschrijving

Not filled in at follow-up.

Datatype

boolean

Alias
UMLS CUI [1,1]
C0521116
UMLS CUI [1,2]
C0003467
UMLS CUI [2,1]
C0003467
UMLS CUI [2,2]
C3887293
UMLS CUI [3,1]
C0521116
UMLS CUI [3,2]
C0030319
UMLS CUI [4,1]
C0030319
UMLS CUI [4,2]
C3887293
Do you have or have you had dementia in the past 12 months?
Beschrijving

Not filled in at follow-up.

Datatype

boolean

Alias
UMLS CUI [1,1]
C0521116
UMLS CUI [1,2]
C0497327
UMLS CUI [2,1]
C0497327
UMLS CUI [2,2]
C3887293
Do you have or have you had hearing problems (despite hearing aid) in the past 12 months?
Beschrijving

Not filled in at follow-up.

Datatype

boolean

Alias
UMLS CUI [1,1]
C0521116
UMLS CUI [1,2]
C3898940
UMLS CUI [1,3]
C3641650
UMLS CUI [1,4]
C0542459
UMLS CUI [2,1]
C3898940
UMLS CUI [2,2]
C3887293
UMLS CUI [2,3]
C3641650
UMLS CUI [2,4]
C0542459
Do you have or have you had problems with vision (despite glasses / contact lenses)) in the past 12 months?
Beschrijving

Not filled in at follow-up.

Datatype

boolean

Alias
UMLS CUI [1,1]
C0521116
UMLS CUI [1,2]
C3665347
UMLS CUI [1,3]
C3641650
UMLS CUI [1,4]
C3843284
UMLS CUI [2,1]
C3665347
UMLS CUI [2,2]
C3887293
UMLS CUI [2,3]
C3641650
UMLS CUI [2,4]
C3843284
Tasks and activities of daily life
Beschrijving

Tasks and activities of daily life

Alias
UMLS CUI-1
C0001288
Can you, fully independently, dress yourself?
Beschrijving

Dress yourself independently

Datatype

integer

Alias
UMLS CUI [1]
C0429966
Can you, fully independently, stand up from sitting in a chair?
Beschrijving

Stand up independently

Datatype

integer

Alias
UMLS CUI [1,1]
C0560792
UMLS CUI [1,2]
C1299583
Can you, fully independently, wash and dry your whole body?
Beschrijving

Independent body hygiene

Datatype

integer

Alias
UMLS CUI [1,1]
C4055522
UMLS CUI [1,2]
C1299583
Can you, fully independently, go up and down the stairs?
Beschrijving

Independent stair climbing

Datatype

integer

Alias
UMLS CUI [1,1]
C0560077
UMLS CUI [1,2]
C1299583
UMLS CUI [2,1]
C0560081
UMLS CUI [2,2]
C1299583
Can you, fully independently, walk outdoors (if necessary with a cane or wheel rollator)?
Beschrijving

Walk outdoor independently with or without cane or wheel rollator

Datatype

integer

Alias
UMLS CUI [1,1]
C4722228
UMLS CUI [1,2]
C4283770
UMLS CUI [1,3]
C1299583
UMLS CUI [2,1]
C0750377
UMLS CUI [2,2]
C4283770
UMLS CUI [2,3]
C1299583
UMLS CUI [3,1]
C1524063
UMLS CUI [3,2]
C0184339
UMLS CUI [3,3]
C4283770
UMLS CUI [3,4]
C1299583
Can you, fully independently, take care of your feet and toenails?
Beschrijving

Independent foot care and care of toenails

Datatype

integer

Alias
UMLS CUI [1,1]
C3873451
UMLS CUI [1,2]
C1299583
UMLS CUI [2,1]
C0749563
UMLS CUI [2,2]
C1299583
Can you, fully independently, do “light” household activities (for example, dusting and tidying up)?
Beschrijving

Household activities done independently

Datatype

integer

Alias
UMLS CUI [1,1]
C4055557
UMLS CUI [1,2]
C1299583
Can you, fully independently, do the shopping?
Beschrijving

Shopping independently

Datatype

integer

Alias
UMLS CUI [1,1]
C4055547
UMLS CUI [1,2]
C1299583
Can you, fully independently, take your medicines?
Beschrijving

Take medicine independently

Datatype

integer

Alias
UMLS CUI [1,1]
C4075001
UMLS CUI [1,2]
C1299583
Can you, fully independently, use your own or public transportation?
Beschrijving

Independent own transportation or public transportation

Datatype

integer

Alias
UMLS CUI [1,1]
C0871194
UMLS CUI [1,2]
C1299583
UMLS CUI [2,1]
C4274917
UMLS CUI [2,2]
C1299583
Information about mouth care and complaints with mouth, jaws or temples
Beschrijving

Information about mouth care and complaints with mouth, jaws or temples

Alias
UMLS CUI-1
C1161186
UMLS CUI-2
C0848667
UMLS CUI-3
C2108445
UMLS CUI-4
C0935456
UMLS CUI-5
C1457887
I experience pain
Beschrijving

Oral, jaw or temple pain

Datatype

boolean

Alias
UMLS CUI [1]
C0221776
UMLS CUI [2]
C0236000
UMLS CUI [3,1]
C0935456
UMLS CUI [3,2]
C0030193
I have chewing complaints
Beschrijving

Chewing comlaints

Datatype

boolean

Alias
UMLS CUI [1]
C0424869
I have dry mouth complaints
Beschrijving

Dry mouth

Datatype

boolean

Alias
UMLS CUI [1]
C0043352
I have swallowing complaints
Beschrijving

Swallowing complaints

Datatype

boolean

Alias
UMLS CUI [1]
C0392678
How you are feeling
Beschrijving

How you are feeling

Alias
UMLS CUI-1
C1527305
How much of the time during the past 4 weeks have you been a very nervous person?
Beschrijving

Nervous during past 4 weeks

Datatype

integer

Alias
UMLS CUI [1,1]
C0849963
UMLS CUI [1,2]
C3828653
How much of the time during the past 4 weeks have you felt calm and peaceful?
Beschrijving

Calm and peaceful during past 4 weeks

Datatype

integer

Alias
UMLS CUI [1,1]
C3829745
UMLS CUI [1,2]
C3828653
How much of the time during the past 4 weeks have you felt downhearted and blue?
Beschrijving

Downhearted and blue during past 4 weeks

Datatype

integer

Alias
UMLS CUI [1,1]
C3828653
UMLS CUI [1,2]
C3829743
How much of the time during the past 4 weeks have you been a happy person?
Beschrijving

Happy person during past 4 weeks

Datatype

integer

Alias
UMLS CUI [1,1]
C3828653
UMLS CUI [1,2]
C3829752
How much of the time during the past 4 weeks have you felt so down in the dumps that nothing could cheer you up?
Beschrijving

Down in the dumps during past 4 weeks

Datatype

integer

Alias
UMLS CUI [1,1]
C3828653
UMLS CUI [1,2]
C3829738
Social activities
Beschrijving

Social activities

Alias
UMLS CUI-1
C0814554
During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)?
Beschrijving

Physical health or emotional problems interfering with social activities past 4 weeks

Datatype

integer

Alias
UMLS CUI [1]
C3484327
Quality of life
Beschrijving

Quality of life

Alias
UMLS CUI-1
C0034380
On a scale of 0 to 10: how do you rate your life at this moment? 0 indicates ‘completely unsatisfied’ and 10 ‘completely satisfied’.
Beschrijving

The following question is about your ‘quality of life’. This refers to what you think about your life. For example, whether you are satisfied with your life, whether you have enjoyment in your life and whether your life gives you satisfaction.

Datatype

integer

Alias
UMLS CUI [1,1]
C3476431
UMLS CUI [1,2]
C0521116
Your care use
Beschrijving

Your care use

Alias
UMLS CUI-1
C0814514
Have you been admitted to the hospital in the past 12 months?
Beschrijving

You had to stay overnight, for example because you had surgery and could not go home the same day. Did you tick “Yes”? Please answer the following question. If not, go to question after next.

Datatype

boolean

Alias
UMLS CUI [1,1]
C0184666
UMLS CUI [1,2]
C3887293
If you ticked "Yes", how many times have you been admitted to the hospital in the past 12 months?
Beschrijving

Admission quantity to hospital past year

Datatype

integer

Alias
UMLS CUI [1,1]
C0184666
UMLS CUI [1,2]
C3887293
UMLS CUI [1,3]
C1265611
How many days did you stay in hospital in total? If you stayed in hospital more than once in the past 12 months, then please sum up the number of days you stayed during each of the admissions.
Beschrijving

Fill in this item only if you selected "Yes" in the prior question.

Datatype

integer

Alias
UMLS CUI [1,1]
C3694481
UMLS CUI [1,2]
C3887293
Have you visited the emergency department of a hospital for yourself in the past 12 months?
Beschrijving

Other names for emergency department are: emergency room (ER), emergency ward, accident & emergency department (A&E) or casualty department.

Datatype

boolean

Alias
UMLS CUI [1,1]
C0586082
UMLS CUI [1,2]
C3887293
If you ticked "Yes", how many times have you visited the emergency department of a hospital for yourself in the past 12 months?
Beschrijving

Visit quantity of emergency department past year

Datatype

float

Alias
UMLS CUI [1,1]
C0586082
UMLS CUI [1,2]
C1265611
UMLS CUI [1,3]
C3887293
Have you visited an out-of-office hours GP service or had a visit from a general practitioner in the evening, night or on the weekend for yourself in the past 12 months?
Beschrijving

Out-of-office hours GP service past year

Datatype

boolean

Alias
UMLS CUI [1,1]
C0017319
UMLS CUI [1,2]
C0498340
UMLS CUI [1,3]
C3887293
UMLS CUI [2,1]
C0017319
UMLS CUI [2,2]
C1947978
UMLS CUI [2,3]
C0587117
UMLS CUI [2,4]
C3887293
UMLS CUI [3,1]
C0017319
UMLS CUI [3,2]
C1947978
UMLS CUI [3,3]
C0240526
UMLS CUI [3,4]
C3887293
UMLS CUI [4,1]
C0017319
UMLS CUI [4,2]
C0581045
UMLS CUI [4,3]
C3887293
If you ticked "Yes", how many times in total have you visited an out-of-office hours GP service or had a visit from a general practitioner in the evening, night or on the weekend for yourself in the past 12 months?
Beschrijving

Visit quantity of out-of-office hours GP service

Datatype

integer

Alias
UMLS CUI [1,1]
C0017319
UMLS CUI [1,2]
C0498340
UMLS CUI [1,3]
C1265611
UMLS CUI [1,4]
C3887293
UMLS CUI [2,1]
C0017319
UMLS CUI [2,2]
C1947978
UMLS CUI [2,3]
C1265611
UMLS CUI [2,4]
C0587117
UMLS CUI [2,5]
C3887293
UMLS CUI [3,1]
C0017319
UMLS CUI [3,2]
C1947978
UMLS CUI [3,3]
C1265611
UMLS CUI [3,4]
C0240526
UMLS CUI [3,5]
C3887293
UMLS CUI [4,1]
C0017319
UMLS CUI [4,2]
C0581045
UMLS CUI [4,3]
C1265611
UMLS CUI [4,4]
C3887293
How many appointments (office hours and house calls) have you had with a general practitioner for yourself in the past 12 months?
Beschrijving

GP visit past year

Datatype

text

Alias
UMLS CUI [1,1]
C0017319
UMLS CUI [1,2]
C1512346
UMLS CUI [1,3]
C1265611
UMLS CUI [1,4]
C3887293
If you ticked "One or more appointments", how many appointments (office hours and house calls) have you had with a general practitioner for yourself in the past 12 months in total?
Beschrijving

GP visit past year

Datatype

float

Alias
UMLS CUI [1,1]
C0017319
UMLS CUI [1,2]
C1512346
UMLS CUI [1,3]
C1265611
UMLS CUI [1,4]
C3887293
Did you receive home care in the past 12 months?
Beschrijving

Receive home care

Datatype

boolean

Alias
UMLS CUI [1,1]
C0204977
UMLS CUI [1,2]
C3887293
Have you had help with household chores (for example: vacuuming, making the bed, grocery shopping) in the past 12 months?
Beschrijving

Answer this question only, if you have ticked "Yes" in the question about receiving home care.

Datatype

boolean

Alias
UMLS CUI [1,1]
C1514756
UMLS CUI [1,2]
C3273800
UMLS CUI [1,3]
C0557036
UMLS CUI [1,4]
C3887293
Have you received home care in the form of help with personal care (for example: help with bathing/showering or dressing) in the past 12 months?
Beschrijving

Answer only this question, if you have ticked "Yes" in the question about receiving home care.

Datatype

boolean

Alias
UMLS CUI [1,1]
C1514756
UMLS CUI [1,2]
C0686948
UMLS CUI [1,3]
C3887293
Have you received home care in the form of nursing care (for example: changing dressings, administering medications, measuring blood pressure) in the past 12 months?
Beschrijving

Answer only this question, if you have ticked "Yes" in the question about receiving home care.

Datatype

boolean

Alias
UMLS CUI [1,1]
C0028682
UMLS CUI [1,2]
C1553498
UMLS CUI [1,3]
C3887293
How many weeks did you receive help with household chores? Please, sum up all weeks in the past 12 months.
Beschrijving

Answer this question only, if you have ticked "Yes" in the question about receiving help with household chores. Please note: a period of 12 months concerns 52 weeks.

Datatype

integer

Alias
UMLS CUI [1,1]
C3273800
UMLS CUI [1,2]
C1514756
UMLS CUI [1,3]
C0557036
UMLS CUI [1,4]
C3887293
UMLS CUI [1,5]
C0557840
How many weeks did you receive help with personal care? Please, sum up all weeks in the past 12 months.
Beschrijving

Answer only this question, if you have ticked "Yes" in the question about receiving personal care. Please note: a period of 12 months concerns 52 weeks.

Datatype

integer

Alias
UMLS CUI [1,1]
C1514756
UMLS CUI [1,2]
C0686948
UMLS CUI [1,3]
C3887293
UMLS CUI [1,4]
C0557840
How many weeks did you receive home care in the form of nursing care? Please, sum up all weeks in the past 12 months.
Beschrijving

Answer only this question, if you have ticked "Yes" in the question about receiving nursing care. Please note: a period of 12 months concerns 52 weeks.

Datatype

integer

Alias
UMLS CUI [1,1]
C0028682
UMLS CUI [1,2]
C1553498
UMLS CUI [1,3]
C1948053
UMLS CUI [1,4]
C0557840
UMLS CUI [1,5]
C3887293
How many hours of help with household chores did you receive during these weeks on average?
Beschrijving

Answer this question only, if you have ticked "Yes" in the question about receiving help with household chores.

Datatype

integer

Maateenheden
  • hours per week
Alias
UMLS CUI [1,1]
C3273800
UMLS CUI [1,2]
C1514756
UMLS CUI [1,3]
C0557036
UMLS CUI [1,4]
C3887293
UMLS CUI [1,5]
C4289948
hours per week
How many hours of help with personal care did you receive during these weeks on average?
Beschrijving

Answer only this question, if you have ticked "Yes" in the question about receiving personal care. Please note: a period of 12 months concerns 52 weeks.

Datatype

integer

Maateenheden
  • hours per week
Alias
UMLS CUI [1,1]
C1514756
UMLS CUI [1,2]
C0686948
UMLS CUI [1,3]
C4289948
UMLS CUI [1,4]
C3887293
hours per week
How many hours of home care in the form of nursing care did you receive during these weeks on average?
Beschrijving

Answer only this question, if you have ticked "Yes" in the question about receiving nursing care.

Datatype

integer

Maateenheden
  • hours per week
Alias
UMLS CUI [1,1]
C0028682
UMLS CUI [1,2]
C1553498
UMLS CUI [1,3]
C4289948
hours per week
In the past 12 months, did you have to stay overnight somewhere else than your own home because of your health? For example, in a nursing home, residential care center, psychiatric hospital or rehabilitation center?
Beschrijving

Stay overnight past year in nursing home, residential care center, psychiatric hospital or rehabilitation center

Datatype

boolean

Alias
UMLS CUI [1,1]
C0018704
UMLS CUI [1,2]
C0439583
UMLS CUI [1,3]
C3177049
UMLS CUI [1,4]
C3887293
UMLS CUI [2,1]
C0439583
UMLS CUI [2,2]
C0028688
UMLS CUI [3,1]
C0439583
UMLS CUI [3,2]
C0237680
UMLS CUI [4,1]
C0439583
UMLS CUI [4,2]
C0259948
UMLS CUI [5,1]
C0439583
UMLS CUI [5,2]
C1550688
If you have stayed somewhere else overnight in the past 12 months, how many times in total?
Beschrijving

Quantity of overnight stays past year

Datatype

integer

Alias
UMLS CUI [1,1]
C0018704
UMLS CUI [1,2]
C0439583
UMLS CUI [1,3]
C3177049
UMLS CUI [1,4]
C0439603
UMLS CUI [1,5]
C3887293
If you have stayed somewhere else overnight in the past 12 months, how long did you stay in this care facility?
Beschrijving

If you stayed more than once in a care facility in the past 12 months, please sum up the number of days of all stays together.

Datatype

integer

Maateenheden
  • days in total
Alias
UMLS CUI [1,1]
C0018704
UMLS CUI [1,2]
C0439583
UMLS CUI [1,3]
C3177049
UMLS CUI [1,4]
C0023303
UMLS CUI [1,5]
C3887293
days in total
In the past 12 months, did you stay somewhere else than your own home during the day for treatment?
Beschrijving

So, you did not stay overnight. For example, you went to day care or day treatment.

Datatype

boolean

Alias
UMLS CUI [1,1]
C0002423
UMLS CUI [1,2]
C3887293
If you ticked "Yes", how many times per week did you stay somewhere else than your own home during the day for treatment in the past 12 months?
Beschrijving

So, you did not stay overnight. For example, you went to day care or day treatment.

Datatype

integer

Alias
UMLS CUI [1,1]
C0002423
UMLS CUI [1,2]
C0456698
UMLS CUI [1,3]
C3887293
Because of your health problems, did you receive help from your family or friends in the past week with household chores such as preparing food, cleaning your house, doing the laundry, ironing or mending your cloths, grocery shopping or do odd jobs in and around the house?
Beschrijving

Support with household chores in the past week

Datatype

boolean

Alias
UMLS CUI [1,1]
C0001288
UMLS CUI [1,2]
C0581904
UMLS CUI [1,3]
C2987125
UMLS CUI [2,1]
C0001288
UMLS CUI [2,2]
C4708444
UMLS CUI [2,3]
C2987125
If you ticked "Yes", how many hours did you receive help from your family or friends in the past week?
Beschrijving

Quantity of hours of support with household chores past week

Datatype

integer

Maateenheden
  • hours per week
Alias
UMLS CUI [1,1]
C0001288
UMLS CUI [1,2]
C0581904
UMLS CUI [1,3]
C0556976
UMLS CUI [2,1]
C0001288
UMLS CUI [2,2]
C4708444
UMLS CUI [2,3]
C0556976
hours per week
Because of your health problems, did you receive help from your family or friends in the past week with personal care (dressing, washing your body, combing your hair, shaving), toileting, transferring in the house, eating, drinken or taking medications?
Beschrijving

Support with personal care in the past week

Datatype

boolean

Alias
UMLS CUI [1,1]
C0563471
UMLS CUI [1,2]
C0581904
UMLS CUI [1,3]
C2987125
UMLS CUI [2,1]
C0563471
UMLS CUI [2,2]
C4708444
UMLS CUI [2,3]
C2987125
UMLS CUI [3,1]
C0150810
UMLS CUI [3,2]
C0581904
UMLS CUI [3,3]
C2987125
UMLS CUI [4,1]
C0150810
UMLS CUI [4,2]
C4708444
UMLS CUI [4,3]
C2987125
UMLS CUI [5,1]
C2371389
UMLS CUI [5,2]
C0581904
UMLS CUI [5,3]
C2987125
UMLS CUI [6,1]
C2371389
UMLS CUI [6,2]
C4708444
UMLS CUI [6,3]
C2987125
UMLS CUI [7,1]
C1279813
UMLS CUI [7,2]
C4708444
UMLS CUI [7,3]
C2987125
UMLS CUI [8,1]
C1279813
UMLS CUI [8,2]
C0581904
UMLS CUI [8,3]
C2987125
UMLS CUI [9,1]
C1290952
UMLS CUI [9,2]
C0581904
UMLS CUI [9,3]
C2987125
UMLS CUI [10,1]
C1290952
UMLS CUI [10,2]
C4708444
UMLS CUI [10,3]
C2987125
If you ticked "Yes", how many hours per week did you receive help from your family or friends in the past week with personal care?
Beschrijving

Quantity of hours per week of support with personal care

Datatype

boolean

Alias
UMLS CUI [1,1]
C0563471
UMLS CUI [1,2]
C0581904
UMLS CUI [1,3]
C0556976
UMLS CUI [2,1]
C0563471
UMLS CUI [2,2]
C4708444
UMLS CUI [2,3]
C0556976
Because of your health problems, did you receive help from your family or friends in the past week with getting around outside the house, making trips, visiting family or friends, dealings with health care (attending your visits to the GP, hospital or treatment), arranging for help, aids or home adjustments, or arranging your finances or paper work?
Beschrijving

Help from family or friends in past week with getting around outside the house, making trips, visiting family or friends, dealings with health care (attending your visits to the GP, hospital or treatment), arranging for help, aids or home adjustments, or arranging your finances or paper work

Datatype

boolean

Alias
UMLS CUI [1,1]
C3842571
UMLS CUI [1,2]
C0581904
UMLS CUI [1,3]
C2987125
UMLS CUI [2,1]
C3842571
UMLS CUI [2,2]
C4708444
UMLS CUI [2,3]
C2987125
UMLS CUI [3,1]
C0086388
UMLS CUI [3,2]
C0581904
UMLS CUI [3,3]
C2987125
UMLS CUI [4,1]
C0086388
UMLS CUI [4,2]
C4708444
UMLS CUI [4,3]
C2987125
UMLS CUI [5,1]
C1300196
UMLS CUI [5,2]
C0557036
UMLS CUI [5,3]
C0581904
UMLS CUI [5,4]
C2987125
UMLS CUI [6,1]
C1300196
UMLS CUI [6,2]
C0557036
UMLS CUI [6,3]
C4708444
UMLS CUI [6,4]
C2987125
UMLS CUI [7,1]
C1300196
UMLS CUI [7,2]
C0449435
UMLS CUI [7,3]
C0581904
UMLS CUI [7,4]
C2987125
UMLS CUI [8,1]
C1300196
UMLS CUI [8,2]
C0449435
UMLS CUI [8,3]
C4708444
UMLS CUI [8,4]
C2987125
UMLS CUI [9,1]
C1300196
UMLS CUI [9,2]
C0850398
UMLS CUI [9,3]
C0581904
UMLS CUI [9,4]
C2987125
UMLS CUI [10,1]
C1300196
UMLS CUI [10,2]
C0850398
UMLS CUI [10,3]
C4708444
UMLS CUI [10,4]
C2987125
UMLS CUI [11,1]
C0149692
UMLS CUI [11,2]
C4708444
UMLS CUI [11,3]
C2987125
UMLS CUI [12,1]
C0149692
UMLS CUI [12,2]
C0581904
UMLS CUI [12,3]
C2987125
UMLS CUI [13,1]
C2986711
UMLS CUI [13,2]
C4708444
UMLS CUI [13,3]
C2987125
UMLS CUI [14,1]
C2986711
UMLS CUI [14,2]
C0581904
UMLS CUI [14,3]
C2987125
UMLS CUI [15,1]
C2371431
UMLS CUI [15,2]
C0581904
UMLS CUI [15,3]
C2987125
UMLS CUI [16,1]
C2371431
UMLS CUI [16,2]
C4708444
UMLS CUI [16,3]
C2987125
UMLS CUI [17,1]
C0577328
UMLS CUI [17,2]
C0581904
UMLS CUI [17,3]
C2987125
UMLS CUI [18,1]
C0577328
UMLS CUI [18,2]
C4708444
UMLS CUI [18,3]
C2987125
If you ticked "Yes", how many hours per week did you receive help from your family or friends in the past week with getting around outside the house, making trips, visiting family or friends, dealings with health care (attending your visits to the GP, hospital or treatment), arranging for help, aids or home adjustments, or arranging your finances or paper work?
Beschrijving

Quantity of hours of Help from family or friends in past week with getting around outside the house, making trips, visiting family or friends, dealings with health care (attending your visits to the GP, hospital or treatment), arranging for help, aids or home adjustments, or arranging your finances or paper work

Datatype

integer

Alias
UMLS CUI [1,1]
C3842571
UMLS CUI [1,2]
C0581904
UMLS CUI [1,3]
C2987125
UMLS CUI [1,4]
C0556976
UMLS CUI [2,1]
C3842571
UMLS CUI [2,2]
C4708444
UMLS CUI [2,3]
C2987125
UMLS CUI [2,4]
C0556976
UMLS CUI [3,1]
C0086388
UMLS CUI [3,2]
C0581904
UMLS CUI [3,3]
C2987125
UMLS CUI [3,4]
C0556976
UMLS CUI [4,1]
C0086388
UMLS CUI [4,2]
C4708444
UMLS CUI [4,3]
C2987125
UMLS CUI [4,4]
C0556976
UMLS CUI [5,1]
C1300196
UMLS CUI [5,2]
C0557036
UMLS CUI [5,3]
C0581904
UMLS CUI [5,4]
C2987125
UMLS CUI [5,5]
C0556976
UMLS CUI [6,1]
C1300196
UMLS CUI [6,2]
C0557036
UMLS CUI [6,3]
C4708444
UMLS CUI [6,4]
C2987125
UMLS CUI [6,5]
C0556976
UMLS CUI [7,1]
C1300196
UMLS CUI [7,2]
C0449435
UMLS CUI [7,3]
C0581904
UMLS CUI [7,4]
C2987125
UMLS CUI [7,5]
C0556976
UMLS CUI [8,1]
C1300196
UMLS CUI [8,2]
C0449435
UMLS CUI [8,3]
C4708444
UMLS CUI [8,4]
C2987125
UMLS CUI [8,5]
C0556976
UMLS CUI [9,1]
C1300196
UMLS CUI [9,2]
C0850398
UMLS CUI [9,3]
C0581904
UMLS CUI [9,4]
C2987125
UMLS CUI [9,5]
C0556976
UMLS CUI [10,1]
C1300196
UMLS CUI [10,2]
C0850398
UMLS CUI [10,3]
C4708444
UMLS CUI [10,4]
C2987125
UMLS CUI [10,5]
C0556976
UMLS CUI [11,1]
C0149692
UMLS CUI [11,2]
C4708444
UMLS CUI [11,3]
C2987125
UMLS CUI [11,4]
C0556976
UMLS CUI [12,1]
C0149692
UMLS CUI [12,2]
C0581904
UMLS CUI [12,3]
C2987125
UMLS CUI [12,4]
C0556976
UMLS CUI [13,1]
C2986711
UMLS CUI [13,2]
C4708444
UMLS CUI [13,3]
C2987125
UMLS CUI [13,4]
C0556976
UMLS CUI [14,1]
C2986711
UMLS CUI [14,2]
C0581904
UMLS CUI [14,3]
C2987125
UMLS CUI [14,4]
C0556976
UMLS CUI [15,1]
C2371431
UMLS CUI [15,2]
C0581904
UMLS CUI [15,3]
C2987125
UMLS CUI [15,4]
C0556976
UMLS CUI [16,1]
C2371431
UMLS CUI [16,2]
C4708444
UMLS CUI [16,3]
C2987125
UMLS CUI [16,4]
C0556976
UMLS CUI [17,1]
C0577328
UMLS CUI [17,2]
C0581904
UMLS CUI [17,3]
C2987125
UMLS CUI [17,4]
C0556976
UMLS CUI [18,1]
C0577328
UMLS CUI [18,2]
C4708444
UMLS CUI [18,3]
C2987125
UMLS CUI [18,4]
C0556976
Closure
Beschrijving

Closure

Alias
UMLS CUI-1
C1521802
Has somebody helped you to complete this questionnaire?
Beschrijving

Help to complete the questionnaire

Datatype

integer

Alias
UMLS CUI [1,1]
C3828841
UMLS CUI [1,2]
C0034394
If yes, what did the help consist of?
Beschrijving

Type of help to complete questionnaire

Datatype

integer

Alias
UMLS CUI [1,1]
C0332307
UMLS CUI [1,2]
C3828841
UMLS CUI [1,3]
C0034394
If you have any comments, please write them down in the space below:
Beschrijving

Comment

Datatype

text

Alias
UMLS CUI [1]
C0947611
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Similar models

TOPICS-MDS Care Receiver Baseline + Follow-up

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Distinction if this form is filled in at baseline or follow-up.
C1522577 (UMLS CUI-1)
C1442488 (UMLS CUI-2)
Item
Please tick, if you fill in this form at baseline or follow-up.
integer
C1522577 (UMLS CUI [1,1])
C1442488 (UMLS CUI [1,2])
Baseline or Follow-up
Code List
Please tick, if you fill in this form at baseline or follow-up.
CL Item
Baseline (1)
CL Item
Follow-up (2)
Item Group
Date of birth, gender and postal code
C1320722 (UMLS CUI-1)
Assessment date
Item
Date of birth
date
C2985720 (UMLS CUI [1])
Date of birth
Item
Date of birth
date
C0421451 (UMLS CUI [1])
Item
Gender
text
C0079399 (UMLS CUI [1])
Gender
Code List
Gender
CL Item
Male (1)
CL Item
Female (2)
Postal code
Item
Postal code (four numbers)
integer
C0421454 (UMLS CUI [1])
Item Group
Personal information
C1955348 (UMLS CUI-1)
Item
In which country were you born?
integer
C1300001 (UMLS CUI [1])
Country of origin
Code List
In which country were you born?
CL Item
The Netherlands (1)
CL Item
Another country (2)
Other country of origin
Item
If you ticked "Another country", in which country were you born?
text
C0205394 (UMLS CUI [1,1])
C1300001 (UMLS CUI [1,2])
Item
In which country was your father born?
integer
C1300001 (UMLS CUI [1,1])
C0015671 (UMLS CUI [1,2])
Country of origin
Code List
In which country was your father born?
CL Item
The Netherlands (1)
CL Item
Another country (2)
Other father's country of origin
Item
If you ticked "Another country", in which country was your father born?
text
C0205394 (UMLS CUI [1,1])
C0015671 (UMLS CUI [1,2])
C1300001 (UMLS CUI [1,3])
Item
In which country was your mother born?
integer
C1300001 (UMLS CUI [1,1])
C0026591 (UMLS CUI [1,2])
Country of origin
Code List
In which country was your mother born?
CL Item
The Netherlands (1)
CL Item
Another country (2)
Other mother's country of origin
Item
If you ticked "Another country", in which country was your mother born?
text
C0205394 (UMLS CUI [1,1])
C1300001 (UMLS CUI [1,2])
C0026591 (UMLS CUI [1,3])
Item
What is the highest level of education that you have completed?
integer
C4264309 (UMLS CUI [1])
Level of education
Code List
What is the highest level of education that you have completed?
CL Item
Fewer than 6 classes of primary school (1)
CL Item
6 Primary school classes / lom-school / mlk-school (2)
CL Item
More than primary school / primary school with uncompleted further (3)
CL Item
(Pre-)vocational secondary education (Ambachtsschool, vmbo) (4)
CL Item
(Pre-)vocational secondary education (Ambachtsschool, vmbo) (4)
CL Item
Secondary vocational education (Mulo / mms / mavo / mbo) (5)
CL Item
University entrance level (Hbs / gymnasium / atheneum) (6)
CL Item
University / tertiary education / higher professional education (hbo) (7)
Item
What is your marital status?
integer
C0024819 (UMLS CUI [1])
Level of education
Code List
What is your marital status?
CL Item
Married (1)
CL Item
Unmarried, no partner (2)
CL Item
Long-term cohabitation, unmarried  (3)
CL Item
Divorced (4)
CL Item
Divorced (4)
CL Item
Widow / widower / partner deceased (5)
Children
Item
Do you have children?
boolean
C0008059 (UMLS CUI [1])
Item Group
Living situation
C2184149 (UMLS CUI-1)
Item
What is your living situation?
integer
C2184149 (UMLS CUI [1])
Living situation
Code List
What is your living situation?
CL Item
Independent, alone (1)
CL Item
Independent, with others (partner, children, etc.) (2)
CL Item
Care facility (nursing home / residential care centre)  (3)
CL Item
Another (4)
Other Living situation
Item
If "Another" was selected, please specify:
text
C0205394 (UMLS CUI [1,1])
C2184149 (UMLS CUI [1,2])
Item Group
Health and disease
C0018759 (UMLS CUI-1)
C0012634 (UMLS CUI-2)
Health in general
Item
On a scale of 0 to 10: how do you rate your health in general TODAY? 0 indicates ‘completely unhealthy’ and 10 ‘completely healthy’.
integer
C0424575 (UMLS CUI [1,1])
C0449438 (UMLS CUI [1,2])
C0750526 (UMLS CUI [1,3])
Item
Mobility
integer
C0547136 (UMLS CUI [1,1])
C0750526 (UMLS CUI [1,2])
Mobility
Code List
Mobility
CL Item
I have no problems in walking about (1)
CL Item
I have slight problems in walking about (2)
CL Item
I have moderate problems in walking about  (3)
CL Item
I have severe problems in walking about  (4)
CL Item
I am unable to walk about (5)
Item
Self-care
integer
C0474417 (UMLS CUI [1,1])
C0750526 (UMLS CUI [1,2])
Mobility
Code List
Self-care
CL Item
I have no problems washing or dressing myself (1)
CL Item
I have slight problems washing or dressing myself (2)
CL Item
I have moderate problems washing or dressing myself  (3)
CL Item
I have severe problems washing or dressing myself (4)
CL Item
I am unable to wash or dress myself (5)
Item
Usual activities (e.g. work, study, housework, family or leisure activities)
integer
C0001288 (UMLS CUI [1,1])
C0750526 (UMLS CUI [1,2])
Mobility
Code List
Usual activities (e.g. work, study, housework, family or leisure activities)
CL Item
I have no problems doing my usual activities (1)
CL Item
I have slight problems doing my usual activities (2)
CL Item
I have moderate problems doing my usual activities (3)
CL Item
I have severe problems doing my usual activities  (4)
CL Item
I am unable to do my usual activities (5)
Item
Pain / discomfort
integer
C0030193 (UMLS CUI [1,1])
C0750526 (UMLS CUI [1,2])
C2364135 (UMLS CUI [2,1])
C0750526 (UMLS CUI [2,2])
Mobility
Code List
Pain / discomfort
CL Item
I have no pain or discomfort (1)
CL Item
I have slight pain or discomfort (2)
CL Item
I have moderate pain or discomfort  (3)
CL Item
I have severe pain or discomfort (4)
CL Item
I have extreme pain or discomfort (5)
Item
Anxiety / depression
integer
C0003467 (UMLS CUI [1,1])
C0750526 (UMLS CUI [1,2])
C0011581 (UMLS CUI [2,1])
C0750526 (UMLS CUI [2,2])
Mobility
Code List
Anxiety / depression
CL Item
I am not anxious or depressed (1)
CL Item
I am slightly anxious or depressed (2)
CL Item
I am moderately anxious or depressed  (3)
CL Item
I am severely anxious or depressed (4)
CL Item
I am extremely anxious or depressed (5)
Memory problems
Item
Do you have complaints about your memory?
boolean
C0233794 (UMLS CUI [1,1])
C1254481 (UMLS CUI [1,2])
Medical consultation
Item
Did you consult a doctor about your memory problems?
boolean
C0233794 (UMLS CUI [1,1])
C3826021 (UMLS CUI [1,2])
Fall in past year
Item
Did you fall in the past 12 months?
boolean
C0085639 (UMLS CUI [1,1])
C3887293 (UMLS CUI [1,2])
Diabetes in past year and current
Item
Do you have or have you had diabetes in the past 12 months?
boolean
C0521116 (UMLS CUI [1,1])
C0011849 (UMLS CUI [1,2])
C0011849 (UMLS CUI [2,1])
C3887293 (UMLS CUI [2,2])
Stroke, cerebral haemorrhage, cerebral infarction or TIA in past year and current
Item
Do you have or have you had a stroke, cerebral haemorrhage (bleed in the brain), cerebral infarction (blocked blood vessel in the brain) or TIA in the past 12 months?
boolean
C0521116 (UMLS CUI [1,1])
C0038454 (UMLS CUI [1,2])
C0038454 (UMLS CUI [2,1])
C3887293 (UMLS CUI [2,2])
C0007787 (UMLS CUI [3,1])
C3887293 (UMLS CUI [3,2])
C0521116 (UMLS CUI [4,1])
C0007787 (UMLS CUI [4,2])
C0007785 (UMLS CUI [5,1])
C3887293 (UMLS CUI [5,2])
C0007785 (UMLS CUI [6,1])
C0521116 (UMLS CUI [6,2])
C0521116 (UMLS CUI [7,1])
C2937358 (UMLS CUI [7,2])
C2937358 (UMLS CUI [8,1])
C3887293 (UMLS CUI [8,2])
Heart failure, myocardial infarction or other heart disease in past year and current
Item
Do you have or have you had a heart failure, myocardial infarction (heart attack) or other heart condition in the past 12 months?
boolean
C0521116 (UMLS CUI [1,1])
C0018801 (UMLS CUI [1,2])
C0018801 (UMLS CUI [2,1])
C3887293 (UMLS CUI [2,2])
C0027051 (UMLS CUI [3,1])
C3887293 (UMLS CUI [3,2])
C0521116 (UMLS CUI [4,1])
C0027051 (UMLS CUI [4,2])
C0205394 (UMLS CUI [5,1])
C3842523 (UMLS CUI [5,2])
C3887293 (UMLS CUI [5,3])
C0205394 (UMLS CUI [6,1])
C3842523 (UMLS CUI [6,2])
C0521116 (UMLS CUI [6,3])
Cancer in past year and current
Item
Do you have or have you had a type of cancer (malignant disease namely) in the past 12 months?
boolean
C0521116 (UMLS CUI [1,1])
C0006826 (UMLS CUI [1,2])
C0006826 (UMLS CUI [2,1])
C3887293 (UMLS CUI [2,2])
Cancer in past year and current
Item
Please specify the type of cancer you have or had have:
text
C0521116 (UMLS CUI [1,1])
C0006826 (UMLS CUI [1,2])
C0006826 (UMLS CUI [2,1])
C3887293 (UMLS CUI [2,2])
Asthma, chronic bronchitis, pulmonary emphysema or COPD in past year and current
Item
Do you have or have you had asthma, chronic bronchitis, a pulmonary emphysema or COPD in the past 12 months?
boolean
C0521116 (UMLS CUI [1,1])
C0004096 (UMLS CUI [1,2])
C0004096 (UMLS CUI [2,1])
C3887293 (UMLS CUI [2,2])
C0521116 (UMLS CUI [3,1])
C0008677 (UMLS CUI [3,2])
C0008677 (UMLS CUI [4,1])
C3887293 (UMLS CUI [4,2])
C0521116 (UMLS CUI [5,1])
C0034067 (UMLS CUI [5,2])
C0034067 (UMLS CUI [6,1])
C3887293 (UMLS CUI [6,2])
C0521116 (UMLS CUI [7,1])
C0024117 (UMLS CUI [7,2])
C0024117 (UMLS CUI [8,1])
C3887293 (UMLS CUI [8,2])
Incontinence in past year and current
Item
Do you have or have you had an involuntary urinary loss (incontinence) in the past 12 months?
boolean
C0521116 (UMLS CUI [1,1])
C0021167 (UMLS CUI [1,2])
C0021167 (UMLS CUI [2,1])
C3887293 (UMLS CUI [2,2])
Osteoarthritis in in past year and current
Item
Do you have or have you had a wearing of the joints (arthrosis, osteoarthritis / degenerative arthritis) in the past 12 months?
boolean
C0521116 (UMLS CUI [1,1])
C0029408 (UMLS CUI [1,2])
C0029408 (UMLS CUI [2,1])
C3887293 (UMLS CUI [2,2])
Arthritis in past year and current
Item
Do you have or have you had a chronic joint inflammation (arthritis) in the past 12 months?
boolean
C0521116 (UMLS CUI [1,1])
C0003864 (UMLS CUI [1,2])
C0003864 (UMLS CUI [2,1])
C3887293 (UMLS CUI [2,2])
Osteoporosis in past year and current
Item
Do you have or have you had a loss of bone tissue (osteoporosis) in the past 12 months?
boolean
C0521116 (UMLS CUI [1,1])
C0029456 (UMLS CUI [1,2])
C0029456 (UMLS CUI [2,1])
C3887293 (UMLS CUI [2,2])
Bone fractures in past year and current
Item
Do you have or have you had a hip fracture or other bone fractures in the past 12 months?
boolean
C0521116 (UMLS CUI [1,1])
C0019557 (UMLS CUI [1,2])
C0019557 (UMLS CUI [2,1])
C3887293 (UMLS CUI [2,2])
C0521116 (UMLS CUI [3,1])
C0205394 (UMLS CUI [3,2])
C0016658 (UMLS CUI [3,3])
C0205394 (UMLS CUI [4,1])
C0016658 (UMLS CUI [4,2])
C3887293 (UMLS CUI [4,3])
Dizziness in past year and current
Item
Do you have or have you had a dizziness in the past 12 months?
boolean
C0521116 (UMLS CUI [1,1])
C0012833 (UMLS CUI [1,2])
C0012833 (UMLS CUI [2,1])
C3887293 (UMLS CUI [2,2])
Neurological disease, Parkinson, Multiple sclerosis or epilepsy in past year and current
Item
Do you have or have you had a Neurological disease (Parkinson’s disease, multiple sclerosis, epilepsy) in the past 12 months?
boolean
C0521116 (UMLS CUI [1,1])
C0027765 (UMLS CUI [1,2])
C0027765 (UMLS CUI [2,1])
C3887293 (UMLS CUI [2,2])
C0521116 (UMLS CUI [3,1])
C0030567 (UMLS CUI [3,2])
C0030567 (UMLS CUI [4,1])
C3887293 (UMLS CUI [4,2])
C0521116 (UMLS CUI [5,1])
C0026769 (UMLS CUI [5,2])
C0026769 (UMLS CUI [6,1])
C3887293 (UMLS CUI [6,2])
C0521116 (UMLS CUI [7,1])
C0014544 (UMLS CUI [7,2])
C0014544 (UMLS CUI [8,1])
C3887293 (UMLS CUI [8,2])
Depression in past year and current
Item
Do you have or have you had a depression in the past 12 months?
boolean
C0521116 (UMLS CUI [1,1])
C0011581 (UMLS CUI [1,2])
C0011581 (UMLS CUI [2,1])
C3887293 (UMLS CUI [2,2])
Anxiety / panic disorder in past year and current
Item
Do you have or have you had anxiety / panic disorder in the past 12 months?
boolean
C0521116 (UMLS CUI [1,1])
C0003467 (UMLS CUI [1,2])
C0003467 (UMLS CUI [2,1])
C3887293 (UMLS CUI [2,2])
C0521116 (UMLS CUI [3,1])
C0030319 (UMLS CUI [3,2])
C0030319 (UMLS CUI [4,1])
C3887293 (UMLS CUI [4,2])
Dementia in past year and current
Item
Do you have or have you had dementia in the past 12 months?
boolean
C0521116 (UMLS CUI [1,1])
C0497327 (UMLS CUI [1,2])
C0497327 (UMLS CUI [2,1])
C3887293 (UMLS CUI [2,2])
Hearing problem despite hearing aid in past year and current
Item
Do you have or have you had hearing problems (despite hearing aid) in the past 12 months?
boolean
C0521116 (UMLS CUI [1,1])
C3898940 (UMLS CUI [1,2])
C3641650 (UMLS CUI [1,3])
C0542459 (UMLS CUI [1,4])
C3898940 (UMLS CUI [2,1])
C3887293 (UMLS CUI [2,2])
C3641650 (UMLS CUI [2,3])
C0542459 (UMLS CUI [2,4])
Vision problem despite glasses/contact lenses in past year and current
Item
Do you have or have you had problems with vision (despite glasses / contact lenses)) in the past 12 months?
boolean
C0521116 (UMLS CUI [1,1])
C3665347 (UMLS CUI [1,2])
C3641650 (UMLS CUI [1,3])
C3843284 (UMLS CUI [1,4])
C3665347 (UMLS CUI [2,1])
C3887293 (UMLS CUI [2,2])
C3641650 (UMLS CUI [2,3])
C3843284 (UMLS CUI [2,4])
Item Group
Tasks and activities of daily life
C0001288 (UMLS CUI-1)
Item
Can you, fully independently, dress yourself?
integer
C0429966 (UMLS CUI [1])
Dress yourself
Code List
Can you, fully independently, dress yourself?
CL Item
Yes, I can do it fully independently without any difficulty (1)
CL Item
Yes, I can do it fully independently but with some difficulty (2)
CL Item
Yes, I can do it fully independently but with great difficulty (3)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
Item
Can you, fully independently, stand up from sitting in a chair?
integer
C0560792 (UMLS CUI [1,1])
C1299583 (UMLS CUI [1,2])
Dress yourself
Code List
Can you, fully independently, stand up from sitting in a chair?
CL Item
Yes, I can do it fully independently without any difficulty (1)
CL Item
Yes, I can do it fully independently but with some difficulty (2)
CL Item
Yes, I can do it fully independently but with great difficulty (3)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
Item
Can you, fully independently, wash and dry your whole body?
integer
C4055522 (UMLS CUI [1,1])
C1299583 (UMLS CUI [1,2])
Dress yourself
Code List
Can you, fully independently, wash and dry your whole body?
CL Item
Yes, I can do it fully independently without any difficulty (1)
CL Item
Yes, I can do it fully independently but with some difficulty (2)
CL Item
Yes, I can do it fully independently but with great difficulty (3)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
Item
Can you, fully independently, go up and down the stairs?
integer
C0560077 (UMLS CUI [1,1])
C1299583 (UMLS CUI [1,2])
C0560081 (UMLS CUI [2,1])
C1299583 (UMLS CUI [2,2])
Dress yourself
Code List
Can you, fully independently, go up and down the stairs?
CL Item
Yes, I can do it fully independently without any difficulty (1)
CL Item
Yes, I can do it fully independently but with some difficulty (2)
CL Item
Yes, I can do it fully independently but with great difficulty (3)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
Item
Can you, fully independently, walk outdoors (if necessary with a cane or wheel rollator)?
integer
C4722228 (UMLS CUI [1,1])
C4283770 (UMLS CUI [1,2])
C1299583 (UMLS CUI [1,3])
C0750377 (UMLS CUI [2,1])
C4283770 (UMLS CUI [2,2])
C1299583 (UMLS CUI [2,3])
C1524063 (UMLS CUI [3,1])
C0184339 (UMLS CUI [3,2])
C4283770 (UMLS CUI [3,3])
C1299583 (UMLS CUI [3,4])
Dress yourself
Code List
Can you, fully independently, walk outdoors (if necessary with a cane or wheel rollator)?
CL Item
Yes, I can do it fully independently without any difficulty (1)
CL Item
Yes, I can do it fully independently but with some difficulty (2)
CL Item
Yes, I can do it fully independently but with great difficulty (3)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
Item
Can you, fully independently, take care of your feet and toenails?
integer
C3873451 (UMLS CUI [1,1])
C1299583 (UMLS CUI [1,2])
C0749563 (UMLS CUI [2,1])
C1299583 (UMLS CUI [2,2])
Dress yourself
Code List
Can you, fully independently, take care of your feet and toenails?
CL Item
Yes, I can do it fully independently without any difficulty (1)
CL Item
Yes, I can do it fully independently but with some difficulty (2)
CL Item
Yes, I can do it fully independently but with great difficulty (3)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
Item
Can you, fully independently, do “light” household activities (for example, dusting and tidying up)?
integer
C4055557 (UMLS CUI [1,1])
C1299583 (UMLS CUI [1,2])
Dress yourself
Code List
Can you, fully independently, do “light” household activities (for example, dusting and tidying up)?
CL Item
Yes, I can do it fully independently without any difficulty (1)
CL Item
Yes, I can do it fully independently but with some difficulty (2)
CL Item
Yes, I can do it fully independently but with great difficulty (3)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
Item
Can you, fully independently, do the shopping?
integer
C4055547 (UMLS CUI [1,1])
C1299583 (UMLS CUI [1,2])
Dress yourself
Code List
Can you, fully independently, do the shopping?
CL Item
Yes, I can do it fully independently without any difficulty (1)
CL Item
Yes, I can do it fully independently but with some difficulty (2)
CL Item
Yes, I can do it fully independently but with great difficulty (3)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
Item
Can you, fully independently, take your medicines?
integer
C4075001 (UMLS CUI [1,1])
C1299583 (UMLS CUI [1,2])
Dress yourself
Code List
Can you, fully independently, take your medicines?
CL Item
Yes, I can do it fully independently without any difficulty (1)
CL Item
Yes, I can do it fully independently but with some difficulty (2)
CL Item
Yes, I can do it fully independently but with great difficulty (3)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
Item
Can you, fully independently, use your own or public transportation?
integer
C0871194 (UMLS CUI [1,1])
C1299583 (UMLS CUI [1,2])
C4274917 (UMLS CUI [2,1])
C1299583 (UMLS CUI [2,2])
Dress yourself
Code List
Can you, fully independently, use your own or public transportation?
CL Item
Yes, I can do it fully independently without any difficulty (1)
CL Item
Yes, I can do it fully independently but with some difficulty (2)
CL Item
Yes, I can do it fully independently but with great difficulty (3)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
Item Group
Information about mouth care and complaints with mouth, jaws or temples
C1161186 (UMLS CUI-1)
C0848667 (UMLS CUI-2)
C2108445 (UMLS CUI-3)
C0935456 (UMLS CUI-4)
C1457887 (UMLS CUI-5)
Oral, jaw or temple pain
Item
I experience pain
boolean
C0221776 (UMLS CUI [1])
C0236000 (UMLS CUI [2])
C0935456 (UMLS CUI [3,1])
C0030193 (UMLS CUI [3,2])
Chewing comlaints
Item
I have chewing complaints
boolean
C0424869 (UMLS CUI [1])
Dry mouth
Item
I have dry mouth complaints
boolean
C0043352 (UMLS CUI [1])
Swallowing complaints
Item
I have swallowing complaints
boolean
C0392678 (UMLS CUI [1])
Item Group
How you are feeling
C1527305 (UMLS CUI-1)
Item
How much of the time during the past 4 weeks have you been a very nervous person?
integer
C0849963 (UMLS CUI [1,1])
C3828653 (UMLS CUI [1,2])
Nervous
Code List
How much of the time during the past 4 weeks have you been a very nervous person?
CL Item
All of the time (1)
CL Item
Most of the time (2)
CL Item
A food bit of the time (3)
CL Item
Some of the time  (4)
CL Item
A little of the time  (5)
CL Item
None of the time (6)
Item
How much of the time during the past 4 weeks have you felt calm and peaceful?
integer
C3829745 (UMLS CUI [1,1])
C3828653 (UMLS CUI [1,2])
Nervous
Code List
How much of the time during the past 4 weeks have you felt calm and peaceful?
CL Item
All of the time (1)
CL Item
Most of the time (2)
CL Item
A food bit of the time (3)
CL Item
Some of the time  (4)
CL Item
A little of the time  (5)
CL Item
None of the time (6)
Item
How much of the time during the past 4 weeks have you felt downhearted and blue?
integer
C3828653 (UMLS CUI [1,1])
C3829743 (UMLS CUI [1,2])
Nervous
Code List
How much of the time during the past 4 weeks have you felt downhearted and blue?
CL Item
All of the time (1)
CL Item
Most of the time (2)
CL Item
A food bit of the time (3)
CL Item
Some of the time  (4)
CL Item
A little of the time  (5)
CL Item
None of the time (6)
Item
How much of the time during the past 4 weeks have you been a happy person?
integer
C3828653 (UMLS CUI [1,1])
C3829752 (UMLS CUI [1,2])
Nervous
Code List
How much of the time during the past 4 weeks have you been a happy person?
CL Item
All of the time (1)
CL Item
Most of the time (2)
CL Item
A food bit of the time (3)
CL Item
Some of the time  (4)
CL Item
A little of the time  (5)
CL Item
None of the time (6)
Item
How much of the time during the past 4 weeks have you felt so down in the dumps that nothing could cheer you up?
integer
C3828653 (UMLS CUI [1,1])
C3829738 (UMLS CUI [1,2])
Nervous
Code List
How much of the time during the past 4 weeks have you felt so down in the dumps that nothing could cheer you up?
CL Item
All of the time (1)
CL Item
Most of the time (2)
CL Item
A food bit of the time (3)
CL Item
Some of the time  (4)
CL Item
A little of the time  (5)
CL Item
None of the time (6)
Item Group
Social activities
C0814554 (UMLS CUI-1)
Item
During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)?
integer
C3484327 (UMLS CUI [1])
Social activities
Code List
During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)?
CL Item
All of the time (1)
CL Item
Most of the time (2)
CL Item
Some of the time  (3)
CL Item
A little of the time  (4)
CL Item
None of the time (5)
Item Group
Quality of life
C0034380 (UMLS CUI-1)
Quality of life at this moment
Item
On a scale of 0 to 10: how do you rate your life at this moment? 0 indicates ‘completely unsatisfied’ and 10 ‘completely satisfied’.
integer
C3476431 (UMLS CUI [1,1])
C0521116 (UMLS CUI [1,2])
Item Group
Your care use
C0814514 (UMLS CUI-1)
Admission to hospital past year
Item
Have you been admitted to the hospital in the past 12 months?
boolean
C0184666 (UMLS CUI [1,1])
C3887293 (UMLS CUI [1,2])
Admission quantity to hospital past year
Item
If you ticked "Yes", how many times have you been admitted to the hospital in the past 12 months?
integer
C0184666 (UMLS CUI [1,1])
C3887293 (UMLS CUI [1,2])
C1265611 (UMLS CUI [1,3])
Days in hospital past year
Item
How many days did you stay in hospital in total? If you stayed in hospital more than once in the past 12 months, then please sum up the number of days you stayed during each of the admissions.
integer
C3694481 (UMLS CUI [1,1])
C3887293 (UMLS CUI [1,2])
Emergency department past year
Item
Have you visited the emergency department of a hospital for yourself in the past 12 months?
boolean
C0586082 (UMLS CUI [1,1])
C3887293 (UMLS CUI [1,2])
Visit quantity of emergency department past year
Item
If you ticked "Yes", how many times have you visited the emergency department of a hospital for yourself in the past 12 months?
float
C0586082 (UMLS CUI [1,1])
C1265611 (UMLS CUI [1,2])
C3887293 (UMLS CUI [1,3])
Out-of-office hours GP service past year
Item
Have you visited an out-of-office hours GP service or had a visit from a general practitioner in the evening, night or on the weekend for yourself in the past 12 months?
boolean
C0017319 (UMLS CUI [1,1])
C0498340 (UMLS CUI [1,2])
C3887293 (UMLS CUI [1,3])
C0017319 (UMLS CUI [2,1])
C1947978 (UMLS CUI [2,2])
C0587117 (UMLS CUI [2,3])
C3887293 (UMLS CUI [2,4])
C0017319 (UMLS CUI [3,1])
C1947978 (UMLS CUI [3,2])
C0240526 (UMLS CUI [3,3])
C3887293 (UMLS CUI [3,4])
C0017319 (UMLS CUI [4,1])
C0581045 (UMLS CUI [4,2])
C3887293 (UMLS CUI [4,3])
Visit quantity of out-of-office hours GP service
Item
If you ticked "Yes", how many times in total have you visited an out-of-office hours GP service or had a visit from a general practitioner in the evening, night or on the weekend for yourself in the past 12 months?
integer
C0017319 (UMLS CUI [1,1])
C0498340 (UMLS CUI [1,2])
C1265611 (UMLS CUI [1,3])
C3887293 (UMLS CUI [1,4])
C0017319 (UMLS CUI [2,1])
C1947978 (UMLS CUI [2,2])
C1265611 (UMLS CUI [2,3])
C0587117 (UMLS CUI [2,4])
C3887293 (UMLS CUI [2,5])
C0017319 (UMLS CUI [3,1])
C1947978 (UMLS CUI [3,2])
C1265611 (UMLS CUI [3,3])
C0240526 (UMLS CUI [3,4])
C3887293 (UMLS CUI [3,5])
C0017319 (UMLS CUI [4,1])
C0581045 (UMLS CUI [4,2])
C1265611 (UMLS CUI [4,3])
C3887293 (UMLS CUI [4,4])
Item
How many appointments (office hours and house calls) have you had with a general practitioner for yourself in the past 12 months?
text
C0017319 (UMLS CUI [1,1])
C1512346 (UMLS CUI [1,2])
C1265611 (UMLS CUI [1,3])
C3887293 (UMLS CUI [1,4])
GP
Code List
How many appointments (office hours and house calls) have you had with a general practitioner for yourself in the past 12 months?
CL Item
Not a single appointment (1)
CL Item
One or more appointments (2)
GP visit past year
Item
If you ticked "One or more appointments", how many appointments (office hours and house calls) have you had with a general practitioner for yourself in the past 12 months in total?
float
C0017319 (UMLS CUI [1,1])
C1512346 (UMLS CUI [1,2])
C1265611 (UMLS CUI [1,3])
C3887293 (UMLS CUI [1,4])
Receive home care
Item
Did you receive home care in the past 12 months?
boolean
C0204977 (UMLS CUI [1,1])
C3887293 (UMLS CUI [1,2])
Help with household chores past year
Item
Have you had help with household chores (for example: vacuuming, making the bed, grocery shopping) in the past 12 months?
boolean
C1514756 (UMLS CUI [1,1])
C3273800 (UMLS CUI [1,2])
C0557036 (UMLS CUI [1,3])
C3887293 (UMLS CUI [1,4])
Help with personal care past year
Item
Have you received home care in the form of help with personal care (for example: help with bathing/showering or dressing) in the past 12 months?
boolean
C1514756 (UMLS CUI [1,1])
C0686948 (UMLS CUI [1,2])
C3887293 (UMLS CUI [1,3])
Nursing care past year
Item
Have you received home care in the form of nursing care (for example: changing dressings, administering medications, measuring blood pressure) in the past 12 months?
boolean
C0028682 (UMLS CUI [1,1])
C1553498 (UMLS CUI [1,2])
C3887293 (UMLS CUI [1,3])
Quantity of weeks of help with household past year
Item
How many weeks did you receive help with household chores? Please, sum up all weeks in the past 12 months.
integer
C3273800 (UMLS CUI [1,1])
C1514756 (UMLS CUI [1,2])
C0557036 (UMLS CUI [1,3])
C3887293 (UMLS CUI [1,4])
C0557840 (UMLS CUI [1,5])
Quantity of weeks of help with personal care
Item
How many weeks did you receive help with personal care? Please, sum up all weeks in the past 12 months.
integer
C1514756 (UMLS CUI [1,1])
C0686948 (UMLS CUI [1,2])
C3887293 (UMLS CUI [1,3])
C0557840 (UMLS CUI [1,4])
Quantity of weeks of nursing care past year
Item
How many weeks did you receive home care in the form of nursing care? Please, sum up all weeks in the past 12 months.
integer
C0028682 (UMLS CUI [1,1])
C1553498 (UMLS CUI [1,2])
C1948053 (UMLS CUI [1,3])
C0557840 (UMLS CUI [1,4])
C3887293 (UMLS CUI [1,5])
Quantity of hours of help with household past year
Item
How many hours of help with household chores did you receive during these weeks on average?
integer
C3273800 (UMLS CUI [1,1])
C1514756 (UMLS CUI [1,2])
C0557036 (UMLS CUI [1,3])
C3887293 (UMLS CUI [1,4])
C4289948 (UMLS CUI [1,5])
Quantity of hours of help with personal care
Item
How many hours of help with personal care did you receive during these weeks on average?
integer
C1514756 (UMLS CUI [1,1])
C0686948 (UMLS CUI [1,2])
C4289948 (UMLS CUI [1,3])
C3887293 (UMLS CUI [1,4])
Quantity of hours of nursing care past year
Item
How many hours of home care in the form of nursing care did you receive during these weeks on average?
integer
C0028682 (UMLS CUI [1,1])
C1553498 (UMLS CUI [1,2])
C4289948 (UMLS CUI [1,3])
Stay overnight past year in nursing home, residential care center, psychiatric hospital or rehabilitation center
Item
In the past 12 months, did you have to stay overnight somewhere else than your own home because of your health? For example, in a nursing home, residential care center, psychiatric hospital or rehabilitation center?
boolean
C0018704 (UMLS CUI [1,1])
C0439583 (UMLS CUI [1,2])
C3177049 (UMLS CUI [1,3])
C3887293 (UMLS CUI [1,4])
C0439583 (UMLS CUI [2,1])
C0028688 (UMLS CUI [2,2])
C0439583 (UMLS CUI [3,1])
C0237680 (UMLS CUI [3,2])
C0439583 (UMLS CUI [4,1])
C0259948 (UMLS CUI [4,2])
C0439583 (UMLS CUI [5,1])
C1550688 (UMLS CUI [5,2])
Quantity of overnight stays past year
Item
If you have stayed somewhere else overnight in the past 12 months, how many times in total?
integer
C0018704 (UMLS CUI [1,1])
C0439583 (UMLS CUI [1,2])
C3177049 (UMLS CUI [1,3])
C0439603 (UMLS CUI [1,4])
C3887293 (UMLS CUI [1,5])
Length of overnight stays past year
Item
If you have stayed somewhere else overnight in the past 12 months, how long did you stay in this care facility?
integer
C0018704 (UMLS CUI [1,1])
C0439583 (UMLS CUI [1,2])
C3177049 (UMLS CUI [1,3])
C0023303 (UMLS CUI [1,4])
C3887293 (UMLS CUI [1,5])
Outpatient day care past year
Item
In the past 12 months, did you stay somewhere else than your own home during the day for treatment?
boolean
C0002423 (UMLS CUI [1,1])
C3887293 (UMLS CUI [1,2])
Quantity of ouptatient day care past year
Item
If you ticked "Yes", how many times per week did you stay somewhere else than your own home during the day for treatment in the past 12 months?
integer
C0002423 (UMLS CUI [1,1])
C0456698 (UMLS CUI [1,2])
C3887293 (UMLS CUI [1,3])
Support with household chores in the past week
Item
Because of your health problems, did you receive help from your family or friends in the past week with household chores such as preparing food, cleaning your house, doing the laundry, ironing or mending your cloths, grocery shopping or do odd jobs in and around the house?
boolean
C0001288 (UMLS CUI [1,1])
C0581904 (UMLS CUI [1,2])
C2987125 (UMLS CUI [1,3])
C0001288 (UMLS CUI [2,1])
C4708444 (UMLS CUI [2,2])
C2987125 (UMLS CUI [2,3])
Quantity of hours of support with household chores past week
Item
If you ticked "Yes", how many hours did you receive help from your family or friends in the past week?
integer
C0001288 (UMLS CUI [1,1])
C0581904 (UMLS CUI [1,2])
C0556976 (UMLS CUI [1,3])
C0001288 (UMLS CUI [2,1])
C4708444 (UMLS CUI [2,2])
C0556976 (UMLS CUI [2,3])
Support with personal care in the past week
Item
Because of your health problems, did you receive help from your family or friends in the past week with personal care (dressing, washing your body, combing your hair, shaving), toileting, transferring in the house, eating, drinken or taking medications?
boolean
C0563471 (UMLS CUI [1,1])
C0581904 (UMLS CUI [1,2])
C2987125 (UMLS CUI [1,3])
C0563471 (UMLS CUI [2,1])
C4708444 (UMLS CUI [2,2])
C2987125 (UMLS CUI [2,3])
C0150810 (UMLS CUI [3,1])
C0581904 (UMLS CUI [3,2])
C2987125 (UMLS CUI [3,3])
C0150810 (UMLS CUI [4,1])
C4708444 (UMLS CUI [4,2])
C2987125 (UMLS CUI [4,3])
C2371389 (UMLS CUI [5,1])
C0581904 (UMLS CUI [5,2])
C2987125 (UMLS CUI [5,3])
C2371389 (UMLS CUI [6,1])
C4708444 (UMLS CUI [6,2])
C2987125 (UMLS CUI [6,3])
C1279813 (UMLS CUI [7,1])
C4708444 (UMLS CUI [7,2])
C2987125 (UMLS CUI [7,3])
C1279813 (UMLS CUI [8,1])
C0581904 (UMLS CUI [8,2])
C2987125 (UMLS CUI [8,3])
C1290952 (UMLS CUI [9,1])
C0581904 (UMLS CUI [9,2])
C2987125 (UMLS CUI [9,3])
C1290952 (UMLS CUI [10,1])
C4708444 (UMLS CUI [10,2])
C2987125 (UMLS CUI [10,3])
Quantity of hours per week of support with personal care
Item
If you ticked "Yes", how many hours per week did you receive help from your family or friends in the past week with personal care?
boolean
C0563471 (UMLS CUI [1,1])
C0581904 (UMLS CUI [1,2])
C0556976 (UMLS CUI [1,3])
C0563471 (UMLS CUI [2,1])
C4708444 (UMLS CUI [2,2])
C0556976 (UMLS CUI [2,3])
Help from family or friends in past week with getting around outside the house, making trips, visiting family or friends, dealings with health care (attending your visits to the GP, hospital or treatment), arranging for help, aids or home adjustments, or arranging your finances or paper work
Item
Because of your health problems, did you receive help from your family or friends in the past week with getting around outside the house, making trips, visiting family or friends, dealings with health care (attending your visits to the GP, hospital or treatment), arranging for help, aids or home adjustments, or arranging your finances or paper work?
boolean
C3842571 (UMLS CUI [1,1])
C0581904 (UMLS CUI [1,2])
C2987125 (UMLS CUI [1,3])
C3842571 (UMLS CUI [2,1])
C4708444 (UMLS CUI [2,2])
C2987125 (UMLS CUI [2,3])
C0086388 (UMLS CUI [3,1])
C0581904 (UMLS CUI [3,2])
C2987125 (UMLS CUI [3,3])
C0086388 (UMLS CUI [4,1])
C4708444 (UMLS CUI [4,2])
C2987125 (UMLS CUI [4,3])
C1300196 (UMLS CUI [5,1])
C0557036 (UMLS CUI [5,2])
C0581904 (UMLS CUI [5,3])
C2987125 (UMLS CUI [5,4])
C1300196 (UMLS CUI [6,1])
C0557036 (UMLS CUI [6,2])
C4708444 (UMLS CUI [6,3])
C2987125 (UMLS CUI [6,4])
C1300196 (UMLS CUI [7,1])
C0449435 (UMLS CUI [7,2])
C0581904 (UMLS CUI [7,3])
C2987125 (UMLS CUI [7,4])
C1300196 (UMLS CUI [8,1])
C0449435 (UMLS CUI [8,2])
C4708444 (UMLS CUI [8,3])
C2987125 (UMLS CUI [8,4])
C1300196 (UMLS CUI [9,1])
C0850398 (UMLS CUI [9,2])
C0581904 (UMLS CUI [9,3])
C2987125 (UMLS CUI [9,4])
C1300196 (UMLS CUI [10,1])
C0850398 (UMLS CUI [10,2])
C4708444 (UMLS CUI [10,3])
C2987125 (UMLS CUI [10,4])
C0149692 (UMLS CUI [11,1])
C4708444 (UMLS CUI [11,2])
C2987125 (UMLS CUI [11,3])
C0149692 (UMLS CUI [12,1])
C0581904 (UMLS CUI [12,2])
C2987125 (UMLS CUI [12,3])
C2986711 (UMLS CUI [13,1])
C4708444 (UMLS CUI [13,2])
C2987125 (UMLS CUI [13,3])
C2986711 (UMLS CUI [14,1])
C0581904 (UMLS CUI [14,2])
C2987125 (UMLS CUI [14,3])
C2371431 (UMLS CUI [15,1])
C0581904 (UMLS CUI [15,2])
C2987125 (UMLS CUI [15,3])
C2371431 (UMLS CUI [16,1])
C4708444 (UMLS CUI [16,2])
C2987125 (UMLS CUI [16,3])
C0577328 (UMLS CUI [17,1])
C0581904 (UMLS CUI [17,2])
C2987125 (UMLS CUI [17,3])
C0577328 (UMLS CUI [18,1])
C4708444 (UMLS CUI [18,2])
C2987125 (UMLS CUI [18,3])
Quantity of hours of Help from family or friends in past week with getting around outside the house, making trips, visiting family or friends, dealings with health care (attending your visits to the GP, hospital or treatment), arranging for help, aids or home adjustments, or arranging your finances or paper work
Item
If you ticked "Yes", how many hours per week did you receive help from your family or friends in the past week with getting around outside the house, making trips, visiting family or friends, dealings with health care (attending your visits to the GP, hospital or treatment), arranging for help, aids or home adjustments, or arranging your finances or paper work?
integer
C3842571 (UMLS CUI [1,1])
C0581904 (UMLS CUI [1,2])
C2987125 (UMLS CUI [1,3])
C0556976 (UMLS CUI [1,4])
C3842571 (UMLS CUI [2,1])
C4708444 (UMLS CUI [2,2])
C2987125 (UMLS CUI [2,3])
C0556976 (UMLS CUI [2,4])
C0086388 (UMLS CUI [3,1])
C0581904 (UMLS CUI [3,2])
C2987125 (UMLS CUI [3,3])
C0556976 (UMLS CUI [3,4])
C0086388 (UMLS CUI [4,1])
C4708444 (UMLS CUI [4,2])
C2987125 (UMLS CUI [4,3])
C0556976 (UMLS CUI [4,4])
C1300196 (UMLS CUI [5,1])
C0557036 (UMLS CUI [5,2])
C0581904 (UMLS CUI [5,3])
C2987125 (UMLS CUI [5,4])
C0556976 (UMLS CUI [5,5])
C1300196 (UMLS CUI [6,1])
C0557036 (UMLS CUI [6,2])
C4708444 (UMLS CUI [6,3])
C2987125 (UMLS CUI [6,4])
C0556976 (UMLS CUI [6,5])
C1300196 (UMLS CUI [7,1])
C0449435 (UMLS CUI [7,2])
C0581904 (UMLS CUI [7,3])
C2987125 (UMLS CUI [7,4])
C0556976 (UMLS CUI [7,5])
C1300196 (UMLS CUI [8,1])
C0449435 (UMLS CUI [8,2])
C4708444 (UMLS CUI [8,3])
C2987125 (UMLS CUI [8,4])
C0556976 (UMLS CUI [8,5])
C1300196 (UMLS CUI [9,1])
C0850398 (UMLS CUI [9,2])
C0581904 (UMLS CUI [9,3])
C2987125 (UMLS CUI [9,4])
C0556976 (UMLS CUI [9,5])
C1300196 (UMLS CUI [10,1])
C0850398 (UMLS CUI [10,2])
C4708444 (UMLS CUI [10,3])
C2987125 (UMLS CUI [10,4])
C0556976 (UMLS CUI [10,5])
C0149692 (UMLS CUI [11,1])
C4708444 (UMLS CUI [11,2])
C2987125 (UMLS CUI [11,3])
C0556976 (UMLS CUI [11,4])
C0149692 (UMLS CUI [12,1])
C0581904 (UMLS CUI [12,2])
C2987125 (UMLS CUI [12,3])
C0556976 (UMLS CUI [12,4])
C2986711 (UMLS CUI [13,1])
C4708444 (UMLS CUI [13,2])
C2987125 (UMLS CUI [13,3])
C0556976 (UMLS CUI [13,4])
C2986711 (UMLS CUI [14,1])
C0581904 (UMLS CUI [14,2])
C2987125 (UMLS CUI [14,3])
C0556976 (UMLS CUI [14,4])
C2371431 (UMLS CUI [15,1])
C0581904 (UMLS CUI [15,2])
C2987125 (UMLS CUI [15,3])
C0556976 (UMLS CUI [15,4])
C2371431 (UMLS CUI [16,1])
C4708444 (UMLS CUI [16,2])
C2987125 (UMLS CUI [16,3])
C0556976 (UMLS CUI [16,4])
C0577328 (UMLS CUI [17,1])
C0581904 (UMLS CUI [17,2])
C2987125 (UMLS CUI [17,3])
C0556976 (UMLS CUI [17,4])
C0577328 (UMLS CUI [18,1])
C4708444 (UMLS CUI [18,2])
C2987125 (UMLS CUI [18,3])
C0556976 (UMLS CUI [18,4])
Item Group
Closure
C1521802 (UMLS CUI-1)
Item
Has somebody helped you to complete this questionnaire?
integer
C3828841 (UMLS CUI [1,1])
C0034394 (UMLS CUI [1,2])
Help to complete the questionnaire
Code List
Has somebody helped you to complete this questionnaire?
CL Item
No, I completed the list alone (1)
CL Item
Yes, somebody helped me to complete the list (2)
Item
If yes, what did the help consist of?
integer
C0332307 (UMLS CUI [1,1])
C3828841 (UMLS CUI [1,2])
C0034394 (UMLS CUI [1,3])
Help to complete the questionnaire
Code List
If yes, what did the help consist of?
CL Item
Someone else has written down the answers, I have chosen the answers myself  (1)
CL Item
Someone else helped me to choose and write down the answers (2)
CL Item
Someone else has chosen and written down the answers for me (3)
Comment
Item
If you have any comments, please write them down in the space below:
text
C0947611 (UMLS CUI [1])
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