Date of birth of caregiver
Item
Date of birth
date
C2348576 (UMLS CUI [1,1])
C0085537 (UMLS CUI [1,2])
Item
Gender
text
C0079399 (UMLS CUI [1,1])
C0085537 (UMLS CUI [1,2])
Postal code
Item
Postal code (four numbers)
integer
C1514254 (UMLS CUI [1,1])
C0085537 (UMLS CUI [1,2])
Date of birth care receiver
Item
Date of birth of your loved one
date
C0421451 (UMLS CUI [1,1])
C0017313 (UMLS CUI [1,2])
C1551356 (UMLS CUI [1,3])
Item
Gender of your loved one
text
C0079399 (UMLS CUI [1,1])
C0017313 (UMLS CUI [1,2])
C1551356 (UMLS CUI [1,3])
Code List
Gender of your loved one
Postal code of care receiver
Item
Postal code of your loved one
integer
C1514254 (UMLS CUI [1,1])
C0017313 (UMLS CUI [1,2])
C1551356 (UMLS CUI [1,3])
Item
What is your relationship with your loved one?
text
C0439849 (UMLS CUI [1,1])
C0085537 (UMLS CUI [1,2])
C0017313 (UMLS CUI [1,3])
C1551356 (UMLS CUI [1,4])
Code List
What is your relationship with your loved one?
CL Item
I'm his/her husband/wife/life partner (1)
CL Item
I'm his/her Sister (-in-law), brother (-in-law) (2)
CL Item
I'm his/her Daugher (-in-law), son (-in-law) (3)
Specification of relationship
Item
If you ticked "Other", please specify
text
C2348235 (UMLS CUI [1,1])
C0439849 (UMLS CUI [1,2])
C0085537 (UMLS CUI [1,3])
C0017313 (UMLS CUI [1,4])
C1551356 (UMLS CUI [1,5])
Living situation with care receiver
Item
Do you live with your loved one?
boolean
C0682072 (UMLS CUI [1,1])
C0017313 (UMLS CUI [1,2])
C1551356 (UMLS CUI [1,3])
Item
In general would you say your health is
text
C0424575 (UMLS CUI [1,1])
C0449438 (UMLS CUI [1,2])
Code List
In general would you say your health is
Item
Compared to one year ago, how would you rate your health in general now?
text
C1707455 (UMLS CUI [1,1])
C0018759 (UMLS CUI [1,2])
C3898100 (UMLS CUI [1,3])
Code List
Compared to one year ago, how would you rate your health in general now?
CL Item
Much better than one year ago (1)
CL Item
A little better now than one year ago (2)
CL Item
About the same (3)
CL Item
Slightly worse now than one year ago (4)
CL Item
Much worse now than one year ago (5)
Assisted in preparing food/drinks, cleaning the house, washing, ironing, sewing clothing, shopping for groceries, odd jobs in the house or garden
Item
In the past week, have you had to help your loved one with household tasks such as preparing food and drinks, cleaning the house, washing, ironing and sewing clothing, shopping for groceries or odd jobs in the house or the garden due to his/her health problems?
boolean
C1269765 (UMLS CUI [1,1])
C1521827 (UMLS CUI [1,2])
C0524819 (UMLS CUI [1,3])
C2987125 (UMLS CUI [1,4])
C1269765 (UMLS CUI [2,1])
C1947930 (UMLS CUI [2,2])
C2987125 (UMLS CUI [2,3])
C1269765 (UMLS CUI [3,1])
C0441648 (UMLS CUI [3,2])
C2987125 (UMLS CUI [3,3])
C1269765 (UMLS CUI [4,1])
C2713000 (UMLS CUI [4,2])
C2987125 (UMLS CUI [4,3])
C1269765 (UMLS CUI [5,1])
C2977585 (UMLS CUI [5,2])
C2987125 (UMLS CUI [5,3])
C1269765 (UMLS CUI [6,1])
C0150768 (UMLS CUI [6,2])
C2987125 (UMLS CUI [6,3])
C1269765 (UMLS CUI [7,1])
C0521114 (UMLS CUI [7,2])
C0043227 (UMLS CUI [7,3])
C3843862 (UMLS CUI [7,4])
C2987125 (UMLS CUI [7,5])
C1269765 (UMLS CUI [8,1])
C0521114 (UMLS CUI [8,2])
C0868963 (UMLS CUI [8,3])
C2987125 (UMLS CUI [8,4])
Hours/week of assistance in household activities
Item
If you ticked "Yes", how many hours have you had to help your loved one with household tasks?
integer
C0001288 (UMLS CUI [1,1])
C1269765 (UMLS CUI [1,2])
C2987125 (UMLS CUI [1,3])
C0556976 (UMLS CUI [1,4])
Assisted with personal care, going to the toilet, moving around the house, eating, drinking or administering medication
Item
In the past week, have you had to help your loved one with personal care (dressing and undressing, washing, combing, shaving), going to the toilet, moving around the house, eating, drinking or administering medication due to his/her health problems?
boolean
C0476651 (UMLS CUI [1,1])
C2987125 (UMLS CUI [1,2])
C0686904 (UMLS CUI [2,1])
C1822189 (UMLS CUI [2,2])
C2987125 (UMLS CUI [2,3])
C1269765 (UMLS CUI [3,1])
C2371429 (UMLS CUI [3,2])
C2987125 (UMLS CUI [3,3])
C1279813 (UMLS CUI [4,1])
C2987125 (UMLS CUI [4,2])
C3469597 (UMLS CUI [5,1])
C3828841 (UMLS CUI [5,2])
C2987125 (UMLS CUI [5,3])
Hours/week of assistance in personal care
Item
If you ticked "Yes", how many hours have you had to help your loved one with personal care ?
integer
C0476651 (UMLS CUI [1,1])
C2987125 (UMLS CUI [1,2])
C0556976 (UMLS CUI [1,3])
Assisting in moving around outside the house, going on outings and visiting family or friends, contacts with healthcare, arranging assistance, devices/home modifications and organising financial and administrative matters
Item
In the past week, have you had to help your loved one with moving around outside the house, going on outings and visiting family or friends, contacts with healthcare (accompanying him/her for example to the general practitioner, the hospital, therapy), arranging assistance, devices and/or home modifications and organising financial and administrative matters due to his/her health problems?
boolean
C1269765 (UMLS CUI [1,1])
C2371431 (UMLS CUI [1,2])
C2987125 (UMLS CUI [1,3])
C1269765 (UMLS CUI [2,1])
C3842924 (UMLS CUI [2,2])
C1269765 (UMLS CUI [2,3])
C2987125 (UMLS CUI [2,4])
C1269765 (UMLS CUI [3,1])
C0332158 (UMLS CUI [3,2])
C0086388 (UMLS CUI [3,3])
C2987125 (UMLS CUI [3,4])
C1269765 (UMLS CUI [4,1])
C0420305 (UMLS CUI [4,2])
C2987125 (UMLS CUI [4,3])
C1269765 (UMLS CUI [5,1])
C0025080 (UMLS CUI [5,2])
C2987125 (UMLS CUI [5,3])
C1269765 (UMLS CUI [6,1])
C0850398 (UMLS CUI [6,2])
C2987125 (UMLS CUI [6,3])
C1269765 (UMLS CUI [7,1])
C0016114 (UMLS CUI [7,2])
C2987125 (UMLS CUI [7,3])
C1269765 (UMLS CUI [8,1])
C1292785 (UMLS CUI [8,2])
C2987125 (UMLS CUI [8,3])
C1300196 (UMLS CUI [9,1])
C1822167 (UMLS CUI [9,2])
C2987125 (UMLS CUI [9,3])
Hours/week of assistance in moving around outside the house, going on outings and visiting family or friends, contacts with healthcare, arranging assistance, devices and/or home modifications and organising financial and administrative matters
Item
If you ticked "Yes", how many hours have you had to help your loved one with moving around outside the house, going on outings and visiting family or friends, contacts with healthcare (accompanying him/her for example to the general practitioner, the hospital, therapy), arranging assistance, devices and/or home modifications and organising financial and administrative matters due to his/her health problems?
integer
C1269765 (UMLS CUI [1,1])
C2987125 (UMLS CUI [1,2])
C0556976 (UMLS CUI [1,3])
Other support than the caregiver
Item
Does your loved one receive help from other caregivers or volunteers besides you?
boolean
C0205394 (UMLS CUI [1,1])
C1521721 (UMLS CUI [1,2])
C0205394 (UMLS CUI [2,1])
C2367294 (UMLS CUI [2,2])
Other support than the caregiver
Item
If you ticked "Yes", how many hours per week did your loved one receive help from other caregivers or volunteers besides you?
integer
C0085537 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C1521721 (UMLS CUI [1,3])
C2584953 (UMLS CUI [1,4])
C0085537 (UMLS CUI [2,1])
C0205394 (UMLS CUI [2,2])
C2367294 (UMLS CUI [2,3])
C2584953 (UMLS CUI [2,4])
How difficult is the care for you
Item
Indicate with a tick on the scale how hard you are finding it to care for your loved one. The closer to ‘0’, the less hard you find the care. The closer to ‘10’, the harder you find the care.
integer
C1299586 (UMLS CUI [1,1])
C1171174 (UMLS CUI [1,2])
Item
I gain ... (of) satisfaction from performing my care tasks.
integer
C0242428 (UMLS CUI [1,1])
C0597198 (UMLS CUI [1,2])
C1947933 (UMLS CUI [1,3])
Code List
I gain ... (of) satisfaction from performing my care tasks.
Item
I have ... (of)problems with my loved one (for example, he/she is demanding, we have communication problems, he/she has started behaving differently).
integer
C0425168 (UMLS CUI [1,1])
C0085537 (UMLS CUI [1,2])
C0017313 (UMLS CUI [1,3])
C1551356 (UMLS CUI [1,4])
Code List
I have ... (of)problems with my loved one (for example, he/she is demanding, we have communication problems, he/she has started behaving differently).
Item
I have ... (of) problems with my own mental health (for example stress, anxiety, despondency, concern about the future).
integer
C1446377 (UMLS CUI [1])
Code List
I have ... (of) problems with my own mental health (for example stress, anxiety, despondency, concern about the future).
Item
I have ... (of) problems with my own physical health (for example being sick more often, fatigue, physical overexertion).
integer
C0033213 (UMLS CUI [1,1])
C0517226 (UMLS CUI [1,2])
Code List
I have ... (of) problems with my own physical health (for example being sick more often, fatigue, physical overexertion).
Item
I have ... (of) problems combining my daily activities (for example work, household, education, family and free time) with my care tasks.
integer
C0740765 (UMLS CUI [1,1])
C0678226 (UMLS CUI [1,2])
C1947933 (UMLS CUI [1,3])
Code List
I have ... (of) problems combining my daily activities (for example work, household, education, family and free time) with my care tasks.
Item
I have ... (of) financial problems concerning my care tasks.
integer
C0549106 (UMLS CUI [1,1])
C1947933 (UMLS CUI [1,2])
Code List
I have ... (of) financial problems concerning my care tasks.
Item
I have ... (of) support (from family / friends / neighbours / acquaintances / volunteers) in performing my care tasks.
integer
C1514756 (UMLS CUI [1,1])
C1521721 (UMLS CUI [1,2])
C1947933 (UMLS CUI [1,3])
Code List
I have ... (of) support (from family / friends / neighbours / acquaintances / volunteers) in performing my care tasks.
Happy at the moment
Item
Indicate with a tick on the scale how happy you are feeling right now. The closer to "0", the unhappier you feel right now. The closer to "10", the happier you feel right now.
integer
C0018592 (UMLS CUI [1,1])
C0521116 (UMLS CUI [1,2])
Feeling a burden by care for the other one
Item
Imagine the following: you and your loved one may select someone yourselves who will take over all your care tasks. There are no extra costs involved and this person will provide all transferred care tasks at your loved one’s home. Indicate by means of a tick on the scale how happy you would feel if this person would take over the care responsibilities from you. The closer to "0", the unhappier you would feel. The closer to "10", the happier you would feel.
integer
C1527305 (UMLS CUI [1,1])
C1947933 (UMLS CUI [1,2])
C1301771 (UMLS CUI [1,3])
Item
How is your quality of life in general?
integer
C0034380 (UMLS CUI [1,1])
C0205246 (UMLS CUI [1,2])
Code List
How is your quality of life in general?
Report mark for quality of life
Item
Which report mark would you give your life at this moment?
integer
C0441800 (UMLS CUI [1,1])
C0034380 (UMLS CUI [1,2])
Item
How is your quality of life in general, in comparison to one year ago?
integer
C1707455 (UMLS CUI [1,1])
C0034380 (UMLS CUI [1,2])
C3898100 (UMLS CUI [1,3])
Code List
How is your quality of life in general, in comparison to one year ago?
CL Item
A little better (2)
CL Item
About the same (3)
CL Item
Slightly worse (4)
Comment
Item
If you have any comments, please write them down in the space below:
text
C0947611 (UMLS CUI [1])