Project - hospital ID
Item
Project - hospital ID:
text
C1709701 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
C1300638 (UMLS CUI [1,3])
Serial number
Item
Serial number:
text
C2348188 (UMLS CUI [1])
General health
Item
On a scale of 0 to 10: how do you rate your health in general? 0 indicates ‘completely unhealthy’ and 10 ‘completely healthy’. Please choose the answer that best fits your situation.
integer
C0424575 (UMLS CUI [1])
Item
Do you experience pain or discomfort at this moment?
integer
C2737161 (UMLS CUI [1,1])
C0521116 (UMLS CUI [1,2])
Code List
Do you experience pain or discomfort at this moment?
Item
Do you have complaints about your memory?
integer
C0025260 (UMLS CUI [1,1])
C0277786 (UMLS CUI [1,2])
Code List
Do you have complaints about your memory?
Item
Can you, fully independently, dress yourself?
integer
C0429966 (UMLS CUI [1])
Code List
Can you, fully independently, dress yourself?
CL Item
Yes, I can do it fully independently, without any difficulty (1)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with some difficulty (2)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with great difficulty (3)
(Comment:en)
(Comment:nl)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
(Comment:en)
(Comment:nl)
Item
Can you, fully independently, stand up from sitting in a chair?
integer
C4055533 (UMLS CUI [1,1])
C1299583 (UMLS CUI [1,2])
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)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with some difficulty (2)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with great difficulty (3)
(Comment:en)
(Comment:nl)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
(Comment:en)
(Comment:nl)
Item
Can you, fully independently, wash and dry your whole body?
integer
C4055522 (UMLS CUI [1,1])
C1299583 (UMLS CUI [1,2])
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)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with some difficulty (2)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with great difficulty (3)
(Comment:en)
(Comment:nl)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
(Comment:en)
(Comment:nl)
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])
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)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with some difficulty (2)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with great difficulty (3)
(Comment:en)
(Comment:nl)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
(Comment:en)
(Comment:nl)
Item
Can you, fully independently, walk outdoors (if necessary with a cane or wheel rollator)?
integer
C4055526 (UMLS CUI [1,1])
C1299583 (UMLS CUI [1,2])
C3844079 (UMLS CUI [2])
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)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with some difficulty (2)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with great difficulty (3)
(Comment:en)
(Comment:nl)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
(Comment:en)
(Comment:nl)
Item
Can you, fully independently, take care of your feet and toenails?
integer
C0150240 (UMLS CUI [1,1])
C1299583 (UMLS CUI [1,2])
C0749563 (UMLS CUI [2,1])
C1299583 (UMLS CUI [2,2])
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)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with some difficulty (2)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with great difficulty (3)
(Comment:en)
(Comment:nl)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
(Comment:en)
(Comment:nl)
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])
C0563970 (UMLS CUI [2])
C0564042 (UMLS CUI [3])
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)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with some difficulty (2)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with great difficulty (3)
(Comment:en)
(Comment:nl)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
(Comment:en)
(Comment:nl)
Item
Can you, fully independently, do the shopping?
integer
C4055547 (UMLS CUI [1,1])
C1299583 (UMLS CUI [1,2])
Code List
Can you, fully independently, do the shopping?
CL Item
Yes, I can do it fully independently, without any difficulty (1)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with some difficulty (2)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with great difficulty (3)
(Comment:en)
(Comment:nl)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
(Comment:en)
(Comment:nl)
Item
Can you, fully independently, take your medicines?
integer
C4075001 (UMLS CUI [1,1])
C1299583 (UMLS CUI [1,2])
Code List
Can you, fully independently, take your medicines?
CL Item
Yes, I can do it fully independently, without any difficulty (1)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with some difficulty (2)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with great difficulty (3)
(Comment:en)
(Comment:nl)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
(Comment:en)
(Comment:nl)
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])
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)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with some difficulty (2)
(Comment:en)
(Comment:nl)
CL Item
Yes, I can do it fully independently, but with great difficulty (3)
(Comment:en)
(Comment:nl)
CL Item
No, I cannot do it fully independently, I can only do it with someone's help (4)
(Comment:en)
(Comment:nl)
Item
How much of the time in the past 4 weeks have you felt calm and peaceful?
integer
C3829745 (UMLS CUI [1,1])
C3828653 (UMLS CUI [1,2])
Code List
How much of the time in 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 good 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 in the past 4 weeks have you felt downhearted and blue?
integer
C3829743 (UMLS CUI [1,1])
C3828653 (UMLS CUI [1,2])
Code List
How much of the time in 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 good 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 in the past 4 weeks have you been a happy person?
integer
C3828653 (UMLS CUI [1,1])
C3829752 (UMLS CUI [1,2])
Code List
How much of the time in 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 good 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
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])
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)
Quality of life
Item
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. 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
C2984049 (UMLS CUI [1])
Item
Has someone helped you to complete this questionnaire?
integer
C3273494 (UMLS CUI [1,1])
C3828841 (UMLS CUI [1,2])
Code List
Has someone helped you to complete this questionnaire?
CL Item
No, I have completed the list alone (1)
CL Item
Yes, someone helped me to complete the list (for example: your partner, brother, sister, child, grandchild, friend, acquaintance, nurse) (2)
Help with filling in this questionnaire - Specification
Item
If anyone helped you to complete the list, please specify:
text
C3273494 (UMLS CUI [1,1])
C3828841 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Item
If yes, what did the help consist of? This is the end of the questionnaire. Thank you very much for completing the questionnaire.
integer
C0332307 (UMLS CUI [1,1])
C3828841 (UMLS CUI [1,2])
C3273494 (UMLS CUI [1,3])
Code List
If yes, what did the help consist of? This is the end of the questionnaire. Thank you very much for completing the questionnaire.
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)