Assessment date
Item
Date of filling in the questionnaire
date
C2985720 (UMLS CUI [1])
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 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])
Item
Do you live with your loved one?
integer
C0682072 (UMLS CUI [1,1])
C0017313 (UMLS CUI [1,2])
C1551356 (UMLS CUI [1,3])
Code List
Do you live with your loved one?
Item
The following questions are about your health. Please tick the answer that best fits your situation. In general would you say your health is
text
C0424575 (UMLS CUI [1,1])
C0449438 (UMLS CUI [1,2])
Code List
The following questions are about your health. Please tick the answer that best fits your situation. 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)
Item
The following questions are about the amount of time that you spend caring for your loved one. You will be asked to write down whether you have given your loved one assistance for various activities of daily life. With ‘assistance’, we mean that you have supported your loved one in the task or have taken over the task entirely. Please fill in as accurately as possible the amount of time that you spend on all activities. For some caregivers it feels like they spend the whole day caring for their loved one. For example, because the care is very hard work. Even so, try to indicate as precisely as possible how much time you really spend caring for your loved one. There are questions further on in this questionnaire about how hard the care feels to you. Complete the questions based on how the previous week has been. Choose another week if your time expenditure in the previous week has been very different to the average week, for example due to illness or vacation. 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?
integer
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])
Code List
The following questions are about the amount of time that you spend caring for your loved one. You will be asked to write down whether you have given your loved one assistance for various activities of daily life. With ‘assistance’, we mean that you have supported your loved one in the task or have taken over the task entirely. Please fill in as accurately as possible the amount of time that you spend on all activities. For some caregivers it feels like they spend the whole day caring for their loved one. For example, because the care is very hard work. Even so, try to indicate as precisely as possible how much time you really spend caring for your loved one. There are questions further on in this questionnaire about how hard the care feels to you. Complete the questions based on how the previous week has been. Choose another week if your time expenditure in the previous week has been very different to the average week, for example due to illness or vacation. 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?
Hours/week of assistance in household activities
Item
If 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])
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?
integer
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])
Code List
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?
Hours/week of assistance in personal care
Item
If 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])
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?
integer
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])
Code List
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?
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 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])
Item
Does your loved one receive help from other caregivers or volunteers besides you?
integer
C0205394 (UMLS CUI [1,1])
C1521721 (UMLS CUI [1,2])
C0205394 (UMLS CUI [2,1])
C2367294 (UMLS CUI [2,2])
Code List
Does your loved one receive help from other caregivers or volunteers besides you?
Other support than the caregiver
Item
If 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 on a scale from 0 to 10 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. Ticking 0 means "not difficult at all", whereas a 10 stands for "far too difficult".
float
C1299586 (UMLS CUI [1,1])
C1171174 (UMLS CUI [1,2])
Item
The following questions are about your situation as a caregiver. 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
The following questions are about your situation as a caregiver. 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 on a scale from 0 to 10 how happy you are feeling right now. 0 means "completely unhappy", whereas a 10 means "perfectly happy".
float
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 on a scale from 0 to 10 how happy you would feel if this person would take over the care responsibilities from you. 0 means "completely unhappy", whereas 10 means "perfectly happy".
float
C1527305 (UMLS CUI [1,1])
C1947933 (UMLS CUI [1,2])
C1301771 (UMLS CUI [1,3])
Item
The following questions are 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. Please tick the box of the answer that best fits your situation. How is your quality of life in general?
integer
C0034380 (UMLS CUI [1,1])
C0205246 (UMLS CUI [1,2])
Code List
The following questions are 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. Please tick the box of the answer that best fits your situation. 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? Enter a number between 0 and 10 here.
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: This is the end of the questionnaire. Thank you very much for completing the questionnaire.
text
C0947611 (UMLS CUI [1])