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Name
Label/Question
1.

ID

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
2.

F001: A2. Visit #

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
3.

F001: A7. Permission

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
4.

F001: B1. Mode of Interview

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
5.

F001: B2. With whom

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
6.

F001: B2a. Proxy code

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
7.

F001: C1a1. MDS: Planning meals

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
8.

F001: C1a2. MDS: Planning meals, how difficult?

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
9.

F001: C1b1. MDS: Setting out food and utensils

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
10.

F001: C1b2. MDS: Food and utensils, how difficult?

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
11.

F001: C1c1. MDS: Cooking

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
12.

F001: C1c2. MDS: Cooking, how difficult?

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
13.

F001: C1d1. MDS: Dishes, dusting, tidying

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
14.

F001: C1d2. MDS: Dishes, dusting, tidying, how difficult?

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
15.

F001: C1e1. MDS: Laundry

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
16.

F001: C1e2. MDS: Laundry, how difficult?

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
17.

F001: C1f1. MDS: Handling money

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
18.

F001: C1f2. MDS: Handling money, how difficult?

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
19.

F001: C1g1. MDS: Bills paid on time

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
20.

F001: C1g2. MDS: Bills paid on time, how difficult?

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
21.

F001: C1h1. MDS: Balancing checkbooks

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
22.

F001: C1h2. MDS: Balancing checkbooks, how difficult?

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
23.

F001: C1i1. MDS: Household expenses

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
24.

F001: C1i2. MDS: Household expenses, how difficult?

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
25.

F001: C1j1. MDS: Doctor appointments

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
26.

F001: C1j2. MDS: Doctor appointments, how difficult?

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
27.

F001: C1k1. MDS: Remebering medications

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
28.

F001: C1k2. MDS: Remebering medications, how difficult?

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
29.

F001: C1l1. MDS: Opening medicine bottles

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
30.

F001: C1l2. MDS: Opening medicine bottles, how difficult?

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
31.

F001: C1m1. MDS: Injections, ointments, bandages

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
32.

F001: C1m2. MDS: Injections, ointments, how difficult?

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
33.

F001: C1n1. MDS: Phone numbers

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
34.

F001: C1n2. MDS: Phone numbers, how difficult?

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
35.

F001: C1o1. MDS: Remembering numbers

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
36.

F001: C1o2. MDS: Remembering numbers, how difficult?

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
37.

F001: C1p1. MDS: Answering phone

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
38.

F001: C1p2. MDS: Answering phone, how difficult?

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
39.

F001: C1q1. MDS: Hanging up

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
40.

F001: C1q2. MDS: Hanging up, how difficult?

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
41.

F001: C1r1. MDS: Shopping

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
42.

F001: C1r2. MDS: Shopping, how difficult?

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
43.

F001: C1s1. MDS: Travel

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
44.

F001: C1s2. MDS: Travel, how difficult?

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
45.

F001: C2a. ADLS: Picking out and gathering clothes

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
46.

F001: C2b. ADLS: Dressing or undressing lower body

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
47.

F001: C2c. ADLS: Tying shoes, fastening pants

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
48.

F001: C2d. ADLS: Putting on or taking off top

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
49.

F001: C2e. ADLS: Fastening, buttoning, zipping

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.


Name
Label/Question
50.

F001: C2f. ADLS: Gathering washcloth, soap, etc.

Taken from: ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), 1999-2008 - Form 001 Final Disposition Form.

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