Start
nshd_89_dsq
STRICTLY CONFIDENTIAL
1989
NATIONAL SURVEY OF HEALTH AND DEVELOPMENT
(Medical Research Council)
Disability Supplementary Questions

Nurse's name

Generic text
Disability Supplementary Questions
For those who answered yes to questions 1a,1b,1c, or 1d please circle the level of disability in the appropriate section

Walking

0
Can walk more than a quarter of a mile without stopping or severe discomfort
1
Can walk more than 200 yd (but less than 1/4 mile) without stopping or severe discomfort
2
Can walk more than 50 yd without stopping or severe discomfort
3
Can only walk a few steps without stopping or severe discomfort
4
Cannot walk at all

Steps and stairs

0
Can walk up and down a flight of stairs in a normal manner without stopping for a rest and and without holding on
1
Can only walk up and down a flight of stairs without stopping for a rest and without holding on if goes sideways or one step at a time
2
Can only walk up and down a flight of 12 stairs if holds on (doesn't need a rest)
3
Can only walk up and down a flight of 12 stairs if holds on and takes a rest
4
Can walk up and down at least one step but cannot manage a flight of 12 stairs
5
Cannot walk up and down one step

Falling

0
Has not fallen in the past year
1
Has fallen once or twice in the past year
2
Has fallen between 3 and 11 times in the past year
3
Has fallen 12 or more times in the past year

Balance

0
Does not need to hold on to something to keep balance
1
Needs to hold on occasionally to keep balance
2
Often needs to hold on to something to keep balance
3
Always needs to hold on to something to keep balance

Bending and straightening

0
Can bend down to sweep up something from the floor and straighten up
1
Can bend down to pick up something from the floor and straighten up
2
Can bend down far enough to touch knees and straighten up
3
Cannot bend down far enough to touch knees and straighten up
For those who answered yes to question 1e please ask the following supplementary question.
Using your [RIGHT/LEFT] arm, how difficult is it for you to ...
Right Left

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

Hold your arm out in front of you to shake hands with someone?
Put your hand up to your head to put a hat on?
Put your hand behind your back to tuck in a blouse/shirt?
Put your arm above your head to reach for something above you?
For those who answered yes to question 1.f please ask the following supplementary question.
Using your [RIGHT/LEFT] hand only, can you ...
Right Left

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

Pick up and carry a 5 lb bag of potatoes?
Turn a tap on and off?
Pick up a small object, such as a safety pin?
If answered no to any activity above ask the following 2 questions
qc_1_f_i == 2
Using your [RIGHT/LEFT] hand only, can you ...
Right Left

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

Pick up and carry a pint of milk?
Pick up and hold a mug of tea or coffee?
Turn the control knobs on a cooker?
I'm going to read out some things which involve holding, gripping or turning and I'd like you to tell me whether it is difficult for you to do them (without using special gadgets)
-

1 - Not difficult at all

2 - Difficult

3 - Impossible

Wring out light washing? (eg a tea towel)
Unscrew the lid of a coffee jar?
Pick up and pour from a full kettle?
Serve food from a pan using a spoon or ladle?
Use a pen or pencil?
Use a pair of scissors?
Tie a bow in laces or string?
For those who answered yes to question 2a,2b,2c,2d,2e,2f,2g or 2h please establish whether or not the activity can be done without help.
Can do without help?

1 - Yes

0 - No

washing hands and face
washing all over
dressing and undressing
getting in and out of a chair
getting in and out of bed
getting to the toilet
using toilet
feeding yourself, including cutting up food

For those who answered yes to question 3a please record below what devices they use.

Generic text

For those who answered yes to question 3b please indicate how often they lose control of their bladder.

5
At least once every 24 hours
4
Less than every 24 hours, but at least once a week
3
Less than once a week, but at least twice a month
2
Less than twice a month, but at least once a month
1
Less than once a month

For those who answered yes to question 3c please establish how often they lose control of their bowels?

5
At least once every 24 hours
4
Less than every 24 hours, but at least once a week
3
Less than once a week, but at least twice a month
2
Less than twice a month, but at least once a month
1
Less than once a month

For those who answered yes to question 4b please circle the level of disability (with glasses or lenses if worn)

1
Can see well enough to read a large print book
2
Can see well enough to read a newspaper headline
3
cannot see well enough to read a newspaper headline

For those who answered yes to question 4c please circle the level of disability (with glasses or lenses if worn)

0
Can recognise a friend across the road, but only with difficulty
1
Sees well enough to recognise a friend across a room (but not across a road)
2
Sees well enough to recognise a friend who is an arm's length away (but not across a room)
3
Sees well enough to recognise a friend if close to his face
4
Can see the shapes of the furniture in this room
5
Can tell by the light where the windows are
6
Cannot tell by the light where the windows are

For those who answered yes to question 5b please circle the level of disability (with hearing aid if worn)

1
Has no difficulty hearing someone talking in a quiet room (with hearing aid)
2
Has no difficulty hearing someone talking in a loud voice in a quiet room
3
Can follow a TV programme at volume others find acceptable
4
Can use a telephone
5
Can hear a door bell, alarm clock or telephone bell
6
Can follow a TV programme with the sound turned up
7
Cannot follow a TV programme with the sound turned up
8
Cannot hear sounds at all
End

nshd_89_dsq

STRICTLY CONFIDENTIAL
NATIONAL SURVEY OF HEALTH AND DEVELOPMENT
(Medical Research Council)
Disability Supplementary Questions
Nurse's name
Generic text
Disability Supplementary Questions
For those who answered yes to questions 1a,1b,1c, or 1d please circle the level of disability in the appropriate section
Walking
0
Can walk more than a quarter of a mile without stopping or severe discomfort
1
Can walk more than 200 yd (but less than 1/4 mile) without stopping or severe discomfort
2
Can walk more than 50 yd without stopping or severe discomfort
3
Can only walk a few steps without stopping or severe discomfort
4
Cannot walk at all
Steps and stairs
0
Can walk up and down a flight of stairs in a normal manner without stopping for a rest and and without holding on
1
Can only walk up and down a flight of stairs without stopping for a rest and without holding on if goes sideways or one step at a time
2
Can only walk up and down a flight of 12 stairs if holds on (doesn't need a rest)
3
Can only walk up and down a flight of 12 stairs if holds on and takes a rest
4
Can walk up and down at least one step but cannot manage a flight of 12 stairs
5
Cannot walk up and down one step
Falling
0
Has not fallen in the past year
1
Has fallen once or twice in the past year
2
Has fallen between 3 and 11 times in the past year
3
Has fallen 12 or more times in the past year
Balance
0
Does not need to hold on to something to keep balance
1
Needs to hold on occasionally to keep balance
2
Often needs to hold on to something to keep balance
3
Always needs to hold on to something to keep balance
Bending and straightening
0
Can bend down to sweep up something from the floor and straighten up
1
Can bend down to pick up something from the floor and straighten up
2
Can bend down far enough to touch knees and straighten up
3
Cannot bend down far enough to touch knees and straighten up
For those who answered yes to question 1e please ask the following supplementary question.

Using your [RIGHT/LEFT] arm, how difficult is it for you to ...

Right Left

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

Hold your arm out in front of you to shake hands with someone?
Put your hand up to your head to put a hat on?
Put your hand behind your back to tuck in a blouse/shirt?
Put your arm above your head to reach for something above you?
For those who answered yes to question 1.f please ask the following supplementary question.

Using your [RIGHT/LEFT] hand only, can you ...

Right Left

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

Pick up and carry a 5 lb bag of potatoes?
Turn a tap on and off?
Pick up a small object, such as a safety pin?

Using your [RIGHT/LEFT] hand only, can you ...

Right Left

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

1 - Yes

2 - No

Pick up and carry a pint of milk?
Pick up and hold a mug of tea or coffee?
Turn the control knobs on a cooker?

I'm going to read out some things which involve holding, gripping or turning and I'd like you to tell me whether it is difficult for you to do them (without using special gadgets)

-

1 - Not difficult at all

2 - Difficult

3 - Impossible

Wring out light washing? (eg a tea towel)
Unscrew the lid of a coffee jar?
Pick up and pour from a full kettle?
Serve food from a pan using a spoon or ladle?
Use a pen or pencil?
Use a pair of scissors?
Tie a bow in laces or string?

For those who answered yes to question 2a,2b,2c,2d,2e,2f,2g or 2h please establish whether or not the activity can be done without help.

Can do without help?

1 - Yes

0 - No

washing hands and face
washing all over
dressing and undressing
getting in and out of a chair
getting in and out of bed
getting to the toilet
using toilet
feeding yourself, including cutting up food
For those who answered yes to question 3a please record below what devices they use.
Generic text
For those who answered yes to question 3b please indicate how often they lose control of their bladder.
5
At least once every 24 hours
4
Less than every 24 hours, but at least once a week
3
Less than once a week, but at least twice a month
2
Less than twice a month, but at least once a month
1
Less than once a month
For those who answered yes to question 3c please establish how often they lose control of their bowels?
5
At least once every 24 hours
4
Less than every 24 hours, but at least once a week
3
Less than once a week, but at least twice a month
2
Less than twice a month, but at least once a month
1
Less than once a month
For those who answered yes to question 4b please circle the level of disability (with glasses or lenses if worn)
1
Can see well enough to read a large print book
2
Can see well enough to read a newspaper headline
3
cannot see well enough to read a newspaper headline
For those who answered yes to question 4c please circle the level of disability (with glasses or lenses if worn)
0
Can recognise a friend across the road, but only with difficulty
1
Sees well enough to recognise a friend across a room (but not across a road)
2
Sees well enough to recognise a friend who is an arm's length away (but not across a room)
3
Sees well enough to recognise a friend if close to his face
4
Can see the shapes of the furniture in this room
5
Can tell by the light where the windows are
6
Cannot tell by the light where the windows are
For those who answered yes to question 5b please circle the level of disability (with hearing aid if worn)
1
Has no difficulty hearing someone talking in a quiet room (with hearing aid)
2
Has no difficulty hearing someone talking in a loud voice in a quiet room
3
Can follow a TV programme at volume others find acceptable
4
Can use a telephone
5
Can hear a door bell, alarm clock or telephone bell
6
Can follow a TV programme with the sound turned up
7
Cannot follow a TV programme with the sound turned up
8
Cannot hear sounds at all
Name

1989 Disability Supplemental Questions