CHARLS Questionnaire

Transcription

1 China Health and Retirement Longitudinal Study Biomarker Questionnaire 2013 中 国 健 康 与 养 老 追 踪 调 查 2013 年 体 检 问 卷 Nov 2015 China Center for Economic Research Institute of Social Science Survey Peking University

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3 Contents 1 BLOOD PRESSURE 1 A EQUIPMENT NEEDED B BLOOD PRESSURE BREATHING 5 A EQUIPMENT NEEDED B BREATHING MEASUREMENT HAND STRENGTH 7 A EQUIPMENT NEEDED B HAND STRENGTH MEASUREMENT BALANCE TESTS SEMI-TANDEM A EQUIPMENT NEEDED B SEMI-TANDEM FULL-TANDEM A EQUIPMENT NEEDED B FULL-TANDEM SIDE-BY-SIDE A EQUIPMENT NEEDED B SIDE-BY-SIDE WALKING SPEED 15 A EQUIPMENT NEEDED B WALKING SPEED REPEATED CHAIR STANDS 19 A EQUIPMENT NEEDED B REPEATED CHAIR STANDS TESTS STANDING HEIGHT 21 A EQUIPMENT NEEDED B STANDING HEIGHT UPPER ARM LENGTH 23

4 A EQUIPMENT NEEDED B UPPER ARM LENGTH MEASURMENT KNEE HEIGHT 25 A EQUIPMENT NEEDED B KNEE HEIGHT WEIGHT 27 A EQUIPMENT NEEDED B WEIGHT MEASUREMENT WAIST CIRCUMFERENCE 29 A EQUIPMENT NEEDED B WAIST CIRCUMFERENCE

5 CHARLS BIOMARKER QUESTIONNAIRE 1 1 BLOOD PRESSURE A EQUIPMENT NEEDED Equipment needed: Omron HEM-7200 Monitor, Batteries, Stopwatch HEM-7200 B BLOOD PRESSURE [INTRO: Now let s talk about the first activity. I d like to measure your blood pressure using this monitor and cuff which I will secure around your left arm. I would like to take three blood pressure measures. I will ask you to relax and remain seated and quiet during the measurements. First, I will place the cuff on your left arm. Once the cuff is placed appropriately on your arm and we are ready to begin, I ll ask you to lay your arm on a flat surface palm facing up so that the center of your upper arm is at the same height as your heart. I will then press the START button. The cuff will inflate and deflate automatically. After we have completed all three measures, I will give you your results. 3 3 ] IWER : Demonstrate the measurement Insert arm cuff plug into jack on the side of the monitor, place the cuff on your left arm approximately 1 2 cm above the elbow. Position the arrows over the brachial artery on the inside of the arm. Press the START/STOP button to show how the cuff with inflate automatically. 1 2 cm / PA001 Do you have a rash, a cast, edema (swelling) in the arm, open sores or wounds, or a significant bruise where the blood pressure cuff will be in contact? 1. Yes Skip to QA001 QA001 PA002 Do you understand the directions for this measurement and agree to take it? 1. Yes Skip to QA002-QA013 QA002-QA013 QA001 Why didn t R complete the blood pressure measurement? (Circle all that apply)

6 2 1 BLOOD PRESSURE 1. R felt it would not be safe 2. IWER felt it would not be safe 3. R refused or was not willing to complete the test 4. R tried but was unable to complete test 5. R did not understand the instructions 6. R had a rash, a cast, edema, etc. on arm; other health reason 7. No suitable space 8. Problem with equipment or supplies 97. Other (Specify) (QA001_1) Go to next measurement QA002-QA013 Conduct the blood pressure measurements [IWER: Record measurements in chart (Enter 993 in systolic reading if R tried but was unable to do it. Enter 999 if R chose not to do it.) ] Measurement Time Systolic Diastolic Pulse 1 (QA002) : (QA003) (QA004) (QA005) (QA002_1) mmhg mmhg P 2 (QA006) : (QA007) (QA008) (QA009) (QA006_1) mmhg mmhg P 3 (QA010) : (QA011) (QA012) (QA013) (QA010_1) mmhg mmhg P IF QA003 = 993 or 999, skip to QA001, QA003 = QA001 QA014 Which arm was used to conduct the measurements? 1. Left arm 2. Right arm QA015 How compliant was R during this measurement? 1. R was fully compliant 2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts 3. R was not fully compliant, but no obvious reason for this

7 CHARLS BIOMARKER QUESTIONNAIRE 3 QA016 What was R s position for this test? 1. Standing 2. Sitting 3. Lying down QA017 Did the R smoke, exercise, consume alcohol or food within the 30 minutes prior to completing the blood pressure test? Yes 8. Don t know

8 4 1 BLOOD PRESSURE

9 CHARLS BIOMARKER QUESTIONNAIRE 5 2 BREATHING A EQUIPMENT NEEDED Equipment needed: Peak flow meter, Disposable mouthpiece(s) packaged in plastic bag B BREATHING MEASUREMENT [INTRO: Next I m going to ask you to perform a simple measurement that will measure how fast you can expel air from your lungs. It is important that you blow as hard and as fast as you can. I would like you to perform the measurement three times. When we are ready to begin, I ll ask you to stand up. Take as deep a breath as possible. Open your mouth and close your lips firmly around the outside of the mouthpiece, and then blow as hard and as fast as you can into the mouthpiece. Like this 3 ] IWER : Demonstrate the measurement Stand up, take a deep breath and then place lips around the outside of the mouthpiece. Blow as hard and as fast as you can. PB001 Do you understand the directions for this measurement and agree to take it? 1. Yes Skip to QB002-QB004 QB002-QB004 QB001 Why didn t R complete the breathing test? (Circle all that apply) 1. R felt it would not be safe 2. IWER felt it would not be safe 3. R refused or was not willing to complete the test 4. R tried but was unable to complete test 5. R did not understand the instructions 6. R could not participate due to health reasons 7. No suitable space 8. Problem with equipment or supplies 97. Other (Specify) (QB001_1) Go to next measurement

10 6 2 BREATHING QB002-QB004 Conduct the breathing measurements [IWER: Record measurements in chart (Record 30 if less than 60; Record 890 if past last tick mark; Record 993 if R tried but was unable; or Record 999 if R chose not to do it.) ] Measurement Measurement Reading 1 (QB002) 2 (QB003) 3 (QB004) IF QB002 = 993 or 999, skip to QB001, QB002 = QB001 QB005 How much effort did R give to this test? 1. R gave full effort 2. R was prevented from giving full effort by illness, pain, or other symptoms or discomforts 3. R did not appear to give full effort, but no obvious reason for this QB006 What was R s position for this test? 1. Standing 2. Sitting 3. Lying down

11 CHARLS BIOMARKER QUESTIONNAIRE 7 3 HAND STRENGTH A EQUIPMENT NEEDED Equipment needed: Dynamometer B HAND STRENGTH MEASUREMENT [INTRO: Now I would like to assess the strength of your hand in a gripping action. I will ask you to squeeze this handle as hard as you can, just for a couple of seconds and then let go. I will take alternately two measurements from your right and your left hands. ] IWER : Demonstrate the measurement Stand, hold the dynamometer at a right angle and squeeze the handle for a few seconds. PC001 Before we begin, I d like to make sure it is safe for you to do this measurement. Have you had surgery or experienced any swelling, inflammation, severe pain, or injury in one or both hands within the last 6 months? 6 1. Yes Skip to PC003 PC003 PC002 In which hand (had surgery or experienced any swelling, inflammation, severe pain, or injury in the last 6 months)? 6 1. Both hands Skip to QC001 QC Left hand only continue but do not perform measurement on left hand 3. Right hand only continue but do not perform measurement on right hand PC003 Do you understand the directions for this measurement and agree to take it? 1. Yes Skip to QC002 QC002 QC001 Why didn t R complete the hand strength test? (Circle all that apply) 1. R felt it would not be safe

12 8 3 HAND STRENGTH 2. IWER felt it would not be safe 3. R refused or was not willing to complete the test 4. R tried but was unable to complete test 5. R did not understand the instructions 6. R could not participate due to surgery, swelling, etc.; other health reason 7. No suitable space 8. Problem with equipment or supplies 97. Other (Specify) (QC001_1) Go to next measurement QC002 Which is your dominant hand? 1. Right hand 2. Left hand 3. Both hands equally dominant QC003-QC006 Conduct the hand strength measurements [IWER: Record 993 if R tried but was unable. Record 999 if R chose not to do it ] Measurement Left Hand Right Hand 1 (QC003) kg (QC004) kg 2 (QC005) kg (QC006) kg IF QC003 or QC004 = 993 or 999, skip to QC001, QC003 QC004 = QC001 QC007 How much effort did R give to this test? 1. R gave full effort 2. R was prevented from giving full effort by illness, pain, or other symptoms or discomforts 3. R did not appear to give full effort, but no obvious reason for this QC008 What was R s position for this test? 1. Standing 2. Sitting 3. Lying down QC009 Did the R rest their arm on a support while performing the test? 1. Yes

13 CHARLS BIOMARKER QUESTIONNAIRE 9 4 BALANCE TESTS [INTRO: I would now like you to try to stand in different positions. I will first describe and show each position to you. Then I d like you to try to do it. If you cannot do particular position, or if you feel it would be unsafe to try to do it, tell me and we ll move on to the next one. Let me emphasize that I do not want you to try to do any activity that you feel might be unsafe. ] 4.1 SEMI-TANDEM A EQUIPMENT NEEDED Equipment needed: Stopwatch, Show Card B SEMI-TANDEM IWER : Demonstrate the measurement For the first one, I want you to try to stand with the side of the heel of one foot touching the big toe of the other foot for about 10 seconds. You may put either foot in front, whichever is more comfortable for you. Like. 10 PD001 Before we begin, do you have any problems from recent surgery, injury or other health conditions that might prevent you from standing up from a chair and balancing? 1. Yes Discuss with him/her whether s/he should attempt each measurement given his/her physical problems after describing each measurement. Do not assume a respondent is too physically limited to attempt a measurement without discussing it with him/her. / / PD002 Do you understand the directions for this measurement and agree to take it? 1. Yes Skip to QD002 QD002

14 10 4 BALANCE TESTS QD001 Why didn t R complete semi-tandem stand? (Circle all that apply) 1. R felt it would not be safe 2. IWER felt it would not be safe 3. R refused or was not willing to complete the test 4. R tried but was unable to complete test 5. R did not understand the instructions 6. R had surgery, injury or other health condition that prevented R from standing 7. No suitable space 8. Problem with equipment or supplies 97. Other (Specify) (QD001_1) Go To Side-by-Side QD002 Did R hold semi-tandem stand for a full 10 seconds without stepping out of place or grabbing hold of anything? Yes Enter amount of time R held stand in seconds with two decimal places (QD003) 993. R tried but was unable 999. R chose not to do it IF QD002 = 993 or 999, skip to QD001, QD002 = QD001 QD004 Did R use any compensatory movements of his/her trunk, arms or legs to steady him/herself during semi-tandem stand? 1. Yes 8. Don t know If R was able to complete the semi-tandem for the full 10 seconds without stepping out of place or grabbing a hold of anything, Go To Full-Tandem. 10 If R was not able to complete the semi-tandem for the full 10 seconds without stepping out of place or grabbing a hold of anything, Go To Side-By-Side. 10

15 CHARLS BIOMARKER QUESTIONNAIRE FULL-TANDEM A EQUIPMENT NEEDED Equipment needed: Stopwatch, Show Card B FULL-TANDEM PE001 Choose measurement according to R s age seconds full-tandem balance measurement 70 years old or above seconds full-tandem balance measurement Less than 70 years old IWER : Demonstrate the measurement Now I want you to try to stand with the heel of one foot in front of and touching the toes of the other foot for about [30/60] seconds. You may put either foot in front, whichever is more comfortable for you. You may use your arms, bend your knees, or move your body to maintain your balance, but try not to move your feet. Try to hold this position until I tell you to stop. Like this. 30/60 PE002 Do you understand the directions for this measurement and agree to take it? 1. Yes Skip to QE002 QE002 QE001 Why didn t R complete full-tandem measurement? (Circle all that apply) 1. R felt it would not be safe 2. IWER felt it would not be safe 3. R refused or was not willing to complete the test 4. R tried but was unable to complete test 5. R did not understand the instructions 6. R had surgery, injury or other health condition that prevented R from standing 7. No suitable space 8. Problem with equipment or supplies

16 12 4 BALANCE TESTS 97. Other (Specify) (QE001_1) Go To Side-by-Side QE002 Did R hold full-tandem stand for a full [30/60] seconds without stepping out of place or grabbing hold of anything? [30/60] 1. Yes Enter amount of time R held stand in seconds with two decimal places (QE003) 993. R tried but was unable 999. R chose not to do it IF QE002 = 993 or 999, skip to QE001, QE002 = QE001 QE004 Did R use any compensatory movements of his/her trunk, arms or legs to steady him/herself during semi-tandem stand? 1. Yes 8. Don t know QE005 Record the type of floor surface that the balance measures were conducted on. 1. Linoleum/tile/wood / / 2. Carpet 3. Clay 4. Concrete 5. Not sure 97. Other (Specify) (QE005_1) QE006 How compliant was R during the balance measurements? 1. R was fully compliant 2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts 3. R did not appear to be fully compliant, but no obvious reason for this

17 CHARLS BIOMARKER QUESTIONNAIRE SIDE-BY-SIDE A EQUIPMENT NEEDED Equipment needed: Stopwatch, Show Card B SIDE-BY-SIDE IWER : Demonstrate the measurement Now I will show you the next movement. I want you to try to stand with your feet together, side-by-side for about 10 seconds. You may use your arms, bend your knees, or move your body to maintain your balance, but try not to move your feet. Try to hold this position until I tell you to stop. Like this. 10 PF001 Do you understand the directions for this measurement and agree to take it? 1. Yes Skip to QF002 QF002 QF001 Why didn t R complete Side-by-Side stand? (Circle all that apply) 1. R felt it would not be safe 2. IWER felt it would not be safe 3. R refused or was not willing to complete the test 4. R tried but was unable to complete test 5. R did not understand the instructions 6. R had surgery, injury or other health condition that prevented R from standing 7. No suitable space 8. Problem with equipment or supplies 97. Other (Specify) (QF001_1) Go To Walking Speed QF002 Did R hold side-by-side stand for a full 10 seconds without stepping out of place or grabbing hold of anything? Yes Enter amount of time R held stand in seconds with two decimal places (QF003)

18 14 4 BALANCE TESTS 993. R tried but was unable 999. R chose not to do it IF QF002 = 993 or 999, skip to QF001, QF002 = QF001 QF004 Did R use any compensatory movements of his/her trunk, arms or legs to steady him/herself during semi-tandem stand? 1. Yes 8. Don t know QF005 Record the type of floor surface that the balance measures were conducted on. 1. Linoleum/tile/wood / / 2. Carpet 3. Clay 4. Concrete 5. Not sure 97. Other (Specify) (QF005_1) QF006 How compliant was R during the balance measurements? 1. R was fully compliant 2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts 3. R did not appear to be fully compliant, but no obvious reason for this

19 CHARLS BIOMARKER QUESTIONNAIRE 15 5 WALKING SPEED A EQUIPMENT NEEDED Equipment needed: Tape measure, Stopwatch, Masking Tape B WALKING SPEED PG002_1 Is R eligible for Walking Speed Test? 1. Yes, R age No, R age < 60 < 60 Skip to Repeated Chair Stands PG002 Next, I would like to assess whether you can walk a very short distance comfortably (using a walking stick or other aid if necessary). First, I want to make sure it is safe to carry out the measurement. Do you have any problems from recent surgery, injury, or other health conditions that might prevent you from walking? 1. No apparent restriction Skip to QG002 QG Yes, recent surgery 3. Yes, injury 4. Yes, other health condition [INTRO: Now let s find a place where we can conduct the measurement. We will need a clear space about 4 meters long in a non-carpeted area, if possible. I m going to place the measuring tape alongside the space where the walk will take place. 4 ] IWER : Demonstrate the measurement Set up the course (2.5 meters) 2.5 This is our walking course. I am going to time you as you walk the course. I will be asking you to walk the cour se two times. I ll walk along side you the whole time during the measurement. Now I d like to demonstrate how to do the measurement. You will start by lining your feet up at the starting point. 2 PG003 Do you understand the directions for this measurement and agree to take it?

20 16 5 WALKING SPEED 1. Yes Skip to QG002 QG002 QG001 Why didn t R complete the Walking Speed measurement? (Circle all that apply) 1. R felt it would not be safe 2. IWER felt it would not be safe 3. R refused or was not willing to complete the test 4. R tried but was unable to complete test 5. R did not understand the instructions 6. R had surgery, injury, or other health condition that prevented R from walking 7. No suitable space 8. Problem with equipment or supplies 97. Other (Specify) (QG001_1) Go to Repeated Chair Stands QG002 Conduct the first walking speed measurements [IWER: I am going to time you as you walk the course at your normal pace. I will be asking you to walk the course at your usual pace a total of two times. I ll walk along side you the whole time during the measurement. I d like you to stand here with your feet lined up. Start walking when I say Begin. Walk all the way past the other end of the tape before you stop. Are you ready to go now? Begin. 2 ] [IWER: Record measurements in chart (Record 993 if R tried but was unable. Record 999 if R chose not to do it) ] Measurement Walking Time 1 (QG002). seconds IF QG002 = 993 or 999, skip to QG001, QG002 = QG001 QG003 Conduct the second walking speed measurements [IWER: Now I want you to repeat the walk. Remember to walk at your usual pace and go all the way past the other end of the course. I d like you to stand here with your feet lined up. Start walking when I say Begin. Are you ready to go now?

21 CHARLS BIOMARKER QUESTIONNAIRE 17 Begin. ] [IWER: Record measurements in chart (Record 993 if R tried but was unable. Record 999 if R chose not to do it) ] Measurement Walking Time 2 (QG003). sec QG004 Record type of floor surface. 1. Linoleum/tile/wood / / 2. Carpet 3. Clay 4. Concrete 5. Not sure 97. Other (Specify): (QG004_1) QG005 Record type of aid used. 1. None 2. Walking stick or cane 3. Elbow crutches 4. Walking frame 97. Other (Specify): (QG005_1) QG006 How compliant was R during this measurement? 1. R was fully compliant 2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts 3. R was not fully compliant, but no obvious reason for this

22 18 5 WALKING SPEED

23 CHARLS BIOMARKER QUESTIONNAIRE 19 6 REPEATED CHAIR STANDS A EQUIPMENT NEEDED Equipment needed: Chair, Stopwatch B REPEATED CHAIR STANDS TESTS IWER Demonstrate the measurement Now I will show you the next movement. Please keep your arms folded across your chest. When I say ready? stand, please stand up straight and then sit down again at your fastest pace five times without stopping in between and without using your arms to push off. Do you think you can do that for me? 5 PH001 Do you understand the directions for this measurement and agree to take it? 1. Yes Skip to QH002 QH002 QH001 Why didn t R complete the Side-by-Side stand? (Circle all that apply) 1. R felt it would not be safe 2. IWER felt it would not be safe 3. R refused or was not willing to complete the test 4. R tried but was unable to complete test 5. R did not understand the instructions 6. R had surgery, injury or other health condition that prevented R from standing 7. No suitable space 8. Problem with equipment or supplies 97. Other (Specify) (QH001_1) Go to Standing Height QH002 Did R can stand up straight and then sit down again at his/her usual pace five times without stopping in between and without using arms to push off?

24 20 6 REPEATED CHAIR STANDS 1. Yes Enter amount of time R held stand in seconds to two decimal places (QH003):. Sec Enter amount of time R held stand in seconds to two decimal places (QH004):. Sec 993. R tried but was unable 999. R chose not to do it IF QH002 = 993 or 999, skip to QH001, QH002 = QH001 QH005 Record the number of stands R completed 0..5 times QH006 Record the chair height from floor to seat in the space provided cm QH007 Did R use his/her trunk arms during repeated chair stands? 1. Yes 2. No 8. Don t Know

25 CHARLS BIOMARKER QUESTIONNAIRE 21 7 STANDING HEIGHT A EQUIPMENT NEEDED Equipment needed: Stadiometer B STANDING HEIGHT Looking straight ahead Shoulders relaxed Arms at sides Shoulder blades buttocks, heels touching surface. Legs straight and knees together Feet flat heels almost together IWER : Demonstrate the measurement Next I will measure your height using this stadiometer. Please stand erect on the floor board of the stadiometer with your back to the vertical backboard of the stadiometer. Your weight should be evenly distributed on both feet. The heels of the feet are placed together with both heels touching the base of the vertical board.

26 22 7 STANDING HEIGHT Place the feet pointed slightly outward at a 60. Your head should be maintained in the Frankfort Horizontal Plane position. 60 PI001 Do you understand the directions for this measurement and agree to take it? 1. Yes QI002 QI002 QI001 Why didn t R complete the breathing test? (Circle all that apply) 1. R felt it would not be safe 2. IWER felt it would not be safe 3. R refused or was not willing to complete the test 4. R tried but was unable to complete test 5. R did not understand the instructions 6. R had humpback, cannot stand, etc. other health reasons 7. No suitable space 8. Problem with equipment or supplies 97. Other (Specify) (QI001_1) Go to Upper Arm Length QI002 Record measurements in chart (Record 993 if R tried but was unable. Record 999 if R chose not to do it) Measurement Height (cm) 1 (QI002) _ , 993, 999 (cm) IF QI002 = 993 or 999, skip to QI001, QI002 = QI001 QI003 How compliant was R during this measurement? 1. R was fully compliant 2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts 3. R was not fully compliant, but no obvious reason for this

27 CHARLS BIOMARKER QUESTIONNAIRE 23 8 UPPER ARM LENGTH A EQUIPMENT NEEDED Equipment needed: MA DING Rule B UPPER ARM LENGTH MEASURMENT Acromion process of scapula Olecranon process. IWER : Demonstrate the measurement Next I will measure your upper arm length PJ001 Do you understand the directions for this measurement and agree to take it? 1. Yes QJ002 QJ002

28 24 8 UPPER ARM LENGTH QJ001 Why didn t R complete the upper arm length? (Circle all that apply) 1. R felt it would not be safe 2. IWER felt it would not be safe 3. R refused or was not willing to complete the test 4. R tried but was unable to complete test 5. R did not understand the instructions 6. R could not participated due to health reasons 7. No suitable space 8. Problem with equipment or supplies 97. Other (Specify) (QJ001_1) Go to Knee Height QJ002 Record measurements in chart (Record 993 if R tried but was unable. Record 999 if R chose not to do it) Measurement Upper Arm Length (cm) 1 (QJ002) , 993, 999 (cm) IF QJ002 = 993 or 999, skip to QJ001, QJ002 = QJ001 QJ003 Which arm was used to conduct the measurements? 1. Left 2. Right QJ004 How compliant was R during this measurement? 1. R was fully compliant 2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts 3. R was not fully compliant, but no obvious reason for this

29 CHARLS BIOMARKER QUESTIONNAIRE 25 9 KNEE HEIGHT A EQUIPMENT NEEDED Equipment needed: MA DING Rule B KNEE HEIGHT IWER : Demonstrate the measurement Next I will measure your knee height. Please sit on a chair with barefoot PK001 Do you understand the directions for this measurement and agree to take it? 1. Yes QK002 QK002 QK001 Why didn t R complete the knee height? (Circle all that apply) 1. R felt it would not be safe

30 26 9 KNEE HEIGHT 2. IWER felt it would not be safe 3. R refused or was not willing to complete the test 4. R tried but was unable to complete test 5. R did not understand the instructions 6. R could not participated due to health reasons 7. No suitable space 8. Problem with equipment or supplies 97. Other (Specify) (QK001_1) Go to Weight Measurement QK002 Record measurements in chart (Record 993 if R tried but was unable. Record 999 if R chose not to do it) Measurement Knee Height (cm) 1 (QK002) , 993, 999 (cm) IF QK002 = 993 or 999, skip to QK001, QK002 = QK001 QK003 Which leg was used to conduct the measurements? 1. Left 2. Right QK004 How compliant was R during this measurement? 1. R was fully compliant 2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts 3. R was not fully compliant, but no obvious reason for this

31 CHARLS BIOMARKER QUESTIONNAIRE WEIGHT A EQUIPMENT NEEDED Equipment needed: Scale B WEIGHT MEASUREMENT PL001 Is R eligible for Weight Measurement? 1. Yes weight < 150kg < No weight 150kg 150kg Skip to Waist Circumference IWER : Demonstrate the measurement Now, I d like to measure your weight. To measure your weight, I will ask you to stand on this scale, with your shoes off, while I read the display PL002 Do you understand the directions for this measurement and agree to take it? 1. Yes Skip to QL002 QL002 QL001 Why weren t you able to measure R s weight? (Circle all that apply) 1. R felt it would not be safe 2. IWER felt it would not be safe 3. R refused or was not willing to complete the test 4. R tried but was unable to complete test 5. R did not understand the instructions 6. R is not able to stand or balance on scale; other health reason 7. No suitable space 8. Problem with equipment or supplies 97. Other (Specify) (QL001_1) Go to Waist Circumference QL002 Record measurements in chart (Record 993 if R tried but was unable. Record 999 if R chose not to do it)

32 28 10 WEIGHT Measurement Weight Measurement (kg) 1 (QL002) , 993, 999 (kg) IF QL002 = 993 or 999, skip to QL001, QL002 = QL001 QL003 Record type of floor surface. 1. Linoleum/tile/wood / / 2. Carpet 3. Clay 4. Concrete 5. Not sure 97. Other (Specify) (QL003_1) QL004 Was R wearing shoes during the measurement? 1. Yes QL005 How compliant was R during this measurement? 1. R was fully compliant 2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts 3. R was not fully compliant, but no obvious reason for this

33 CHARLS BIOMARKER QUESTIONNAIRE WAIST CIRCUMFERENCE A EQUIPMENT NEEDED Equipment needed: Soft Tape Measure B WAIST CIRCUMFERENCE IWER : Demonstrate the measurement Now I m going to perform a simple measurement of your waist circumference. For this measurement it is important for you to be standing. I will ask you to identify where on your body your navel (belly button) is located. I will then place this soft measuring tape around your waist, over your clothing, holding it securely at the level of your navel. Once the tape measure is placed appropriately around your waist then we are ready to begin. I will ask you to take a normal breath and exhale, holding your breath at the end of the exhale. I will then record the measurement. Stand and locate navel. Place measuring tape over the clothing around the waist at the level of the navel. Take a normal breath and exhale, holding breath at end of exhale and letting the tape out slightly. PM001 Ask if necessary: ( Before we begin, do you feel you are able to stand while we do this measurement? ) 1. Yes Skip to QM001 QM001 PM002 Do you understand the directions for this measurement and agree to take it? 1. Yes Skip to QM002 QM002 QM001 Why weren t you able to measure R s waist? (Circle all that apply) 1. R felt it would not be safe 2. IWER felt it would not be safe 3. R refused or was not willing to complete the test 4. R tried but was unable to complete test 5. R did not understand the instructions

34 30 11 WAIST CIRCUMFERENCE 6. R is not able to stand; other health reason 7. No suitable space 8. Problem with equipment or supplies 97. Other (Specify) (QM001_1) The End QM002 Record measurements in chart (Record 993 if R tried but was unable. Record 999 if R chose not to do it) Measurement Waist Measurement (cm) 1 (QM002) , 999 (cm) IF QM002 = 993 or 999, skip to QM001, QM002 = QM001 QM003 What difficulties occurred during this measurement? (Circle all that apply) 1. None 2. R had breathing difficulties 3. R was unable to hold breath at the end of the exhale 4. R was prevented from giving full effort by illness, pain, or other symptoms or discomforts 5. R did not appear to give full effort, but no obvious reason for this 6. Had difficulty or unable to locate navel 97. Other (Specify) (QM003_1) QM004 How compliant was R during this measurement? 1. R was fully compliant 2. R was prevented from fully complying due to illness, pain, or other symptoms or discomforts 3. R was not fully compliant, but no obvious reason for this QM005 Was the R wearing bulky clothing during this measurement? 1. Yes