healthy life

Hello:
You are invited to participate in our survey about the way of healthy life. Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions. Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential.

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.

Name

Age

Occupation

First of all, how would you evaluate the hospitals in your area in their ability to treat health problems related to age?

Which of the following best describes your capacities to perform everyday activities:

You can perform all physical activities of daily living without assistance. (Excellent capacity)

You can perform all physical activities without assistance but may need some help with the heavy work such as laundry and housekeeping. (Good capacity)

You regularly require help with certain physical activities and/or heavy work but can get through any single day without help. (Moderate capacity)

You need help each day but not necessarily throughout the day or night. (Severely impaired capacity)

You need help throughout the day and/or night to carry out the activities of daily living. (Completely impaired capacity)

How healthy are you?

Very healthy

Healthy

Moderately healthy

Not healthy

How often do you participate in at least 30 minutes of exercise?

Less than once a week

1-3 times a week

4-7 times a week

More than 7 times a week

For each of the following activities rate whether you strongly disagree, disagree, are neutral, agree, or strongly agree that they are an important part of a healthy lifestyle: