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July 15, 2011

Content Documentation
For The
National Health And Aging Trends Study (NHATS)
Data Collection Instruments

Conducted by the Johns Hopkins Bloomberg School of Public Health and Westat

Sponsored by the National Institute on Aging

Table of Contents

In-Person Interview

  • Interview Setup (IS)
    • Age
    • Sex
    • Proxy Interview and Reason for Proxy
  • Residence (RE)
    • Physical structure of residence
  • Health Conditions (HC)
    • Chronic conditions
    • Hospital Stays and Surgeries
    • Falls
    • Depression and Anxiety
    • Sleep Quality
  • Housing Type (HT)
    • Length and Type of Residence
    • Lives in Residential Care
    • Lives in Retirement Community
  • Service Environment (SE)
    • Services available and used
    • Extra charges for services
  • Household (HH)
    • Marital Status and History
    • Spouse/Partner Characteristics
    • Other Household Members Characteristics
  • Children and Siblings (CS)
    • Characteristics of children not living with sample person
    • Family characteristics of sample person's children
  • Social Network (SN)
    • Confidant number and characteristics
  • Home Environment (HO)
    • Access to the Home
    • Building Amenities
    • Features inside the Home/Private Living Space
  • Environmental Modifications (EM)
    • Features added and out -of-pocket costs
    • Out-of-pocket costs of other devices for daily activities
  • Community (CM)
  • Technological Environment (TE)
    • Cell phones and computer availability and use
  • Mobility Devices (MD)
    • Availability and use
  • Sensory and Physical Impairments and Symptoms (SS)
    • Vision and Hearing
    • Chewing and Speaking
    • Pain
    • Physical Impairments and Severity
  • Physical Capacity (PC)
    • 12 activities (includes Nagi items on walking, climbing, lifting, reaching, grasping objects)
  • Cognition (Proxy) (CP)
    • Memory Rating
    • Dementia screening
    • Behavior problems
  • Cognition (Sample Person) (CG)
    • Self-rated memory
    • Orientation to date
    • Immediate and delayed 10 word recall
    • Orientation (names of President and Vice President)
    • Clock drawing test
  • Mobility (MO)
    • Going outside one's home
      • Frequency, device use, help, difficulty, frequency change, consequences of no help/difficulty
    • Getting around inside one's home
      • Frequency of device use, help, difficulty, frequency change, consequences of no help/difficulty
    • Getting out of bed
      • Frequency of device use, help, difficulty, consequences of no help/difficulty
  • Duration of Mobility Accommodations (DM)
    • Months/Years of mobility help
    • Months/Years of mobility device use
    • Help and device use at age 65
  • Driving and Transportation (DT)
    • Driving status
    • Frequency and avoidance in driving
    • Other transportation used
  • Household Activities (HA)
    • Laundry
      • Who does, help for health reason, difficulty, frequency change, consequences of no help/difficulty
    • Shopping for Groceries or Personal Items
      • Who does, help for health reason, difficulty, frequency change, consequences of no help/difficulty
    • Making Hot Meals
      • Who does, help for health reason, difficulty, frequency change, consequences of no help/difficulty
    • Paying Bills or Banking
      • Who does, help for health reason, difficulty, frequency change, consequences of no help/difficulty
    • Less Common Money Matters
      • Who helps
      • Reasons for help: health or functioning, or other
  • Self-Care Activities (SC)
    • Eating
      • Used equipment/devices, help, frequency by self, difficulty
    • Getting Cleaned Up
      • Frequency used equipment/devices, help, frequency by self, difficulty, frequency change, consequences of no help/difficulty
    • Toileting
      • Frequency used equipment/devices, help, frequency by self, difficulty, consequences of no help/difficulty
    • Dressing
      • Used equipment/devices and frequency, help, frequency by self, difficulty, consequences of no help/difficulty
  • Duration of Self-Care Accommodations (DS)
    • Months/Years of help with self-care activities
    • Help at age 65 with self-care activities
  • Medical Care Activities (MC)
    • Prescribed Medicines
      • Where and how obtained, frequency used reminders, help for health reason, difficulty, frequency change, consequences of no help/difficulty
    • Managing Doctor Visits
      • Transportation, who sits in, what companion does at visit
    • Managing Bills and Insurance
      • Who helps
  • Participation (PA)
    • Activities
    • Participation restrictions due to health, transportation
  • Smoking (SD)
  • Performance Activities Eligibility (PE)
  • Performance Activities Booklet (pdf)
    • Balance activities
    • Chair stands
    • Walking
    • Grip strength
    • Peak air flow
    • Waist circumference
  • Height and Weight (HW)
  • Early Life (EL)
    • State or country of birth
    • Childhood: Health, financial well-being, lived with both parents, residence
    • Education
    • Parents living or age at death
  • Race, Ethnicity, and Language (RL)
    • Race
    • Hispanic Ethnicity
    • Language other than English
  • Veteran's Status (VA)
  • Well-Being and Age Identity (WB)
    • Positive and negative affect
    • Self-realization
    • Age identity
    • Self-efficacy and resilience
  • Insurance Plans (IP)
    • Medicare Part D and supplemental
    • Medicaid
    • Tri-care
    • Long-term care insurance
  • Labor Force (LF)
    • Status as working, unemployed, out of labor force
    • Hours and pay for person and spouse/partner
    • Longest-held occupation
  • Home Ownership (HP)
    • Mortgage balance
    • Home value
    • Rent
    • Public housing
  • Income and Assets (IA)
    • Sources of income: Social Security, SSI, VA Pension, Interest/dividend
    • Income amounts last month and total income for year
    • Assets and current worth retirement accounts (worth and withdrawals), mutual funds/stocks, bonds, checking/savings, CDs, business/farm/real estate
  • Car Ownership (CO)
  • Economic Well-being (EW)
    • Credit Card Debt
    • Medical Debt
    • Financial transfer to and from children/relatives
    • Public Program participation
  • Helpers (HL)
    • Relationship to person
    • Helping schedule and hours
    • Paid or unpaid
    • Sources of payment and amount last month
  • NLTCS Screener Questions (LS)
  • Environmental Checklist (IR)
    • Conditions inside and outside home

Facility Questionnaire

  • Facility Questionnaire (FQ)
    • Type of Residential Care Place
    • Services available
    • Services available at sample person's level of care and charges
    • Sources of payment and amounts in last month

Introduction

This document describes the content of the data collection instruments for the National Health and Aging Trends Study (NHATS). It is organized by sections and in the order sections are administered in the NHATS interview. A description of items in each section is provided, with relevant information about administration and, where applicable, information on sources for items and references.

Who is represented by the NHATS sample?

The sample is nationally representative of Medicare beneficiaries ages 65 and older. Persons on Medicare are estimated at about 96% of all persons in this age group (U.S. House of Representatives Ways and Means Committee, 1998).

What are the data collection instruments for NHATS?

The primary data collection instrument is the In-Person Interview questionnaire. Two other data collection instruments are used. One is the Performance Activities Booklet which is used to record results of the physical performance activities. The other is the Facility Questionnaire (FQ) which is administered to a staff person when a sample person resides in a residential care setting, including a nursing home.

Who are the NHATS respondents?

Most sample persons respond for themselves. Proxy respondents are used in instances where the sample person cannot respond and information is collected on the reasons a proxy is used (see IS). When the sample person is in a residential care setting, a staff person at the place serves as a respondent to the Facility Questionnaire (see FQ).

Which data collection instruments are used for which respondents?

For purposes of data collection, distinctions were made among persons: in residential care settings that are nursing homes, in residential care settings other than nursing homes, and in all other residential settings.

Persons in all residential settings except nursing homes are administered the In-Person Interview and the Performance Activities Booklet. The Facility Questionnaire is administered to a staff person whenever a sample person is determined to live in a residential care setting.

How is residential care defined for purposes of data collection?

Nursing home residents are defined in two ways: 1) if the address from the Medicare enrollment file is a nursing home, or 2) if, upon contact, the interviewer learns that the sample person is in a nursing home and is told that the sample person is not expected to return home. If a sample person is in a nursing home upon contact but is expected to leave the nursing home, the in-person interview is conducted with the sample person, upon return, or a proxy for that individual.

Residential care places, other than nursing homes, are defined by questions in the Housing Type section (HT): 1) identification of the place the person lives as "group home/board and care/or supervised housing" or "assisted living facility or continuing care retirement community" or 2) indicating that the place the sample person lives has areas you can move to if care is needed, offers help with medications or self-care, or offers meals.

Interview Setup (IS)

The Interview Setup provides an introduction to the study, confirms age and gender for the sample person, and identifies whether a proxy respondent is being used and why. When a proxy respondent is used information is collected on:

  • reasons a proxy was used (dementia or cognitive impairment reported by proxy, sample person is too ill, speech or hearing impaired, or another reason)
  • relationship of the proxy to the sample person; and
  • familiarity with the sample person's daily routine.

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Residence (RE)

The Residence section collects information on the type of physical structure the sample person lives in-free-standing (detached) single house, single house attached to others, mobile home or trailer, multi-unit (2+) building, or other (specify). Type of structure is used in skip patterns for some other sections of the interview.

At baseline, physical structure is coded by the interviewer based on observation unless the interview is being conducted somewhere other than the sample person's residence. In these cases, the sample person is asked to identify the physical structure of his/her residence.

The sample person's address is confirmed in this section as well.

Other sections collecting information on place sample person lives

  • Housing Type (HT): length of residence and type of place
  • Service Environment (SE): if sample person is in residential care (other than nursing home) services available and used
  • Home Environment (HO): features of the home environment
  • Environmental Modifications (EM): whether features of the home environment were added and out-of-pocket costs if so; out-of-pocket costs for other devices for daily activities
  • Environmental Checklist (IR): conditions inside and outside the home
  • Facility Questionnaire (FQ): if sample person is in residential care (including nursing home) services available at place and in sample person's area; payment information in last month

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Health Conditions (HC)

This section collects self-reported chronic conditions and diseases, selected health care utilization, information on falls, and measures of depression, anxiety, and sleep quality.

Overall Health and Conditions: Overall health is asked first, followed by whether the person has ever been told by a doctor that he/she has any of several chronic conditions. Types of cancer, age at diagnosis if dementia/Alzheimer's disease is reported, and broken or fractured bones since age 50 are asked. An open-ended question asks whether there is another serious disease or illness the person has been told he/she has by a doctor.

Hospital Stays and Surgeries: Overnight hospital stays within the last 12 months, the number of overnight hospital stays in the last 12 months, and whether the person ever had certain types of surgery (e.g., knee replacement, hip repair/replacement, cataract, back or spine, heart) are collected. For surgeries, the timing-within the last 12 months and, if not, at what age this occurred-is ascertained. Falls: Falls are defined as "any fall, slip, or trip in which you lose your balance and land on the floor or ground or at a lower level." This wording mirrors the definition used in the Women's Health and Aging Study (Guralnik et al. 1995). Information includes: falls within the last month and within the last year, number of falls in the last year, whether persons worried about falling down in the last month, and whether that worry limited activities.

Depression and Anxiety: NHATS uses the PHQ-2 and the GAD-2, which are brief screening instruments for depression and anxiety, respectively. The questions are administered to self-respondents only: "Over the last month, how often have you: a) had little interest or pleasure in doing things; b) felt down, depressed, or hopeless; c) felt nervous, anxious, or on edge; d) been unable to stop or control worrying?" Response categories are: not at all, several days, more than half the days, nearly every day. Items "a" and "b" form the PHQ-2; items "c" and "d" form the GAD-2. Scores are calculated for each measure separately, or for a combined measure, based on summing scores for the items (0 = not at all; 1= several days; 2=more than half the days; 3=nearly every day). The reference period of "one month" was used in NHATS to correspond to the reference period for measures of functioning (e.g. self-care, mobility); the usual reference period is 2 weeks. For sensitivity, specificity, and recommended cut-points for the PHQ-2, the GAD-2 and a 4-item combined measure, see Kroenke et al. (2003, 2007, 2009) and Lowe et al. (2009).

Sleep Quality: Three questions are included on sleep in the last month: how often it takes more than 30 minutes to fall asleep at night, how often someone had trouble falling back asleep on nights he/she woke up, and how often he/she took medication to sleep. Response categories are: every night, most nights, some nights, rarely, never.

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Housing Type (HT)

Length of residence at current address is asked. A description of the place the person lives- private residence, group home/board and care/supervised housing, assisted living facility or continuing care retirement community, religious group quarters, and other-is obtained. All persons are asked whether their home is part of a retirement community or a senior housing community. This section also is used to determine whether the sample person lives in a residential care setting and a Facility Questionnaire should be administered. The items used for this purpose are:

  • identification of the place the person lives as "group home/board and care/or supervised housing" or "assisted living facility or continuing care retirement community" or
  • a positive response to any of 3 questions about the place-are there different areas you can move to if you need care; is help offered with medications or activities like bathing or dressing; are meals for residents offered. Because of the skip patterns employed for these questions, they should not be used for analyses of services in residential care environments. Either the Service Environment (SE) section (the person's report of services available and used) and/or the Facility Questionnaire (FQ) (staff report of services offered to residents) should be used for this purpose.

A question about how people who live in residential care describe their private living space is also asked for operational purposes (as a wording fill for later questions).

Other sections collecting information on place sample person lives

  • Residence (RE): physical structure of residence
  • Service Environment (SE): if sample person is in residential care (other than nursing home) services available and used
  • Home Environment (HO): features of the home environment
  • Environmental Modifications (EM): whether features of the home environment were added and out-of-pocket costs if so; out-of-pocket costs for other devices for daily activities
  • Environmental Checklist (IR): conditions inside and outside the home
  • Facility Questionnaire (FQ): if sample person is in residential care (including nursing home) services available at place and in sample person's area; payment information in last month

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Service Environment (SE)

This section is administered only to persons in residential care (other than nursing homes). The Service Environment questions are asked if questions in the HT section indicate the person is in residential care. Otherwise this section is skipped.

The questions asked are: services available at the place person lives whether or not he/she uses these; services used in the last month; and, for services used, if there is an extra charge. The list of services covers meals; help with mediations, bathing and dressing, laundry, housekeeping; transportation and socializing.

Other sections collecting information on place sample person lives

  • Residence (RE): physical structure of residence
  • Housing Type (HT): length of residence and type of place
  • Home Environment (HO): features of the home environment
  • Environmental Modifications (EM): whether features of the home environment were added and out-of-pocket costs if so; out-of-pocket costs for other devices for daily activities
  • Environmental Checklist (IR): conditions inside and outside the home
  • Facility Questionnaire (FQ): if sample person is in residential care (including nursing home) services available at place and in sample person's area; payment information in last month

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Household (HH)

The Household section gathers information on the person's spouse/partner and those who live with the sample person.

Marital Status and History: Marital status is asked and, if married or with a partner, years in relationship. For persons widowed or divorced, month and year that a spouse passed away or a marriage ended is obtained.

Spouse/Partner characteristics: For persons who are married/partnered, spouse/partner gender, date of birth, education, and need for help with personal care is obtained. Whether the spouse/partner lives with the sample person is confirmed and, if the spouse/partner does not, the type of place the spouse/partner lives is asked.

Other Household Member characteristics: For all other household members, relationship to the sample person, gender, and date of birth are obtained.

Other sections collecting information on family

  • Children and Siblings (CS): For children who are not living in sample person's household, relationship to sample person, gender, date of birth, and city and state of residence are asked. For all children, education, marital status, and information on their children is asked. Number of living siblings is obtained.
  • Early life (EL): Questions on whether parents are living and age at death are asked.

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Children and Siblings (CS)

For children who do not live with the sample person, relationship to the sample person, gender, date of birth, and city and state of residence are asked. For all children, this section obtains education, marital status, number of their children and number of their children under age 18. The section also includes questions on the number of living brothers and sisters.

Other sections collecting information on family

  • Household (HH): Information about household members who are family includes: relationship to sample person, gender, and date of birth. Additional information is collected for a spouse/partner (education, need for help with personal care, types of residence if not in household).
  • Early life (EL): Questions on whether parents are living and age at death are asked.

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Social Network (SN)

Persons are asked to name up to 5 people that they "talk to about important things." Important things may include good or bad things that happen, problems the person is having, or important concerns. Information for each social network member includes relationship to the sample person, gender, age, and location (city/state). The NHATS approach to social network is consistent with a traditional approach for egocentric social network data collection used in several surveys and is directly comparable to The National Social Life Health & Aging Project Confidant Roster (http://www.norc.uchicago.edu/nshap; Cornwell et al., 2009).

The order in which social network members are listed should not be taken to indicate the order in which they were named by the respondent. The social network questions are not asked of proxy respondents.

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Home Environment (HO)

The Home Environment section collects information on three concepts: access to the home, building amenities, and features inside the person's home or (residential care) private living space (Freedman et al. 2006).

Access to the home: Questions are on the presence of stairs, common or shared entrances for multi-unit dwellings, and presence of a ramp at the entrance.

Building (multi-unit structure) amenities: These include: an elevator, stair lift/glide, shared spaces for meals and socializing, bath amenities (a bathtub, shower stall, grab bar in the bathtub/shower, a bath/shower seat, raised toilet/seat, grab bars around toilet, medical emergency system), a private kitchen area, and working microwave. For persons in residential care, an additional question is asked about whether the person has a private bathroom with bath/shower.

Features inside the home (if not multi-unit structure): These include: number of floors, bedroom/kitchen/bath on same floor, elevator, stair lift/glide, bath amenities (a bathtub, shower stall, grab bar in the bathtub/shower, a bath/shower seat, raised toilet/seat, grab bars around toilet, medical emergency system), and working microwave.

Other sections collecting information on place sample person lives

  • Residence (RE): physical structure of residence
  • Housing Type (HT): length of residence and type of place
  • Service Environment (SE): if sample person is in residential care (other than nursing home) services available and used
  • Environmental Modifications (EM): whether features of the home environment were added and out-of-pocket costs if so; out-of-pocket costs for other devices for daily activities
  • Environmental Checklist (IR): conditions inside and outside the home
  • Facility Questionnaire (FQ): if sample person is in residential care (including nursing home) services available at place and in sample person's area; payment information in last month

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Environmental Modifications (EM)

This section refers to features of the home that were identified in HO and asks for each whether it was present when the person moved in or whether it has been added since. If any features were added, the person is asked to identify those added in the last year. Overall costs for features added in the last year to the person or his/her family is asked. A separate question asks about overall costs in the last year for devices that help with daily activities: glasses, hearing aids, canes, walkers, wheelchairs, scooters, reaching devices, dressing devices, adapted eating utensils.

Other sections collecting information on place sample person lives

  • Residence (RE): physical structure of residence
  • Housing Type (HT): length of residence and type of place
  • Service Environment (SE): if sample person is in residential care (other than nursing home) services available and used
  • Home Environment (HO): features of the home environment
  • Environmental Checklist (IR): conditions inside and outside the home
  • Facility Questionnaire (FQ): if sample person is in residential care (including nursing home) services available at place and in sample person's area; payment information in last month

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Community (CM)

Persons are asked whether they agree a lot, agree a little, or do not agree with three statements about their community: people know each other well, people are willing to help each other, and people in the community can be trusted. These measures were adapted for use in NHATS from Cagney et al. (2009) and Sampson et al. (1997) to accommodate multiple residential settings.

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Technological Environment (TE)

Items focus on communication and information technology available to persons and their use of this type of technology. Questions on availability ask about whether the person has a working: cell phone, other telephone, and computer. Questions on use ask about frequency of sending messages by email or texting and using a computer at locations outside the home (if no computer in the home). Persons also are asked about going on the Internet or online in the last month to: shop for groceries or personal items, pay bills or do banking, order or refill prescriptions, contact his/her medical providers, handle Medicare or other insurance matters, or get information about the his/her health conditions.

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Mobility Devices (MD)

The Mobility Device section asks about use of mobility-related assistive technology (cane, walker, wheelchair, scooter) in the last month.

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Sensory and Physical Impairments and Symptoms (SS)

This section addresses vision, hearing, and limitations or impairments in several body systems. Also in this section are questions on symptoms of pain and fatigue. The reference period is the last month.

Vision and Hearing: Questions are on close and distant vision, hearing, and use of vision or hearing aids.

Chewing/Speaking: Persons are asked about problems with chewing or swallowing and problems in speaking or being understood when talking.

Symptoms of Pain and fatigue: Persons are asked whether they are bothered by pain, activity limitations due to pain, frequency of medication for pain, and location of pain (back, hips, knees etc.). Persons are asked about having low energy or being easily exhausted and whether this limited their activities.

Physical Impairments and Severity: For a series of problems, respondents are first asked whether they experienced the problem in the last month and, if so, whether the problem limited their activities (adapted from Freedman et al. 2010). The following problems are asked about: breathing problems; limited strength or movement in shoulders, arms, hands; limited strength or movement in hips, legs, knees, or feet; balance/coordination.

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Physical Capacity (PC)

Capacity measures represent the building blocks that underlie the ability to do more complex tasks like self-care or household activities. Capacity measures in NHATS include both self-report items, including traditional Nagi measures (1965), and performance-based measures (both physical and cognitive). For a more detailed discussion see Freedman 2009, and Freedman et al. 2011.

Items in this section ask about ability to do 12 activities. The items are paired as follows: walk 6 blocks (about � mile)/walk 3 blocks, walk up 20 stairs/walk up 10 stairs, lift and carry 20 pounds/lift and carry 10 pounds, kneel down without holding on to anyone or anything/bend over without holding on to anyone or anything, put a heavy object on a shelf overhead/reach up over head, open a sealed jar using hands only/grasp small objects. Persons who are able to do the first, and harder, activity in each pair, are not asked the second. Those who say "no" or "don't know" to the first item, are asked the second.

Analyses from a Validation Study conducted prior to fielding the NHATS Round 1, showed that these items can be nested for purposes of administration and that a scale constructed from these items has good reliability and compares favorably with a scale using traditional Nagi items only (Freedman et al. 2011).

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Cognition (Proxy) (CP)

Brief cognitive screening instruments are used in NHATS to provide measures of cognitive functioning (see CG section). When the interview is being administered to a Proxy Respondent the CP section is asked. In addition, an attempt is made to administer the cognitive functioning items to the sample person (see CG Cognition).

The CP section includes: (1) a rating of the person's memory at the present time, (2) an 8-item screening instrument designed for administration to informants which differentiates between persons with and without probable dementia (the AD8), and (3) questions on behavior problems.

The AD8: The AD8 is an 8-item measure that was designed for administration to informants for purposes of identifying persons with dementia (Galvin et al. 2005, 2006). The items assess memory, temporal orientation, judgment, and function. The questions ask about "changes due to thinking and memory problems." In clinical settings the instrument is typically administered to a family member and changes are in the context of "the last several years." In NHATS, if the proxy respondent is not a relative and has known the person for less than 1 year, the question is framed as "since you have known (person)."

The AD8 is scored from 0-8 (1 = yes, a change; 0 = no, no change). For information on recommended cutpoints, sensitivity and specificity, and correlations with other dementia screening instruments, see Galvin et al. (2005, 2006). For NHATS, an additional response (dementia/Alzheimers reported by proxy) was added to accommodate situations in which the proxy respondent indicates (in response questions about "changes") that there has been no change because the SP has dementia and, for example, does not remember the month or year. The NHATS recommendation is that these responses be scored as 1 for purposes of calculating the total score.

Behavior Problems: The proxy respondent is asked to report problems observed in the last year: 1) did he/she ever get lost in a familiar environment, 2) did he/she ever wander off and not return by himself/herself, 3) was he/she able to be left alone for an hour or so, and, 4) did he/she hear or see things that were not really there. These questions are administered in the Health and Retirement Survey (persons 65 and older starting in 1998, Ofstedal et al. 2005) and were included in the National Long Term Care Survey.

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Cognition (Sample Person) (CG)

The NHATS Cognition section is designed to provide information about several aspects of cognitive functioning including memory (self-rated, whether memory interferes with daily activities, and immediate and delayed 10 word recall), orientation (date, month, year, day of week; naming President and Vice President), executive function (clock drawing test), and retrieval of information (delayed 10 word recall). When a proxy interview is being conducted the proxy respondent is asked whether some questions about memory could be asked of the sample person. If the proxy declines, a reason is obtained (e.g. sample person has dementia/Alzheimer's disease, is unable to speak or hear). If the proxy agrees, the CG section is administered.

This section also includes items where the interviewer can note if there are problems in administration: difficulty hearing words read or interruption during reading of the words; whether the respondent used aids for tasks even when asked not to.

Self-Rated Memory: Persons are asked to rate their memory currently, how often memory problems interfered with daily activities in the last month, and how their memory is currently compared to 1 year ago.

Orientation to date: Respondents are asked "without looking at a calendar or watch, please tell me today's date," which includes the month, day, year and day of the week. Probes to elicit any component that was not volunteered are allowed (e.g. persons who give the month, day and year but not the day of the week are asked-do you know what day it is today?). The interviewer notes if the sample person looked at a calendar, newspaper, watch, or other aid for the date.

Immediate and Delayed 10 Item Word Recall: A list of 10 nouns is read to respondents as they appear on the computer screen. The person is asked recall as many words as possible, in any order. The respondent is given up to 2 minutes. Sample persons are randomly assigned to one of three lists that are fielded in the Health and Retirement Study (Ofstedal et al., 2005). (List assignments in subsequent years will rotate so that persons receiving list 1 in Round 1 will receive list 2 in Round 2; those receiving list 2 will receive list 3; those receiving list 3 will receive list 1 and so on). The delayed word recall is administered after the President/Vice President naming and the Clock Drawing Test. Respondents are asked what words they recall from the list read earlier.

Orientation based on naming President and Vice President: Respondents are asked the names of the President and Vice President. Probes to obtain both the first and last names are allowed.

Clock Drawing: The respondent is given a sheet of paper and an erasable pen. They are asked to draw a clock on the piece of paper and the interviewer says, "Start by drawing a large circle. Put all of the numbers in the circle and set the hands to show 11:10 (10 past 11)." The respondent has 2 minutes to complete the activity. Interviewers may repeat the instructions as needed. See Shulman (2000) for an overview; NHATS scoring for the Clock Drawing Test is based on Schretlen et al. (2010).

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Mobility (MO)

Mobility, self-care and household activities all represent key areas of functioning for assessing trends and dynamics in disability. Within each section there are several activities. For each activity, questions are structured to provide insight into the extent to which the activity is done independently and the use of accommodations in the form of devices, environment, or assistance from others. For a more detailed discussion see Freedman 2009, and Freedman et al. 2011. Questions about behavior change-changes in the frequency of the activity-and unmet need (Allen 2007) -in the form of consequences related to difficulty or lack of help-also are asked. When combined, information on extent and frequency of leaving one's home or moving around inside can be used to characterize life space constriction.

Summary table of Mobility section questions on going outside, getting around inside, and getting out of bed

Questions Going Outside Getting Around Inside Getting Out of Bed
Frequency of doing activity X X*  
Frequency of using mobility devices to do activity X** X** X**
Who helps [1] X X X
Frequency by self (without help) X X X
How difficult by self (using mobility devices) X** X** X**
Compared to a year ago does more or less often X X  
Consequence because too difficult/ or no help X X X

*Persons who never leave their home or apartment are asked about leaving the room where they sleep.
**Devices reported in MD section.
[1] Individuals who are named as helpers are flagged and routed to the Helper Section (HL).

This section covers: going outside one's home, getting around inside one's home, and getting out of bed. A series of questions is asked on: frequency in the last month, use of mobility devices or assistance from others in doing the activity, how often the activity is done by oneself, changes compared to a year ago, and being unable to do the activity due to difficulty or lack of assistance.

Going outside one's home: Frequency of leaving one's home (or building if multi-unit, see RE Section) is asked first. Persons who go outside are asked frequency of mobility device use, whether anyone helps with going outside and, if so, who that is. Frequency of going outside by oneself is asked; those who indicate they go outside by themselves are asked about difficulty (using any devices). Persons are asked compared to a year ago whether they leave their home or building more often, less often or about the same. The final question asks whether the person had to stay in because it was too difficult to go out by oneself or there was no one to help.

Getting around inside one's home or building (if multi-unit): Persons in multi-unit buildings are asked frequency of leaving their apartment or unit to go to other areas of the building. Persons who indicate they never leave their home (or go to other areas of the building) are asked frequency of leaving the room where they sleep. Persons are asked frequency of using mobility devices to get around inside their home or building. Everyone also is asked about frequency of holding onto walls or furniture when getting around inside. Persons are asked whether anyone helps with getting around inside and, if so, who that is. Frequency of getting around inside by oneself is asked; those who indicate they get around by themselves are asked about difficulty (using any devices). Persons are asked compared to a year ago whether they go around their home or building more often, less often or about the same. The final question asks whether there are places in the home or building the person did not go because it was too difficult or no one was there to help.

Getting out of bed: If mobility devices are used, persons are asked frequency of using these to get out of bed. Persons are asked whether anyone helps with getting out of bed and, if so, who that is. Frequency of getting out of bed by oneself is asked; those who indicate they get out of bed by themselves are asked about difficulty (using any devices). The final question asks whether the person ever had to stay in bed because no one was there to help him/her or it was too difficult by himself/herself.

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Duration of Mobility Accommodations (DM)

This section fills in information about the duration of help (or lack of help) with mobility and mobility-related devices prior to Round 1. For mobility activities, persons who reported help in the last month with going outside, getting around inside, or getting out of bed (see MO Section) follow one path, while those who reported no help with these activities in the last month follow another. Similarly, persons who reported using a mobility device in the last month (see MD Section) follow one path, while those reporting no device use follow another. A question about assistance and device use when the person "turned 65" is asked of everyone.

Persons who reported help in the last month: Persons are asked whether they have been getting help for a year or more. Those answering "yes" are asked for how many years. Those answering "no, less than a year" are asked in what month they first got help with any of these mobility activities.

Persons who reported no help in the last month: Persons are asked whether they ever had help in the last year with getting out of bed, getting around inside, or going outside. Those answering "yes" are asked in what month they last got help with any of these mobility activities.

Persons who reported using a mobility device in the last month: Persons are asked whether they have used mobility devices for a year or more. Those answering "yes" are asked for how many years. Those answering "no, less than a year" are asked in what month they first used these.

Persons who reported no mobility device use in the last month: Persons are asked whether they ever used mobility devices in the last year. Those answering "yes" are asked in what month they last used these.

At age 65: Persons are asked whether they had help with mobility activities or were using mobility devices around the time they turned 65. Persons skip this item if they reported "lifetime/since birth" (in response to "how many years" asked earlier) or have a duration of use/help that extends to age 65 or earlier.

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Driving and Transportation (DT)

The Driving and Transportation section gathers information on the frequency of driving in the last month, for persons who no longer drive the date or age a person last drove, driving situations persons avoided in the last month (nighttime driving, driving alone, on busy roads or highways, in the rain or other bad weather), and other ways someone got around in the last month (walking, getting a ride, using a van/shuttle provided by residence, using van/shuttle for seniors or persons with disabilities, public transportation, taxi, other). If persons get rides from others, who gives rides (up to 2 people) and the relationship of these individuals to the sample person is asked.

Other sections collecting information on transportation

  • Participation (PA): Questions are asked about whether transportation problems ever kept someone from doing selected activities in the last month.
  • Medical care (MC): Persons are asked how they get to their regular doctor.
  • Household activities (HA): Persons are asked how they get to the store to shop for groceries or personal items.
  • Service Environment (SE): For persons in residential care places, information is collected about the availability and use of vans or shuttles to get to doctors or stores and events.
  • Facility Questionnaire (FQ): Information about transportation services offered by the place is obtained from the staff person interviewed.

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Household Activities (HA)

Mobility, self-care and household activities all represent key areas of functioning for assessing trends and dynamics in disability. Within each section there are several activities. For each activity, questions are structured to provide insight into the extent to which the activity is done independently and the use of accommodations in the form of devices, environment, or assistance from others. For a more detailed discussion see Freedman (2009), and Freedman et al. (2011). Questions about behavior change-changes in the frequency of the activity-and unmet need (Allen 2007)-in the form of consequences related to difficulty or lack of help-also are asked.

This section covers how Household Activities are done. The activities are: laundry, shopping for groceries or other personal items, making hot meals, handling bills and banking, and handling less common money matters. These activities and handling prescribed medicines (in MC Section) are often included in measures of instrumental activities of daily living (Lawton & Brody, 1969). For each activity the first question is about how the activity is done: always did activity by self, always did it together with someone else, someone else always did it, it varied, or not done in last month. These responses are on a SHOW CARD which is handed to the respondent. The interviewer also reads the response options. Subsequent questions flow from these responses. Validity and reliability of measures of limitations in these activities using NHATS items is reported in Freedman et al. (2011).

Summary table of Household Activity section questions for laundry, shopping, hot meals, banking and bills

Questions Always Did It By Self Always Did It Together With Someone Else Someone Else Always Did It It Varied

Did by Self
It Varied

Never Did by Self
Not Done
Questions specific to activity (see below) X X X X X  
Who did activity with or for person [1]   X X X X  
Help for health/functioning or other reason   X* X* X* X* X**
How difficult to do by self X     X    
Compared to a year ago does by self more or less often X X   X    
Consequence because of difficulty or no help X X X X X X

*Not asked if person who helps is staff from place the person lives.
** If not done, asked as "Was that because of your health or functioning or some other reason?"
[1] Individuals who are named as helpers are flagged and routed to the Helper Section (HL).

The general sequence is the same for laundry, shopping for groceries or personal items, making hot meals, handling bills and banking. The sequence for handling less common money matters differs and is described below (see Questions specific to activity).

Always did activity by self: Persons in this category are asked how difficult doing the activity is; compared to a year ago whether they do the activity more or less often; and whether the activity could not be done in the last month because it was too difficult to do.

Always did it together with someone else: Persons are asked who did the activity with them and-unless the helper was a staff person from the place the sample person lives-whether this was because of health or functioning or some other reason. Also asked is whether compared to a year ago persons do the activity more or less often, and (if help was for a health or functioning reason or helper was a staff person from the place the person lives) whether in the last month the activity could not be done because there was no one to help.

Someone else always did it: Persons are asked who did the activity for them. Whether this was because of health or functioning or some other reason is asked unless the helper was a staff person from the place the person lives. Also asked (if help was for a health or functioning reason or helper was a staff person in place person lives) is whether in the last month the activity was not done because there was no one to help.

It varied: Persons are asked whether, in the last month, they ever did the activity by themselves. Both response groups (yes/no) are asked who did the activity with or for them and-unless the helper was a staff person from the place the person lives-whether this was because of health or functioning or some other reason.

Those who say "yes" (ever did the activity by themselves) are asked: how difficult it is to do the activity by themselves; compared to a year ago whether they do the activity by themselves more or less often; and whether the activity could not be done in the last month because it was too difficult to do. These questions parallel those for persons who "always did activity by self."

Those who say "no" (never did activity by themselves) and report that help was for a health or functioning reason or the helper was a staff person from the place the person lives are asked whether in the last month the activity could not be done because there was no one to help. This question parallels the final question for persons who responded "always did it together with someone else" or "someone else always did it."

Not done in last month: These persons are asked whether the activity was not done for a health or functioning reason or other reason. If the reason was health or functioning, they are asked whether in the last month the activity was not done because it was too difficult to do.

Questions specific to activity

Each activity also has questions specific to the activity.

  • Laundry: where laundry is done
  • Shopping for groceries or personal items: how groceries or personal items are paid for (cash, check, debit card, credit card); how got to the store to shop (transportation options); ever use a motorized cart when at the store; ever lean on the shopping cart to help get around the store
  • Making hot meals: how often hot meals were restaurant meals, including eat-in, take-out or delivered meals (not including meals provided as a service at the place person lives); how often use microwave oven to make hot meals
  • Handling bills and banking: none
  • Handling less common money matters: Persons are asked whether in the last year, money matters-opening, closing or cashing in CDs, checking, money market or retirement accounts or applying for loans-needed handling. If the answer is "yes," persons are asked whether anyone helped with these and, if so, who. These individuals are flagged as helpers and routed to the Helper Section.

Reasons for help

With the exception of people who always do the activity by themselves, everyone is asked whether help-when someone does the activity with or for the person-is for health or functioning or other reasons. One or both options may be selected.

In a Validation Study done prior to the NHATS baseline, lengthy lists of both health or functioning reasons and other reasons were provided for interviewers. Results from the Validation Study suggested that a small number of responses that are commonly given in each category should be shown as onscreen aids for the interviewer. For "health or functioning" these are responses of: age; memory; vision; mention of specific health conditions, diseases, or surgery; or unable to drive. Coded as "other reason" are responses of: shared activity, always done this way, someone else wanted to do it, pay someone, doesn't like to do it.

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Self-Care Activities (SC)

Mobility, self-care and household activities all represent key areas of functioning for assessing trends and dynamics in disability. Within each section there are distinct activities. For each activity, questions are structured to provide insight into the extent to which the activity is done independently and the use of accommodations in the form of devices, environment, or assistance from others. For a more detailed discussion see Freedman (2009) and Freedman et al. (2011).

Questions about behavior change-changes in the frequency of the activity-and unmet need (Allen 2007)-in the form of consequences related to difficulty or lack of help-also are asked.

This section covers how Self-Care Activities are done. The activities are: eating, getting cleaned up, using the toilet, and dressing. These activities (and walking around inside or getting out of bed in some formulations) are often included in activities of daily living (Katz et al. 1963; 1970).

Summary table of Self-care section questions for eating, getting cleaned up, using the toilet, dressing

Questions Eating Getting cleaned up Using the toilet Dressing
Used equipment/devices to do X     X
Frequency of using equipment/devices X X* X* X
Help with activity X X X X
How often by self and without help X X X X
Who helps [1] X X X X
How difficult by self (using equipment/devices) and without help X X X X
Compared to a year ago does by self more or less often   X   X
Consequence because too difficult/ or no help X X X X

*Use of equipment/devices is reported in HO section.
[1] Individuals who are named as helpers are flagged and routed to the Helper Section (HL).

The general sequence for each activity covers whether devices are used to do the activity and frequency of use, whether there is help with the activity and who provides it, frequency of doing the activity by oneself, difficulty doing the activity, and whether the activity did not get done in the last month because of difficulty or lack of help.

Eating: Persons are asked whether in the last month they used adapted utensils to eat and, if yes, frequency. Everyone is asked whether anyone ever helped them eat, for instance, by cutting up food or feeding them and, if so, who helps. Persons are asked how often they ate without help, and how much difficulty they had eating-with adapted utensils if used-by themselves and without help. Persons who have help or have some difficulty (versus no difficulty) are asked whether in the last month they ever went without eating because there was no one to help or it was too difficult by themselves.

Getting Cleaned Up: Persons are asked how, in the last month, they usually clean up- by taking a shower, bathing in a tub, or washing up some other way- and, if more than one is named, which they did most often. Persons who reported using grab bars to shower or bathe (see HO Section) are asked frequency of using grab bars; those who reported using bath or shower seats (see HO section) are asked frequency of using these. Everyone is asked whether in the last month anyone ever helped them shower/bathe/wash up and, if so, who helped. Persons are asked how often they got cleaned up without help, and how much difficulty they had -with grab bars or shower/tub seats if used-by themselves and without help. Persons are asked compared to a year ago whether they get cleaned up more or less often. Those who have help or have some difficulty (versus no difficulty) are asked whether in the last month they ever went without showering/bathing/washing up because there was no one to help or it was too difficult by themselves.

Using the Toilet: Persons are asked whether in the last month they used: a portable commode, disposable pads or undergarments, grab bars around the toilet (if in the home, see HO Section), raised toilet or raised toilet seat (if in the home, see HO Section). Everyone is asked whether in the last month anyone ever helped them use the toilet. Persons are asked how often they used the toilet by themselves and without help, and how much difficulty they had -with grab bars or raised toilet/toilet seat if in the home-by themselves and without help. Those who have help or have some difficulty (versus no difficulty) are asked whether in the last month they ever went accidently wet or soiled their clothes because there was no one to help or it was too difficult by themselves.

Dressing: Persons are asked how often they got dressed in the last month and whether they used any special items to get dressed, such as a button hook, reacher or grabber, or clothes that are designed to get on and off easily. Everyone is asked whether in the last month anyone ever helped them get dressed. Persons are asked how often they got dressed by themselves and without help, and how much difficulty they had -with special items for dressing if used-by themselves and without help. Persons are asked compared to a year ago whether they get dressed more or less often. Those who have help or have some difficulty (versus no difficulty) are asked whether in the last month they ever went without getting dressed because there was no one to help or it was too difficult by themselves.

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Duration of Self-Care Accommodations (DS)

This section fills in information about the duration of help (or lack of help) from others with self-care activities - eating, getting cleaned up, using the toilet, or getting dressed. Like the earlier section on duration of mobility accommodations (see DM Section), persons who reported help in the last month follow one path, while those who reported no help with these activities in the last month follow another. A final question asks about help when the sample person "turned 65."

Persons who reported help in the last month: Persons are asked whether they have been getting help for a year or more. Those answering "yes" are asked for how many years. Those answering "no, less than a year" are asked in what month they first got help with any of these self-care activities.

Persons who reported no help in the last month: Persons are asked whether they ever had help in the last year with eating, getting cleaned up, using the toilet, or getting dressed. Those answering "yes" are asked in what month they last got help with any of these activities.

At age 65: Persons are asked whether they got help with self-care activities around the time he/she turned 65. Persons skip this item if they reported "lifetime/since birth" (in response to "how many years" asked earlier) or have a duration of help that extends to age 65 or earlier.

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Medical Care Activities (MC)

This section covers: how the sample person handles their prescription medicines, how doctor visits are managed, and how medical bills and insurance are handled. The items on prescription medicines are structured like those for Household Activities (HA). Questions about doctor visits cover how persons get to the doctor, who goes along, and whether anyone sits in on the visit with the sample person. The questions on medical bills and insurance focus on assistance from others.

Prescription Medicines: The first question asks whether the sample person takes any medicines prescribed by a doctor. Those answering "no" skip to the next set of questions on how doctor visits are managed. Persons taking medicines are asked whether they: always did activity by self, always did it together with someone else, someone else always did it, it varied, or not done in last month (see HA section). Subsequent questions flow from these responses.

Summary table of questions on handling medications

Questions Always did it by self Always did it together with someone else Someone else always did it It Varied

Did by self
It Varied

Never did by self
Where medicines from; how obtained; frequency of using reminders X X   X X
Who kept track with or for person [1]   X X X X
Help for health/functioning or other reason   X* X* X* X*
How difficult to keep track by self X     X  
Compared to a year ago does by self more or less often X X   X  
Mistake made because too difficult by self/no one to help [2] X X X X X

*Not asked if person who kept track with or for the sample person is staff from place sample person lives.
** If not done, asked as "Was that because of your health or functioning or some other reason?"
[1] Individuals who are named as helpers are flagged and routed to the Helper Section (HL).
[2] Unmet need item (Allen, 2007)

Always did activity by self: Persons are asked where medicines are from; how they are obtained; and frequency of use of reminders to keep track; how difficult it is to keep track of medicines by themselves; compared to a year ago whether they keep track by themselves more or less often; and whether a mistake was ever made in the last month because it was too difficult to keep track.

Always did it together with someone else: Persons are asked where medicines are from; how they are obtained; frequency of use of reminders to keep track. In addition, they are asked who kept track of their medicines with them and-unless the helper was a staff person from the place the sample person lives-whether this was because of health or functioning or some other reason. Also asked is whether compared to a year ago, persons keep track by themselves more or less often and (if help was for a health or functioning reason or helper was a staff person in place person lives) whether in the last month a mistake in taking medicines was made because no one was there to help or keep track of medicines with them.

Someone else always did it: Persons are asked who kept track of their medicines for them. Whether this was because of health or functioning or some other reason is asked unless the helper was a staff person from the place the sample person lives. If help was for a health or functioning reason or helper was a staff person in place person lives, persons are asked whether in the last month a mistake in taking medicines was made because no one was there to help or keep track of medicines for them.

It varied: Persons are asked whether, in the last month, they ever kept track of their medicines by themselves. Both response groups (yes/no) are asked: where medicines are from; how they are obtained; frequency of use of reminders to keep track. In addition, they are asked who kept track of their medicines with them and-unless the helper was a staff person from the place the sample person lives-whether this was because of health or functioning or some other reason.

Those who said "yes" (ever kept track of their medicines by themselves) are asked: how difficult it is to keep track of medicines by themselves; compared to a year ago whether they keep track by themselves more or less often; and whether a mistake was ever made in the last month because it was too difficult to keep track. These questions parallel those for persons who "always did activity by self."

Those who said "no" (never kept track of medicines by themselves) and reported that help was for a health or functioning reason or helper was a staff person in place person lives are asked whether in the last month a mistake in taking medicines was made because no one was there to help or keep track of medicines for them. This question parallels the final question for persons who responded "always did it together with someone else" or "someone else always did it."

Not done in last month: These persons are asked whether the reason keeping track of medicines was not done was for health or functioning or other reasons. If the reason was health or functioning, they are asked whether in the last month they did not keep track because it was too difficult to do.

Medical Care: Respondents are asked if the sample person has a regular doctor and if that doctor (or any doctor if no regular doctor is reported) has been seen in the last year. Persons who have not seen a doctor in the last year are routed to the Medical Bills and Insurance Questions. All others are asked about means of transportation to the doctor, whether anyone sits in with the person on doctor visits and, if so, who that is (most often if more than one person named). Individuals who are named as "sitting in on doctor visits" are flagged and routed to the Helper Section (HL) (except for those who are staff persons from the place the person lives). The last question is about what the person who sits in on the visit does: helps with getting on exam table or dressing, reminders to ask doctor, asks doctor questions, or helps the sample person to understand what the doctor was saying.

Medical Bills and Insurance: If respondents report a change to a Medicare supplemental plan, a prescription drug plan, or managed care enrollment in the last year, they are asked if anyone helped with these decisions. Individuals who are named as helpers are flagged and routed to the Helper Section (HL) (except for helpers who are a staff person from the place the person lives).

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Participation (PA)

These questions reflect participation in activities that are elective but valued (Freedman, 2009). Questions are asked about participation (yes/no) in activities in the last month, whether health or transportation problems ever kept the person from doing the activity, and how important it is to do the activity. Freedman et al. (2011) confirmed the reliability of the participation measures in the form of a scale; reliability of individual items varies.

Activities with full sequence: The full sequence-was the activity done, did health or functioning ever keep person from doing, did transportation problems ever keep person from doing, how important is it to do-is asked for: visiting in person with friends or family not living with person; attending religious services; participating in clubs, classes or other organized activities; and going out for enjoyment (dinner, a movie, to gamble, hear music or see a play).

Activities with selected follow-up: For both "work for pay or in a business" and "doing volunteer work," only whether the activity was done and, if so, whether health or functioning ever kept someone from doing the activity are asked. Persons who report "providing care for or looking after an adult or child who cannot care for themselves" are asked who that person is and how they are related. All persons are asked whether in the last month they ever "walked for exercise" or "did vigorous activities (e.g. working out)." A last question asks respondents to identify a favorite activity (entered as open text); they are asked whether health or functioning ever kept them from doing this activity in the last month.

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Smoking (SD)

The Smoking section captures cigarette smoking status (current, past, never smoked), amount if smoked (cigarettes per day) and duration of smoking (age started or stopped). Smoking status is defined by the response to "ever smoked cigarettes regularly, at least 1 cigarette a day." These items allow measures of pack years and number of years smoking to be calculated.

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Performance Activities Eligibility (PE)

The NHATS includes physical performance activities (walking, balance, chair stands, grip strength, peak air flow) as well as waist circumference. Some of these activities should not be attempted by individuals under certain circumstances. This section is administered to determine which activities the respondent should be asked to try. Additional information about the physical performance activities, the NHATS administration protocol, and results from the Validation Study can be found in Kasper et al. (forthcoming 2011).

Exclusion criteria: Questions are asked to determine which activities persons will be asked to do. Exclusion criteria by activity are:

  • Grip strength: surgery, or flare up of pain, in both hands or wrists; surgery to both arms or shoulders within last 3 months
  • Walking 3 meters: uses a wheelchair or scooter every time to get around inside home (see MO Section); unable to walk a short distance by self (using mobility devices)
  • Chair stands: person unable to get up from chair without using mobility devices or help; surgery on both hips within 3 months
  • Balance stands: person who always uses a mobility device to get out of bed (see MO Section) or never got out of bed by self (see SC Section) says he/she is unable to stand without holding on to anyone or anything
  • Peak air flow: none
  • Waist circumference: none

This section also indicates which hand should be used for the grip strength activity (dominant hand unless exclusion criteria apply to that hand). Persons who always use a cane or walker inside the home (see MO Section) are told they may use their cane or walker for the 3 meter walking activity. Whether the device was used is recorded in the Performance Activities Booklet.

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Performance Activities Booklet

The results of the performance activities are recorded in the Performance Activities Booklet which is mailed in by interviewers and scanned for data entry. Before each activity the interviewer reads a description of the activity and demonstrates the activity for the respondent. The interviewer then asks the respondent whether he/she "thinks it would be safe to try this." It the respondent does not feel safe, the interviewer does not feel the activity would be safe, or a proxy does not feel the activity would be safe, this is recorded and that activity is skipped. Other reasons that an activity is not attempted also are recorded and include: respondent does not understand instructions, could not find appropriate chair (for chair stands) or space for walking course (walking).

Balance activities: There are 5 of these-side-by-side, semi-tandem, full tandem, one leg eyes open, one leg eyes closed. Persons are asked to hold these stands for 10 seconds. Whether the activity was completed (yes/no) is recorded. These stands progress from easy (side-by-side) to hard (one leg eyes closed). Persons only move to the next balance activity if the complete the prior easier one.

Chair stands: Persons first do a single chair stand (getting up and sitting back down without using arms). Whether the activity was completed (yes/no) is recorded. Persons who complete the single chair stand are asked to attempt the repeated chair stand. Persons are asked to do 5 repeated chair stands as quickly as the can. Time to complete the activity is recorded.

Walking: A 3 meter walking course is laid out on a level surface. Persons are timed as they walk from the start to finish and timed again on the return. Both times are recorded.

Grip strength: Persons are given a dynamometer and asked squeeze as hard as they can. The reading on the dynamometer is recorded. The activity is done twice.

Peak air flow: Persons are asked to blow into a peak air flow meter. The reading on the meter is recorded. The activity is done twice.

Waist circumference: A tape measure is used to measure waist circumference while the person is standing (or sitting if they are unable to stand).

The performance activities and protocol for administration used in NHATS draw on several prior studies including the Women's Health and Aging Study (Simonsick et al. 1997), the Established Populations for Epidemiologic Studies Of The Elderly, and the Health and Retirement Survey. The walking, balance activities, and chair stands are components of the Short Physical Performance Battery (Guralnik et al. 1994).

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Height and Weight (HW)

This section obtains self-reported current height and weight, height and weight at age 50, and unintentional weight loss (lost 10 pounds or more in the last year and not trying to lose weight).

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Early Life (EL)

The Early Life section covers selected life experiences. Topics in this section are:

  • Place of birth (state if US, country otherwise);
  • If not born in US, year or age the person came to live in the US;
  • Health as a child (excellent, very good, good, fair, poor);
  • How well off financially when growing up;
  • Lived with both parents at age 15; if not, lived with mother, father, other relatives or nonrelatives;
  • Residence at age 15 (city/town, state);
  • Education
  • Mother and father still living; if not, age at death.

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Race, Ethnicity, and Language (RL)

This section collects race (multiple categories are allowed and respondents are asked to select a primary race in these cases). Hispanic ethnicity and subgroups (Mexican American/Chicano, Puerto Rican, Cuban American, Other) are obtained. The NHATS Interview has been translated into Spanish and administration in Spanish is documented. Three questions on language are included: whether the sample person speaks a language other than English (not asked for Spanish language administration), how well the person understands English when spoken, how well he/she speaks English (very well, well, not well, not at all).

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Veteran's Status (VA)

The Veteran's Status section asks: whether the person served on active duty in the Armed Forces of the United States, periods of service on active duty, and whether the person was an active member of the National Guard or a military reserve unit.Periods of service on active duty follow those recommended for the American Community Survey (ACS) by a joint VA-Census Bureau Committee. NHATS periods of service are identical to those in the 2010 ACS with two exceptions: the May 1975 to August 1980 and September 1980 to July 1990 are collapsed to May 1975 to July 1990; the February 1955 to February 1961 and March 1961 to July 1964 are collapsed to February 1955 to July 1964.

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Well-Being and Age Identity (WB)

The Well-Being section obtains information about positive and negative affect (frequency of feelings in the last month (e.g., cheerful, bored, full of life, upset), self-realization (agreement with statements about life: life has meaning and purpose, feel confident and good about self, gave up trying to improve life long ago, likes living situation), age identity (age person feels), and self-efficacy and resilience (agreement with statements: other people determine activities, I do what I want, I adjust to change). These items draw on similar items from MIDUS (Midlife in the U.S. A Study of National Health and Wellbeing; data and documentation at ICPSR http://www.icpsr.umich.edu/icpsrweb/ICPSR/). Reference periods and response categories differ across studies that have used these items. NHATS uses "last month" as the reference period and, in general, fewer response categories.

This section is not asked of proxy respondents.

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Insurance Plans (IP)

Questions are asked about prescription drug coverage, Medigap or Medicare supplemental insurance, Medicaid coverage, and coverage under TRICARE. Questions on long-term care insurance ask whether: "not including government programs, persons have any insurance that would pay for a year or more of care in a nursing home, assisted living, or in their own home." Those who answer "yes" are asked what types of care are covered, premium amount in the last calendar year, and how long they have had the policy (in either years or age at purchase).

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Labor Force (LF)

This section is designed to provide a measure of labor force participation - employed, unemployed, not in the labor force-consistent with definitions produced by the Current Population Survey. Work-related income in the past month is asked for persons and their spouses/partners (see IA Section for other income sources and amounts). For those working, hours worked, paycheck schedule, and paycheck amounts are asked. Persons who are in residential care (see HT and FQ) and who said in the PA Section that they had not worked for pay or in a business they own in the last month, are not asked questions about labor force participation.

All persons are asked about their longest held occupation (the work they did most of their lives).

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Home Ownership (HP)

Questions are asked about home ownership for all sample persons except those in residential care (see HT and FQ). Topics covered are: whether persons own or rent their home; details about mortgages (if the mortgage is paid off, monthly payment amounts, time left until mortgage is paid off, mortgage balance), and the present value of the home. Assets (and their worth) other than a home are collected in the IA Section. For persons who rent, monthly payment amount is asked. Persons whose monthly rent is less than $500 are asked if their home is Section 8 or public housing or housing for low-income seniors.

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Income and Assets (IA)

The Income and Assets section collects information on: sources of income (except for earned income, see LF Section), income amounts by source and total income from all sources, major assets (other than home ownership, see HP section, and car ownership, see CO section), and the current value or worth of major assets. Other information in this section includes: whether Social Security is received by mail or direct deposit, and the year and month person started receiving Social Security.

Time Frame: Many questions are framed in terms of the "last month." In this section the last month refers to the month prior to the interview month (e.g. for interviews in May, the last month would be April). A few questions are framed in terms of the last year, meaning calendar year.

Response Options: In order to make responding to the IA questions easier several steps are taken. First, respondents are invited in the opening of the IA section to "Please feel free to refer to any records or other persons that may be of assistance in answering these questions." Second, in the case of couples, the respondent can choose to report each income source or asset jointly (e.g. amount in both persons' retirement accounts), separately for the sample person and the spouse/partner (e.g. amount in sample person's retirement account and amount in spouse/partner's account, or amount in only one if only one person has such an account), or in combination (e.g. worth of joint checking account and worth of spouse's separate account). Third, although questions on income amounts and asset values ask for a dollar amount, interviewers can follow-up as needed with a statement that "We don't need an exact dollar amount. The nearest $100/$1000 is fine. "(The amount varies by type of income and asset). This indicates to the respondent that precision to the exact dollar is not expected.

Don't Know responses: Income and assets are often sensitive topics and nonresponse tends to be higher for these types of questions. NHATS has addressed this issue in two ways: 1) a statement that explains why this information is needed is in the introduction to the IA Section and can be repeated by the interviewer as needed; 2) use of SHOW CARDS with bracketed ranges for dollar amounts tailored to types of income and assets when respondents say they "don't know" an amount. Most surveys use a bracketing approach - either unfolding (as in the Health and Retirement Survey) or fixed ranges (as in the Survey of Consumer Finance) to reduce missing data. 5 fixed ranges (for single persons and couples separately)were developed for questions that ask for dollar amounts based on data from the Survey of Consumer Finance for 2007 adjusted to 2011 dollars.

Summary table of elements in the IA section and location of other income/asset information

Sources of Income and Income Amounts Time frame Section if not IA
Social Security Last Month  
Supplemental Security Income (SSI) Last Month  
Veteran's Administration Last Month  
Pension plan Last Month  
Earned Income (SP and Spouse/Partner) Last Month/Last Paycheck Labor Force (LF)
Interest/dividend income from any: mutual funds/stocks, bonds, bank accounts, or CDs Last Year  
Total income from all sources Last Year  
Assets and Value    
Retirement accounts Current worth/amount withdrawn last month/amount withdrawn last year  
Mutual funds or stocks Current worth  
Bonds Current worth  
Checking account Current worth  
Savings account Current worth  
Certificates of Deposit Current worth  
Business, farm or real estate (besides home) Current worth  
Home Current worth/current outstanding mortgage balance Home Ownership (HP)
Cars/other vehicles Current worth Car ownership (CO)

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Car Ownership (CO)

Questions are: whether any cars, trucks, or vans are owned, the number of vehicles owned, and their present value. Other assets (and their worth) are included in the IA Section and the HP section.

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Economic Well-being (EW)

This Section asks about some types of debt, financial gifts from sample persons to relatives and from relatives to sample persons, and participation in government assistance programs.

Debt: Questions cover whether credit card balances are paid off each month and the total balance owed on all cards. Whether any amount owed on credit cards is for medical care and the amount owed is asked. Respondents also are asked whether any medical bills are being paid off over time and, if so, the amount.

Financial gifts to and from the sample person: Persons are asked whether in the last year they received "any financial help or financial gifts from children or other relatives either regularly - like every month-or just every so often as needed." Who helped out is asked and for children the specific child is identified. An amount in the last year is asked. These questions are repeated for financial help or gifts from sample persons to children or other relatives. Grandchildren are coded separately from children and other relatives.

Government assistance: Participation in the last year in food stamps, food assistance such as Meals-on-Wheels, and energy assistance programs is asked.

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Helpers (HL)

This section is designed to obtain information about persons identified as Helpers with activities in earlier sections. Questions are asked about each person who is identified as a "helper" with activities in: Mobility (MO), Driving and Transportation (DT), Household Activities (HA), Self Care Activities (SC), and Medical Care Activities (MC). NHATS identifies as "helpers" people who are doing household activities or medication management with or for sample persons, those who give rides or sit in on doctor visits, and those who help with mobility and self-care activities. This information can be used to characterize the involvement of others in meeting the demands of routine daily activities and, when help is for health reasons, understanding how help from others bridges the gap between individual capacity and doing necessary activities.

The Helper section questions are not asked of persons identified as staff persons at the place where a sample person lives.

Activities where Helpers can be identified:

  • Getting around outside, getting around inside, getting out of bed (MO Section)
  • Persons who give the sample person a ride to get to places (DT Section; two persons can be identified)
  • Laundry, shopping for groceries or personal items, preparing hot meals, handling bills and banking, less common money matters (HA Section)
  • Eating, getting cleaned up, using the toilet, getting dressed (SC Section)
  • Keeping track of medications, sitting in on doctor visits, making decisions about insurance and medical matters (MC Section)

Helper characteristics: Relationship of the helper to the sample person is obtained when a person is identified as helping with an activity. Questions in the HL Section obtain information on whether help is regular or varies. If regular, days per week is asked. For all helpers, days in the last month and hours per day on days when help is provided are asked. For helpers other than spouses/partners, whether the helper is paid and who pays (family, government program, insurance, other) is asked. If the person or his/her family pays, the amount last month is asked. This can be reported as an hourly rate, a weekly rate or a monthly rate. If a government program is named as a payer, the type of program is asked (Medicaid, Medicare, a state program or something else).

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NLTCS Questions (LS)

NHATS has included items from the National Long-Term Care Survey (NLTCS) screener as a means of providing a cross-walk between NLTCS disability prevalence estimates and estimates based on NHATS. The source of the NLTCS items is the 2004 NLTCS Screener.

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Environmental Checklist (IR)

Interviewers record their observation of conditions inside and outside the home. This includes: condition in the home (flaking paint, pests, broken furniture, flooring, tripping hazards, clutter), condition of the environment around home (litter, graffiti, vacant houses, foreclosure signs), and the condition of the home's exterior ( windows, foundation, outside of home, roof, walking surfaces).

Other sections collecting information on place sample person lives

  • Residence (RE): physical structure of residence
  • Housing Type (HT): length of residence and type of place
  • Service Environment (SE): if sample person is in residential care (other than nursing home) services available and used
  • Home Environment (HO): features of the home environment
  • Environmental Modifications (EM): whether features of the home environment were added and out-of-pocket costs if so; out-of-pocket costs for other devices for daily activities
  • Facility Questionnaire (FQ): if sample person is in residential care (including nursing home) services available at place and in sample person's area; payment information in last month

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Facility Questionnaire (FQ)

The FQ collects information about the place the person lives when the residence is a nursing home or other residential care setting (see When the FQ is administered). Questions focus on: describing the place; whether the part of the place where the person lives has a different name from the overall place; whether the person's residence is independent living, assisted living, special care/memory care/Alzheimer's unit, nursing home; other levels of care available at place, services available to people at the sample person's current level of care; services that are part of the person's service package; whether there are extra charges for each service available; sources of payment in the last month for person's care and total payment by each source; total monthly payment for care; primary source of payment for care.

When the FQ is administered: The FQ is administered for all nursing home residents. Otherwise, items in Housing Type (HT) are used to determine whether a sample person lives in a residential care setting and a Facility Questionnaire should be administered. The items used for this purpose are:

  • identification of the place the person lives as "group home/board and care/or supervised housing" or "assisted living facility or continuing care retirement community" or
  • a positive response to any of 3 questions about the place-are there different areas you can move to if you need care; is help offered with medications or activities like bathing or dressing; are meals for residents offered. Because of the skip patterns employed for these questions, they should not be used for analyses of services in residential care environments. Either the Service Environment (SE) section (the person's report of services available and used) and/or the Facility Questionnaire (FQ) (staff report of services offered to residents) should be used for this purpose.

This approach casts a wide net that will include not only assisted living facilities, but other residential environments (subsidized senior housing, retirement communities) that have services available to residents. In places where appropriate staff cannot be identified the FQ is not administered.

Other sections collecting information on place sample person lives

  • Residence (RE): physical structure of residence
  • Housing Type (HT): length of residence and type of place
  • Service Environment (SE): if sample person is in residential care (other than nursing home) services available and used
  • Home Environment (HO): features of the home environment
  • Environmental Modifications (EM): whether features of the home environment were added and out-of-pocket costs if so; out-of-pocket costs for other devices for daily activities
  • Environmental Checklist (IR): conditions inside and outside the home

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