Questions | Answers |
---|---|
Do you have difficulty seeing, even if wearing glasses? | No difficulty; Some difficulty; A lot of difficulty; Cannot do at all |
Do you have difficulty hearing, even if using a hearing aid? | No difficulty; Some difficulty; A lot of difficulty; Cannot do at all |
Do you have difficulty walking or climbing steps? | No difficulty; Some difficulty; A lot of difficulty; Cannot do at all |
Do you have difficulty remembering or concentrating? | No difficulty; Some difficulty; A lot of difficulty; Cannot do at all |
Do you have difficulty (with self-care such as) washing all over or dressing? | No difficulty; Some difficulty; A lot of difficulty; Cannot do at all |
Using your usual (customary) language, do you have difficulty communicating, for example, understanding or being understood by others? | No difficulty; Some difficulty; A lot of difficulty; Cannot do at all |