Canadian Health Survey on Seniors

For Information onlyThis is an electronic survey example for information purposes only. This is not a working questionnaire.

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Table of Contents

Introduction to CHSS (INT)

Introduction to CHSS (INT) - Question identifier:INT_R01

The next questions are for the Canadian Health Survey on Seniors. This voluntary survey focuses on the health of Canadians aged 65 and over. The data will be used to better understand factors that contribute to healthy aging.

General health (GEN)

General health (GEN) - Question identifier:GEN_R01

The following question is about health. By health, we mean not only the absence of disease or injury but also physical, mental and social well-being.

General health (GEN) - Question identifier:GEN_Q02

Compared to one year ago, how would you say your health is now? Is it...?

  • 1: Much better now than 1 year ago
  • 2: Somewhat better now (than 1 year ago)
  • 3: About the same as 1 year ago
  • 4: Somewhat worse now (than 1 year ago)
  • 5: Much worse now (than 1 year ago)
  • 8: RF
  • 9: DK

Sleep 2 (SL2)

Sleep 2 (SL2) - Question identifier:SL2_R01

Now a question about sleep.

Sleep 2 (SL2) - Question identifier:SL2_Q02

How often do you have trouble going to sleep or staying asleep?

  • 1: None of the time
  • 2: A little of the time
  • 3: Some of the time
  • 4: Most of the time
  • 5: All of the time
  • 8: RF
  • 9: DK

Chronic conditions (CCC)

Chronic conditions (CCC) - Question identifier:CCC_R015

Now I'd like to ask about other long-term health conditions which you may have. We are interested in "long-term conditions" which are expected to last or have already lasted 6 months or more and that have been diagnosed by a health professional.

Chronic conditions (CCC) - Question identifier:CCC_Q055

Do you have back problems, excluding scoliosis, fibromyalgia and arthritis?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Chronic conditions (CCC) - Question identifier:CCC_Q092

Do you have chronic kidney disease?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Chronic conditions (CCC) - Question identifier:CCC_Q155

Do you have a bowel disorder such as Crohn's Disease, ulcerative colitis, Irritable Bowel Syndrome or bowel incontinence?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Chronic conditions (CCC) - Question identifier:CCC_Q160

What kind of bowel disease do you have?

  • 1: Crohn's Disease
  • 2: Ulcerative colitis
  • 3: Irritable Bowel Syndrome
  • 4: Bowel incontinence
  • 5: Other
  • 8: RF
  • 9: DK

Chronic conditions (CCC) - Question identifier:CCC_Q165

Do you have urinary incontinence?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Chronic conditions (CCC) - Question identifier:CCC_Q183

Do you have Parkinson's Disease?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Chronic conditions (CCC) - Question identifier:CCC_R191

Remember, we're interested in conditions diagnosed by a health professional and that are expected to last or have already lasted 6 months or more.

Chronic conditions (CCC) - Question identifier:CCC_Q191

Do you have cataracts?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Chronic conditions (CCC) - Question identifier:CCC_Q201

Do you have glaucoma?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Chronic conditions (CCC) - Question identifier:CCC_Q202

Do you have diabetic retinopathy?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Chronic conditions (CCC) - Question identifier:CCC_Q203

Do you have age-related macular degeneration (AMD)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Chronic conditions (CCC) - Question identifier:CCC_Q311

Do you have post-traumatic stress disorder?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Vaccines (VAC)

Vaccines (VAC) - Question identifier:VAC_R01

Now a few questions about vaccination.

Vaccines (VAC) - Question identifier:VAC_Q01

As an adult, have you ever had the pneumococcal vaccine, which protects against pneumonia?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Vaccines (VAC) - Question identifier:VAC_Q05

What are the reasons that you have not had the pneumococcal vaccine?

  • 01: Never heard of this vaccine
  • 02: Respondent - did not think it was necessary
  • 03: Doctor - did not mention it
  • 04: Has not gotten around to it
  • 05: Feelings of fear or discomfort
  • 06: Bad reaction to previous vaccine
  • 07: Unsure of / do not believe in benefits of vaccine
  • 08: Fear of what the vaccine contains
  • 09: Cost of the vaccine
  • 10: Other
  • 98: RF
  • 99: DK

Vaccines (VAC) - Question identifier:VAC_Q10

As an adult, have you ever had the shingles vaccine, also known as herpes zoster vaccine?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Vaccines (VAC) - Question identifier:VAC_Q15

What are the reasons that you have not had the shingles vaccine?

  • 01: Never heard of this vaccine
  • 02: Respondent - did not think it was necessary
  • 03: Doctor - did not mention it
  • 04: Has not gotten around to it
  • 05: Feelings of fear or discomfort
  • 06: Bad reaction to previous vaccine
  • 07: Unsure of / do not believe in benefits of vaccine
  • 08: Fear of what the vaccine contains
  • 09: Cost of the vaccine
  • 10: Other
  • 98: RF
  • 99: DK

Instrumental Activities of Daily Living (IAL)

Instrumental Activities of Daily Living (IAL) - Question identifier:IAL_R01

Now I'd like to ask you about some activities of daily living, activities that can be done without help, with some help or which you are unable to do. You may feel that some of these questions do not apply to you, but it is important that we ask the same questions of everyone.

Instrumental Activities of Daily Living (IAL) - Question identifier:IAL_Q01A

Can you use the telephone without help, including looking up numbers and dialling?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Instrumental Activities of Daily Living (IAL) - Question identifier:IAL_Q01B

Can you use the telephone with some help (you can answer the phone or dial the operator in an emergency, but need a special phone or help in getting the number or dialling)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Instrumental Activities of Daily Living (IAL) - Question identifier:IAL_Q01C

Are you completely unable to use the telephone?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Instrumental Activities of Daily Living (IAL) - Question identifier:IAL_Q02A

Can you get to places out of walking distance without help (you drive your own car, or travel alone on buses, or taxis)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Instrumental Activities of Daily Living (IAL) - Question identifier:IAL_Q02B

Can you get to places out of walking distance with some help (you need someone to help you or go with you when travelling)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Instrumental Activities of Daily Living (IAL) - Question identifier:IAL_Q02C

Are you unable to travel unless emergency arrangements are made for a specialized vehicle, like an ambulance?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Instrumental Activities of Daily Living (IAL) - Question identifier:IAL_Q03A

Can you go shopping for groceries or clothes without help (taking care of all shopping needs yourself)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Instrumental Activities of Daily Living (IAL) - Question identifier:IAL_Q03B

Can you go shopping for groceries or clothes with some help (you need someone to go with you on all shopping trips)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Instrumental Activities of Daily Living (IAL) - Question identifier:IAL_Q03C

Are you completely unable to do any shopping?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Instrumental Activities of Daily Living (IAL) - Question identifier:IAL_Q04A

Can you prepare your own meals without help (you plan and cook full meals yourself)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Instrumental Activities of Daily Living (IAL) - Question identifier:IAL_Q04B

Can you prepare your own meals with some help (you can prepare some things but are unable to cook full meals yourself)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Instrumental Activities of Daily Living (IAL) - Question identifier:IAL_Q04C

Are you completely unable to prepare any meals?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Instrumental Activities of Daily Living (IAL) - Question identifier:IAL_Q05A

Can you do your housework without help (you can clean floors, etc.)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Instrumental Activities of Daily Living (IAL) - Question identifier:IAL_Q05B

Can you do your housework with some help (you can do light housework but need help with heavy work)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Instrumental Activities of Daily Living (IAL) - Question identifier:IAL_Q05C

Are you completely unable to do any housework?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Instrumental Activities of Daily Living (IAL) - Question identifier:IAL_Q06A

Can you take your own medicine without help (in the right doses at the right time)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Instrumental Activities of Daily Living (IAL) - Question identifier:IAL_Q06B

Can you take your own medicine with some help (you are able to take medicine if someone prepares it for you or reminds you to take it)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Instrumental Activities of Daily Living (IAL) - Question identifier:IAL_Q06C

Are you completely unable to take your medicine?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Instrumental Activities of Daily Living (IAL) - Question identifier:IAL_Q07A

Can you handle your own money without help (you write cheques, pay bills, etc.)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Instrumental Activities of Daily Living (IAL) - Question identifier:IAL_Q07B

Can you handle your own money with some help (you manage day-to-day buying but need help with managing your chequebook or paying your bills)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Instrumental Activities of Daily Living (IAL) - Question identifier:IAL_Q07C

Are you completely unable to handle your money?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Basic Activities of Daily Living (ADL)

Basic Activities of Daily Living (ADL) - Question identifier:ADL_R01A

Now I'd like to ask you about some other basic activities of daily living. Remember, these are activities that can be done without help, with some help or which you are unable to do.

Basic Activities of Daily Living (ADL) - Question identifier:ADL_Q01A

Can you eat without help (you are able to feed yourself completely)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Basic Activities of Daily Living (ADL) - Question identifier:ADL_Q01B

Can you eat with some help (you need help with cutting your food, etc.)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Basic Activities of Daily Living (ADL) - Question identifier:ADL_Q01C

Are you completely unable to feed yourself?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Basic Activities of Daily Living (ADL) - Question identifier:ADL_Q02A

Can you dress and undress yourself without help (including picking out clothes)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Basic Activities of Daily Living (ADL) - Question identifier:ADL_Q02B

Can you dress and undress yourself with some help?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Basic Activities of Daily Living (ADL) - Question identifier:ADL_Q02C

Are you completely unable to dress and undress yourself?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Basic Activities of Daily Living (ADL) - Question identifier:ADL_Q03A

Can you take care of your own appearance without help, for example, combing your hair [and shaving]?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Basic Activities of Daily Living (ADL) - Question identifier:ADL_Q03B

Can you take care of your own appearance with some help?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Basic Activities of Daily Living (ADL) - Question identifier:ADL_Q03C

Are you completely unable to take care of your own appearance?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Basic Activities of Daily Living (ADL) - Question identifier:ADL_Q04A

Can you walk without help?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Basic Activities of Daily Living (ADL) - Question identifier:ADL_Q04B

Can you walk with some help from a person, or with the use of a walker or crutches, etc.?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Basic Activities of Daily Living (ADL) - Question identifier:ADL_Q04C

Are you completely unable to walk?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Basic Activities of Daily Living (ADL) - Question identifier:ADL_Q05A

Can you get in and out of bed without any help or aids?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Basic Activities of Daily Living (ADL) - Question identifier:ADL_Q05B

Can you get in and out of bed with some help (either from a person or with the aid of some device)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Basic Activities of Daily Living (ADL) - Question identifier:ADL_Q05C

Are you totally dependent on someone else to lift you in and out of bed?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Basic Activities of Daily Living (ADL) - Question identifier:ADL_Q06A

Can you take a bath or shower without help?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Basic Activities of Daily Living (ADL) - Question identifier:ADL_Q06B

Can you take a bath or shower with some help (you need help from someone getting in and out of the tub or you need special attachments on the tub)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Basic Activities of Daily Living (ADL) - Question identifier:ADL_Q06C

Are you completely unable to take a bath and a shower yourself?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Basic Activities of Daily Living (ADL) - Question identifier:ADL_Q07A

Do you ever have trouble getting to the bathroom on time?

  • 1: Yes
  • 2: No
  • 3: No, has a catheter or colostomy
  • 8: RF
  • 9: DK

Basic Activities of Daily Living (ADL) - Question identifier:ADL_Q07B

How often do you wet or soil yourself (either day or night)?

  • 1: Never or less than once a week
  • 2: Once or twice a week
  • 3: Three times a week or more
  • 8: RF
  • 9: DK

Oral health 4 (OH4)

Oral health 4 (OH4) - Question identifier:OH4_Q10A

Can you brush your teeth or dentures without help?

  • 1: Yes
  • 2: No
  • 3: Not applicable
  • 8: RF
  • 9: DK

Oral health 4 (OH4) - Question identifier:OH4_Q10B

Can you brush your teeth or dentures with some help?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Oral health 4 (OH4) - Question identifier:OH4_Q10C

Are you completely unable to brush your teeth or dentures yourself?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Oral Health 3 (OH3)

Oral Health 3 (OH3) - Question identifier:OH3_R01

Next, some questions about the health of your mouth, including your teeth or dentures, tongue, gums, lips and jaw joints.

Oral Health 3 (OH3) - Question identifier:OH3_Q01

In general, would you say the health of your mouth is:

  • 1: ... excellent?
  • 2: ... very good?
  • 3: ... good?
  • 4: ... fair?
  • 5: ... poor?
  • 8: RF
  • 9: DK

Oral Health 3 (OH3) - Question identifier:OH3_Q02

Do you have one or more of your own teeth?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Oral Health 3 (OH3) - Question identifier:OH3_Q03

Do you wear dentures, dental prosthesis or false teeth?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Oral Health 3 (OH3) - Question identifier:OH3_Q04

In the past 12 months, that is, from ^YEARAGO to yesterday, how often have you found it uncomfortable to eat any food because of problems with your mouth?

  • 1: Often
  • 2: Sometimes
  • 3: Rarely
  • 4: Never
  • 8: RF
  • 9: DK

Oral Health 3 (OH3) - Question identifier:OH3_Q05

In the past 12 months, that is, from ^YEARAGO to yesterday, how often have you avoided eating particular foods because of problems with your mouth?

  • 1: Often
  • 2: Sometimes
  • 3: Rarely
  • 4: Never
  • 8: RF
  • 9: DK

Oral Health 3 (OH3) - Question identifier:OH3_Q06

Now a few questions about your regular dental care habits.

How often do you usually brush your teeth and/or dentures? (For example: twice a day, three times a week, once a month.)

Min = 0; Max = 500

Oral Health 3 (OH3) - Question identifier:OH3_N06

Select the reporting period.

  • 1: Per day
  • 2: Per week
  • 3: Per month
  • 4: Per year

Oral Health 3 (OH3) - Question identifier:OH3_Q07

How often do you usually floss your teeth? (For example: twice a day, three times a week, once a month.)

Min = 0; Max = 500

Oral Health 3 (OH3) - Question identifier:OH3_N07

Select the reporting period.

  • 1: Per day
  • 2: Per week
  • 3: Per month
  • 4: Per year

Oral Health 3 (OH3) - Question identifier:OH3_Q09A

When was the last time you saw a dental professional?

  • 1: Less than 1 year ago
  • 2: 1 year to less than 2 years ago
  • 3: 2 years to less than 3 years ago
  • 4: 3 years to less than 4 years ago
  • 5: 4 years to less than 5 years ago
  • 6: 5 or more years ago
  • 7: Never
  • 8: RF
  • 9: DK

Oral Health 3 (OH3) - Question identifier:OH3_Q09B

What are the reasons you have not seen a dental professional in the past 3 years?

  • 01: Have not gotten around to it
  • 02: Respondent - did not think it was necessary
  • 03: Dental professional - did not think it was necessary
  • 04: Personal or family responsibilities
  • 05: Not available - at time required
  • 06: Not available - in the area
  • 07: Waiting time was too long
  • 08: Transportation - problems
  • 09: Language - problem
  • 10: Cost
  • 11: Did not know where to go/uninformed
  • 12: Fear (e.g. painful, embarrassing, find something wrong)
  • 13: Wears dentures
  • 14: Unable to leave house because of a health problem
  • 15: Other - Specify
  • 98: RF
  • 99: DK

Oral Health 3 (OH3) - Question identifier:OH3_Q10A

Do you have insurance or a government program that covers all or part of your dental expenses?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Care receiving 2 (CR2)

Care receiving 2 (CR2) - Question identifier:CR2_R01A

The following questions are about different types of assistance that you may have received because of a health condition or limitation that affects your daily activities. Please include only assistance from family, friends, or neighbours. Exclude assistance from paid workers or volunteer organizations.

Care receiving 2 (CR2) - Question identifier:CR2_Q01A

During the past 12 months, did you receive short-term or long-term assistance, because of a health condition or limitation that affects your daily life, for any of the following activities from family, friends, or neighbours?

  • 01: Personal care such as assistance with eating, dressing, bathing, or toileting
  • 02: Medical care such as help taking medicine or help with nursing care (for example, dressing changes or foot care)
  • 03: Managing care such as making appointments
  • 04: Help with activities such as housework, home maintenance or outdoor work
  • 05: Transportation, including trips to the doctor or for shopping
  • 06: Meal preparation or delivery
  • 07: None
  • 08: Other - Specify
  • 98: RF
  • 99: DK

Care receiving 2 (CR2) - Question identifier:CR2_Q01B

For which type of activity did you receive the most assistance?

  • 01: Personal care such as assistance with eating, dressing, bathing, or toileting
  • 02: Medical care such as help taking medicine or help with nursing care (for example, dressing changes or foot care)
  • 03: Managing care such as making appointments
  • 04: Help with activities such as housework, home maintenance or outdoor work
  • 05: Transportation, including trips to the doctor or for shopping
  • 06: Meal preparation or delivery
  • 07: None
  • 08: ^CR2_S01A
  • 98: RF
  • 99: DK

Care receiving 2 (CR2) - Question identifier:CR2_R04

You mentioned that during the past 12 months, you received assistance with [personal care/medical care/managing care/housework or home maintenance/transportation/meal preparation or delivery/the other care you specified]. We are interested in finding out a little bit more about the person who has dedicated the most time and resources to helping you with this activity.

Care receiving 2 (CR2) - Question identifier:CR2_Q04

Is the person from whom you received the most assistance:

  • 1: ... living in this household?
  • 2: ... living outside of this household?
  • 8: RF
  • 9: DK

Care receiving 2 (CR2) - Question identifier:CR2_Q07

What is the name of this person?

  • 01: MEMBER 1
  • 02: MEMBER 2
  • 03: MEMBER 3
  • 04: MEMBER 4
  • 05: MEMBER 5
  • 06: MEMBER 6
  • 07: MEMBER 7
  • 08: MEMBER 8
  • 09: MEMBER 9
  • 10: MEMBER 10
  • 98: RF
  • 99: DK

Care receiving 2 (CR2) - Question identifier:CR2_Q08

What is the first name of this person?

Long Answer Length = 25

Care receiving 2 (CR2) - Question identifier:CR2_Q12

What is [the person from whom you received the most assistance]'s gender?

  • 1: Male
  • 2: Female
  • 3: Or please specify
  • 8: RF
  • 9: DK

Care receiving 2 (CR2) - Question identifier:CR2_Q14

How old is [the person from whom you received the most assistance]?

Min = 5; Max = 130

Care receiving 2 (CR2) - Question identifier:CR2_Q15

What is the relationship between you and [the person from whom you received the most assistance]?

  • 01: Husband or wife
  • 02: Common-law partner
  • 03: Father or mother
  • 04: Son or daughter (birth, adopted or step)
  • 05: Brother or sister
  • 06: Foster father or mother
  • 07: Foster son or daughter
  • 08: Grandfather or grandmother
  • 09: Grandson or granddaughter
  • 10: In-law
  • 11: Other related
  • 12: Unrelated
  • 98: RF
  • 99: DK

Care receiving 2 (CR2) - Question identifier:CR2_Q16

How long have you been receiving assistance from [the person from whom you received the most assistance] for [personal care/medical care/managing care/housework or home maintenance/transportation/meal preparation or delivery/the other care you specified]?

  • 1: Less than six months
  • 2: Six months to less than one year
  • 3: One year to less than three years
  • 4: Three years to less than five years
  • 5: Five years or more
  • 8: RF
  • 9: DK

Care receiving 2 (CR2) - Question identifier:CR2_Q17A

During the past 12 months, did you receive assistance from [the person from whom you received the most assistance] with [personal care/medical care/managing care/housework or home maintenance/transportation/meal preparation or delivery/the other care you specified]:

  • 1: ... on a regular basis?
  • 2: ... occasionally or infrequently?
  • 8: RF
  • 9: DK

Care receiving 2 (CR2) - Question identifier:CR2_Q17B

(During the past 12 months,) how often did you receive assistance from [the person from whom you received the most assistance] with [personal care/medical care/managing care/housework or home maintenance/transportation/meal preparation or delivery/the other care you specified]? Was it:

  • 1: ... daily?
  • 2: ... at least once a week?
  • 3: ... at least once a month?
  • 4: ... less than once a month?
  • 8: RF
  • 9: DK

Care receiving 2 (CR2) - Question identifier:CR2_Q18

(During the past 12 months,) how much time in an average [day/week/month/occasion] did you receive assistance from [the person from whom you received the most assistance] with [personal care/medical care/managing care/housework or home maintenance/transportation/meal preparation or delivery/the other care you specified]? Was it:

  • 1: ... less than 1 hour?
  • 2: ... 1 hour to less than 3 hours?
  • 3: ... 3 hours to less than 5 hours?
  • 4: ... 5 hours to less than 10 hours?
  • 5: ... 10 hours or more?
  • 8: RF
  • 9: DK

Community services use (CSU)

Community services use (CSU) - Question identifier:CSU_R01

Now we are interested in community support services you may have received because of a health condition or a limitation that affects your daily activities. By this we mean services provided by organizations and not individuals, for free or for a minimal payment. Exclude assistance from family, friends or neighbours.

Community services use (CSU) - Question identifier:CSU_Q01

In the past 12 months, did you receive any of the following community support services?

  • 01: Friendly visiting (e.g. regular visit from a companion, providing friendship and company)
  • 02: Adult day program (e.g. specialized programs of therapeutic, social and recreational activities)
  • 03: Grounds maintenance services (e.g. snow removal or lawn mowing)
  • 04: Faith outreach services
  • 05: Transportation, including trips to the doctor or for shopping
  • 06: Foot care
  • 07: Food bank
  • 08: Support groups (e.g. grief support group)
  • 09: None
  • 10: Other - specify
  • 98: RF
  • 99: DK

Access to health care services (ACC)

Access to health care services (ACC) - Question identifier:ACC_R001

The next questions are about the use of various health care services.

I will start by asking about your experiences getting health care from a medical specialist such as a cardiologist, endocrinologist, allergist, [urologist, gynecologist] or psychiatrist (excluding an optometrist).

Access to health care services (ACC) - Question identifier:ACC_Q005

In the past 12 months, did you require a visit to a medical specialist for a diagnosis or a consultation?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q010

In the past 12 months, did you ever experience any difficulties getting the specialist care you needed for a diagnosis or consultation?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q015

What types of difficulties did you experience?

  • 01: Difficulty getting a referral
  • 02: Difficulty getting an appointment
  • 03: Waited too long between booking appointment and visit
  • 04: Waited too long to see the specialist (i.e. in-office waiting)
  • 05: Service not available at time required
  • 06: Service not available in the area
  • 07: Transportation problems
  • 08: Language problem
  • 09: Cost
  • 10: General deterioration of health
  • 11: Appointment cancelled or deferred by specialist
  • 12: Unable to leave the house because of a health problem
  • 13: Other
  • 98: RF
  • 99: DK

Access to health care services (ACC) - Question identifier:ACC_R020

The following questions are about any surgery, not provided in an emergency, that you may have required, such as cardiac surgery, joint surgery - knee or hip and cataract surgery, excluding laser eye surgery.

Access to health care services (ACC) - Question identifier:ACC_Q020

In the past 12 months, did you require any non-emergency surgery?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q025

In the past 12 months, did you ever experience any difficulties getting the surgery you needed?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q030

What types of difficulties did you experience?

  • 01: Difficulty getting an appointment
  • 02: Difficulty getting a diagnosis including obtaining a diagnostic test
  • 03: Waited too long for a hospital bed to become available
  • 04: Waited too long for surgery
  • 05: Service not available at time required
  • 06: Service not available in the area
  • 07: Transportation problems
  • 08: Language problem
  • 09: Cost
  • 10: General deterioration of health
  • 11: Appointment cancelled or deferred by surgeon or hospital
  • 12: Unable to leave the house because of a health problem
  • 13: Other
  • 98: RF
  • 99: DK

Access to health care services (ACC) - Question identifier:ACC_R035

Now, some questions about MRIs, CAT Scans and angiographies provided in a non-emergency situation.

Access to health care services (ACC) - Question identifier:ACC_Q035

In the past 12 months, did you require one of these tests?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q040

In the past 12 months, did you ever experience any difficulties getting the tests you needed?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Access to health care services (ACC) - Question identifier:ACC_Q045

What types of difficulties did you experience?

  • 01: Difficulty getting a referral
  • 02: Difficulty getting an appointment
  • 03: Waited too long to get an appointment
  • 04: Waited too long to get test (i.e. in-office waiting)
  • 05: Service not available at time required
  • 06: Service not available in the area
  • 07: Transportation problems
  • 08: Language problem
  • 09: Cost
  • 10: General deterioration of health
  • 11: Did not know where to go (i.e. information problems)
  • 12: Unable to leave the house because of a health problem
  • 13: Other
  • 98: RF
  • 99: DK

Social Participation Barriers (SPB)

Social Participation Barriers (SPB) - Question identifier:SPB_R01

The next questions are about activities that you may have participated in during the past 12 months.

Social Participation Barriers (SPB) - Question identifier:SPB_Q09

In the past 12 months, have you felt like you wanted to participate in more social, recreational or group activities?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Social Participation Barriers (SPB) - Question identifier:SPB_Q10

What prevented you from participating in more activities?

  • 01: Cost
  • 02: Transportation problems
  • 03: Activities not available in the area
  • 04: Location not physically accessible
  • 05: Location is too far
  • 06: Health condition limitation
  • 07: Time of the activities not suitable
  • 08: Don't want to go alone
  • 09: Personal or family responsibilities
  • 10: Language-related reasons
  • 11: Too busy
  • 12: Afraid or concerns about safety
  • 13: Other - Specify
  • 98: RF
  • 99: DK

Transportation (TRA)

Transportation (TRA) - Question identifier:TRA_R01

Now some questions about transportation.

Transportation (TRA) - Question identifier:TRA_Q01

Do you have a valid driver's licence? (Include cars, vans, trucks and motorcycles.)

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Transportation (TRA) - Question identifier:TRA_Q02

In the past month, how often did you drive? Was it:

  • 1: ... 6 or 7 days a week?
  • 2: ... 4 or 5 days a week?
  • 3: ... 1 to 3 days a week?
  • 4: ... 1 to 3 days in the past month?
  • 5: ... Not at all in the past month?
  • 8: RF
  • 9: DK

Transportation (TRA) - Question identifier:TRA_Q04

In general, which is your most common form of transportation?

  • 01: Passenger in a motor vehicle
  • 02: Drive a motor vehicle
  • 03: Taxi or similar paid services
  • 04: Public transportation such as bus, rapid transit, subway or train
  • 05: Accessible transit
  • 06: Cycling
  • 07: Walking
  • 08: Wheelchair or motorized cart
  • 98: RF
  • 99: DK

Falls (FAL)

Falls (FAL) - Question identifier:FAL_R01

Now some questions about falls that you may have experienced. We are interested in falls where you hurt yourself enough to limit some of your normal activities.

Falls (FAL) - Question identifier:FAL_Q01

In the past 12 months, did you have any falls?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Falls (FAL) - Question identifier:FAL_Q02

How many times have you fallen in the past 12 months?

Min = 1; Max = 30

Falls (FAL) - Question identifier:FAL_Q03

What has been your most serious injury or problem due to a fall within the past 12 months?

  • 01: No serious injury
  • 02: Sprain/strain
  • 03: Bruises
  • 04: Cuts
  • 05: Discomfort
  • 06: Fracture of hip
  • 07: Fracture of leg
  • 08: Fracture of arm or wrist
  • 09: Fracture of back/vertebra
  • 10: Head injury
  • 11: Other - Specify
  • 98: RF
  • 99: DK

Falls (FAL) - Question identifier:FAL_Q04A

Did you receive any medical attention from a health professional within 48 hours following this injury?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Falls (FAL) - Question identifier:FAL_Q04B

Were you hospitalized for this injury?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Falls (FAL) - Question identifier:FAL_Q05

When did your fall happen? Was it:

  • 1: ... less than one month ago?
  • 2: ... 1 month to less than 3 months ago?
  • 3: ... 3 months to less than 6 months ago?
  • 4: ... 6 or more months ago?
  • 8: RF
  • 9: DK

Falls (FAL) - Question identifier:FAL_Q06

How did your fall happen?

  • 01: Tripped or stumbled while walking
  • 02: In bathroom or bathtub
  • 03: Going up or down stairs / steps
  • 04: While engaged in a sport or physical exercise (except walking)
  • 05: While reaching for something
  • 06: From furniture (e.g., bed, chair)
  • 07: From elevated position (e.g., ladder, tree, roof)
  • 08: Due to health problems (e.g., faint, weakness, dizziness, hip/knee gave out, seizure)
  • 09: Other - Specify
  • 98: RF
  • 99: DK

Falls (FAL) - Question identifier:FAL_Q07

Where did this fall happen?

  • 1: Inside of your home
  • 2: Outside of your home, but inside
    a building
  • 3: Outdoors
  • 8: RF
  • 9: DK

Falls (FAL) - Question identifier:FAL_Q08

Was snow or ice a factor in your fall?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Falls (FAL) - Question identifier:FAL_Q09

Were you using an assistive device (for example, walker, wheelchair, cane, leg brace or grab bar) at the time of your fall?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Falls (FAL) - Question identifier:FAL_Q10

At the present time, are you getting follow-up care from a health professional because of an injury caused by a fall [that occurred more than a year ago?]

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Falls (FAL) - Question identifier:FAL_Q11

Are you worried or concerned that in the future you might fall?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Falls (FAL) - Question identifier:FAL_Q12

As a result of this concern, have you stopped doing some things you used to do or liked to do?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Loneliness (LON)

Loneliness (LON) - Question identifier:LON_R01

The next questions are about how you feel about different aspects of your life. For each one, tell me how often you feel that way.

Loneliness (LON) - Question identifier:LON_Q01

How often do you feel that you lack companionship?

  • 1: Hardly ever
  • 2: Some of the time
  • 3: Often
  • 8: RF
  • 9: DK

Loneliness (LON) - Question identifier:LON_Q02

How often do you feel left out?

  • 1: Hardly ever
  • 2: Some of the time
  • 3: Often
  • 8: RF
  • 9: DK

Loneliness (LON) - Question identifier:LON_Q03

How often do you feel isolated from others?

  • 1: Hardly ever
  • 2: Some of the time
  • 3: Often
  • 8: RF
  • 9: DK

Adaptation of homes (ADH)

Adaptation of homes (ADH) - Question identifier:ADH_R01

Now some questions about adaptations you may have made to your home to facilitate your daily activities and to help you stay at home (e.g., installed grab bars, handrails, access ramp or chair lift).

Adaptation of homes (ADH) - Question identifier:ADH_Q01

Have you ever made any adaptations to your home to facilitate your daily activities?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Adaptation of homes (ADH) - Question identifier:ADH_Q05

Did your home already have adaptations to facilitate your daily activities?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Adaptation of homes (ADH) - Question identifier:ADH_Q15

Which of the following adaptations does your home have?

  • 1: Grab bars
  • 2: Handrails
  • 3: Lever handles on doors or faucets
  • 4: Adapted bathing facilities (e.g., lowered or walk-in bathtub or shower)
  • 5: Access ramp
  • 6: Chair lift or lift device
  • 7: Other
  • 8: RF
  • 9: DK

Adaptation of homes (ADH) - Question identifier:ADH_Q20

Were any of these adaptations made as a result of a home care consultation?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Adaptation of homes (ADH) - Question identifier:ADH_Q25

Are there any adaptations that you think you need but do not have?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health technological use (HTU)

Health technological use (HTU) - Question identifier:HTU_R01

The next set of questions is about Internet use and digital technologies.

Health technological use (HTU) - Question identifier:HTU_Q01

In the past 12 months, did you use the Internet?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health technological use (HTU) - Question identifier:HTU_Q05

In the past 12 months, did you use the Internet to search for medical or health-related information?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health technological use (HTU) - Question identifier:HTU_Q10

In the past 12 months, have you viewed online or downloaded your health information, such as your tests or laboratory results?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health technological use (HTU) - Question identifier:HTU_R15

The next questions are about digital technologies you can use in your home to monitor your health. They include devices to measure blood pressure, blood sugar and physical activity, as well as smart phones, digital tablets or wearable devices such as a watch or a clip-on device.

Health technological use (HTU) - Question identifier:HTU_Q15

In the past 12 months, have you used any digital device to help you monitor or manage certain aspects of your health and well-being?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Health technological use (HTU) - Question identifier:HTU_Q20

Are you using this technology in partnership with a care provider, such as a nurse or doctor, who views this data to help you manage your health?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Administration information (ADM)

Administration information (ADM) - Question identifier:ADM_Q505

Statistics Canada will combine your responses from this survey with information from the Canadian Community Health Survey [, including tax data]. Statistics Canada [Statistics Canada, your provincial ministry of health and the "Institut de la Statistique du Québec"/Statistics Canada and your provincial ministry of health] may combine your responses with information from other surveys or administrative sources.

  • 1: Continue
  • 2: Respondent does not want his or her responses combined with other sources
  • 3: Other [e.g., respondent hung up, interview suspended or interrupted]

Administration information (ADM) - Question identifier:ADM_R525

To avoid duplication of surveys, Statistics Canada has signed agreements to share the data from the Canadian Health Survey on Seniors with provincial ministries of health, Health Canada and the Public Health Agency of Canada.

Provincial ministries of health may make the data available to local health authorities. With the exception of postal code, names, addresses and telephone numbers will not be provided.

Administration information (ADM) - Question identifier:ADM_R530

To avoid duplication of surveys, Statistics Canada has signed agreements to share the data from the Canadian Health Survey on Seniors with provincial ministries of health, the "Institut de la Statistique du Québec", Health Canada and the Public Health Agency of Canada.

The "Institut de la Statistique du Québec" and provincial ministries of health may make this data available to local health authorities. With the exception of postal code, names, addresses and telephone numbers will not be provided.

Administration information (ADM) - Question identifier:ADM_Q535

These organizations have agreed to keep the data confidential and use it only for statistical purposes.

Do you agree to share the data provided?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Administration information (ADM) - Question identifier:ADM_N540

Was this interview conducted on the telephone or in person?

  • 1: On telephone
  • 2: In person
  • 3: Both

Administration information (ADM) - Question identifier:ADM_N545

Was the respondent alone when you asked the health component of this questionnaire?

  • 1: Yes
  • 2: No
  • 9: DK

Administration information (ADM) - Question identifier:ADM_N550

Do you think that the answers of the respondent were affected by someone else being there?

  • 1: Yes
  • 2: No
  • 9: DK

Administration information (ADM) - Question identifier:ADM_N555

Record language of interview.

  • 01: English
  • 02: French
  • 03: Chinese
  • 04: Italian
  • 05: Punjabi
  • 06: Spanish
  • 07: Portuguese
  • 08: Polish
  • 09: German
  • 10: Vietnamese
  • 11: Arabic
  • 12: Tagalog (Filipino)
  • 13: Greek
  • 14: Tamil
  • 15: Cree
  • 16: Afghan (Dari, Pashto)
  • 17: Cantonese
  • 18: Hindi
  • 19: Mandarin
  • 20: Persian (Farsi, Dari, Tajiki)
  • 21: Russian
  • 22: Ukrainian
  • 23: Urdu
  • 24: Inuktitut
  • 90: Other - Specify
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