Health care motion sensor spectacles

Age category:

Gender:

Male

Female

How would you evaluate your overall health. Would you say you are:

In good physical health. (No significant illnesses or disabilities. Only routine medical care such as annual checkups required.)

Mildly physically impaired. (You have only minor illnesses and/or disabilities which might benefit from medical treatment or corrective measures.)

Moderately physically impaired. (You have one or more diseases or disabilities which are either painful or which require substantial medical treatment.)

Severely physically impaired. (You have one or more illnesses or disabilities which are either severely painful or life threatening, or which require extensive medical treatment.)

Totally physically impaired. (Confined to bed and requiring full-time medical assistance or nursing care to maintain vital bodily functions.)

What about the amount of social support you receive from your family, friends, and the like. When you have the need to talk to someone or go on outings with friends and/or relatives, do you feel there is someone who fulfills these needs?

High degree of social support. (Much support is either given or is available, if needed, from family and friends.)

Above average degree of social support. (Given or potentially available from family and friends.)

Average degree of social support from family and friends is given or potentially available.

Below average degree of social support. (While some support is available from friends, there is no family member to help)

No support or potential support is available from either family or friends.

Other

Can you get to places out of walking distances:

Without help

With some help

Completely unable to travel unless special arrangements are made

Other

Can you speak?

Yes

Can you do your own housework:

Without help

With some help

Completely unable to do any housework

Other

Can you go shopping for groceries:

Without help

With some help

Completely unable to do any shopping

Other

Can you prepare your own meals?

Without help

With some help

Completely unable to prepare any meals

Other

Do you take care of your own appearance, things like comging your hair (for men shaving) etc?

Without help

With some help

Someone does all these types of things for you

Other