听 | No difficulty | Some difficulty | A lot of difficulty | Cannot do it at all | |
---|---|---|---|---|---|
a | Do you have difficulty seeing, even if wearing glasses? | 1 | 2 | 3 | 4 |
b | Do you have difficulty hearing, even if using a hearing aid? | 1 | 2 | 3 | 4 |
c | Do you have difficulty walking or climbing steps? | 1 | 2 | 3 | 4 |
d | Do you have difficulty remembering or concentrating? | 1 | 2 | 3 | 4 |
e | Do you have difficulty (with self-care such as) washing all over or dressing? | 1 | 2 | 3 | 4 |
f | Using your usual (customary) language, do you have difficulty communicating, (for example understanding or being understood by others)? | 1 | 2 | 3 | 4 |