Short Initial Assessment
(Refusers Questionnaire)

  
 


 

Short Initial Assessment:
General Information

When?

Time 1

Time 2

Time 3

Time 4

Time 5

Time 6

Time 7

Where?

Intake Assessment
(EE)
Intake Assessment
(EE)
Intake Assessment
(EE)
Intake Assessment
(EE)
-
-
-

Questionnaire

EE:
Short Initial Assessment
EE:
Short Initial Assessment
EE:
Short Initial Assessment
EE:
Short Initial Assessment
-
-
-

SIR Data bank

EE:
ZPK
rec / table 9 (Z1KURZ)
EE:
ZPK
rec / table 109 (Z2KURZ)
EE:
ZPK
rec / table 209 (Z3KURZ)
EE:
ZPK
rec / table 309 (Z4KURZ)
-
-
-
 

At the first contact, apart from motivating the target person to take part in the Intensive Protocol, the interviewers always attempted to carry out an Intake Assessment. If the potential participant had any doubts or uncertainties with respect to his / her suitability for the study or the questions to be answered, or seemed inclined to refuse to take part, the interviewer suggested beginning with the so-called Short Initial Assessment. The participant could thus gain a first impression of the type of questions asked in the study, and see whether full participation would be too tiring or taxing.

Similar to the complete Intake assessment, the Short Initial Assessment consists of items from all four research units. For the most part, it corresponds to the first 16 questions of the Intake Assessment (20 at Time 2, 22 at Time 3).

If the target person refused to answer the Short Initial Assessment, the Refusers Questionnaire was sent by post 3 or 4 weeks after the first contact, and the recipient was asked to answer the questions in writing if at all possible. Those who had absolutely refused to allow any further contact and those for whom further contact was unacceptable due to health reasons were excluded from this procedure. The Short Initial Assessment made it possible to collect at least basic information on the target person on the one hand, and to perhaps encourage a more intensive contact on the other hand. (At the end of the Short Initial Assessment the participant was asked whether he / she would agree to further contact at a later date.)

At Time 5, Time 6, and Time 7 neither the Short Initial Assessment nor the Refusers Questionaire were applied.

 


 

Short Initial Assessment:
Instruments / Items used in BASE

Note:
According to the design, variable names for Time 1 have the prefix z1, names for Time 2 have the prefix z2,
names for Time 3 have the prefix z3, and names for Time 4 have the prefix z4.


BASE items / variables

English translation

Variable names
Time 1

Variable names
Time 2

Variable names
Time 3

Variable names
Time 4

1.

Geburtsdatum laut St / vage

Date of birth according to participant / vague

z1e1x1d / m / y / z1e1
+
+
+

2.

Formaler Familienstand

Formal marital status

z1e3
+
+
+

3.

Datum verwitwet / geschieden / vage

Date widowed / divorced / vague

z1e4x1m / y / z1e4
+
+
+

4.

Anzahl Kinder

Number of children

z1e5
+
+
+

5.

Allein lebend

Lives alone

z1e6
+
+
+

6.

Zusammenlebend mit Partner / Sohn / Tochter / Sonst. Familienangehör. / Freunde / Sonstige

Lives with partner / son / daughter / other member of the family / friends / other

z1e7x1 / 2 / 3 / 4 / 5 / 6

+
+
+

7.

Anzahl sonstiger Mitbewohner

Number of other cohabitants

z1e7sons
-
-
-

8.

Seniorenwohnhaus oder Heim

Old people's housing unit / home

z1e8
+
+
+

9.

Datum Einzug Wohnung / Heim / vage

Date moved into flat / home / vague

z1e9x1m / y / z1e9
+
+
+

10.

Schulabschluß / Lehre

School certificate / appren-ticeship

z1e10 / 11
-
-
-

11.

Lebenszufrieden-heit / Scale-Type

Life satisfaction / Scale type

z1e12 / x2
+
+
+

12.

Körperliche Gesundheit / Scale-Type

Somatic health / Scale type

z1e13 / x2
+
+
+

13.

Seelische und geistige Gesundheit / Scale-Type

Mental health / Scale type

z1e14 / x2
+
+
+

14.

Gedächtnis / Scale-Type

Memory / Scale type

-
z2e12nx1 / 2
+
+

15.

Das Schönste im Leben 1 / 2

The best thing in life 1 / 2

-
-
z3e13x1 / 2
+

16.

Veränderung Zufriedenheit letzte 12 Monate / Scale-Type

Change in satisfaction over the last 12 months / Scale type

-
z2e12lx1 / 2
+
+

17.

Veränderung körperliche Gesundheit letzte 12 Monate / Scale-Type

Change in somatic health over the last 12 months / Scale type

-
z2e13lx1 / 2
+
+

18.

Veränderung seelische Gesundheit letzte 12 Monate / Scale-Type

Change in psychological health over the last 12 months / Scale type

-
z2e14lx1 / 2
+
+

19.

Veränderung Gedächtnis letzte 12 Monate / Scale-Type

Change in memory over the last 12 months / Scale type

-
z2e12nl1 / 2
+
+

20.

ADL: Hilfe beim Aufstehen / Ankleiden / zur Toilette / beim Baden / bei Nahrungs-aufnahme

ADL: Help with getting up / getting dressed / using toilet / bathing / eating

-
-
z3e18x1 / 2 / 3 / 4 / 5
+

21.

Anzahl der Aktivitäten in den letzten 12 Monaten verändert? / Scale-Type

Change in number of activities over the last 12 months? / Scale type

-
-
z3e19x1 / 2
+

22.

Besondere Ereignisse in den letzten 12 Monaten?

Particular events over the last 12 months?

-
z2e108n
+
+

23.

Ereignis1 / 2 / 3 / 4 / 5

Event 1 / 2 / 3 / 4 / 5

-
z2e110n1 / 2 / 3 / 4 / 5
+
+

24.

Ereignis1 / 2 / 3 / 4 / 5 erwartet oder unerwartet

Event 1 / 2 / 3 / 4 / 5 expected or unexpected

-
-
z3e22x1 / 2 / 3 / 4 / 5
+

25.

Weitere Kontaktaufnahme?

Further contact?

z1e16
-
z3e23
z4e23
  

 
 

Refusers Questionnaire:
Instruments / Items used in BASE

Note:
According to the design, variable names for Time 1 have the prefix z1, names for Time 2 have the prefix z2,
names for Time 3 have the prefix z3, and names for Time 4 have the prefix z4.


BASE items / variables
English translation
Variable names
Time 1
Variable names
Time 2
Variable names
Time 3
Variable names
Time 4

1.

Verweigerer-Kurzfragebogen

Refusers Questionnaire

z1everw
+
+
+

2.

Fta-ID

Interviewer ID

z1efta
+
+
+

3.

Geschlecht St

Sex of participant

-
z2esex
-
-

4.

Datum des 1. Interviews

Date of 1st interview

z1e1day / mo / yr
+
+
+

5.

Beginn / Ende / Dauer des 1. Interviews

Start / end / length of 1st interview

z1e1on / off / time
+
+
+

6.

Art der Befragung: 1. Interview

Type of assessment: 1st interview

z1e1way
+
+
+

7.

Datum des 2. Interviews

Date of 2nd interview

-
-
z3e2day / mo / yr
+

8.

Beginn / Ende / Dauer des 2. Interviews

Start / end / length of 2nd interview

-
-
z3e2on / off / time
+

9.

Art der Befragung: 2. Interview

Type of assessment: 2nd interview

-
-
z3e1way
+

10.

Datum des 3. Interviews

Date of 3rd interview

-
-
z3e3day / mo / yr
+

11.

Beginn / Ende / Dauer des 3. Interviews

Start / end / length of 3rd interview

-
-
z3e3on / off / time
+

12.

Art der Befragung: 3. Interview

Type of assessment: 3rd interview

-
-
z3e3way
+

13.

Gesamtzeit der Sitzungen

Total length of sessions

-
-
z3etotal
+

14.

MMSE: Butter / Uhr / Nagel (T3: Auto / Blume / Kerze

MMSE: butter / clock / nail (T3: car / flower / candle)

-
z2e56x1 / 2 / 3
+
+

15.

MMSE: Heutiges Datum / Wochentag

MMSE: date / day of the week

-
z2e57 / 58 / 59 / 60
+
+

16.

MMSE: 1. / 2. / 3. / 4. / 5. Subtraktion

MMSE: 1. / 2. / 3. / 4. / 5. Subtraction

-
z2e61x1 / 2 / 3 / 4 / 5
+
+

17.

MMSE:Vogel rückwärts buchstabieren

MMSE: spell "Vogel" ["bird"] backwards

-
z2e62x1 / 2 / 3 / 4 / 5
+
+

18.

MMSE: Butter / Uhr / Nagel (T3: Auto / Blume / Kerze (Wiederholung)

MMSE: butter / clock / nail (T3: car / flower / candle) (repetition)

-
z2e63x1 / 2 / 3
+
+

19.

Verweigerer: Eingang Kurzbefragung Datum

Refusers: Date Refusers Questionnaire received

z1evday / mo / yr
-
-
-