CATKA*

[^Have/Has] [^you/[^name]] received help from anyone with walking 100 yards, in the last month?

INTERVIEWER: Include help even if it was for a short time or provided by husband/ wife/ another family

member.

01 Yes

02 No

CATKB*

What about climbing several flights of stairs without resting?

EXPLAIN IF NECESSARY: Include help even if it was for a short time or provided by husband/ wife/

another family member.

ASK IF NECESSARY: [^Have/Has] [^you/[^name]] received help from anyone with climbing several

flights of stairs without resting, in the last month?

01 Yes

02 No

CATKC*

What about climbing one flight of stairs without resting?

EXPLAIN IF NECESSARY: Include help even if it was for a short time or provided by husband/ wife/

another family member.

ASK IF NECESSARY: [^Have/Has] [^you/[^name]] received help from anyone with climbing one flight of

stairs without resting, in the last month?

01 Yes

02 No

CATKD*

What about dressing, including putting on shoes and socks?

EXPLAIN IF NECESSARY: Include help even if it was for a short time or provided by husband/ wife/

another family member.

ASK IF NECESSARY: [^Have/Has] [^you/[^name]] received help from anyone with dressing, including

putting on shoes and socks, in the last month?

01 Yes

02 No

CATKE*

What about walking across a room?

EXPLAIN IF NECESSARY: Include help even if it was for a short time or provided by husband/ wife/

another family member.

ASK IF NECESSARY: [^Have/Has] [^you/[^name]] received help from anyone with walking across a

room, in the last month?

01 Yes

02 No

CATKF*

What about bathing or showering?

EXPLAIN IF NECESSARY: Include help even if it was for a short time or provided by husband/ wife/

another family member.

ASK IF NECESSARY: [^Have/Has] [^you/[^name]] received help from anyone with bathing or showering,

in the last month?

01 Yes

02 No