From: Vitor Quality of Life Scale for the Elderly: evidence of validity and reliability
How satisfied are you with… | Very dissatisfied | Dissatisfied | Neither satisfied nor dissatisfied | Satisfied | Very satisfied | |
---|---|---|---|---|---|---|
1 | Your health? | 1 | 2 | 3 | 4 | 5 |
2* | The attention you pay to your own health? | 1 | 2 | 3 | 4 | 5 |
3 | Pain intensity? | 1 | 2 | 3 | 4 | 5 |
4 | Pain intensity when performing activities of daily living? | 1 | 2 | 3 | 4 | 5 |
5 | Amount of medicine you take? | 1 | 2 | 3 | 4 | 5 |
6 | The effects of the medicine you take? | 1 | 2 | 3 | 4 | 5 |
7* | You memory? | 1 | 2 | 3 | 4 | 5 |
8 | Your ability to take care of yourself? | 1 | 2 | 3 | 4 | 5 |
9* | Your ability to control your own life? | 1 | 2 | 3 | 4 | 5 |
10 | The possibility to live many years? | 1 | 2 | 3 | 4 | 5 |
11* | The health of your family? | 1 | 2 | 3 | 4 | 5 |
12 | Your children? | 1 | 2 | 3 | 4 | 5 |
13 | Your family happiness? | 1 | 2 | 3 | 4 | 5 |
14 | Your sex life? | 1 | 2 | 3 | 4 | 5 |
15 | Your husband/wife, boyfriend/girlfriend, companion? | 1 | 2 | 3 | 4 | 5 |
16 | Your friends? | 1 | 2 | 3 | 4 | 5 |
17* | The emotional support you receive from your family? | 1 | 2 | 3 | 4 | 5 |
18 | The emotional support you receive from others who are not family members? | 1 | 2 | 3 | 4 | 5 |
19* | Your ability to be responsible for the family? | 1 | 2 | 3 | 4 | 5 |
20* | How helpful are you? | 1 | 2 | 3 | 4 | 5 |
21 | Your mount of concerns? | 1 | 2 | 3 | 4 | 5 |
22 | The neighborhood? | 1 | 2 | 3 | 4 | 5 |
23 | Your house or apartment? | 1 | 2 | 3 | 4 | 5 |
24 | Your neighborhood? | 1 | 2 | 3 | 4 | 5 |
25* | Your work (If you have any job with or without remuneration)? | 1 | 2 | 3 | 4 | 5 |
26* | The fact that you do not have a job (due to retirement, unemployment or disability)? | 1 | 2 | 3 | 4 | 5 |
27* | Years of education you completed? | 1 | 2 | 3 | 4 | 5 |
28* | The way you manage your own money? | 1 | 2 | 3 | 4 | 5 |
29 | Your leisure and fun activities? | 1 | 2 | 3 | 4 | 5 |
30* | Your possibility to have a happy future? | 1 | 2 | 3 | 4 | 5 |
31 | Your peace of mind and tranquility? | 1 | 2 | 3 | 4 | 5 |
32* | Your faith in God? | 1 | 2 | 3 | 4 | 5 |
33 | Your achievement of personal goals? | 1 | 2 | 3 | 4 | 5 |
34 | Your happiness? | 1 | 2 | 3 | 4 | 5 |
35 | Your general life? | 1 | 2 | 3 | 4 | 5 |
36 | Your personal appearance? | 1 | 2 | 3 | 4 | 5 |
37 | Yourself? | 1 | 2 | 3 | 4 | 5 |
38 | Your activities of daily living? | 1 | 2 | 3 | 4 | 5 |
39* | Your ability to make your own choices? | 1 | 2 | 3 | 4 | 5 |
40 | Safety at home (house or apartment)? | 1 | 2 | 3 | 4 | 5 |
41 | Safety in your neighborhood? | 1 | 2 | 3 | 4 | 5 |
42 | The type of life you are having? | 1 | 2 | 3 | 4 | 5 |
43 | Your ability to move your arms and your legs? | 1 | 2 | 3 | 4 | 5 |
44 | Your ability to walk back and forth? | 1 | 2 | 3 | 4 | 5 |
45 | Your ability to take walks? | 1 | 2 | 3 | 4 | 5 |
46 | Your ability to stand up? | 1 | 2 | 3 | 4 | 5 |
47 | Your ability to get in and out of cars or buses? | 1 | 2 | 3 | 4 | 5 |
48 | How is your family? | 1 | 2 | 3 | 4 | 5 |
49 | The departure of your children from home? | 1 | 2 | 3 | 4 | 5 |
50 | The professional choice of your children? | 1 | 2 | 3 | 4 | 5 |
51* | Your religion? | 1 | 2 | 3 | 4 | 5 |
52* | Your life experiences? | 1 | 2 | 3 | 4 | 5 |
53* | Your current life? | 1 | 2 | 3 | 4 | 5 |
54* | The amount of income received? | 1 | 2 | 3 | 4 | 5 |
55 | Safety in public roads? | 1 | 2 | 3 | 4 | 5 |
56* | Your ability to make decisions? | 1 | 2 | 3 | 4 | 5 |
57* | The health care received? | 1 | 2 | 3 | 4 | 5 |
58* | Appreciation expressed by family members? | 1 | 2 | 3 | 4 | 5 |
59 | Appreciation expressed by other people? | 1 | 2 | 3 | 4 | 5 |
60* | Life opportunities? | 1 | 2 | 3 | 4 | 5 |
61 | Attention given by people? | 1 | 2 | 3 | 4 | 5 |
62 | Public road conditions? | 1 | 2 | 3 | 4 | 5 |
63 | Availability of elevators, ramps and handrails in buildings or other places? | 1 | 2 | 3 | 4 | 5 |
64 | City buses? | 1 | 2 | 3 | 4 | 5 |
65 | Safety and comfort in city buses? | 1 | 2 | 3 | 4 | 5 |
66 | Public assistance received? | 1 | 2 | 3 | 4 | 5 |
67 | Reserved lines in banks, supermarkets and other places? | 1 | 2 | 3 | 4 | 5 |
68 | The number of reserved lines in banks, supermarkets and other places? | 1 | 2 | 3 | 4 | 5 |
69 | Reserved parking spaces in banks, supermarkets and other places? | 1 | 2 | 3 | 4 | 5 |
70 | Number of reserved parking spaces in banks, supermarkets and other places? | 1 | 2 | 3 | 4 | 5 |