This is a short survey that is conducted on behalf of the European Research Project titled Silver
Economy, aiming at researching needs and interests for seniors at the age 55 and above. We are
asking some questions here in order to determine some needs in the area of mobility and social as
well as psychological needs of elderly. We will appreciate your answers to our questions.
1.
Yes
No
Do you use any equipment to improve your mobility?
2.
If yes, what kind of equipment do you use? Please mark all relevant answers
Motorbike
Scooter
Electrical Bike
Car
Electric wheelchair for indoor mobility
Electric wheelchair for outdoor mobility
Lift
Other equipment: ………………………………………………………….
3.
What kind of equipment would you like to use? Please mark all relevant answers
Motorbike
Scooter
Electrical Bike
Car
Electric wheelchair for indoor mobility
Electric wheelchair for outdoor mobility
Lift
I do not need one
Other equipment: ………………………………………………………….
4.
Why so far you hadn’t use the electric mobility equipment? Please mark all relevant answers
There is not enough information about such equipment
I don’t know if there exists anything possibly useful for me
I don’t know where to buy it
It is to expensive
My town is not prepared for using these vehicles (no charging points, ramps, narrow sidewalks, etc.)
Any other responses: …………………………………………………………………………
5.
Are you in general interested in health improvement?
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
6.
How do you define your physical condition?
Very good
Good
Neither good nor bad
Poor
Very poor
7.
What do you do for your health improvement? Please mark all relevant answers
Regular physical sport activities (swimming, yoga, Nordic walking etc)
Regular walks (walking a dog, walking with friends)
Regular home activities (shopping, cleaning, cooking etc)
Healthy diet
Regular medical checks
Any other responses: …………………………………………………………………………
8.
What health services would you like to use? Please mark all relevant answers
Free regular health checks
Structured and guided sport activities
Health lectures/seminars of health of elderly people
Health tourism (travels to spas, journeys to countryside for enjoying nature etc.)
I don’t want to use any of these health services
Any other responses: …………………………………………………………………………
9.
Does municipality in which you live offer any activities? Please mark all relevant answers
Yes
No
I do not know
10. Does municipality in which you live offer any activities for seniors?
Yes
No
I do not know
11. If yes- what kind of activities are offered? Please mark all relevant answers
Activities
Walks
Cultural activities (movie/theatre/opera/concerts)
Social meetings
Games (chess, bulee)
Cooking
Artistic activities (knitting, embroidery, sewing)
Other ………………………………………………………………..
12.
Do you need assistance in everyday life?
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
13. If yes: what kind of assistance would you need? Please mark all relevant answers
Cleaning the home
Cooking
Shopping
Walking a dog
Transportation
Daily hygiene
Medication
Walking
Using public transportation
Help in dealing with administrative issues/institutions
Fixing broken things (plumbing, electricity)
Help with daily hygiene
Help with direct health issues: fi injections
Installing and starting new home equipment (washing machines, tv sets, etc)
Other: …………………………………………………………………………
14. Do you use the Internet
Yes I can use internet on my own
Yes I use internet with help of others (friends, spouses)
No I do not use internet at all
Other: …………………………………………………………………………
15. How often (on the average) are you visited by friends, family etc?
Once in a week
Twice and more in a week
Once in a month
Other: …………………………………………………………………………
16. What do you enjoy doing in free time? Please mark three most important answers
Meeting friends or relatives (children, grandchildren etc.)
Traveling
Exercising
Reading
Cooking or baking
Housekeeping
Gardening
Doing handwork (like knitting, sewing , woodworks etc.)
Watching television
Going movies/theater/opera/museums/concerts
Shopping
Any other responses:……………………………………………………………..
17. Does your society treat seniors well?
Definitely yes
Rather yes
Neither yes nor not
Rather no
Definitely no
18. In my society seniors are: (Please mark all relevant answers)
Respected
Admired
Treated as good customers
Reach
Independent
Happy
Smiling
Beautiful
Active
Sociable
Healthy
Important
Disrespected
Pity
Excluded as customers
Poor
Dependent
Unhappy
Sad
Ugly
Passive
Lonely
Sick
Not important
19. Main activities of seniors are: (Please mark all relevant answers)
Focusing on their fulfillment
Taking care of their medical needs
Developing their interests
Leisure
Help in rearing grandchildren
Help to their children
Activity in charity organizations
Work on behalf of children and youth
Excercising
Other: …………………………………………………………………………
20. Which picture, in your opinion, represents seniors' status in your society in the best way? Choose one
picture. ( annex 1)
A
B
C
D
Personal data:
21. Your gender:
………………………………………………………….………………………………………………….………………………………
22. Age:
………………………………………………………….………………………………………………….………………………………
23. Population in your city/village …………………………………………………………………………………………………………………………………
24. Income per month ( in local currency) …………………………………….………………………………
25. Do you live own place or institution/residential care facilities? …………………………………….………………………………
26. If in facility- please give us a name: …………………………………………………………………….……………………………………………………
27. Do you life with a family member? ………………………………………………………………….…………………………………………………..
28. Do you have children? ………………………………………………………….………………………………………………….………………………………