N.B.: The person has had (or is expected to have) the complaint(s) for at least 6 months.

Enter one of the following codes in each cell:

[] Tick this box if A to G = 1, 5, 7 or 9, and proceed to P22.

A. Seeing (even when using glasses)

[] 1 No difficulty / problems
[] 2 Some difficulty
[] 3 Much difficulty
[] 4 Not able to do this at all
[] 5 Doesn't apply, considering age
[] 7 Don't know
[] 9 No response

B. Hearing (even when using a hearing aid)

[] 1 No difficulty / problems
[] 2 Some difficulty
[] 3 Much difficulty
[] 4 Not able to do this at all
[] 5 Doesn't apply, considering age
[] 7 Don't know
[] 9 No response

C. Walking or going up and down stairs

[] 1 No difficulty / problems
[] 2 Some difficulty
[] 3 Much difficulty
[] 4 Not able to do this at all
[] 5 Doesn't apply, considering age
[] 7 Don't know
[] 9 No response

D. Remembering and concentrating

[] 1 No difficulty / problems
[] 2 Some difficulty
[] 3 Much difficulty
[] 4 Not able to do this at all
[] 5 Doesn't apply, considering age
[] 7 Don't know
[] 9 No response

E. Personal care

[] 1 No difficulty / problems
[] 2 Some difficulty
[] 3 Much difficulty
[] 4 Not able to do this at all
[] 5 Doesn't apply, considering age
[] 7 Don't know
[] 9 No response

F. Lifting / reaching / carrying

[] 1 No difficulty / problems
[] 2 Some difficulty
[] 3 Much difficulty
[] 4 Not able to do this at all
[] 5 Doesn't apply, considering age
[] 7 Don't know
[] 9 No response

G. Communicating / talking

[] 1 No difficulty / problems
[] 2 Some difficulty
[] 3 Much difficulty
[] 4 Not able to do this at all
[] 5 Doesn't apply, considering age
[] 7 Don't know
[] 9 No response