关于活力老人群体日常生活与需求的调查

问卷说明

本研究已通过西交利物浦大学研究伦理委员会审查批准。本次调查采用完全匿名方式开展，所有数据仅用于学术研究，严格保密，不会向任何第三方泄露您的个人信息。您参与本调查完全自愿，可在任何阶段无条件退出，无需说明理由，且不会因此受到任何不利影响。继续填写本问卷即表示您已阅读并同意以上内容。

Participant Information

This study has been approved by the Research Ethics Committee of Xi’an Jiaotong-Liverpool University. All responses will be collected anonymously and used for academic research purposes only. Your personal information will be kept strictly confidential and will not be disclosed to any third party. Participation is entirely voluntary, and you may withdraw at any time without giving a reason and without any negative consequences. By continuing to complete this questionnaire, you confirm that you have read and agree to the above.
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1. 您的年龄属于以下哪一组?Which age group do you belong to?
55–59岁/55–59 years old
60–64岁/60–64 years old
65–69岁/65–69 years old
70–74岁/70–74 years old
75岁及以上/75 years old and above
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2. 您目前的居住情况是?/What is your current living arrangement?
独居/Living alone
与配偶同住/Living with spouse
与子女同住/Living with children
与其他家人或亲友同住/Living with other family members, relatives or friends
其他/Other
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3. 您平时外出、买东西、散步或参加活动时，一般情况如何?/How would you describe your general ability to go out, shop, take walks, or participate in activities in daily life?
完全可以自己完成/Fully independent
大部分可以自己完成，偶尔需要帮助/Mostly independent with occasional assistance
经常需要别人帮助/Frequently require assistance from others
基本不能独立完成/Largely unable to perform independently
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4. 您目前是否有长期需要关注的身体健康问题?/Do you have any chronic health conditions that require long-term management?
没有/No
有，但对日常生活影响不大/Yes, but with minimal impact on daily life
有，并且对日常生活有一定影响/Yes, with moderate impact on daily life
有，并且对日常生活影响较大/Yes, with significant impact on daily life
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5. 您平时会不会有一些记忆上的小困难?例如忘记事情、忘记带东西、忘记吃药或错过安排等。/Do you experience mild memory difficulties in daily life, such as forgetting things, forgetting to bring items, forgetting to take medication, or missing appointments?
几乎没有/ Rarely
偶尔会/Occasionally
经常会/Frequently
需要家人或他人提醒较多/Rely heavily on reminders from family members or others
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6. 在日常生活中，您是否需要别人提供帮助?/Do you require assistance from others in activities of daily living?
基本不需要/Generally not required
偶尔需要/Occasionally required
经常需要/Frequently required
非常依赖他人帮助/Highly dependent on assistance from others
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7. 如果您需要帮助，通常是谁帮助您?/If you require assistance, who typically provides it to you? (Multiple choices allowed)【多选题】
配偶/Spouse
子女/Children
其他家人/Other family members
邻居或朋友/Neighbors or friends
看护者/保姆/护理人员/Caregivers/nannies/care workers
社区工作人员/Community staff
基本没有固定帮助的人/No fixed helper
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8. 您平时一天里最常做哪些事情?/What are your most common daily activities? (Multiple choices allowed)【多选题】
做饭/打扫/Cooking/house cleaning
买菜/购物/Grocery shopping/go shoppings
看电视/休息/Watching television/resting
散步/去公园/ Walking/visiting parks
锻炼/活动身体/Exercising/physical activity
照顾孙辈/家庭事务/Caring for grandchildren/household affairs
使用手机/电脑/Using mobile phones/computers
与朋友聊天或参加活动/Chatting with friends or participating in social activities
其他/Other
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9. 在这些日常活动中，您最常遇到哪些问题?/What difficulties do you most frequently encounter in these daily activities? (Multiple choices allowed)【多选题】
行动不方便/ Limited mobility
容易忘事或漏事/Frequent forgetfulness or oversight
看病/买药不方便/Inconvenience in accessing medical care/purchasing medication
没有人陪伴或社交少/Lack of companionship or limited social interaction
家务或购物不方便/Inconvenience in housework or shopping
不太会使用手机或智能设备/ Difficulty using mobile phones or smart devices
睡眠不好/Poor sleep quality
缺少适合自己的活动/ Lack of suitable activities
其他/Other
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10. 如果未来有相关产品或服务，您最希望它帮助您解决哪一类问题?/If relevant products or services become available in the future, which type of support would you most prefer them to provide?【多选题】
健康提醒/Health reminders
安全监测/紧急帮助/Safety monitoring/emergency assistance
记忆提醒/Memory reminders
购物/出行帮助/Shopping/mobility assistance
家务支持/Household support
社交陪伴/Social companionship
文娱活动推荐/Recommendations for recreational activities
手机/技术使用帮助/Assistance with mobile phone/technology usage
暂时不确定/Uncertain for the time being
问卷星提供技术支持
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