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Questionnaire: Case-finding: My Home, My Choice

Are you 85 years old or older?
Male?
In general, do you have any health problems that require you to limit your activities?
Do you need someone to help you on a regular basis?
In general, do you have any health problems that require you to stay at home?
In case of need, can you count on someone close to you?
Do you regularly use a cane, a walker or a wheelchair to move about?
Only people meeting certain criteria will be contacted by the tracking team to obtain a more precise picture of their needs. By submitting this questionnaire online, you consent to a telephone follow-up.