Baseline Questionnaire - GeroNet

During the past 4 weeks, have you had any of the followingproblems with your work or other regular daily activities asa result of your physical health?11. During the past 4 weeks, have you cut down the amountof time you spent on work or other activities as aresult of your physical health?___ Yes___ No12. During the past 4 weeks, have you accomplished lessthan you would like as a result of your physicalhealth?___ Yes___ No13. During the past 4 weeks, were you limited in the kindof work or other activities as a result of yourphysical health?___ Yes___ No14. During the past 4 weeks, did you have difficultyperforming your work or other activities (for example,it took extra effort) as a result of your physicalhealth?___ Yes___ NoDuring the past 4 weeks, have you had any of the followingproblems with your work or other regular daily activities asa result of any emotional problems (such as feelingdepressed or anxious)?15. During the past 4 weeks, have you cut down the amountof time you spent on work or other activities as aresult of emotional problems?___ Yes___ No16. During the past 4 weeks, have you accomplished lessthan you would like as a result of emotional problems?___ Yes___ No