Aging in Hingham - Town of Hingham Massachusetts

12. Do you require help with household activities? For example: doing routinehousehold chores like cleaning or yard work.Yes No13. Do you require help with daily activities? For example: using the telephone orpreparing your meals, food shopping, taking medication, or keeping track of bills.Yes No14. Do you require help with personal activities? For example: using the toilet, taking abath or shower, or getting dressed.Yes No15. Referring to any of the activities in questions 12 - 14 for which you answered“Yes”: Who helps you with these activities? (Check all that apply)N/A, I don't require any helpI pay someone to help meA friend or neighbor helps meA family member helps meSomeone else helps me (please specify):_________________________I need help but have no one to assist me16. Over the last month, how often did you feel sad, depressed, or “down in thedumps?” (Check one)NeverRarelySometimesOftenAlways17. How many times did you visit a medical doctor or other health care professional forany reason, in the last 12 months?0 times1 – 2 times3 –4 times5 or more times58