LEIPAD Questionnaire

1. How would you rate your overall physical health?
0Excellent‚ 1Good‚ 2Not so good‚ 3Bad
2. Are you able to get up and down the stairs without help?
0 Without difficulty‚ 1 With difficulty‚ 2 Only with help‚ 3 Not able at all
3. Are you able to dress all by yourself?
0 Without difficulty‚ 1 With difficulty‚ 2 Only with help‚ 3 Not able at all
4. Are you able to eat by yourself?
0 Without difficulty‚ 1 With difficulty‚ 2 Only with help‚ 3 Not able at all
5. Are you able to bathe or take a shower by yourself? 
0 Without difficulty‚ 1 With difficulty‚ 2 Only with help‚ 3 Not able at all
6. Do you have sleep problems?
0 No‚ not at all‚ 1 Yes‚ minor‚ 2 Yes‚ moderate‚ 3 Yes‚ very severe
7. Do you feel tired‚ without energy?
0 Never‚ 1 Occasionally‚ 2 Rather often‚ 3 Very often
8. Do you have difficulties concentrating?
0 Never‚ 1 Occasionally‚ 2 Rather often‚ 3 Very often
9. Are you able to accomplish your usual tasks either at home‚ at work‚ or elsewhere?
0 Yes‚ fully‚ 1 For the greater part‚ 2 Only some‚ 3 No‚ none
10. Can you shop all by yourself?
0 Without difficulty‚ 1 Alone‚ with difficulty‚ 2 Only with help‚ 3 Not able at all
11. Can you travel by public transportation?
0 Without difficulty‚ 1 Alone‚ with difficulty‚ 2 Only with help‚ 3 Not able at all
12. How much do your physical health problems (if any) stand in the way of doing the things you want to do?
0 Not at all‚ 1 Somewhat‚ 2 Rather much‚ 3 Much
13. How often‚ would you say‚ does it happen that you are not able to think clearly or that you are confused?
0 Very rarely‚ 1 Rarely‚ 2Often‚ 3 Very often
14. How much do your problems with thinking (if any) stand in the way of doing the things you want to do?
0 Not at all‚ 1 Somewhat‚ 2 Rather much‚ 3 Much
15. How good is your memory?
0Excellent‚ 1Good‚ 2Poor‚ 3Bad
16. How much do your memory problems (if any) stand in the way of doing the things you want to do?
0 Not at all‚ 1 Somewhat‚ 2 Rather much‚ 3 Much
17. Taking everything in consideration‚ how anxious do you feel?
0 Not anxious at all‚ 1 Somewhat anxious‚ 2 Anxious‚ 3 Very anxious
18. How much do your feelings of anxiety (if any) stand in the way of doing the things you want to do?
0 Not at all‚ 1 Somewhat‚ 2 Rather much‚ 3 Much
19. Taking everything in consideration‚ how depressed (blue) do you feel at present?
0 Not depressed at all‚ 1 Somewhat depressed‚ 2 Depressed‚ 3 Very depressed
20. How much do your depressed feelings (if any) stand in the way of doing the things you want to do?
0 Not at all‚ 1 Somewhat ‚2 Rather much ‚3 Much
21. How satisfied are you with your social ties or relationships?
0 Very satisfied‚ 1 Satisfied‚ 2 Dissatisfied‚ 3 Very dissatisfied
22. Do you feel emotionally satisfied in your relationships with other people?
0 Not at all‚ 1 A little‚ 2 Quite a bit‚ 3 Very much
23. Is there someone to talk to about personal affairs when you want to?
0 Nearly always ‚1 Fairly often ‚2 Occasionally ‚3 Not at all
24. Are you interested in sex?
0 Not at all‚ 1 A little‚ 2 Quite a bit‚ 3 Very much
25. How often do you have sexual contact?
0 Never‚ 1 Occasionally‚ 2 Rather often‚ 3 Very often
26. How satisfied are you with your ability to manage your hobbies or recreational activities?
0 Very satisfied‚ 1 Satisfied‚ 2 Dissatisfied‚ 3 Very dissatisfied
27. How satisfied are you with your financial situation?
0 Very satisfied‚ 1 Satisfied‚ 2 Dissatisfied‚ 3 Very dissatisfied
28. Do you feel you cannot afford the standard of living you would like?
28. Do you feel that you cannot afford the standard of living you would need?
0 Not at all ‚1 A little ‚2 Much ‚3 Very much so
29. How satisfied are you with your life at present when compared to the past?
0 Very satisfied‚ 1 Satisfied‚ 2 Dissatisfied‚ 3 Very dissatisfied
30. Taking everything in consideration‚ how would you expect things will go in the future?
0 Much better‚ 1 Better‚ 2 Worse‚ 3 Much worse
31. How much do your expectations of the future stand in the way of doing or initiating the things you want to do (want)?
0 Not at all‚ 1 Somewhat‚ 2 Rather much‚ 3 Much
32. I feel easily annoyed or irritated.
0 Never‚ 1 Occasionally‚ 2 Rather often‚ 3 Very often
33. I have temper outbursts that I cannot control.
0 Never‚ 1 Occasionally‚ 2 Rather often‚ 3 Very often
34. I get into arguments with others.
0 Never‚ 1 Occasionally‚ 2 Rather often‚ 3 Very often
35. I tend to be resentful.
0 Not at all‚ 1 A little ‚2 Quite a bit ‚3 Very much
36. Taking everything in consideration‚ do you feel inferior to other people?
0 Not at all‚ 1 Somewhat ‚2 Rather much ‚3 Much
37. How often do you avoid things (refrain from doing things) because you feel inferior?
0 Very rarely‚ 1 Rarely‚ 2Often‚ 3 Very often
38. I tend to have a negative opinion of myself.
0 Not at all ‚1 A little ‚2 Quite a bit ‚3 Very much
39. How often do you feel that most people cannot be trusted?
0 Never‚ 1 Occasionally‚ 2 Rather often‚ 3 Very often
40. Do you trust in God or some superior being?
0 No‚ 1 Yes
41. Do you find comfort or support in such a belief?
0 No‚ 1 Yes
42. Is the following statement true or false in your situation?
“I am always ready to go out of my way to help someone else”
0 False‚ 1 True
43. Is the following statement true or false in your situation?
“I like to gossip at times”
0 False‚ 1 True
44. Is the following statement true or false in your situation?
“There have been times when I was quite jealous of the good fortune of others”
0 False‚ 1 True
45. Is the following statement true or false in your situation?
“Over the past several years‚ I am often troubled by the difficulties I have dealing with others”.
0 False ‚1 True
46. Is the following statement true or false in your situation?
“Over the past several years‚ I am bothered by the kind of person I am”.
0 False ‚1 True
47. Is the following statement true or false in your situation?
“Over the past several years‚ the way I behave often gets me into trouble‚ either on the job‚ at home‚ or elsewhere”.
0 False ‚1 True
48. Is the following statement true or false in your situation?
“Over the past several years‚ other people often seem to be bothered by the things I do or say”.
0 False‚ 1 True
49. Is the following statement true or false in your situation?
“I haven’t got as far in life as I’d like to because of the kind of person I am”.
0 False‚ 1 True
 
This instrument can be found on pages 215-216 of Quality of life and longevity: a study of centenarians. Available online at: http://ageing.oxfordjournals.org/content/27/2/207.full.pdf
 
Core instrument (31 items)
Physical functioning scale (theoretical score: 0-15): items 1‚ 6‚ 7‚ 9 and 12
Self-care scale (theoretical score: 0-18): items 2‚ 3‚ 4‚ 5‚ 10 and 11
Depression and anxiety scale (theoretical score: 0-12):  items 17‚ 18‚ 19 and 20
Cognitive functioning scale (theoretical score: 0-15): items 8‚ 13‚ 14‚ 15 and 16
Social functioning scale (theoretical score: 0-9): items 21‚ 22 and 23
Sexual functioning scale (theoretical score: 0-6): items 24and 25
Life satisfaction scale (theoretical score: 0-18): items 26‚ 27‚ 28‚ 29‚ 30 and 31
Moderators (18 items)
The perceived personality disorder scale (theoretical score: 0-6): items 39‚ 45‚ 46‚ 47‚ 48 and 49
The anger scale (theoretical score: 0-4): items 32‚ 33‚ 34and 35
The social desirability scale (theoretical score: 0-3): items 42‚ 43 and 44
Self-esteem scale (theoretical score: 0-3): items 36‚ 37 and 38
Trust in God scale (theoretical score: 0-2): items 40‚ and 41
 

De Leo‚ D.‚ Diekstra‚ R. F.‚ Lonnqvist‚ J.‚ Trabucchi‚ M.‚ & Cleiren‚ M.‚ Frisoni‚ G. Della Buono‚ M.‚ Haltunen‚ A.‚ Zucchetto‚ M.‚ Rozzini‚ R.‚ Grigoletto‚ F.‚ & Sampaio-Faria‚ J. (1998). LEIPAD‚ an internationally applicable instrument to assess quality of life in the elderly. Behavioral Medicine‚ 24‚ 17-27.

MARIROSA DELLO BUONO‚ ORNELLA URCIUOU‚ DIEGO DE LEO. (1998). Quality of life and longevity: a study of centenarians. Age and Ageing; 27: 207-216

Bailey. Cara L‚. (2003). Designing a life of wellness; Evaluation of the demonstration program at the Wilder Humboldt campus. Wilder Research Center. www.wilder.org

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