Ageing Well Questionnaire

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If you are completing the survey on behalf of someone, please answer as if the person themselves was responding to the question. Which age group do you belong?

50-59 years

60-69 years

70-79 years

80-89 years

90-99 years

100 years +

If you feel lonely either all or some of the time, what would help you
Please tick all that apply

Not Applicable - I’m not lonely

Having someone to talk to, face to face

Having someone to talk to over the telephone

Attending a community activity

Being able to socialise and meet people

Access to open green spaces

Or tell us how loneliness affects you and what would help

This is required

What do you like to do that keeps you active, mentally as well as physically?
Please tick all that apply

I don't do any activities

Exercise e.g running, walking, leisure activities

Singing or dancing

Craft activities, knitting, art classes etc

Socialisation and meeting new people

Learning new things

Reading, playing games, doing puzzles etc.

Play computer games

Volunteering

Other please state

This is required

Are there things you like to do that you can’t afford?

Yes

If yes and you are happy to do so, please tell us the reason/s why and how this impacts on your life/wellbeing

This is required

How active are you, how often do you do moderate physical exercise?
Moderate physical activity that raises your heart rate, makes you breathe faster and feel warmer. One way to tell if you are working at a moderate intensity level is you can still talk but not sing.

Not at all active

Active up to one hour per week

Active up to 20 minutes per day

Active 20-30 minutes per day

Active 3 times a week

Active more than 3 times a week

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If you are completing the survey on behalf of someone, please answer as if the person themselves was responding to the question. Which age group do you belong?

Health and Wellbeing If you needed it, what would help to better manage your health and wellbeing? (Wellbeing, the state of being comfortable, healthy and happy) Please tick all that apply

If you feel lonely either all or some of the time, what would help youPlease tick all that apply

What do you like to do that keeps you active, mentally as well as physically?Please tick all that apply

Are there things you like to do that you can’t afford?

How active are you, how often do you do moderate physical exercise? Moderate physical activity that raises your heart rate, makes you breathe faster and feel warmer. One way to tell if you are working at a moderate intensity level is you can still talk but not sing.

Health and Wellbeing
If you needed it, what would help to better manage your health and wellbeing? (Wellbeing, the state of being comfortable, healthy and happy)
Please tick all that apply

If you feel lonely either all or some of the time, what would help you
Please tick all that apply

What do you like to do that keeps you active, mentally as well as physically?
Please tick all that apply

How active are you, how often do you do moderate physical exercise?
Moderate physical activity that raises your heart rate, makes you breathe faster and feel warmer. One way to tell if you are working at a moderate intensity level is you can still talk but not sing.