Functional Activities Questionnaire (FAQ)
Pfeffer‚ 1982‚ Revised 1984
پرسشنامه فعالیت های عملکردی
1. Writing checks‚ paying bills‚ balancing checkbook‚ keeping financial records
_____ A. Someone has recently taken over this activity completely or almost completely.
_____ B. Requires frequent advice or assistance from others (e.g.‚ relatives‚ friends‚ business associates‚ banker)‚ which was not previously necessary.
_____ C. Does without any advice or assistance‚ but more difficult than used to be or less good job.
_____ D. Does without any difficulty or advice.
_____ E. Never did and would find quite difficult to start now.
_____ F. Didn’t do regularly but can do normally now with a little practice if they have to.
2. Making out insurance or Social Security forms‚ handling business affairs or papers‚ assembling tax records
_____ A. Someone has recently taken over this activity completely or almost completely‚ and that someone did not used to do any or as much.
_____ B. Requires more frequent advice or more assistance from others than in the past.
_____ C. Does without any more advice or assistance than used to‚ but finds more difficult or does less good job than in the past.
_____ D. Does without any difficulty or advice.
_____ E. Never did and would find quite difficult to start now‚ even with practice.
_____ F. Didn’t do routinely‚ but can do normally now should they have to.
3. Shopping alone for clothes‚ household necessities and groceries
_____ A. Someone has recently taken over this activity completely or almost completely.
_____ B. Requires frequent advice or assistance from others.
_____ C. Does without advice or assistance‚ but finds more difficult than used to or does less good job.
_____ D. Does without any difficulty or advice.
_____ E. Never did and would find quite difficult to start now.
_____ F. Didn’t do routinely but can do normally now should they have to.
4. Playing a game of skill such as bridge‚ other card games or chess or working on a hobby such as painting‚ photography‚ woodwork‚ stamp collecting
_____ A. Hardly ever does now or has great difficulty.
_____ B. Requires advice‚ or others have to make allowances.
_____ C. Does without advice‚ or assistance‚ but more difficult or less skillful than used to be.
_____ D. Does without any difficulty or advice.
_____ E. Never did and would find quite difficult to start now.
_____ F. Didn’t do regularly‚ but can do normally now should they have to.
5. Heat the water‚ make a cup of coffee or tea‚ and turn off the stove
_____ A. Someone else has recently taken over this activity completely‚ or almost completely.
_____ B. Requires advice or has frequent problems (for example‚ burns pots‚ forgets to turn off stove).
_____ C. Does without advice or assistance but occasional problems.
_____ D. Does without any difficulty or advice.
_____ E. Never did and would find quite difficult to start now.
_____ F. Didn’t usually‚ but can do normally now‚ should they have to.
6. Prepare a balanced meal (e.g.‚ meat‚ chicken or fish‚ vegetables‚ dessert)
_____ A. Someone else has recently taken over this activity completely or almost completely.
_____ B. Requires frequent advice or has frequent problems (for example‚ burns pots‚ forgets how to make a given dish).
_____ C. Does without much advice or assistance‚ but more difficult (for example‚ switched to TV dinners most of the time because of difficulty).
_____ D. Does without any difficulty or advice.
_____ E. Never did and would find quite difficult to do now even after a little practice.
_____ F. Didn’t do regularly‚ but can do normally now should they have to.
7. Keep track of current events‚ either in the neighborhood or nationally
_____ A. Pays no attention to‚ or doesn’t remember outside happenings.
_____ B. Some idea about major events (for example‚ comments on presidential election‚ major events in the
news or major sporting events).
_____ C. Somewhat less attention to‚ or knowledge of‚ current events than formerly.
_____ D. As aware of current events as ever was.
_____ E. Never paid much attention to current events‚ and would find quite difficult to start now.
_____ F. Never paid much attention‚ but can do as well as anyone now when they try.
8. Pay attention to‚ understand‚ and discuss the plot or theme of a one-hour television program; get something out of a book or magazine
_____ A. Doesn’t remember‚ or seems confused by‚ what they have watched or read.
_____ B. Aware of the general idea‚ characters‚ or nature while they watch or read‚ but may not recall later; may not grasp theme or have opinion about what they saw.
_____ C. Less attention‚ or less memory than before‚ less likely to catch humor‚ points which are made quickly‚ or subtle points.
_____ D. Grasps as quickly as ever.
_____ E. Never paid much attention to or commented on T.V.‚ never read much and would probably find very difficult to start now.
_____ F. Never read or watched T.V. much‚ but read or watch as much as ever and get as much out of it as ever.
9. Remember appointments‚ plans‚ household tasks‚ car repairs‚ family occasions (such as birthdays or anniversaries)‚ holidays‚ medications
_____ A. Someone else has recently taken this over.
_____ B. Has to be reminded some of the time (more than in the past or more than most people).
_____ C. Manages without reminders but has to rely heavily on notes‚ calendars‚ schemes.
_____ D. Remembers appointments‚ plans‚ occasions‚ etc. as well as they ever did.
_____ E. Never had to keep track of appointments‚ medications or family occasions‚ and would probably find very difficult to start now.
_____ F. Didn’t have to keep track of these things in the past‚ but can do as well as anyone when they try.
10. Travel out of neighborhood; driving‚ walking‚ arranging to take or change buses and trains‚ planes
_____ A. Someone else has taken this over completely or almost completely.
_____ B. Can get around in own neighborhood but gets lost out of neighborhood.
_____ C. Has more problems getting around than used to (for example‚ occasionally lost‚ loss of confidence‚ can’t find car‚ etc.) but usually O.K.
_____ D. Gets around as well as ever.
_____ E. Rarely did much driving or had to get around alone and would find quite difficult to learn bus routes or make similar arrangements now.
_____ F. Didn’t have to get around alone much in past‚ but can do as well as ever when has to.
نسخه ای دیگر
Functional Activities Questionnaire
1. Writing checks‚ paying bills‚ balancing checkbook
2. Assembling tax records‚ business affairs‚ or papers
3. Shopping alone for clothes‚ household necessities‚ or groceries
4. Playing a game of skill‚ working on a hobby
5. Heating water‚ making a cup of coffee‚ turning off stove after use
6. Preparing a balanced meal
7. Keeping track of current events
8. Paying attention to‚ understanding‚ discussing TV‚ book‚ magazine
9. Remembering appointments‚ family occasions‚ holidays‚ medications
10.Traveling out of neighborhood‚ driving‚ arranging to take buses
Dependent = 3‚ Requires assistance = 2‚ Has difficulty but does by self = 1‚ Normal = 0‚ Never did [the activity] but could do now = 0‚ Never did and would have difficulty now = 1
شرح سایت روان سنجی: این ابزار غربالگری استقلال فرد در فعالیت های روزمره زندگی برای مطالعه جامعه مسن های طبیعی و دمانس خفیف است.
اعتبار: همبستگی میان گویه ها و نمره کل 0.80
نمره گذاری: این پرسشنامه می تواند توسط یک فرد غیر متخصص مانند: همسر، خویشاوند و یا دوست صمیمی تکمیل شود.
چگونگی دستیابی
منبع برای آگاهی بیشتر
Pfeffer‚ RI.‚ Kurosaki‚ TT.‚ Harrah‚ CH‚ et al. (1981). A survey diagnostic tool for senile dementia. American Journal Epidemiology‚ 114:515–527.
Pfeffer‚ RI.‚ Kurosaki‚ TT.‚ Harrah‚ CH.‚ et al.(1982). Measurement of functional activities in older adults in the community. Journal of Gerontology‚ 37:323–329.
Pfeffer‚ RI.‚ Kurosaki‚ TT.‚ Chance‚ JM.‚ et al. (1984). Use of the Mental Function Index in older adults: reliability‚ validity and measurement of change over time. American Journal Epidemiology‚ 120:922–935.
McDowell‚ Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires‚ Third Edition. OXFORD UNIVERSITY PRESS