Questionnaire on living conditions of the elderly

City: _ _ _ _ _ _ Interviewee: _ _ _ _ _ Gender: Age:

1. Who do you live with?

live alone

B only lives with his wife.

Live with your wife and children.

D only lives with children.

2. Your education level: _ _ _ _ _ _

A, primary school B, junior high school C, senior high school D, university E, other _ _ _ _ _ _ (fill in details)

3. Your personal monthly income: _ _ _ _ _ _ _

A, under 500 yuan b, 500- 1000 yuan c,1000-2,000 yuan d, more than 2,000 yuan.

4. Your income source: _ _ _ _ _ _ (multiple choice questions)

A, state subsidy b, pension c, current work income d, child support.

E, other _ _ _ _ _ _ _ (fill in details)

5. Your previous industry _ _ _ _ _

A government agency b agricultural production c industrial manufacturing d commercial trade e other _ _ _ _

6. Are you still working?

A. Yes _ _ _ _ _ _ _ _ _ (specific work) B No, but often participate in community service C No, spend their twilight years at home.

7. Your health status: _ _ _ _ _ _ _ _ _

A, very good B, good C, average D, poor.

8. Your hobby: _ _ _ _ _ _ _ (multiple choices)

A, Poker, Mahjong B, Taiji, Morning Run C, Chyi Chin Calligraphy and Painting D, Stock speculation and real estate speculation.

E. Travel, Vacation F Other _ _ _ _ _ (Fill in)

9. For your present life:

A is very satisfied, B feels that C is generally dissatisfied, D is not satisfied, and E is other.

10 The monthly alimony for children is:

A does not need to support "C200-500 yuan D500" below B200.

1 1 What you are most worried about at this stage is:

A children's career and life b their own health c family relations d housework problems

12 your attitude towards the form of domestic service:

A. Welcome B. Acceptable C. Doesn't matter D. Oppose E. Resolutely oppose

13 What service do you want most now: (multiple choices)

A psychological service b medical care c diet care

Entertainment, leisure, housework, others.

14 Your usual contact with other elderly people

Frequent contact, mutual assistance or activities.

B the relationship is distant and there is not much communication. He only visits during holidays.

Little or no contact.

15 your understanding of the surrounding pension institutions

Large-scale and well-equipped, it is an ideal activity place for the elderly.

B The scale is small and the equipment is insufficient, so we can only make up the number.

There are few or no such venues.

D not clear

16 If you had a choice, where would you rather go to enjoy your life?

A home and children.

At home (no children)

Sanatorium or sanatorium

tourist attraction

Subjective problem

1. Is your child always with you?

How do children take care of you?

(No) How do you solve your usual difficulties in life?

2. What do you think of some old people who struggle for their livelihood all the year round?

3. Talk about your past work experience (specific interview)