Questionnaire
Section A (Biodata)
SEX: Male[ ]
Female[ ]
Female[ ]
AGE: 65-74years[ ]
75years and above[ ]
75years and above[ ]
EDUCATIONAL STATUS: Literate [
] illiterate [ ]
] illiterate [ ]
RELIGIOUS STATIS: Christian
[ ]
Islam [ ] Pagan [ ]
Others [ ]
[ ]
Islam [ ] Pagan [ ]
Others [ ]
MARITAL STATUS: Married [ ] Divorced [ ]
Widow/Widower [ ]
Widow/Widower [ ]
OCCUPATION: Trader[ ]
Farmer [ ] Pensioner [
] Farming/Pensioner [ ] Trading/Farming [ ]
Farmer [ ] Pensioner [
] Farming/Pensioner [ ] Trading/Farming [ ]
Section B
1.
Are aware of the important of good feeding habit to human health?
Yes( ) No( ).
Are aware of the important of good feeding habit to human health?
Yes( ) No( ).
2.
Do you know that excess intake of food especially in an unbalanced
proportion can lead to over weight? Yes(
) No( ).
Do you know that excess intake of food especially in an unbalanced
proportion can lead to over weight? Yes(
) No( ).
3.
Do you know that not eating enough food containing necessary food
nutrients can lead to malnutrition? Yes(
) No( ).
Do you know that not eating enough food containing necessary food
nutrients can lead to malnutrition? Yes(
) No( ).
4.
Do you eat three square meal a day? Yes( )
No( ).
Do you eat three square meal a day? Yes( )
No( ).
5.
Do you know that skipping of meal can lead to malnutrition? Yes( ) No( ).
Do you know that skipping of meal can lead to malnutrition? Yes( ) No( ).
6.
Is ignorance a cause of malnutrition among the elderly? Yes( ) No(
).
Is ignorance a cause of malnutrition among the elderly? Yes( ) No(
).
7.
Is ageing a cause of malnutrition? Yes(
) No( ).
Is ageing a cause of malnutrition? Yes(
) No( ).
8.
Does lack of socio interaction, contact or communication with other
people in elderly lead to malnutrition? Yes(
) No( ).
Does lack of socio interaction, contact or communication with other
people in elderly lead to malnutrition? Yes(
) No( ).
9.
Does dieting causes malnutrition? Yes(
) No( ).
Does dieting causes malnutrition? Yes(
) No( ).
10.
Is poverty a cause of malnutrition? Yes(
) No( ).
Is poverty a cause of malnutrition? Yes(
) No( ).
11.
Do you know that lack of proper nutrition can lead to malnutrition?
Yes( )
No( ).
Do you know that lack of proper nutrition can lead to malnutrition?
Yes( )
No( ).
12.
Does excess intake of food especially in an unbalanced proportion in
elderly promotes heart disease? Yes( )
No( ).
Does excess intake of food especially in an unbalanced proportion in
elderly promotes heart disease? Yes( )
No( ).
13.
Does lack of proper nutrition in elderly cause physical disabilities
such as arthritis and vision impairment? Yes (
) No ( ).
Does lack of proper nutrition in elderly cause physical disabilities
such as arthritis and vision impairment? Yes (
) No ( ).
14.
Does ageing lead to reduction in
the sense of taste? Yes( ) No( ).
Does ageing lead to reduction in
the sense of taste? Yes( ) No( ).
15.
Is loss of appetite among the elderly sometimes as a result of
depression? Yes( ) No( ).
Is loss of appetite among the elderly sometimes as a result of
depression? Yes( ) No( ).
16.
Does eating of balanced diet prevent malnutrition? Yes( )No(
).
Does eating of balanced diet prevent malnutrition? Yes( )No(
).
17.
Does regular intake of alcohol before and during meals lessen appetite?
Yes( ) No( ).
Does regular intake of alcohol before and during meals lessen appetite?
Yes( ) No( ).
18.
Is regular exercise before and after meals helpful? Yes( ) No(
).
Is regular exercise before and after meals helpful? Yes( ) No(
).
19.
Does increase intake of fruits and vegetables help to reduce health
problem associated with feeding habit? Yes (
) No ( ).
Does increase intake of fruits and vegetables help to reduce health
problem associated with feeding habit? Yes (
) No ( ).
