Caregiver Nutrition Knowledge Survey

1. Who do you provide care for?

Who do you provide care for? Spouse/Partner

Friend

Relative

Other

If you chose ‘Friend,’ ‘Relative,’ or ‘Other,’ please specify

2. How long have you been an elder caregiver?

How long have you been an elder caregiver?

3. How many chronic medical conditions does this person have (Refer to question 1)?

How many chronic medical conditions does this person have (Refer to question 1)?

If so please list their medical conditions below.

4. How often do you prepare meals or snacks for the individual you care for (including cooking and shopping)?

How often do you prepare meals or snacks for the individual you care for (including cooking and shopping)? Never

Rarely

Sometimes

Frequently

Always

5. On a scale of 1 to 5, please rate how well you feel that this individual’s nutritional needs are being met?

On a scale of 1 to 5, please rate how well you feel that this individual’s nutritional needs are being met? 1- Very Poor

2- Poor

3- Fair

4- Good

5- Very Good

6. On a scale of 1 to 5, please rate your knowledge of the nutritional needs of older adults.

On a scale of 1 to 5, please rate your knowledge of the nutritional needs of older adults. 1- Very Poor

2- Poor

3- Fair

4- Good

5- Very Good

7. In regards to older adult nutrition, what specifically do caregivers need more information about?

In regards to older adult nutrition, what specifically do caregivers need more information about?

8. How have you obtained information regarding the nutritional needs for the person you provide care for in the past?

How have you obtained information regarding the nutritional needs for the person you provide care for in the past?

9. On a scale of 1 to 5, please rate the likelihood that you would utilize a website that provides information on nutrition as it relates to caregiving?

On a scale of 1 to 5, please rate the likelihood that you would utilize a website that provides information on nutrition as it relates to caregiving? 1- Would not

2- Unlikely

3- Probably

4- It is likely

5- Definitely Would

10. Which of the following would you like to see included on such a website? (Check all that apply)

Which of the following would you like to see included on such a website? (Check all that apply) Ability to comment

Community resource information

Recipes

Articles

Message Board

Guest writers

Nutritional needs for chronic conditions

Other (please specify)