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Which of these statements most aligns with your attitude toward health care decisions?
I want to make my health care decisions and choices.
I want my doctor(s) to make my health care decisions and choices.
How comfortable are you speaking up for yourself at doctor appointments?
Very confident
Confident
Somewhat confident
Neutral
Somewhat unconfident
Unconfident
Very unconfident
Have you heard of the phrase “age-friendly” as it relates to health care experiences?
Yes
No
Not sure
Age-friendly health care describes care that prioritizes what a person wants. This kind of care also includes regular conversations about an individual’s medication list, mental/cognitive health and the importance of staying active and mobile. Do your doctors practice health care like this?
My doctor(s) practice all of this
My doctor(s) practice some of this
My doctor(s) don’t practice this
Not sure
Do you think you would benefit from this kind of care?
Yes
No
Not sure
How often do doctors or nurses ask about your daily routine to inform care plans? (For example, a doctor could ask questions to find out which physical activities are important to someone to avoid prescribing medications that make it harder to participate in activities.)
Always
Sometimes
Occasionally
Never
Not sure
How often do doctors and nurses discuss mental health and cognition with you?
Always
Sometimes
Occasionally
Never
Not sure
How often do doctors and nurses discuss staying mobile and active with you?
Always
Sometimes
Occasionally
Never
Not sure
Does it seem like doctors are cautious about the number of medications they prescribe you?
Always
Sometimes
Occasionally
Never
Not sure
If you’re 65 or older, do you see a geriatrician?
Yes
No
I’m under 65
I don’t know
If you don’t see a geriatrician, why is that?
I don’t know how to find one
I didn’t know that was an option
I like the doctor I have
There aren’t any in my area
It’s hard to get an appointment with one
It doesn’t seem necessary
I’m under 65
I do see a geriatrician
Other (please specify)
Culturally-competent care is care that is tailored to a person’s identities including race, ethnicity, gender, sexual orientation, ability, socioeconomic status.
How often do you receive culturally-competent care?
Always
Sometimes
Occasionally
Never
Not sure
How would you describe where you live?
Urban
Rural
Suburban
Prefer not to say
What is your gender?
Female
Male
Non-binary
Prefer to self-describe (open text field)
Prefer not to say
What is your age?
18-24
25-34
35-44
45-54
55-64
65-74
75-84
85-94
95 years or older
Prefer not to say
What is your annual income?
Less than $20,000 per year
$20,000-$49,999 per year
$50,000-$74,999 per year
$75,000-$100,000 per year
More than $100,000 per year
Prefer not to say
Is there anything else you’d like to tell us about this topic?
May a Next Avenue reporter follow up with you via email about your responses to this survey?
Name
Email Address
Phone Number
Current Progress,
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