This is a short, anonymous survey on one aspect of human behaviour. There are 10 multiple-choice questions, and two short-answer open questions. It takes about three minutes to complete the whole survey.  I would like to get as many responses as possible from a diversity of people in different age groups, so I invite you to share the survey widely. Thank you for participating and for sharing the survey. Susan Macaulay, advocate and blogger.
If you have a problem seeing the survey, or some of the questions are cut off, please try changing your browser or using a different device. 

On average, how often do you leave your home (i.e. house, apartment, shared living space) for any reason (e.g. to go to work, go shopping, go to school, get some exercise, do chores, etc.). Select the answer that most applies.

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* 1. On average, how often do you leave your home (i.e. house, apartment, shared living space) for any reason (e.g. to go to work, go shopping, go to school, get some exercise, do chores, etc.). Select the answer that most applies.

Regardless of the frequency, for what purpose(s) do you leave your home when you go out? (select as many as apply)

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* 2. Regardless of the frequency, for what purpose(s) do you leave your home when you go out? (select as many as apply)

Do you sometimes forget your purpose or become disoriented or lost for any reason while outside your home? For example, get to the grocery story and forgot the specific item(s) you went for? Forget where you parked your car and have to search for it in the parking lot? Drive by an exit or a turnoff you were supposed to take while driving? Take a wrong turn and become lost? Go into the garage to get something and forget why you are there?

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* 3. Do you sometimes forget your purpose or become disoriented or lost for any reason while outside your home? For example, get to the grocery story and forgot the specific item(s) you went for? Forget where you parked your car and have to search for it in the parking lot? Drive by an exit or a turnoff you were supposed to take while driving? Take a wrong turn and become lost? Go into the garage to get something and forget why you are there?

If you answered "yes" to question 3, how many times do you think any and/or all of these types of things might have happened to you in the last 12 months?

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* 4. If you answered "yes" to question 3, how many times do you think any and/or all of these types of things might have happened to you in the last 12 months?

How long could you stay in your home without going out before you would start to feel restless and want to go out?

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* 5. How long could you stay in your home without going out before you would start to feel restless and want to go out?

Regardless of the amount of time it would take for you to want to go out from your home, how would you feel/react if you were unable to leave when you wanted to because for some strange/unknown reason you couldn't find the doors or, if you could find them, you couldn't open them when you did?

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* 6. Regardless of the amount of time it would take for you to want to go out from your home, how would you feel/react if you were unable to leave when you wanted to because for some strange/unknown reason you couldn't find the doors or, if you could find them, you couldn't open them when you did?

If you couldn't find or open the doors to leave your home when you wanted to, what might you do? What action (if any) might you take?

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* 7. If you couldn't find or open the doors to leave your home when you wanted to, what might you do? What action (if any) might you take?

How do you identify?

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* 8. How do you identify?

What is your age?

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* 9. What is your age?

In what country do you currently reside?

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* 10. In what country do you currently reside?

As far as you are aware, do you have any form of dementia? (e.g. Alzheimer disease)

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* 11. As far as you are aware, do you have any form of dementia? (e.g. Alzheimer disease)

Do you have or have you had any role in dementia care?

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* 12. Do you have or have you had any role in dementia care?

Additional comments? 

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* 13. Additional comments? 


As the survey is anonymous, I don't know who the responses or comments are from; you may contact me at the links below. Thanks again, Susan  

I invite you to follow my blog
MyAlzheimersStory.com;

Or to contact me via this page:
http://myalzheimersstory.com/contact-susan/ 
If you want to know the results, add your email address below (MAS subscribers add your email here too).

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* 14. If you want to know the results, add your email address below (MAS subscribers add your email here too).

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