1.If you needed to find out information related to aging (either for yourself or a family member), please indicate the likelihood of using each of the following sources of information:

Extremely likely

Very likely

Somewhat likely

Not very likely

Not at all likely

Print media (e.g., newspapers)

Extremely likely

Very likely

Somewhat likely

Not very likely

Not at all likely

TV/Radio

Extremely likely

Very likely

Somewhat likely

Not very likely

Not at all likely

Internet

Extremely likely

Very likely

Somewhat likely

Not very likely

Not at all likely

Social media (e.g., Facebook)

Extremely likely

Very likely

Somewhat likely

Not very likely

Not at all likely

Library

Extremely likely

Very likely

Somewhat likely

Not very likely

Not at all likely

Healthcare providers

Extremely likely

Very likely

Somewhat likely

Not very likely

Not at all likely

50+ Centers

Extremely likely

Very likely

Somewhat likely

Not very likely

Not at all likely

Office on Aging and Independence/ Maryland Access Point of Howard Co.

Extremely likely

Very likely

Somewhat likely

Not very likely

Not at all likely

Faith community

Extremely likely

Very likely

Somewhat likely

Not very likely

Not at all likely

Word-of-mouth

Extremely likely

Very likely

Somewhat likely

Not very likely

Not at all likely

Family / Friends

Extremely likely

Very likely

Somewhat likely

Not very likely

Not at all likely

2.How important is it to you for Howard County to have available information on the following?

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Avoiding financial exploitation/scams

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Retirement/financial planning

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Health insurance options

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Transitioning from work to retirement

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Home modifications

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Home maintenance

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Housing options

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Taking care of an older adult

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Aging in Place – remaining in your home safely

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Financial benefits available

Extremely important

Very important

Somewhat important

Not very important

Not at all important

3.How important is it to you for Howard County to have available the following?

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Job training/skill building for older adults

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Information on how to find out about and apply for jobs

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Access to physical health services/care

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Access to mental health services/care

Extremely important

Very important

Somewhat important

Not very important

Not at all important

4.Please rate the likelihood that you would engage in the following volunteer activities in the next 12 months, if asked:

Extremely likely

Very likely

Somewhat likely

Not very likely

Not at all likely

Provide rides to older adults

Extremely likely

Very likely

Somewhat likely

Not very likely

Not at all likely

Prepare meals for others

Extremely likely

Very likely

Somewhat likely

Not very likely

Not at all likely

Deliver home delivered meals/groceries

Extremely likely

Very likely

Somewhat likely

Not very likely

Not at all likely

Assist with simple home repairs/maintenance (e.g., snow shoveling, cut grass)

Extremely likely

Very likely

Somewhat likely

Not very likely

Not at all likely

Make home visits (i.e., friendly visitor) to isolated individuals

Extremely likely

Very likely

Somewhat likely

Not very likely

Not at all likely

Provide phone calls to check on isolated individuals and/or stressed caregivers

Extremely likely

Very likely

Somewhat likely

Not very likely

Not at all likely

Volunteer at hospital or medical facilities

Extremely likely

Very likely

Somewhat likely

Not very likely

Not at all likely

Mentoring

Extremely likely

Very likely

Somewhat likely

Not very likely

Not at all likely

Participate on boards/commissions/work groups

Extremely likely

Very likely

Somewhat likely

Not very likely

Not at all likely

5.How important is it to you for Howard County to have available?

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Continuing education classes

Extremely important

Very important

Somewhat important

Not very important

Not at all important

50+ Centers convenient to you

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Community centers convenient to you

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Social activities for older adults

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Racial, ethnic or culturally based organizations

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Organized sports/exercise activities you can participate in

Extremely important

Very important

Somewhat important

Not very important

Not at all important

6.Which of the following represents a barrier to transportation/personal mobility for you? (check all that apply):

Do not own a car

Do not have family/friends who are willing/able to give me rides as often as needed

Unable to drive due to medical/health concerns

Restrict driving due to weather conditions, daylight hours, etc.

Public transportation not convenient/available in my area

Difficulty walking and/or climbing stairs

Fear of falling

No, or poorly maintained, sidewalks in neighborhood

No barriers (none of the above)

Other (please specify)

7.How important is it to you for Howard County to have available the following at 50+ Centers?

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Exercise classes

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Evening activities

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Weekend activities

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Games (cards, boardgames)

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Educational activities (lectures, etc.)

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Arts & crafts activities

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Arts related performances (movies, concerts, dances)

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Activities in other locations but coordinated by the 50+ Centers (walking/cycling clubs, tai chi)

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Health and Wellness classes

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Ethnic or culturally diverse activities

Extremely important

Very important

Somewhat important

Not very important

Not at all important

8.Which of the following screenings would you be interested in having available to you at 50+ Centers (check all that apply to you):

Blood Pressure

Hearing

Vision/Glaucoma

Depression

Fall Prevention/Balance

Skin Cancer

Cognition (dementia) / Memory

Fitness Assessments

9.If you are (or might wind up) providing assistance to a family member or friend with a disability/illness, which of the following services are important to you:

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Respite care on weekend

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Respite care during workweek

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Practical trainings on how to assist a family member with a disability/illness

Extremely important

Very important

Somewhat important

Not very important

Not at all important

In-person support groups

Extremely important

Very important

Somewhat important

Not very important

Not at all important

On-line or telephone support groups

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Information on alternative living arrangements

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Information about medical conditions/treatments

Extremely important

Very important

Somewhat important

Not very important

Not at all important

Information on in-home care options

Extremely important

Very important

Somewhat important

Not very important

Not at all important

10.In what year were you born?

11.In what zipcode do you live?

12.What is your gender?

Male

Female

Other (please specify)

13.What is your race and ethnicity? (check all that apply)

White

Black or African American

Hispanic or Latino

Asian or Asian American

Other (please specify)

14.What is your highest level of education you have completed?

Less than high school

High school

Trade school or associates degree

Bachelor’s degree

Graduate degree (Masters, Doctorate, MD, JD)

15.Household income:   What was your approximate household income in the prior year?

Less than $ 10,000

$ 10,000 – $ 49,999

$ 50,000 – $ 99,999

$100,000 – $149,999

$150,000 – $199,999

$200,000 or more

16.How often in the last 90 days (3 months) have you attended/used the services of the following:

Never

1 time only

2 or more times

Do not know

A Howard County 50+ Center

Never

1 time only

2 or more times

Do not know

A Howard County public library

Never

1 time only

2 or more times

Do not know

The Loan Closet of Howard County

Never

1 time only

2 or more times

Do not know

Office-based, in person, or in-home services provided by the Howard County Office on Aging and Independence

Never

1 time only

2 or more times

Do not know

A fitness center (e.g., YMCA/Columbia Association)

Never

1 time only

2 or more times

Do not know

A Howard County Community Center (e.g. Roger Carter Center)

Never

1 time only

2 or more times

Do not know

A faith community sponsored social activity or service

Never

1 time only

2 or more times

Do not know

Howard Community College

Never

1 time only

2 or more times

Do not know

17.Are you (check all that apply):

Howard County employee

Provider of services to older adults

Member of advisory or advocacy group

County resident

None of the above

Other (please specify)