Table 2

 Items in the short questionnaire on self reported ability to care for self and others and accidental injuries

ItemYesNo
1In the past 3 months have you had any accidents?
Specify type of accident
2In the past 3 months have you had any treatment for an accidental injury?
Specify treatment
3Does your eyesight prevent you from attending to the needs of a spouse, relative or friend?
4Does your eyesight prevent you from attending to your own needs?