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What is your Gender?
 
Male
 
Female
 
 
 
What is your age?
 
65-75
 
75-85
 
85-95
 
95+
 
 
 
Ethinicity
 
Caucasian
 
African American
 
Hispanic
 
Asian
 
Other
 
 
 
Highest level of education?
 
High School
 
Some College
 
College Graduate
 
Graduate Degree
 
 
 
Who was your Caregiver?
 
None
 
Children
 
Spouse
 
Paid caregiver
 
Other
 
 
 
Number of Caregivers?
 
0-1
 
1-2
 
2-3
 
3-4
 
4+
 
 
 
What was your caregiver's gender
 
Male
 
Female
 
Both
 
 
 
Caregiver's Ethnicity?
 
Caucasian
 
African American
 
Hispanic
 
Asian
 
Other
 
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