Age Friendly Sacopee Valley Initiative
We are hoping to learn more about the strengths and needs of older people in our area so that we can work with our local communities to become "age-friendly". If you are 50 years old or more, we invite you or someone in your household who can help you complete this survey- your answers will be helpful for planning and decision-making. Please email sacopeegratefulundead@gmail.com if you have any questions about this survey.
If you would like to have a copy of the results from this survey or would like to know more about the Age-Friendly Sacopee Valley Initiative, please share your name and contact information (email or phone):
Your answer
What town do you live in?
Your answer
I can walk to the center of town
How many years have you lived in your town?
How do you identify yourself?
What is your age
Check all that apply:
Required
How many people live in your household, including yourself?
If you do not live alone, with whom do you live? (Please check all that apply)
Required
Is your home warm enough in the winter?
If no, please check all issues that apply:
How do you get around? (Please check all that apply)
Required
If transportation is a problem for you, why? (Please check all that apply)
What keeps you from going places you need to go? (Please check all that apply)
Required
How do you find out what's happing in your community? (Please check all that apply)
Required
Is it easy to find out about community events and local activities?
When you go out, what kinds of things do you do? (Please check all that apply)
Required
Do you volunteer? (Please check all that apply)
Required
Are you as social as you want to be?
If no, please check all issues that apply
Please check all the services you need now
Required
If you don't visit some public places like the post office or libraries, why not? (Please check all that apply)
Where do you get your food? (Please check all that apply)
Required
What food issues do you have, if any? (Please check all that apply)
Do you have a problem with falls or fear of falling?
If yes, what if anything, have you done to prevent falls? (Please check all that apply)
Do you have the health care services that you need?
If no, what do you need?
Your answer
Do you feel safe with the people you live with?
If no, what do you need to feel safe?
Your answer
Do you feel safe in the community where you live?
If no, what do you need to feel safe?
Your answer
As you age, where do you want to live? (Please check all that apply)
Required
As you age, how will you get to the places you want to go? (Please check all that apply)
Required
As you age, who will you spend time with? (Please check all that apply)
Required
If you have other things to tell us, please use the space below.
Your answer
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