SUCCESSFUL RETIREMENT SURVEY FOR PEOPLE OVER 18

 

 

PARTICIPANT CONSENT FORM & QUESTIONNAIRE 

Last updated 18/05/2006

By pressing the ‘SUBMIT’ button at the end of the online questionnaire, you are consenting that your questionnaire responses may be used as part of the study for Successful Retirement.

 

Personal Identification Code    Please enter a 6 - 10 digit password of your choosing using a combination of letters and numbers (e.g. blog22).
Please keep this password for your records as a means to keep track of your survey responses if you wish to withdraw from the study after submitting your responses.

 

Please answer all the questions and thank you for your participation.

1.  What is your date of birth   

2.   Current Age                        

3    Sex :     Male 

                    Female

4.   Were you born in Australia?        Yes      No

5.   If No: Please nominate the country you were born in, in the box below:

    

6.  Do you currently live in Australia?    Yes    No

7.  If No: Please nominate which country you now live in, in the box below:

    

8. Are you currently in paid employment?      Yes No 

9. If Yes, please nominate from the  list of options that best describes the status of your employment.

Casual

Part time (less than 30 hours a week)

Full Time (more than 30 hours a week)

Self Employed

   10. If No, please check the circumstances that best describe your current status.

Unemployed receiving no government benefits

Unemployed receiving government benefits

Unemployed receiving trust funds

Student

Primary Carer for elderly
Primary Carer of children
Retired receiving a pension
Self funded retiree through superannuation
Self funded retiree with other income support

 

   11. What does work mean to you? Please select the answer that most represents your response or write a comment in the space provided?

A means of raising money to support myself and my family

Continuing interests

Well being

Lifestyle

Choices
Work makes my life fortunate
Income
Mental Stimulation
Socialising opportunities
A way to make friends
Financial security
Happiness
Means to an end
Survival
Other, Comment in 100 words or less

 

 

12. When you retire or if you have retired, what do you expect to be your main source of income? Please select a response from the check box.

Government pension

Self funded superannuation

Income producing assets

Other – Please state

 

 

 13. In your opinion, is the pension you receive enough?  YES   NO

 14. From the following list, Which level of education have you attained?     Please check the appropriate response? 

No education

Primary education

Secondary Education

Trade Certificate

TAFE Certificate/Diploma
University degree
Post Graduate qualifications
On the job work experience

 

   17. If you are currently working, at what age would you like to retire?   

                                                         Between

20 and 30

31 and 40

41 and 50

51 and 60

61 and 70

71 and over

Never

 

Satisfaction with Life Scale

Below are five statements that you may agree or disagree with. Using the 1 – 7 scales below indicate your agreement with each item. Please be open and honest in your responding.

For each question choose from the following alternatives:

7 = Strongly Agree
6 = Agree
5 = Slightly Agree
4 = Neither Agree nor Disagree
3 = Slightly Disagree
2 = Disagree
1 = Strongly Disagree

1. In most ways my life is close to ideal

   1    2     3    4    5    6    7 
   

2. The conditions of my life are excellent

   1    2     3    4    5    6    7 
   

3. I am satisfied with my life

   1    2     3    4    5    6    7 
   

4. So far I have gotten the important things I want in life

   1    2     3    4    5    6    7 
   

5. If I could live my life over, I would change almost nothing

  1     2     3    4    5    6    7 
   

 This Satisfaction with Life Scale is copyright. All rights reserved. Reproduced in Electronic Format from:
Pavot, W. & Diener, E. (1993). Review of the Satisfaction With Life Scale. Psychological Assessment, .5, 164-172.

 

Duke Social Support Index

1. How many persons within one hours travel (of your home/from here) do you feel you can depend on or feel very close to? Do not include members of your own family.

Number:  
 

2. How many times during the past week did you spend some time with someone who does not live with you?
For example, you went to see them or they came to visit you, or you went out together.

None

Once

Twice

Three Times

Four

Five

Six

Seven or More

 

3. How many times did you talk to someone – friends, relatives or others – on the telephone in the past week?
(either they called you, or you called them)

None

Once

Twice

Three Times

Four

Five

Six

Seven or More

 

4. About how often did you go to meetings of social clubs, religious meetings, or other groups that you belong to in the past week?

None

Once

Twice

Three Times

Four

Five

Six

Seven or More

 

5. Does it seem that your family and friends (i.e. people who are important to you) understand you most of the time, some of the time, or hardly ever?
 

Hardly Ever

Some

Most

 

6. Do you feel useful to your family and friends (i.e. people important to you) most of the time, some of the time, or hardly ever? 

Hardly Ever

Some

Most

 

7. Do you know what is going on with your family and friends most of the time, some of the time, or hardly ever? 

Hardly Ever

Some

Most

 

8. When you are talking with your family and friends, do you feel you are being listened to most of the time, some of the time, or hardly ever? 

Hardly Ever

Some

Most

 

9. Do you feel you have a definite role (place) in your family and among your friends most of the time, some of the time, or hardly ever? 

Hardly Ever

Some

Most

 

10. Can you talk about your deepest problems with at least some of your family and friends most of the time, some of the time, or hardly ever? 

Hardly Ever

Some

Most

 

11. How satisfied are you with the kinds of relationships you have with your family and friends? Very dissatisfied, somewhat dissatisfied, or satisfied? IF NO FAMILY OR FRIENDS would you say that you are very dissatisfied, somewhat dissatisfied, or satisfied with not having any of these relationships? 

Very Dissatisfied

Somewhat Dissatisfied

Satisfied

 

Depression, Anxiety and Stress Scale

Please read each statement and circle a number 0, 1, 2 or 3 which indicates how much the statement applied to you over the past week.  There are no right or wrong answers.  Do not spend too much time on any statement.

The rating scale is as follows:

0  Did not apply to me at all

1  Applied to me to some degree, or some of the time

2  Applied to me to a considerable degree, or a good part of time

3  Applied to me very much, or most of the time

 

1

I found it hard to wind down

0       1     2      3

2

I was aware of dryness of my mouth

0       1     2      3

3

I couldn't seem to experience any positive feeling at all

0       1     2      3

4

I experienced breathing difficulty (eg, excessively rapid breathing,
breathlessness in the absence of physical exertion)

0       1     2      3

5

I found it difficult to work up the initiative to do things

0       1     2      3

6

I tended to over-react to situations

0       1     2     3

7

I experienced trembling (eg, in the hands)

0       1     2      3

8

I felt that I was using a lot of nervous energy

0       1     2      3

9

I was worried about situations in which I might panic and make
a fool of myself

0       1     2      3

10

I felt that I had nothing to look forward to

0       1     2      3

11

I found myself getting agitated

0       1     2      3

12

I found it difficult to relax

0       1     2      3

13

I felt down-hearted and blue

0       1     2      3

14

I was intolerant of anything that kept me from getting on with
what I was doing

0       1     2      3

15

I felt I was close to panic

0      1      2      3

16

I was unable to become enthusiastic about anything

0      1      2      3

17

I felt I wasn't worth much as a person

0      1      2      3

18

I felt that I was rather touchy

0      1      2      3

19

I was aware of the action of my heart in the absence of physical
exertion (eg, sense of heart rate increase, heart missing a beat)

0      1      2      3

20

I felt scared without any good reason

0      1      2      3

21

I felt that life was meaningless

0      1      2      3

 

Post Traumatic Stress Disorder – Civilian Checklist

 Many people have lived through or witnessed one of the events listed below.

  • Motor vehicle, cycle, plane, boating or other transport accident

  • Industrial (workplace) or farm accident

  • Fire, or explosion  

  • Natural disaster, eg tornado, hurricane, flood, major earthquake

  • Non-sexual assault by a family member or someone you know  

  • Non-sexual assault by a stranger 

  • Sexual assault by a family member or someone you know

  • Sexual assault by a stranger

  • Military combat or a war zone

  • Sexual contact under 18 with someone 5 or more years older

  • Imprisonment, eg prison inmate, prisoner of war, hostage

  • Torture

  • Life-threatening illness

  • Life-threatening injury

  • Other traumatic event

   Did any of the events listed above happen to you?                Yes         No 

Below is a list of problems and complaints that people sometimes have in response to stressful life experiences.  Read each one carefully and circle one of the numbers to indicate how much you have been bothered by that problem IN THE PAST MONTH.   If you have experienced a number of stressful life events, rate each problem with respect to the event that bothers you the most.

 

 

Not

At all

A little bit

Moderately

Quite

a bit

Extremely

1.       Repeated, disturbing memories, thoughts, or images of the stressful experience?

 

 

1

 

2

 

3

 

4

 

5

2.       Repeated, disturbing dreams of the stressful experience?

 

 

1

 

2

 

3

 

4

 

5

3.       Suddenly acting or feeling as if the stressful experience were happening again (as if you were reliving it)?

 

 

1

 

2

 

3

 

4

 

5

4.       Feeling very upset when something reminded you of the stressful experience?

 

 

1

 

2

 

3

 

4

 

5

5.       Having physical reactions (eg. heart pounding, trouble breathing, sweating) when something reminded you of the stressful experience?

 

 

1

 

2

 

3

 

4

 

5

6.       Avoiding thinking about or talking about the stressful experience or avoiding having feelings related to it?

 

 

1

 

2

 

3

 

4

 

5

7.       Avoiding activities or situations because they reminded you of the stressful experience?

 

 

1

 

2

 

3

 

4

 

5

8.       Trouble remembering important parts of the stressful experience?

 

 1

 2

 3

 4

 5

9.       Loss of interest in activities that you used to enjoy?

 

 

1

 

2

 

3

 

4

 

5

10.    Feeling distant or cut off from other people?

 

1

2

3

4

5

11.    Feeling emotionally numb or being unable to have   loving feelings for those close to you?

 

 1

 2

 3

 4

 5

12.    Feeling as if your future somehow will be cut short?

 

 1

 2

 3

 4

 5

13.    Trouble falling or staying asleep?

 

1

2

3

4

5

14.    Feeling irritable or having angry outbursts?

 

1

2

3

4

5

15.    Having difficulty concentrating?

 

1

2

3

4

5

16.    Being "superalert" or watchful or on guard?

 

1

2

3

4

5

17.    Feeling jumpy or easily startled?

 

1

2

3

4

5

 

Successful Retirement

1. Describe what retiring means to you? Please write your comments in 150 words or less in the space provided.

 

2. What is, or was, your greatest concern about retiring? Please write your comments in 150 words or less in the space provided.

3. What is the role for older people in society after retirement? Please write your comments in 150 words or less in the space provided.

 

Future Participation?

       If you are willing to be contacted about participating in the next stage of this research please    

      enter  your e-mail address here

      If you prefer not to be contacted, leave this blank.

Thank you for your participation in this study. By pressing the “SUBMIT” button you are consenting that your questionnaire responses may be used as part of the study for “Successful Retirement”

 If you wish to print this study and send it to the researcher then please also print and sign the “CONSENT FORM” and send in with your survey.