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251
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ПРИЛОЖЕНИЯ
Приложение А
(справочное)
Опросник для пожилых людей с нарушениями слуха HHIE
ФИО_________________________________________
Дата_________________________________________
Возраст_______________________________________
Номер карты___________________________________
Шкала
№
Да –
4 балла
Иногда
2 балла
Нет –
0 баллов
С
1
Проблемы со слухом заставляют Вас пользоваться
телефоном меньше чем Вам хотелось бы?
Э
2
Проблемы со слухом заставляют Вас нервничать
при общении с незнакомыми людьми?
С
3
Из-за проблем со слухом Вы избегаете людей?
Э
4
Проблемы со слухом делают Вас раздражительным?
Э
5
Проблемы со слухом заставляют Вас нервничать
при общении с членами Вашей семьи?
С
6
Вызывает ли проблема со слухом
трудности при посещении различных мероприятий?
С
7
Испытываете ли Вы проблемы со слухом,
когда кто-то говорит шепотом?
Э
8
Чувствуете ли Вы себя больным
в связи проблемой со слухом?
С
9
Вызывают ли проблемы со слухом трудности
при посещение друзей, родственников, соседей?
Э
10
Проблемы со слухом заставляют Вас чувствовать
себя расстроенным при общении с окружающими?
С
11
Вызывают ли проблемы со слухом
трудности при посещении различных мероприятий
(театров, экскурсий, и т.д.)?
Э
12
Проблемы со слухом заставляют Вас нервничать?
С
13
Заставляет ли Вас проблема со слухом меньше
навещать друзей, родственников, соседей?
Э
14
Испытываете ли Вы трудности в семье
из-за проблем со слухом?
С
15
Испытываете ли Вы трудности
при прослушивании телевизора или
радио из-за проблем со слухом?
С
16
Проблемы со слухом заставляют Вас меньше
посещать магазины?
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