Table 2 Questions for each item in the MIDAM-LTC

For each item the following two questions can be asked:

a. Does this apply to you? (think about the past 2 days)

No

Yes

b. If so, to what extent does this influence your sense of dignity?

Not at all

A little

Somewhat

Quite a lot

Very much

1

2

3

4

5

Example:

a. Does this apply to you?

b. Does this influence your sense of dignity?

Not at all ← →Very much

I am incontinent

❑ No ↓ (item 2)

❑ Yes → (question b)

1

2

3

4

5

I have little privacy

❑ No ↓

❑ Yes →

1

2

3

4

5