Q.1
To what age do you expect to live?
*
50 or younger
51-60
61-70
71-80
81-90
91 or older
Q.2
How do you feel compared to your chronological age?
*
10 years younger
10 years older
20 years older
20 years younger
About the same
Q.3
What are the top two things you're doing to fight aging?
*
Staying active
Managing chronic ailments
Eating right
Regular time with family or friends
Avoiding toxins (like BPA, cigarette smoke)
Reducing stress
Doing brain-boosting exercises
Getting enough sleep
Regular checkups
Q.4
What’s left on your bucket list? (Choose all that apply.)
*
Master a new hobby or language
I don't have a bucket list.
Travel
Seeing children/grandchildren hit milestones
Athletic feat or extreme sport (run a marathon, go sky-diving, etc.)
Attend a major special event (Super Bowl, awards ceremony, etc.)
Reaching financial retirement goals
Q.5
Do you want to live to 100?
*
Yes
No
Q.6
If you don’t want to live to 100, why not?
*
Don’t want to burden others
Don’t want to be alone
Will run out of money
Don’t want to lose mental/physical capabilities
I want to live to 100.
Q.7
What was your oldest parent’s age at death (or current age if still living)?
*
50-60
61-70
71-80
81-90
91 or older
Q.8
Based on your family history, what's your biggest health concern?
*
Heart disease
Cancers
Alzheimer's
Obesity
Diabetes
Mental health
Other:
Q.9
How much do you believe genetics determine how long you will live?
*
A fair amount
Not at all
Not totally, but they have a lot of influence
Only a little bit
My genes will control my destiny lifespan
Q.10
Which of the following have you used to determine your inherited health risks? (Choose all that apply.)
*
Family health history or tree
Genome mapping
Genetic testing
Talking to family members
I have not taken any steps
Q.11
What do you think is the most promising medical innovation that will help us all live longer and healthier?
*
Immunotherapy
Genetic testing & engineering
Vaccines
Better disease screening/early detection
Stem cells
Personalized health care
Better knowledge of nutrition
Other
Q.12
Do you think happiness affects length of life?
*
Yes
No
Q.13
What’s the biggest source of stress in your life?
*
Health
Work
Family
Relationships
Financial
Q.14
How do you best manage your stress? (Choose all that apply.)
*
Drink
Eat
Watch TV
Relaxing hobby
Connect with friends
Pray
Meditate
Exercise
Q.15
Have you noticed any signs of memory loss or recall issues?
*
Yes
No
Q.16
What steps have you taken to protect your memory? (Choose all that apply.)
*
Getting plenty of sleep
Taking anti-aging supplements
Exercising
Staying active
Eating a brain-healthy diet
Playing brain games
Q.17
If you don’t get enough sleep, what’s the primary reason?
*
Stress
Chronic pain
Snoring partner
Not enough time/too busy
Have trouble falling asleep
Have trouble staying asleep
I get plenty of sleep.
Q.18
Are you a caregiver for a parent, spouse or other adult?
*
Yes
No
Q.19
If you’re a caregiver, what’s one of the biggest challenges?
*
Not enough time or help
Strain on relationships
My personal health
Money
Stress
Worry about the future
I'm not a caregiver
Q.20
At what age do you plan to retire? (If you have already retired, indicate the age of your retirement.)
*
Under 60
61-70
71-80
81-90
91 or older
Q.21
How do you plan to spend/are you spending your retirement years? (Choose all that apply.)
*
Volunteering/mentoring
Relaxing
Working part-time
Spending time with family
Traveling
Q.22
Do you plan to make/have you made any of these major changes with retirement? (Choose all that apply.)
*
Move closer to family
Downsize
Move to warmer climate
Move to urban area
Move closer to medical care
I don't plan to make any of these changes
Q.23
If you live a long healthy life, where do you think you’ll be living in the last five years?
*
With family
On my own
In a retirement community
In a nursing home
In assisted living
Q.24
On a scale of 1–5, with 1 being not confident at all and 5 being very confident, how confident do you feel that you have enough money/financial knowledge to live to 100?
*
1
2
3
4
5
Q.25
What would make you happier in your golden years? (Choose all that apply.)
*
More friends to engage with
Better health
More time with grandchildren
More time with family
Financial stability
More sex
Q.26
Which screenings do you get on a regular basis to maintain your health? (Choose all that apply.)
*
Prostate/PSA
Total body MRI
Cervical cancer
Mammogram
Colonoscopy
Cholesterol/BP
Skin check
Q.27
What, if any, changes to your diet have you made as you have aged? (Choose all that apply.)
*
I have tried to cut out sugar
I’ve moved toward becoming a vegetarian/vegan
I have moved to a low-carb/high-protein diet
I eat less fast food
I haven’t made any changes to my diet
Q.28
Do you have a “health buddy” and/or “financial buddy” in your life who helps keep you accountable?
*
Yes, a health buddy
Yes, a financial buddy
Both
Neither
Q.29
What strategies would you consider to stay healthy as you age? (Choose all that apply.)
*
Exercising more
Using new technology (like Uber)
Playing regular brain games
Getting mental health services
Significantly changing diet
Volunteering
Alternative medicine (acupuncture, etc.)
Q.30
What is your age?
*
Under 30
31-40
41-50
51-60
61-70
71 or older
Q.31
Please enter your address.
*
City
State
Zip Code
Q.32
Please enter your name. (Mandatory if you’d like to be included in a drawing for a $500 Amazon gift card)
First Name
Last Name
Q.33
Please enter your email address. (Mandatory if you’d like to be included in a drawing for a $500 Amazon gift card)
Email