I find it a bit unintuitive that "no change" errors are valued the same as "opposite" errors (e.g. answering "positive" when the change was actually negative).

I find it a bit unintuitive that "no change" errors are valued the same as "opposite" errors (e.g. answering "positive" when the change was actually negative). I find it far less interesting when the discrepancy is whether there is any change or not than when the effect is actually opposite to what one would apparently expect. Additionally as others have pointed out some of the questions and answers aren't very clear (though maybe it's just my reading comprehension that's failing). I too am unhappy about the way the elderly question is posed -- it's not clear whether all of the programs were actually focussing on reducing mortality. In fact the introduction mentions that it's merely one of several goals and from anecdotal evidence I would expect that the mortality metric is thrown off by patients stabilizing once their health has deteriorated enough to require them to be placed under permanent care -- that you're less (or equally likely) to die doesn't mean you're more (or equally) healthy.