This worksheet was referenced in my SXSW talk: Helping Aunt Ginny; Alzheimer's, Technology and Me. To see the Google Doc template, go here: https://drive.google.com/previewtemplate?id=0Ao3I_RGlqjEgdFhfZHc5YWxsOTFxSlR0V0pVTkRxSUE&mode=public
Bangalore Call Girl Whatsapp Number 100% Complete Your Sexual Needs
Caregiver worksheet for those helping individuals with Alzheimer's
1. Behavior Profile
Orientation
1. Fails to recognize friends
2. Fails to recognize family
3. Forgets year
4. Forgets month
5. Forgets day of the week
6. Unable to name place (town, etc)
7. Fails to recognize familiar places
8. Gets lost in neighborhood (walking)
9. Gets lost driving
10. Gets lost in own home
11. More confused at night
12. More confused in new places
13. Wanders and gets lost
Memory
14. Loses/misplaces small items
15. Loses/misplaces valuable things
16. Forgets to pay bills
17. Forgets to eat
18. Unable to recall what was read
19. Forgets to turn things off
20. Forgets what the conversation is about
21. Unable to follow what is on TV
22. Forgets to bathe
23. Forgets major events of the day
24. Forgets major events of the week
25. Forgets major events of the distant past
Language
26. Unable to initiate conversation
27. Misunderstands what others say
28. Unable to respond to questions
29. Has trouble finding the right words
30. Just speaks in phrases
31. Avoids questions
32. Unable to verbalize needs
33. Repeatedly says same things
34. What is said makes little sense
Ambulation/Movement
35. Walks short, shuffling gait
36. Gait slow and labored
37. Tires easily when walking
38. Unable to get up from chair alone
39. Unable to use stairs
40. Unable to use eating utensils
41. Unable to write name
42. Hands/arms shake
Behavior problems
43. Has problems sleeping
44. Has toileting accidents
45. Talks excessively about past
46. Denies problems
47. Gets upset easily
48. Becomes physically violent
49. Shows poor judgement
50. Has trouble taking medications
51. Drives unsafely
52. Very withdrawn, refuses to leave house
53. Very nervous and restless
54. Walks and paces constantly
55. Very suspicious/paranoid
56. Has delusional ideas
57. Has hallucinations
58. Sexually inappropriate
Other?
This handy chart was in Alzheimer's: A Caregiver's Guide and Sourcebook. I was using this to determine when things reached a
critical point.
How often it occurs
How bothersome
Always
Usually
Sometimes
Never
Extremely
Very much
Moderately
A little
Not at all
A little
Sometimes
Never
How much it bothers you
Extremely
Very much
Moderately
A little
Not at all
How often it occurs
Always
Usually
Sometimes
Never
How much it bothers you
Extremely
Very much
Moderately
A little
Not at all
How often it occurs
Always
Usually
Sometimes
Never
How much it bothers you
Extremely
Very much
Moderately
A little
Not at all
How often it occurs
Always
Usually
Sometimes
Never
How much it bothers you
Extremely
Very much
Moderately
A little
Not at all
Notes
Not at all
How often it occurs
Always
Usually
Notes
Behavior first noted?
Moderately
Notes
Behavior first noted?
How much it bothers you
Extremely
Very much
Notes
Behavior first noted?
Never
Notes
Behavior first noted?
Sometimes
http://www.amazon.com/Alzheimers-Caregivers-Guide-Sourcebook-Edition/dp/0471379670/ref=sr_1_fkmr0_2?ie=UTF8&qid=1360259358&sr=8-2-fkmr0&keywords=alzheimer%
27s+caregiver+resource+guide
Notes
Behavior first noted?
How often it occurs
Always
Usually
Buy the book here:
Behavior first noted?