Memory and Alzheimer's Assessment Tool

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Emeritus Senior Living

We recognize that each family's experience in caring for someone with memory loss or Alzheimer's is unique. We offer an assessment tool that is designed to help you identify areas where you may need additional help, resources or tools when caring for your loved one.

Do you need help?

Use our assessment tool to learn where you may be in need of additional help. (Check if problems occur at least 2-3 times per week for your loved one)

Orientation

Trouble remembering recent events

Trouble remembering significant events from the past

Forgetting what day it is

Being unaware of time of day

Wandering or getting lost

Recognition

Unable to recognize familiar people

Unable to recognize familiar surroundings

Tasks

Starting but not finishing things

Difficulty concentrating on a task

Unable to follow verbal directions

Ambulation

Sitting down without warning while walking

Problem with falling or loss of balance

Unusual gait pattern (i.e. shuffling, fast pace, leaning)

Bumping into objects without seeing them

Anxiety/Fear

Asking the same question over and over again

Being suspicious or accusative

Being restless

Being constantly talkative

Seeing or hearing things that are not there

Dietary

Eating sweets excessively

Attempting to eat non-edible items

Decreased appetite*

Excessive appetite*

Refusing to eat*

*Can also be sign of depression

*Based upon Memory and Behavior Problem Checklist created by Orr-Rainey, Nancy and Tori, Linda 1990

Depression

Spending long periods of time inactive

Talking little or not at all

Appearing sad or depressed

Appearing anxious or worried

Dwelling on the past

Crying and being tearful

Commenting about death of self or others

Personal

Doing things that are embarassing to you

Difficulty with bathing and personal hygiene

Aggressiveness

Engaging in combative episodes (i.e. hitting, scratching, or biting)

Destroying property or personal belongings

Engaging in behavior that is dangerous to others or self

Miscellaneous Problems

Losing or misplacing items

Hiding things


You have answered "Yes" to: Questions

Next Steps

Follow these next steps if you answered "Yes" to 5 or more questions

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Bring this checklist on your next appointment with your family physician to guide your discussions.

Contact the Alzheimer's Association for more information at: 1-800-272-3900 or at www.alz.org.

Bring this in to your nearest Emeritus community TODAY for your free caregiver resource kit.