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This is a booklet about
a person living with
Alzheimer’s disease or
other dementia.
Name:___________________
All about
me
Please put a photo of yourself
in the space provided.
© 2012, Alzheimer Society of Canada. All rights reserved.
All About Me-E
The Alzheimer Society is the leading nationwide health charity for people living
with Alzheimer’s disease and other dementias. Active in communities across
Canada, the Society
• Offers information, support and education programs for people with
dementia, their families and caregivers
• Funds research to find a cure and improve the care of people with dementia
• Promotes public education and awareness of Alzheimer’s disease and other
dementias to ensure people know where to turn for help
• Influences policy and decision-making to address the needs of people with
dementia and their caregivers.
For more information, contact your local Alzheimer Society or visit our website at
www.alzheimer.ca.
1
Table of contents
All about me .............................................................................................................................................. 2
Introduction ........................................................................................................................................2
Contact information ..........................................................................................................................3
Other important numbers .................................................................................................................4
Medical information ..........................................................................................................................4
Getting to know me
.................................................................................................................................5
My personal life ....................................................................................................................................5
In the past .............................................................................................................................................6
Likes and dislikes ..................................................................................................................................6
My routines
................................................................................................................................................8
A typical day .........................................................................................................................................8
Enjoying each day ................................................................................................................................9
Help with daily living ......................................................................................................................... 11
Help with daily living chart ..........................................................................................................12
Meal time .......................................................................................................................................14
Regular weekly activities calendar ................................................................................................... 15
Special considerations
............................................................................................................................16
Journal
...................................................................................................................................................... 19
Replacement pages
................................................................................................................................21
2
Introduction
This booklet is all about you, a person living with Alzheimer’s disease or other dementia.
Although you have a form of dementia, you are still the same person you have always been. This
booklet is designed to focus on the positive: what you are good at rather than what is no longer
possible.
You and your primary caregiver* know what makes you feel comfortable better than anyone.
By answering the questions in this booklet, you will have a record of what makes you content
and at ease that can be used when your primary caregiver cannot be with you and others need
to provide care and support. Anyone can use this booklet to give you the best day possible now
and as the disease progresses.
The first section of this booklet is designed to help someone new to supporting you get to know
you better. It will also suggest conversation topics that may make you feel more at ease and
contribute to more enjoyable times together.
Other sections of this booklet allow you and your caregiver to outline your usual habits: your
daily routines, your likes and dislikes and what makes you enjoy each day. This information will
help new caregivers maintain the routines that give you a sense of security, comfort and pleasure.
When completing this booklet, always keep in mind the main purpose: to give as clear a picture
as possible of you to help others provide care when the person who usually supports you is
unavailable.
To help others provide effective care, keep this book in an easy-to-find location. You and your
caregivers can review it from time to time to note changes and plan for the future. There are
replacement pages at the back that you can use to make any updates or changes.
*The term “caregiver” is used throughout this booklet to mean anyone who supports you.
All about me
3
Contact information
This booklet contains information about:
Some of the information is provided by:
Names, phone numbers, email addresses of significant people in my life (family, friends,
neighbours):
Name:
Relationship:
Phone number:
Email address:
Name:
Relationship:
Phone number:
Email address:
Name:
Relationship:
Phone number:
Email address:
Name:
Relationship:
Phone number:
Email address:
All about me
4
Other important numbers
Family doctor (name, phone number, address):
Ambulance:
Police:
Fire:
Poison Control:
Local Alzheimer Society:
Home-care services:
Spiritual or faith leader:
Other:
Medical information
Other than having dementia, are there other medical issues that the caregiver should know
about?
Please provide any important information on:
Allergies:
Hearing:
Vision:
Medications (attach list, if necessary) – include dosage and frequency
All about me
5
This section is like a photograph. Try to use as much detail as you can to give readers a real sense
of your personality.
My personal life
How do you like to be addressed? (e.g. nickname, Mr., Mrs., Miss, first name)
When were you born?
Where?
Single/married/partner/longstanding relationship(s) with
Name:
We’ve been together since (year)
Where have you lived?
Describe this relationship (e.g. loving, difficult, supportive)
Children (names and where they are now living)
Are they involved in your life now? If so, how?
Do you have any pets? If so, what are their names?
Getting to know me
6
In the past
What kind of jobs did you have? (e.g. homemaker, lawyer, nurse, electrician, teacher)
How do you feel about the job(s) you have done? (e.g. proud, satisfied, indifferent)
If you were asked about the major milestones in your life, what would you likely talk about?
(e.g. major life events, favourite places visited)
Likes and dislikes
What makes you physically more comfortable? (e.g. always have glasses on, have a hearing aid
in, daily lotion to prevent dry skin, toe spacers)
What makes you happy? (e.g. conversation topics, activities, sports, music performances, being
around children/animals)
What do you dislike? (e.g. foods, activities, topics of conversation, music, smells)
What comforts you when you’re upset?
What frightens you?
Getting to know me
7
Life story (Please describe any other details of your life that would help create a full picture of you
as a “whole person.” What would you want others to know about you?)
Getting to know me
8
My routines
A typical day
Routine is important for all of us, but can be especially helpful for a person with dementia.
Writing down your daily routine will help you see how you spend your time and help others who
might be providing care.
Try to look at your care through the eyes of someone who has never met you before. Do you like
to sleep in, have a bath in the evening, or go for a daily walk?
Use this section to describe regular daytime activities. Include activities you are involved in as well
as your caregiver. Include anything that provides pleasure, comfort, or something you particularly
don’t like.
Morning (usual wake up time ______________________ ). How do you start your day?
Afternoon
Evening
Night (usual bedtime )
9
My routines
Enjoying each day
A person living with dementia is just like everyone else, a whole person with likes and dislikes,
opinions, values and experience. Though some skills are lost as the disease progresses, many
remain. Here are some activities that may bring you pleasure and will help you continue to live a
full life while adding enjoyment to time spent with others.
Music
Do you like to listen to music? Yes No
If yes, what kind? (e.g. classical, jazz, folk, blues, or all kinds of music)
What effect does it have on you?
Do you play an instrument? Yes No
If yes, what kind of instrument do you play? (e.g. guitar, violin, clarinet)
Do you enjoy singing? Yes No
What effect does it have on you?
Reading
Do you like to read? Yes No
If yes, what do you like to read? (e.g. classics, science fiction, romance, adventure, fantasy, news,
short stories)
Do you like to be read to? Yes No
10
Television
Do you like watching TV? Yes No
If yes, what are your favourite shows?
Games
Do you like to play games? Yes No
If yes, what kind of games do you like? (e.g. cards, crosswords, puzzles, Sudoku)
Sports
Are you interested in sports? Yes No
If yes, what sports do you like to play or follow? (e.g. golf, hockey, tennis, skating)
Hobbies
Do you have hobbies that you enjoy? Yes No
If yes, what kind of hobbies? (e.g. scrapbooking, crafts, photography)
Do you do household chores? (e.g. meal preparation, dusting, sweeping) Yes No
If yes, is there any household chore you particularly enjoy?
What other activities do you enjoy? (e.g. car rides, attending community programs, sitting by
the window)
My routines
11
My routines
Help with daily living
How much help, if any, do you need with routine daily activities such as dressing, bathing or
getting in and out of bed?
The chart on the next page lists typical routine daily activities. Feel free to change the chart to
include activities that apply to you.
Where you are able to be completely independent, write “no help needed.” When you need
help, note how much help you need.
The “Useful tips” section is a good place for caregivers to note the degree of stress the activity
creates and what special approaches might be helpful.
Here is a sample chart to guide you.
Activity Useful tips Is help needed?
Tub/shower
Usual time: 8:00 a.m.
Twice a week
• Prefer shower, don’t like
bath
• Enjoy music or
conversation during bath
time
• Give lots of time
• Respect privacy
• Be patient
• Need help in and out
Dressing
• Can button shirt, put on
underwear and socks
• Need to take dirty clothes
away immediately
• Can dress independently if
clothes put on bed in right
order
• Offer help tying shoe laces
• May need help from time
to time
12
My routines
Activity Useful tips Is help needed?
Tub/shower
Dressing
Dental care/dentures
Eye care/glasses
Hearing aid
Hair care
• Professional style/cut
Makeup/shave
In/out of chair
In/out of bed
13
My routines
Activity Useful tips Is help needed?
On stairs
Use of toilet
Use of appliances
• e.g. kettle, stove, electric
shaver
Household tasks
• e.g. sweeping, dusting,
vacuuming, meal
preparation, garden work
Financial
Responsibility with money
Walking
• Habits, usual routes, ability
to be independent
Preparing for bed
14
Meal time
An enjoyable breakfast:
Lunch:
Dinner:
Snacks:
Any particular likes or dislikes?
What assistance, if any, is required?
Cutting:
Use of cutlery:
Hot and cold liquids:
To learn more about how to make meal times more enjoyable, read the Alzheimer Society’s
information sheet on the topic, available at www.alzheimer.ca/mealtimes.
My routines
15
My routines
Regular weekly activities calendar
Use this calendar to show regular outings or appointments. You can use pencil so changes can be
made every month, or a make a copy for each month.
Month:
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
16
Note: The questions in this section are designed to be answered by your primary caregiver. Your
input will be valuable to give the best information possible.
Alzheimer’s disease and other dementias progress over time. As the disease progresses, your
abilities will change.
The information in this section will help anyone supporting you know what these changes are
and how they affect your mood, behaviour and abilities. Your caregiver can suggest ways that
help you feel content, engaged and secure. For example – Is there a special approach that helps?
Does your behaviour change only at certain times? Are there warning signs?
Below are examples of common situations.
The term “family member” is used to mean anyone with dementia whom you support.
Unsafe walking (e.g. “wandering”)
Does your family member walk outside in ways that are unsafe? (e.g. will go out in winter
wearing only a dressing gown) Yes No
If yes, what safety precautions do you use? (e.g. camouflaged doors, ID bracelet, regular walks
with a neighbour)
Do they become upset when returned home? Yes No
If yes, is there a special approach to use to help them feel calm?
Are they registered with the MedicAlert
®
Safely Home
®
program? Yes No
If yes, what is the number of your local police station if they become lost? ______________.
What is their MedicAlert
®
Safely Home
®
ID bracelet #? ___________________________.
Night time restlessness
Does this occur? Yes No
If “yes,” what safety precautions do you use? (e.g. nightlight, disconnecting stove or turning
off water valves before retiring at night, locking closet door to prevent dressing at odd hours)
Special considerations
17
What helps to re-settle the person?
Restlessness
Does this occur at certain times of the day?
What helps to settle the person? (e.g. a walk or a distracting activity)
Anger or agitation
Does this occur at certain times? (e.g. bathing, meal time)
What usually triggers this? (e.g. rushing the person, too many instructions given at once)
When anger occurs, what responses tend to be helpful?
Does your family member suspect people of stealing from them? How do you deal with this?
Repetition
When they repeat themselves over and over, what responses are helpful?
Special considerations
18
Hiding or hoarding articles
Are there particular places to check where your family member “stores” specific things?
Does anything need to be kept out of reach? (e.g. knives, tools such as electronic drills)
Safety precautions
List any additional information that is important for other caregivers. (e.g. doors or cupboards
to be kept locked, such as where toxic cleaning fluids are stored)
Are any other safety measures being used? (e.g. alarms, GPS locating devices)
Communication
If your family member has difficulty understanding and following instructions, what do you do?
Is there anything that helps?
To learn more about Communication, please read the Alzheimer Society’s information sheet on
the topic, available at www.alzheimer.ca/communication.
Are there any other areas of concern and/or tips for care that comfort, reassure, support the
person?
Special considerations
19
Journal
Alzheimer’s disease follows a number of stages. While these stages can be somewhat predictable,
the course of the disease will vary from person to person. Changes in physical condition, such as
flu, pneumonia, infection or constipation can often result in changes in mood and behaviour. By
noting changes, the person who supports you may be able to determine a pattern and prevent
a situation from getting worse. It is particularly important to keep a record when medications
are used. Recording these items in a journal will help caregivers when they are talking with your
doctor. Caregivers should take this “All about me” booklet to your appointments.
Anyone providing care can use these pages to record all the events in a particular day.
Here is a sample journal.
Date Comments
Mar. 30/12 To bed 8:30 p.m. -- up again 2:00 a.m. Wandered through house, could
not settle down. Did not recognize me.
Mar. 31/12 Another night with no sleep!
Apr. 1/12 Still won’t sleep. Now dozing all day.
Doctor’s appointment April 4/12.
Apr. 5/12 On new medication for an infection. Slept till 6:00 a.m. I’m trying to keep
her awake during the day. I think things are getting better.
20
Photocopy this page to create your own journal.
Date Comments
Journal
21
Replacement pages
This page outlines things that have changed since I first filled out this booklet.
Date Changes
22
This page outlines things that have changed since I first filled out this booklet.
Date Changes
Replacement pages
23
This page outlines things that have changed since I first filled out this booklet.
Date Changes
Replacement pages
24
This page outlines things that have changed since I first filled out this booklet.
Date Changes
Replacement pages
Alzheimer Society of Canada
20 Eglinton Avenue West, 16th Floor, Toronto, Ontario, M4R 1K8
Tel: (416) 488-8772 1-800-616-8816 Fax: (416) 322-6656
Email: info@alzheimer.ca Website: www.alzheimer.ca
Facebook: facebook.com/AlzheimerCanada Twitter: twitter.com/AlzCanada
Charitable registration number: 11878 4925 RR0001
All About Me-E 2017
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Completed 10 July 2022

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