02 November 2007

Observation Log

To help the doctor keep track of how your loved one is doing, use this Observation Log.

To help the doctor keep track of how your loved one is doing, use this Observation Log.

Before an appointment with your doctor, please fill out an Observation Log based on your most recent observations of your loved one.

Only a few minutes are needed to complete this form, but it will encourage clear communications between the doctor and you.

The Observation Log gives your doctor an update of your loved one's condition quickly, to make the most of your office visit. It will also help your doctor measure how effective the current treatment is, and decide if any adjustments are necessary.

Please place a tick inthe appropriate column to inform the doctor of changes observed in your loved one since the last visit or last dose adjustment. At the bottom, do the same to indicate how these changes have affected you. if not applicable or can't assess, check "No noticeable change from usual".

NOTE: No change, improvement, or even minimal decline are all positive signs of treatment effectiveness.

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  No noticeable change Slight change Significant change
Daily activities:
  • Bathing, using the bathroom, grooming, dressing
  • Eating habits, manners
  • Sleeping patterns
  • Ability to use household appliances
  • Motivation to do things, general mood, cooperativeness
  • Anxiety level, restlessness, agitation, pacing
  • Participation in conversation, recognising family/friends
  • Engaging in social activities, interest in hobbies and leisure activities
  • Remembering names/events, ability to find appropriate words
  • Keeping track of time, awareness of environment, ability to follow instructions
Impact on caregiver:
  • Depression, inability to cope, anger/frustration with your loved one
  • Inability to sleep through the night
  • Interference with your ability to work or participate in social activities

For more information visit: Dementia SA: or Alzheimer’s South Africa:


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