Questionnaire for relatives of patients with dementia

Block I. Emotions

1. What do you feel when you think about your relative having dementia?

2. What irritates you?

the illness disrupts my plans my relative behaves unusually I don't know what to do uncertainty nothing irritates me

other:

3. What are you afraid of?

I won't cope emotionally and morally I won't cope financially others will judge me I will also have this illness I'm not afraid of anything

other:

Block II. Communication

1. What difficulties do you experience in communicating with a relative with dementia?

I don't know how to communicate with my relative I don't have enough patience for communication no problems

other:

2. What knowledge and skills do you think you need to maintain communication with your relative?

special training and support from a specialist is needed knowledge about the psychological characteristics of a person with dementia is needed additional knowledge and skills are not needed

other:

3. What additional tools do you need for effective communication with the patient?

special guides for organizing communication special organization of space no additional tools are needed

other:

Block III. Social and everyday orientation of the patient in space

1. What skills has your relative with dementia lost in social and everyday orientation?

reduced spatial orientation skills reduced/lost personal hygiene skills reduced/lost self-care skills reduced/lost physical and motor functions

other:

2. What knowledge do you and your family members need to maintain the social and everyday orientation of your relative with dementia at home?

knowledge about maintaining personal hygiene knowledge about maintaining self-care skills knowledge about supporting cognitive functions knowledge about safe behavior at home and outside knowledge about supporting physical and motor functions

other:

3. What additional tools do you need to organize safe behavior for your relative with dementia?

special care products for dementia patients special organization of space assistance from medical and social rehabilitation services in organizing the process of accompanying a relative with dementia help from a caregiver

other:

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