• Finding the right physician
• Questions to ask in selecting a physician
• Your healthcare team
• Developing a treatment plan together
• Communicating with family and others

Finding the right physician
Because of the slow and long-term nature of AD, it is extremely important that caregivers and people with AD find a healthcare professional whom they are able to understand, trust, and communicate comfortably with over time. Both caregivers and people with AD will need a physician who not only knows about the special needs and stresses of AD, but also is available and accessible.

Questions to ask in selecting a physician
Here are some suggested questions you may want to ask your physician:

• How often do you schedule examinations for AD patients and their families?
• How do you manage questions from caregivers?
• Are all my visits and calls covered by Canadian medical coverage (e.g., OHIP)?
• Are you involved with clinical trials in this area?
• Within what time frame do you generally return phone calls?
• Will I need to be referred to other physicians or specialists?

Additionally, your caregivers may have questions that they would like to ask. Caregivers should take the time to develop a list of questions to ask your prospective doctors about the treatment and management of AD. Use information from this and other websites to ask more specific questions about AD itself. You and your caregiver(s) should not be afraid to ask tough questions about the quality of care.

Your healthcare team
Physician
The primary physician for helping you manage your Alzheimer Disease could be your current family doctor, or another physician with a special interest and expertise in Alzheimer Disease. Your family physician may also refer you to a specialist for diagnosis or ongoing care.

Nurse
You may want to seek the assistance of a nurse. Nurses can teach you and your caregivers how to cope with problematic day-to-day activities such as bathing, transfers (e.g., in and out of baths or beds), eating, administering medications, and using special devices. If you want a nurse to visit you at home, ask your physician or your contact at the local Alzheimer Society (1-800-616-8816 or visit www.alzheimer.ca) or your local healthcare agency for a referral.

Pharmacist
Your pharmacist is an important link between yourself, your caregiver and other healthcare providers. Pharmacists can provide you with additional information about AD and can help answer any questions that you may have about your medication for AD. They can also advise you on potential drug interactions that may occur if you are also taking medications for other health problems.

Physical or occupational therapist
These healthcare specialists can also help with everyday activities. They are experts on useful home environmental modifications, such as the correct installation of grab bars and handrails, and, as such, are an essential part of the Alzheimer support team. Ask your physician for a referral if you feel their services are required.

Social worker
Social workers can be invaluable resources because of their networking expertise—they have connections with many important community agencies and resources. They can also arrange for counselling to help you cope with the stresses of Alzheimer Disease.

Developing a Treatment Plan Together
You and your caregivers may rely on the expertise of members from your healthcare team (such as those listed above), and likewise they also rely on observation and feedback from caregivers and from you. Working together, you, your caregiver(s) and your healthcare team will be able to develop a treatment plan that best serves your needs and requirements.

By keeping a diary or log, caregivers can provide the following valuable information:

• Changes in or patterns of cognitive and behavioural symptoms
• Reactions and responses to medications
• Shifts in ability to perform activities of daily living

In addition to medical management, a comprehensive treatment plan will include strategies for dealing with deteriorating psychological and social skills. A complete team may include a social worker, physical therapist, psychologist, home health aide, dietitian, attorney who specializes in seniors and clergy — all of whom would be helpful at different stages of the disease process.

Communicating With Family and Others
Sharing the AD diagnosis can give others the opportunity to provide the help, support and understanding that you need. When you tell people about Alzheimer Disease, it is worth remembering that some of them may find it difficult to accept at first. Be patient. Breaking this kind of news is never easy. Determine the most appropriate way to communicate the diagnosis. Remember that everyone has a different communication style and/or way of receiving and sharing information. Responses will vary depending on the relationships you have with others. Determine who needs to know and when is an appropriate communication time. Shielding certain family members may or may not make sense. A social worker, counsellor, psychologist, clergy member, or primary care physician can help you and your family with the communication process. Start with an explanation that Alzheimer Disease is not a part of normal aging, but a disease of the brain that results in impaired memory, thinking and behaviour. This reassures them that the disease is a “real” medical condition, not a psychological or emotional disorder and that unusual behaviour/symptoms can be part of a medical disease.

As time progresses and the reality of the diagnosis sets in, the following should be kept in mind:

1. Everyone should try to become as knowledgeable as possible about AD. Print and share the information and resources on this website and elsewhere on the Internet. AD support organizations such as the Alzheimer Society of Canada also have useful materials for you, your caregivers and your families (see resource section of this website).
2. Prospective caregivers will have a variety of feelings and responses. It is normal for people to go through various stages of denial, fear, and anger following diagnosis. Some people may simply refuse to accept the diagnosis for a long time.
3. There may be family members who, because of temperament, age, or life skills, will not be able to provide support to the extent that you, or the primary caregiver, may want. Knowing and accepting this in advance will reduce family frictions and lingering resentments.