Arthur N. Rupe Caregiver Survey

Thank you for agreeing to participate in this survey!
Alzheimer's Family Services Center is conducting an important study about issues related to caregiver education and resources about dementia. The project is being funded through a grant from the Arthur N. Rupe Foundation.

Your responses and your identity will be kept strictly confidential.  Only group findings will be reported.

* 1. What is your gender?

* 2. What is your age?

* 3. Which of the following do you identify with? (Please select all that apply.)

* 4.  How involved are/were you in the care of the person you know with Alzheimer’s disease/dementia?

* 5. Do you consider yourself to be:

* 6. Which source(s) of information did you use to learn about Alzheimer’s disease or dementia? (Please select all that apply.)

* 7. When your loved one was diagnosed with Alzheimer’s disease or another dementia, how prepared did you feel to deal with this person’s future?  

* 8. At the time of diagnosis, were there any areas in which you could have used more or better support/information? (Please select all that apply.)

* 9. According to your health care professional, what stage of Alzheimer’s disease/dementia is the person you care for currently in?

* 10. How did your life change since you started caring for someone with Alzheimer’s disease/dementia? (Please select all that apply.)

* 11. Where does or did your loved one with Alzheimer’s disease or another dementia live? (Please select all that apply.)

* 12. What is the highest level of education you have completed or the highest degree you have received?

* 13. Which of the following income categories best describes your total 2015 household income before taxes?

* 14. What topics would you like the caregiver books to cover? (Please select the topics you are interested in.)

* 15. Please select your TOP FIVE (5) topics from the previous question, and rank them from 1 to 5 by order of importance (1 = most important topic).

* 16. Is there anything else you'd like to share with us?

Thank you for completing this survey! For any questions, please feel free to reach us anytime at (714) 593-1868.
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