Navigating Dementia, Together

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We appreciate you taking the time to complete this brief survey to enable us to better understand the impact of Dementia in Bermuda. Responses will be used to guide future program develop, advocacy and education initiatives.

Email *

1. Select the answer that best describes who you are: *

I have concerns about my memory

I have received a diagnosis of Dementia

I am a family member of someone living with Dementia

I am a professional caregiver

I am an agency/organisation

Other:

2. Gender: *

Male

Female

Other:

3. Age Range: *

Under 18 years

18-25

25-40

40-65

65-80

80+ years

Other:

4. Race: *

Black

White

Asian

Mixed Race

Other

5. Location: *

Sandys

Southampton

Warwick

Paget

Pembroke

Devonshire

Smiths

Hamilton Parish

St. Georges

City of Hamilton

No Fixed Abode

Other:

6. Health Insurer: *

I do not hold health insurance

HIP

Futurecare

GEHI

Argus

BF&M

Other:

7. Diagnosis

No formal diagnosis

Dementia (generalised)

Alzheimer's Disease

Vascular Dementia

Dementia with Lewy Bodies

Frontotemporal Dementia

Mixed Dementia (more than one type)

Early Onset Dementia (under age 65 years)

Other

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8. Reason for connecting with NorthStar Dementia (check all that apply): *

General information

Local Resource Listings

Comprehensive Dementia Assessment

Determining level of care required

Identifying safety concerns

Home Environment Assessment

Caregiver education & training

Caregiver support

Personalised Care Planning

Case Management Services

Support surrounding management of challenging behaviours

Risk Reduction: Falls

Risk Reduction: Skin Integrity Concerns

Risk Reduction: Wandering

Risk Reduction: Senior abuse/neglect

Assisting with hiring a caregiver

Bringing my loved one home from hospital

Transitioning my loved one to a Long Term Care Facility

Palliative Care Support

Financial Assistance

Other:

Required

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