What to write in a caregiver daily log for someone with dementia

Why a daily log is worth the effort

People living with dementia often cannot explain what is bothering them. The National Institute on Aging (NIA) puts it plainly in its guidance on common medical problems: the person may not be able to tell you what is wrong, so caregivers should watch for signs of illness and tell a doctor what they see. A log turns those observations into something a doctor can read, instead of a memory you have to reconstruct in the exam room.

It helps the people giving care as well. The NIA notes that behavior changes can come from the disease itself or from other things, including pain, lack of sleep, constipation, hunger, thirst, side effects of new medications, or a noisy environment, and that keeping track of common behavioral changes can help caregivers and health care providers recognize a pattern and work out the cause. One restless evening means little. Five restless evenings in a row, written down with the times, are something a doctor can work with.

Alzheimer's Society, the UK dementia charity, recommends keeping a diary of behavior and the circumstances around it, and a record of what works, so it can be shared with family, friends, or health and social care professionals who also look after the person.

What to record every day

Keep the categories the same every day; the value of a log is in comparing one day with the next. A workable set is six: meals and drinks, medications, bowel and bladder, sleep, mood and behavior, and pain.

1. Meals and drinks. What was offered and roughly how much was eaten. The Alzheimer's Association lists changes in eating habits among the details worth taking to the doctor. The NIA advises paying attention to how much fluid the person drinks, and lists dry mouth, dizziness, a rapid heart rate and hallucinations among the signs of dehydration.
2. Medications. Which doses were given and when, and any that were refused or missed. The NIA recommends keeping a list of every medication with the time it should be taken, how much, and the reason it was prescribed. The log records what actually happened against that list; it is not a place to adjust anything. The NIA is explicit that a person should not stop taking a medication without checking with their health care provider first.
3. Bowel and bladder. Bowel movements and any accidents, with times. The NIA notes that people with Alzheimer's often have changes in bowel habits and asks caregivers to let a health care provider know about any change. The Alzheimer's Association suggests learning the person's routine toilet schedule and watching for nonverbal cues such as restlessness, pacing, unusual sounds or faces, or sudden silence.

Sleep, mood and pain

1. Sleep. When the person went to sleep, when they woke, and any time they were up in the night. In its factsheet on sleep, Alzheimer's Society says that keeping a diary of when a person is having sleep problems can really help a clinician see what is happening, and advises speaking to the GP or nurse if sleep problems last several weeks or more and are making the person more unwell. The Alzheimer's Association suggests making notes about what happens before sundowning, the late-day confusion and agitation some people experience, to help identify triggers.
2. Mood and behavior. A word or two for how the person seemed, and a sentence for anything unusual. Alzheimer's Society offers the questions to answer: when and where does the behavior happen, does it always happen in the same place, and does it happen with the same person or in similar circumstances?
3. Pain. A person with advanced dementia may not be able to say they are in pain. The NIA describes how it may show instead: groans or sighs, grimacing when touched, becoming upset, or sitting in unusual positions to guard the part of the body that hurts. The Alzheimer's Association adds physical signs such as pale or flushed skin, dry pale gums, mouth sores, vomiting, feverish skin or swelling, and behavior changes such as anxiety, agitation, trembling, shouting and sleeping problems. If the person can rate their own pain, write the number down. If not, write what you saw.

How to write an entry someone else can use

An entry is useful when a stranger could read it and picture what happened. That means a time, what you observed, and who observed it. The Alzheimer's Association's advice before doctor visits is to be as specific as you can: when does it happen, how often, and does something seem to trigger it? "Ate about half of lunch, pushed the plate away at 12:40" answers those questions. "Bad day" does not.

Write what you saw rather than what you think it means. "Holding her right knee on the stairs, said it hurts" is an observation a doctor can use. "Arthritis flaring up" is a conclusion, and it may be the wrong one. Leaving the interpretation to the clinician keeps the record trustworthy.

If more than one person provides care, every entry should carry the writer's name, so the doctor knows whose account is whose.

Changes that should not wait for the log

A log is for patterns over days and weeks. Some changes need a doctor sooner. The Alzheimer's Association lists situations in which the person should see a doctor right away: if they are suddenly more confused, have a major change in memory or mood, faint or fall, are suddenly unable to speak or move part of the body, have a fever, or are suddenly incontinent.

The NIA likewise says that sudden or rapidly fluctuating changes in behavior, especially after an infection or a recent medication change, should be brought to a doctor's attention immediately. Alzheimer's Society notes that sudden changes in behavior are often caused by a physical health problem such as constipation, pain or a urinary tract infection, and suggests asking the GP to check. Make the call first; the log can catch up afterwards.

Common caregiver log mistakes

Writing only on bad days. If entries appear only when something goes wrong, there is nothing to compare against. Ordinary days are the baseline that makes a change visible.

Keeping several logs at once. A notebook at the house, a note on someone's phone and a family group chat each hold part of the week. Alzheimer's Society's advice to share records with everyone who looks after the person only works when the entries end up in one place before the appointment.

Leaving it at home. The log does its job in the exam room. The Alzheimer's Association recommends making notes about changes and bringing them to the appointment along with a written list of questions. A paper notebook works if it travels to each visit. CarePage is one phone-based option: six one-tap buttons for meals, medications, bowel movements, sleep, mood and pain, each with an optional note, a timeline that shows who logged what, and a one-page PDF of the last seven days to hand the doctor.

This guide summarizes published guidance from the National Institute on Aging, the Alzheimer's Association and Alzheimer's Society. It is general information, not medical advice. Talk with the person's doctor or nurse about any change you notice, and call emergency services in an emergency.

Frequently asked questions