Day clinic for dementia: "After two days, patients are transformed"

In the day clinic for people with neurological dementia, relatives receive support and assistance. The combination of neurological examinations and therapies is unique in Germany. Patients find the quality of life there. VIP News has examined the device.

Wiltrud Lange, 78, has been suffering from dementia for three years. A cerebral hemorrhage caused a stroke in 2016. In the months that followed, it soon became clear that your mental capacity was gradually decreasing. After a re-education in 2017 and outpatient care at the Schön Klinik München Schwabing, Chief Medical Officer Jürgen Herzog made a proposal to the couple last year: a stay at the Neurology Clinic.

Neurological day hospital for dementia in Munich Schwabing

The day clinic is set to provide patients and their loved ones with personalized help. They should be able to cope better with dementia. In Schwabing, specially trained neurologists, neuropsychologists, therapists and nurses collaborate with specialists from the neighboring Schön Klinik München Schwabing. Patients with dementia have been treated for many years in this specialized neurological clinic.

Three days a week, Wolfgang Lange accompanied his wife to the establishment at nine o'clock in the morning and at four o'clock he came to pick her up. From January to March 2019, she was patient at the clinic. His memory had decreased before the visit, just like his car. There were times when she was very apathetic. But thanks to activating therapies and medical treatments, she feels better now.

Today, about three months later, she is just visiting the clinic. She is sitting in one of the light treatment rooms with her husband and chief doctor, Jürgen Herzog. On the wall, a picture of a meadow of green flowers is suspended. It's hot, with a carafe of water and glasses on the table.

Unique concept in Germany

The neurological day clinic is one of a kind. There are several day clinics, each with its own specialization. But the treatment of dementia patients in Germany is mainly in the hands of psychiatrists. It often happens that behavioral problems occur at an advanced stage of the disease: delusions, hallucinations – typical psychiatric symptoms.

"Dementia is a brain disease," says Herzog. As Chief Medical Officer, he heads the Department of Neurology. "During the course of the disease, many neurological facets are revealed.Epileptic seizures, gait disorders, incontinence – these symptoms require the intervention of a neurologist."

In addition, many neurological diseases develop only during dementia. Parkinson's, multiple sclerosis, stroke – as in Wiltrud Lange.

"Such patients often fall into a supply hole." Herzog decided, in collaboration with his team, to design a neurological day clinic for dementia. In November 2018, the institution was able to welcome its first patient.

Exciting, but not the time?

The Alzheimer Society fears a sharp increase in dementia

Dementia is one of the most common and consistent neuropsychiatric disorders in the elderly. In Germany, 1.7 million people are currently suffering from this deterioration of their intellectual abilities.

Most are affected by Alzheimer's disease. The disease progressively destroys the orientation, judgment, language, and ability to calculate and distinguish parts of the personality. More than 300,000 new cases occur each year. The German Alzheimer Society fears that the number of diseases will exceed 3 million by 2050.

Signs of dementia are linked to forgetting recent events. Sufferers have difficulty performing the usual activities and suffer from speech disorders. Often, they lose track of their financial affairs, they exhibit mood swings, anxiousness, irritability or mistrust previously unknown. Errors, mistakes or confusion that they deny.

Wiltrud Lange suffered after his stroke in addition to oblivion, even in case of severe walking difficulties and balance disorders. As part of individual and group therapies, doctors and nurses helped her regain her balance and walk.

A regular daily structure gives the patient's orientation

Therapies and exams are embedded in a repetitive daily structure. Individual sections always take place by time blocks. "Patients can rest assured that appointments take place at the same time – it's very important – it gives them stability and stability, they get used to it."

In the next room is an older, gray-haired man with a nurse. He seems focused, looking at a country puzzle. "That's what a therapy session can look like," says Herzog. "What are the neighboring countries of France?", Asks the nurse. The man hesitates, then he says: "Italy? And Germany." Long-term memory works well in many patients, but not short-term memory.

There is also a small kitchen in the clinic. There, a patient prepares a fruit salad. "What are you cutting?" Herzog asks. "Uh, apples," she answers. Herzog smiled: "And for what?" The patient then stops. She looks around her. "I do not know, what's cooking again?"

According to Herzog, nurses and doctors are constantly demanding of their patients. "They are reaching their cognitive limit – it's very exhausting, but it shows that many still have resources."

Often, many tasks would be assigned to patients at home. "It's easier, more convenient or faster, which is why we think it's important to challenge the people involved," says Herzog.

Wiltrud Lange is making progress

"It has been good for my wife," says Wolfgang Lange. "Therapeutic measures, group and individual therapies.Of course, I can not say that after the stay, everything was correct again.But it has progressed in many areas." He hopes that his health will not deteriorate further.

"If it stays that way, then I'm happy," he said, looking at his wife. He taps his thigh, looks at her with encouragement. "Do you drink something?" It's very hot. "Wiltrud Lange nods, taking a sip of the glass of water on the table in front of her.

Patients with obvious signs of dementia and acute or urgent problems arrive at the clinic. For legal and private insureds, the day clinic serves as a counterpart to hospital treatment. Affected individuals receive regular treatment, examinations and treatment.

Only they do not spend the night in the hospital, but can sleep at home. Their jackets hang patients in their lockers in the morning. A turtle, an elephant, a kangaroo – to distinguish lockers, animal motifs are attached.

"My wife and I live very close here in Schwabing," explains Wolfgang Lange. "It's lucky for us that she first found a place here in a detox center, and then at the day clinic. And it was not so easy! "Due to administrative and billing issues, he had to fight for this place.

Relief for parents

"It would be absurd if she had been sent elsewhere, so I came here every day during the rehab, we went to the park and came back for dinner and then got a seat at the local day clinic. Nothing better would have happened to us. "

The clinic is a great relief for loved ones. You can leave the responsibility between the therapists and the doctors for a while. "I was able to take care of myself suddenly," remembers Wolfgang Lange. "This constant pressure has just dropped me off."

In his normal daily life, he has a 24-hour program: "I always have to be careful if she gets up or if she goes somewhere, I always have to control and supervise, I'm always in the duty, I have to see if everything Okay, and I have to take care of the house. "He laughs. "I am at the front, I am the leader."

Wolfang Lange fights for his wife. They have been a couple for over 50 years. When they met for the first time, he was in his early twenties. "We had to get married quickly because of my wife's profession," he says.

"I was a teacher." Wiltrud Lange is no longer absent. "Community college," she said softly. "Yes, exactly," her husband helps her. "To stay a teacher in Upper Bavaria, it was enough to get married – we did it quickly before she submitted her documents." He laughs.

When he talks about his past, Wiltrud Lange remembers

Wiltrud Lange was first transferred to a small village near Mühldorf am Inn. There, she taught students from surrounding farms. She smiled as she heard her husband tell her story. She seems to know exactly what he's talking about. Seems to recognize things again. Her eyes are clearer, she nods impatiently. Students The small oil stove in his room. The cabinet, which was only three feet.

"Of course, I've always tried to take her to Munich," says Wolfgang Lange. "I was with government officials, I told them how alone they were." His efforts have been successful. Wiltrud Lange was allowed to return.

"My wife is a Münchner, Schwabingerin, and for them the worst thing would be to move somewhere else for the long term – after all, she was born and raised here." Munich is for her a home. As for the other patients of the day clinic.

The city of Munich connects patients

"The place of residence Munich plays a big role for our patients, the city they live in and sometimes have always lived in. Munich is a pillar of conversation for everyone here," says Herzog. Many sufferers have a similar biography, often only the details are different.

"They share familiar and familiar places, they come from Munich, they remember what they did earlier." Auxiliary nurses animated such discussions but could withdraw gradually. "Communication and interaction are born between patients," says Herzog.

The memories of age are often still intact

He calls it "a therapeutic biography". As the memory of many patients with dementia is still intact, it would be easier to start talking about their resume. "This requires a degree of openness – but for many older people, their past is a common denominator." He looks at Wiltrud Lange. She smiles with uncertainty.

Munich. The city is also ubiquitous in the rooms of the clinic. This becomes clear when visiting the clinic. Everywhere there are images of sights in Munich, for example the silhouette of the Frauenkirche. In the floor of the room with paved pattern. At the end of the corridor is a May mast, surrounded by benches. "Viktualienmarkt", is on a sign on the wall.

"Many institutions for people with dementia are trying to adapt the design of their rooms to the patient environment," says Herzog. For example, in Weesp near Amsterdam, there is an entire village for people with dementia. This differs from an ordinary village especially by one point: it has a locked access door.

"At home, I have to be careful that my wife does not run away, sometimes she becomes almost too independent for me," laughs Wolfgang Lange. The day clinic also contains safety precautions. "Many patients want to move, but their orientation is severely impaired," says the head doctor, "they are often lost."

As a result, the clinic plan was deliberately designed so that no one could get lost. There is a long hallway, through the bright lamps, patients are routed optically several times to the entrance and the center of the establishment. "They are almost attracted," smiles Herzog.

Safety precautions are necessary

The design of the exit door is also special. From the inside, it is not recognizable as such, it is covered with an ivy leaf. "It's like that nobody cares around us carelessly," says Herzog. The windows can also be closed from the inside.

The Schön Klinik has a dementia treatment center for inpatients for over ten years. Over the years, Herzog has been trying to develop a dementia-based treatment concept.

The day clinic's work has changed his point of view: "The day clinic showed me one thing: a stationary treatment concept is bad with few exceptions." We strive to encourage patients to adopt a stationary concept – we literally run after them so that they do not run away.You have to give them drugs so that they fit into our everyday routine. patients, who do not seem to fit in any grid, in a classic medical corset, and it does not work. "

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In the day clinic, it was easier. In the bright and friendly rooms, patients have the impression of just visiting. However, they could keep their usual structures and their caregivers. Large icons on the toilet help the patient find their way around. The signs on the walls also illustrate the date and the season with colorful images.

Day clinic performs more than one hospital treatment

Herzog has seen many changes and improvements in his patients in recent months: "People who were aggressive at home beat their caregivers and ran away – sometimes they are transformed after two days. You benefit enormously from this offer. "

"Fortunately, my wife has never been aggressive," says Wolfgang Lange. "The problem is rather that she gives very little.I never know whether you like it or not.I asked her what her day was, so she does not know, her short-term memory is very bad." He looks at his wife next to him. She seems distracted, does not seem to notice that he is talking about her. Wolfgang Lange sighs. "Recently, I told him that I would soon buy a parrot from someone to talk to – it's just difficult."

To make life easier for parents, the day clinic offers consultation appointments. "The majority of parents are overwhelmed," says Herzog. "The information is difficult to access, if only sporadically in some places." Also on the Internet, research on this generation is usually not, which is why we are trying to look at the whole thing. life with our family council. "

Interviews and checklists allow family members to perform various tasks. In addition, the therapists observed the condition of the family members themselves. "Finally, they also need support."

"Life is just like that, I can not change it."

Everyday life has become boring. Wolfgang Lange reads a lot of newspapers, sometimes doing crosswords with his wife. "She can do it well, I'm always amazed at the quality of your long-term memory, she often writes something before I think about it."

In the past, they often went for long walks, he recalls. Today, they go around the block once. Wiltrud Lange often sits in a wheelchair, more than the lantern garden fence she usually does not handle.

"Life is like that, I can not change it, I just hope things will not get worse," Wolfgang Lange says. He taps again on his wife's thigh, encouraging him silently to drink. But Wiltrud Lange does not take his drink. She only smiles. Wolfgang Lange sighs.

The disease has struck out of nowhere. But the 79-year-old has worked for years in the insurance industry. He took precautions. "Whether it's care, a daily allowance or a very basic caring insurance, I've finished everything at that time.And even though many have smiled in the past – today, It's okay, financially I can handle everything and everything. "

Herzog smiled at him: "They were suddenly confronted with this new situation in life, and they just accepted, you're both a good example, they show us: with the right help, with the family and the professionals, you can always maintain your quality of life.And it is the purpose of our installation. "

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