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"Patients Transform After Two Days": A Visit to a Daily Dementia Clinic

She is supported and assisted in a daily clinic for neurological disease by dementia and relatives. The combination of neurological examinations and therapies is unique in Germany. There, patients regain quality of life. VIP News looked at the device.

Wiltrud Lange, 78, has been suffering from dementia for three years. Bleeding in her brain caused her stroke in 2016. In the months that followed, it quickly became clear that your mental capacity was constantly diminishing. Following the rehab 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 in a day clinic for a neurologist.

Day Hospital for Dementia in Munich Schwabing

The Daily Clinic has set itself the goal of providing individually tailored assistance to patients and relatives. They should deal with dementia better. At Schwabing, neurologists, neuropsychologists, therapists, and specially trained nurses work together with experts from the neighboring Schön Clinic Munich Schwabing. Dementia patients have been treated for many years at this specialist neurological clinic.

Three days a week Wolfgang Lange accompanied his wife to the institution at nine o'clock in the morning, and at 4 o'clock he picked her up again. From January to March 2019, she was a patient at the clinic. Her memory had diminished before the visit, as had her drive. There were times when she was very apathetic. But thanks to activating therapies and medical treatment, he feels better now.

Today, about three months later, she is only visiting the clinic. He sits in one of the bright treatment rooms with his wife and head doctor Jürgen Herzog. On the wall hangs a picture of a meadow of green flowers. It's a hot day, with a chair of water and a few glasses on the table.

Unique concept in Germany

The neurologist's daily clinic is unique in its kind. There are several daily clinics, each with its own specialization. But the treatment of dementia patients in Germany is mostly in the hands of psychiatrists. Behavioral problems often occur in the late stages of the disease: delusions, hallucinations – typical psychiatric symptoms.

"Dementia is a brain disease," explains Jürgen Herzog. He heads the neurology department as chief medical officer. "Many neurological aspects are revealed during the illness. Epileptic seizures, gait disorders, incontinence – these symptoms require a neurologist."

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

"Such patients often fall into the supply hole." So Herzog and his team decided to design a daily clinic for neurological disease. In November 2018, it was possible for the institution to receive its first patient.

Exciting, but no time?

Alzheimer's society fears a strong rise in dementia

Dementia is one of the most common and consequence of neuropsychiatric disorders in old age. In Germany, 1.7 million people currently suffer from this impairment of intellectual ability.

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

Signs of dementia are to forget recent events. Patients have difficulty performing normal activities and suffer from speech disorders. They often lose track of their financial affairs, exhibiting previously unknown mood swings, anxiety, irritability or distrust. Mistakes, mistakes, or confusions they negate.

Wiltrud Lange suffered from a stroke in addition to oblivion, even under severe difficulty in walking and balance. In individual and group therapies, doctors and nurses helped her regain her gait and balance.

Regular daily structure gives the patient orientation

Therapies and examinations are integrated into a recurring daily structure. Individual sections always take place in hourly blocks. "Patients can be sure that appointments are taking place at the same time. This is very important. It gives them stability and stability, they get used to that rhythm."

In the next room sits a sitting, older man with a nurse. He seems focused, leaning over the puzzle. "This is what a therapy session might look like," Herzog explains. "Which are the neighboring countries of France?" The nurse asks. The man hesitates and then says, “Italy? And Germany.” Long-term memory works well in many patients, but short-term memory does not.

The clinic also has a small kitchen. There the patient prepares a fruit salad. “What are you cutting?” Herzog asks. "Ehm, apples," he replies. Herzog smiled, "And for what?" The patient then pauses. She looks around. "I don't know. What are we going to cook again?"

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

Often, many tasks would take away patients in their home environment. "It's easier, more practical or faster. That's why we think it's important to challenge those who are affected," Herzog explains.

Wiltrud Lange advanced

"It did my wife good," Wolfgang Lange says. "Therapeutic measures, group and individual therapy. Of course I cannot say that after the stay everything was ok again. But it has made progress in many areas. "She hopes her condition will no longer worsen.

"If it remains as it is, then I am satisfied," he says, looking at his wife. He touches her thigh, looking at her reassuringly. "Do you drink something, please? It's very hot." Wiltrud Lange nodded, taking a small sip from the glass of water on the table in front of her.

Patients with clear evidence of dementia and an acute or urgent problem arrive at the clinic. For individuals who are legally and privately insured, the day care clinic acts as an antiviral treatment. Those affected receive treatment, regular check-ups and treatment.

It's just that they don't spend the night in the hospital but can sleep at home. Their jackets hang patients in closets in the morning. Turtle, elephant, kangaroo – to distinguish cabinets, animal motifs are attached.

"My wife and I live very close together, here in Schwabing," explains Wolfgang Lange. "We were very fortunate that she first got a place here in rehab and then a day clinic. And it wasn't that easy!" Due to administrative and billing issues, he had to fight for this place.

Relatives for relatives

"It would be nonsense if she was sent elsewhere. So I came here every day during rehab. We went to the park and went back for dinner. Then she got a place at a local day clinic – something better couldn't have happened to us."

Clinic means great relief for relatives. You can put the responsibility in the hands of the therapist and the doctor for a while. "I suddenly managed to take care of myself," recalls Wolfgang Lange. "That constant pressure just knocked me down."

In a normal daily routine, he has a 24-hour program: "I always have to be careful about getting up or going somewhere. I always have to control and control, I am always on duty. I have to see if everything is okay. Besides, I have to take care of the household." He laughs. "I'm in the front, I'm the frontman."

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

"I used to be a teacher." Wiltrud Lange was no longer absent. "On social college," he says quietly. "Yes, exactly," her husband comes to her aid. "To remain a teacher in Upper Bavaria, you only had to be married. We did this quickly before she handed in her papers."

When she talks about her past, Wiltrud Lange remembers

Wiltrud Lange was initially moved to a small village near Mühldorf am Inn. There she taught students from the surrounding farms. She smiles as she hears her husband talk about her past. He seems to know exactly what he is talking about. Things seem to be recognizing again. Her eyes are clearer, she nods. Students. A small oil stove in her room. A cabinet that was only three feet tall.

"Of course, I was always trying to get her to Munich," Wolfgang Lange explains. "I was with government officials. I told them how lonely they were." His efforts proved successful, Wiltrud Lange was allowed to return.

"My wife is a Münchner, a Schwabingerin. The worst part for them would be to move to another place in the long run. After all, she was born and raised here." Munich means home to her. As for the other patients of the day clinic.

The city of Munich connects patients

"The place of residence of Munich plays a big role for our patients. The city where they live and sometimes have always lived, brings them together. Munich is the anchor of the conversation for everyone who is here," explains Jürgen Herzog. Many patients have similar biographies, often only the details are different.

They come from Munich, remember what they did earlier. "Carers assistants moderated such discussions but were able to gradually withdraw. "Communication and interaction occur between patients," Herzog says.

Memories of age are often still intact

He calls it "therapeutic biographical work." Because the memory of many dementia patients is still intact, it would be easier to start a conversation about their CVs. "This requires a degree of openness – but for many older people, their past is a common denominator." He looked at Wiltrud Lange. She smiles uncertainly.

Munich. The city is also ubiquitous in clinic rooms. This becomes clear during the clinic tour. Everywhere there are pictures of sights in Munich, for example the silhouette of Frauenkirche. In the hallway floor with a cobblestone motif. At the end of the hall is a maypole, around it benches. "Viktualienmarkt," stands on a street sign on the wall.

"Many dementia facilities are trying to adapt the design of their rooms to the patient's environment," explains Herzog. For example, in Weesp, near Amsterdam, there is a whole village for people with dementia. This is different from an ordinary village, especially at one point: it has a locked access door.

"At home, I have to be careful that my wife doesn't run away. Sometimes, she almost becomes too independent for me," laughs Wolfgang Lange. There are also safety precautions in the day clinic. "Many patients have an urge to move, but are severely impaired in their orientation," says the head doctor, "they often get lost."

Therefore, the plan of the clinic was thoughtfully designed so that no one could be lost. It is a long hallway, through bright lights patients are again and again optically directed to the entrance and center of the facility. "They are almost attracted to them," Herzog smiled.

Safety precautions are required

Exit door design is also special. It is not recognizable from the inside, it is covered with ivy-covered foil. "It's the way no one carelessly spins around us," Herzog explains. The windows can also be closed from the inside.

Schön Klinik has had a hospital dementia center for over ten years. Over the years, Herzog has tried to develop the concept of dementia-based treatment.

A job at a day clinic changed his outlook: "The day clinic showed me one thing: The concept of inpatient care is bad with a few exceptions. We try to push patients into the inpatient concept. We literally run after them so they don't run away. You have to give them medicines so to fit into our classic daily routine. We're trying to force patients, who don't seem to fit into any network, into a classic medical corset. And that just doesn't work. "

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In a day clinic this was easier. In bright, friendly rooms, patients feel they are just visiting. However, they were able to retain their usual structures and caregivers. Big icons on the toilet help the patient find themselves. Signs on the walls also illustrate the date and season with colorful paintings.

The daily clinic achieves more than one hospital treatment

Herzog has noticed many changes and improvements to his patients in the last few months: "People who have been aggressive at home, beating caregivers and running away – sometimes transformed after two days. You have an immense benefit from this offer."

"Fortunately, my wife has never been aggressive," says Wolfgang Lange. "The problem is that she gives very little. I never know if you like her or not. If I ask her what her day was like, then she doesn't know, short-term memory is just really bad." She seems absent, does not seem to notice that he is talking about her. Wolfgang Lange sighed. "I told her recently that I was going to buy a parrot soon for someone to talk to. It's just hard."

To make life easier for relatives, the day clinic offers counseling sessions. "Most relatives are dissatisfied," Herzog explains. "This information is difficult to access, even sporadically in certain places. Also on the Internet, these generations are usually not. That's why with family counseling we try to look at the whole life situation."

Conversations and checklists allow relatives to play through different tasks. In addition, the therapists also observed the condition of the relatives themselves: "Finally, they need support."

"Life is like that, I can't change it."

Everyday life became boring. Wolfgang Lange reads a lot of newspapers, sometimes doing crossword puzzles with his wife. "She can do it well. It always amazes me how good your long-term memory is. She often writes something before I think about it."

In the past, they often went for long walks, he remembers. Today they visit the block once. Wiltrud Lange often sits in a wheelchair, more than from a garden fence to a lantern he usually does not operate.

"Life is like that, I can't change it. I can only hope things don't get worse," Wolfgang Lange explains. He taps his wife's thigh again, quietly urging her to drink. But Wiltrud Lange doesn't take her glass. She just smiles. Wolfgang Lange sighed.

The disease hit him from nowhere. But the 79-year-old has worked in the insurance industry for years. He took precautions. "Whether it's worry, daycare or very basic insurance, that's all I'm done with. Even if many have laughed at me in the past – I'm fine today. Financially, I can handle everything."

Herzog smiled at him. “So suddenly they were faced with this new life situation. And they just accepted it. You are both a great and successful example. They show us: With the right help, you can still maintain your quality of life with your relatives and professionals. And that is the goal of our facility. "

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