New faces, strange waiting rooms, fear of pain – for people with dementia, visits to the doctor often mean a lot of stress. Anja Kälin from Desideria Care explains how to overcome the difficulties.
In Germany, 1.8 million people live with dementia. Relatives of patients with dementia often report that a visit to the dentist can be very challenging, says Anja Kälin, systemic coach and family therapy consultant at Desideria Care. "This is because communication with a patient can be more difficult depending on the phase of the disease and, of course, there are also fears and uncertainties, for example because the patient can no longer understand the need for treatment."
Only a few dentists are specially equipped for the treatment of dementia
Such situations confuse, overwhelm and lead to unnecessary stress for everyone involved. That's why Anja Kälin and her colleagues at Desideria Care demand: "There is an urgent need for more dementia-sensitive dental practices that are also easy to find if necessary." We report on the hospital of the Ludwig-Maximilians-University here (text below) – but of course there are capacity limits here. Furthermore, there are a few doctors in private practice, such as Vapula Haukongo in Munich, who specialize in patients with disabilities.
Accompanying persons should be open about the diagnosis of dementia
"Until now, it has often been an odyssey to find a dentist who is well prepared for the special needs of people with dementia," says Anja Kälin. In addition to patience during treatment, she would like to see good information from the doctors, especially in advance. But the relatives or accompanying persons are also in demand: "It takes the willingness and awareness of the accompanying person to deal openly with the dementia diagnosis and to let the doctor's office in on the problem so that it can adapt to the situation." After all, dealing with dementia is challenging - for everyone involved.
+Anja Kälin is a coach at the Desideria Care association, which takes care of the relatives of dementia patients in particular. As the daughter of a mother suffering from dementia, she is particularly interested in strengthening family resources and potential.
© Desideria Care
The emergency plan when a dementia patient needs to go to a clinic
Inpatient admission to a hospital, whether planned or unplanned, is also a challenge for a person with dementia, says Anja Kälin. On the one hand, the illness challenged him both physically and mentally. At the same time, he has to adapt to the unfamiliar environment, to be able to remember and learn new things. "Patients are plagued by questions like: Why am I here? How did I get here? What are the names of the people I meet? Where is my room and how do I find my way back to my bed?" explains the expert. She advises to weigh up the benefits and risks of treatment in hospital with the referring doctor in advance when planning treatment. In addition, it is good to look for a dementia-sensitive hospital in the region. Dementia-sensitive hospitals, for example, have adapted information systems for better orientation, clinic companions for individual support and involve relatives in care right from the start.
Prepare a bag with clothes and important documents in case of an emergency
Acute situations in which people with dementia unexpectedly come to the emergency room are a particular challenge. "Basically, it is good to be prepared for such emergencies and always have a bag ready with clothing, living wills, power of attorney, medication plan and a list of important contacts and caregivers," advises Anja Kälin.
Sometimes an alarm clock and picture manage to alleviate the tension
Sometimes relatives and relatives cannot travel with the ambulance. Relatives can take countermeasures here – by openly reporting on the patient's change in dementia. In any case, a familiar person has a positive effect on the condition of people with dementia and thus facilitates care. Even in hospitals, it is recommended that patients are accompanied by people they trust and that they have personal things with them that give them support, such as a picture of the family, an alarm clock, their favorite pillow or the like.
+Going to the dentist with dementia: This is how it works.
© dpa/Benjamin Nolte
The dental practice with time and heart: Visit to the special outpatient clinic of the LMU Dental Clinic in Munich for people with disabilities, dementia or Parkinson's disease
"Normal dentists often don't have patience," says patient Falk S. It hurts him when he is asked, for example, why he twitches and has difficulty opening his mouth. Falk S. has been restricted since birth, he suffers from infantile cerebral palsy, i.e. a permanent disorder of the postural and musculoskeletal system. However, the 39-year-old gets along well, for example, has been working for 17 years at the Goretex company in Putzbrunn and, thanks to his wheelchair, can also go to doctors on his own. It's just that everything takes a little longer for him – and unfortunately he has often felt that some people don't want to take this extra time. He is all the happier that he has found a place in Munich that is perfect for him.
A practice in which the law "time is money" seems to have been repealed: the special outpatient clinic for people with special support needs at the dental clinic of the Ludwig-Maximilians-Universität (LMU) in Goethestraße. "We treat patients with disabilities here and are specially equipped for this purpose," explains head Dr. Marc Auerbacher. He is a senior physician and certified specialist in senior dentistry of the German Society of Dentistry. "Our department is unique in the German state university landscape," says Dr. Auerbacher. The institution was founded in 2012 on the initiative of the director of the dental clinic, Prof. Reinhard Hickel, who has now been awarded the Order of Merit of the Federal Republic of Germany, among other things.
In the 250-square-meter practice, there are extra-large treatment rooms and sanitary facilities that are also easy to access with wheelchairs. In addition, there is a special chair for 30,000 euros, in which patients in a heavy electric wheelchair can also be treated without having to leave the wheelchair. And one thing is missing that otherwise seems to be omnipresent: time pressure. "The treatment of people with severe disabilities is time-consuming and personnel-intensive. Young dentists who have to pay practice rents often cannot afford this effort. This is because in the case of people with statutory health insurance with special treatment needs, this expense is not adequately covered financially," says Dr. Auerbacher. However, he cannot treat countless patients in his small area – new patients in particular would therefore have to expect waiting times for appointments. Dr. Auerbacher hopes that the special department of the dental clinic will set a precedent. He worked as an occupational therapist before studying dentistry and can therefore respond particularly to people with disabilities. He also passes on his knowledge to students, with whom he visits patients weekly at the Day Clinic for Geriatrics in Ziemssenstraße. After all, in order to treat patients with disabilities, special knowledge is required.
Parkinson's disease, for example, is often associated with swallowing disorders. People with dementia often do not understand what is required of them and, for example, do not want to open their mouths. "You need a lot of patience and empathy here," says Dr. Auerbacher. For people with intellectual disabilities, fear is often one of the biggest barriers. "It's about building trust, preferably with a constant and empathetic team."
It is important for Dr. Auerbacher and his team to avoid that these people are treated too often under general anesthesia for dental treatment. Many studies have shown that anesthesia is not necessarily beneficial, especially for dementia patients.
This article contains only general information on the respective health topic and is therefore not intended for self-diagnosis, treatment or medication. It is in no way a substitute for a visit to the doctor. Unfortunately, individual questions about clinical pictures may not be answered by our editors.