Nationwide unique institution for patients with cognitive impairment or dementia
28.10.2013
In Germany, approximately 1.3 million people currently suffer from dementia. About 250,000 incident cases are estimated per year. Dementia is the leading cause of dependency and disability among older persons. The disease impacts on patients and their caregivers and families medically, psychologically, and emotionally. Acute or chronic co-morbidities like infections or fractures after falls are frequent, challenging causes of hospitalization. To attend the special needs of these patients, their families as well as of the University Medicine care system, the Medical Center of Johannes Gutenberg University Mainz (JGU) offers a special and nationwide unique range of services. Under the motto "Supervision, Guidance, and Service," specially trained employees give afflicted patients individual on-site care such as personal escort services or alike. The service catalog of the new Dementia Service Center also includes specific training of medical staff and advising for caregivers. The Dementia Service Center is currently a pilot project. A total of ten model wards from five different specialized clinics and treatment centers of Mainz University Medical Center are involved.
In addition to the existential significance of the fate of the development of dementia, the illness presents many challenges to the afflicted and their social environment. Outpatient and inpatient medical care systems as well as society as a whole are faced with special challenges in this respect. With the goal of improving nursing and health care quality through a wide range of services for patients with dementia, Mainz University Medical Center has established the Dementia Service Center as a pilot project supervised by the President of the Nursing Board. It provides patients who suffer from memory loss and disorientation with a personal escort service for examinations within the clinic and supports patients and their families in the organizational matters of their hospital stay. In addition, patients should receive the best possible support so that they are able to actively participate in their own healing process. Another key mission is to develop new approaches for the treatment, supervision, and support of cognitively impaired patients and to communicate them to all involved employees of Mainz University Medical Center, for example, through targeted training.
With the growing number of elderly patients, Mainz University Medical Center is experiencing a proportionate influx of patients who are afflicted with cognitive impairment all the way through to dementia. For people afflicted with dementia, a stay in a hospital can be an unsettling and frightening experience due to the foreign environment, unfamiliar people around, and unusual procedures and requirements, to which patients frequently react with restlessness, defensiveness, or other challenging behaviors. From the perspective of the caregivers, the Dementia Service Center and its work are advantageous, because knowledge of the specific situation of the patients has already proven to be helpful for all of those involved. When employees recognize early on and know how to professionally handle relevant cognitive impairment, they are much more capable of mastering complex work situations. "Hospital nursing care for patients with dementia is extremely demanding of all employees. The range of services of the Dementia Service Center is intended to be a support system. It is important to us that the patients and caregivers receive direct and immediate assistance," emphasized Evelyn Möhlenkamp, President of the Nursing Board at Mainz University Medical Center.
Professor Andreas Fellgiebel, Chief Physician and Director of Dementia Research and Dementia Medical Care at the Clinic for Psychiatry and Psychotherapy of the Mainz University Medical Center, explained: "With our service center, we also seek to raise awareness for the problem of dementia in the hospital and to reduce the still existing stigma associated with dementia in medicine as well as in society."
According to conservative estimates, at least twelve percent of older patients in inpatient hospital care are affected by dementia. In accordance with referral diagnoses, however, the hospital stay is generally the result of other physical illnesses and not the dementia itself. "Frequently, problems and impairments resulting from dementia were already apparent before the patient's hospital stay, although the dementia was not formally diagnosed. In the case of previously diagnosed dementia, the dementia diagnosis often goes unreported during inpatient intake. Both cases clearly have something to do with the stigmatization of the disease, which still predominates. We are then confronted with the problem that the additional need for support of the patient is underestimated from the very start of inpatient treatment. This in turn leads to excessive demands on both the patient and the treatment team. Nurses and doctors reach their limits faster and time input and costs increase", added Fellgiebel.
The Dementia Service Center is a pilot project, in which ten wards from five different clinics and departments of Mainz University Medical Center are participating. This currently includes the Department of Ophthalmology, the Department of Neurology, the Department of Orthopedics and Trauma Surgery, the Department of Urology, and the Department of Internal Medicine I of the Mainz University Medical Center. The procedure of the pilot project intends for all patients 70 years and older to be asked to participate in a short test procedure at one of the participating wards upon intake.
Eva Quack, Director of the Dementia Service Center, said: "First experiences show quite clearly that the supporting services of the center disburden both patients and caregivers at the model wards. For patients, the opportunity to have an additional reference person on their side during their hospital stay and therefore more attention is a positive aspect. Altogether, we recognize that with the support offered by the Dementia Service Center, we are closing a gap in the patient care process."
The Dementia Service Center will be initially operated for two years and is funded by the Rhineland-Palatinate Ministry for Social Affairs, Labor, Health, and Demographics with a total of EUR 53,000. The project will be scientifically evaluated through corresponding concomitant research. If the pilot project receives a positive evaluation, the services of the Dementia Service Center are to be expanded to the entire Mainz University Medical Center.
Dementia is a general term for a number of neurodegenerative illnesses. Normal symptoms of old age do not necessarily have to lead to dementia as an irreversible fate. Dementia is understood as a condition of ongoing and frequently also progressing mental deficiency that leads to a significant impairment of independent lifestyle in old age. The risk of dementia increases significantly with increasing life expectancy. Only two percent of seniors age 60 to 65 have dementia, whereas the chance of being afflicted with dementia increases to 20 percent after 80 years. The risk of dementia in the last year of life currently affects 30 percent of the population.