Level of care for dementia

Dementia patients become more and more in need of care as the disease progresses. For the support of the patients as well as their relatives, a nursing care level can be applied for via the nursing care insurance funds. The degree of need for care is determined by employees of the local medical service and then evaluated in a system of levels.

The care levels 1-3 can be achieved. Many dementia patients can, when they are at the beginning of their illness, still require largely independent care but still need regular help with certain activities. The displeasure of many relatives about not reaching the first care level has led to the introduction of a care level 0.

Here, the nursing time required can be less than 90 minutes per day, which is a prerequisite for nursing level 1. A “limited everyday competence” is sufficient to achieve nursing level 0 and thus to receive approved financial support. If there is a suspicion that the currently approved level of care is no longer sufficient to meet the patient’s needs, a renewed review can be sought.

At care level 2, at least 3 hours and at care level 3 at least 5 hours per day must be devoted to the care of the patient. An important role is played by the amount of time spent on basic care, which includes physical hygiene, dressing, going to the toilet and eating. The financial support provided to the patients or their relatives can either be used to hire a nurse or to facilitate family internal care.

Therapy

From the often unfavourable prognosis of dementia it can already be seen that, on the whole, there are only quite unsatisfactory therapeutic approaches in dementia treatment. First of all, it must be noted that there is no drug that can treat or even cure the cause of dementia. The physician must therefore pay special attention to whether the dementia in question is one of the more treatable types (e.g. depression etc.).

Overall, the therapeutic approach is very complex. Especially in the early stages of dementia, herbal preparations can achieve an improvement of the symptoms. Ginkgo preparations are particularly suitable for improving brain performance.

Although the effect of ginkgo has been scientifically proven, the mechanism of action of ginkgo has not yet been clarified beyond doubt. Much more potent drugs can improve the symptoms of dementia. There are various drug-based approaches that have been shown to slow down the overall dementia development (so-called antidementia drugs).

Typical drugs here are: Memantine (e.g. Akatinol Memantine ®), Piracetam (e.g. Nootrop ®) Rivastigmine (e.g.

Exelon ®) Galantamine (e.g. Reminyl ®) In addition, numerous other drugs are used, depending on the accompanying symptoms. If additional hallucinations occur, ideally low-dose neuroleptics (e.g. Risperdal ®) are used. In the case of additional depressive symptoms, antidepressants are used.

Therapeutic care must be taken to ensure that some antidepressants can intensify the dementia symptoms. For this reason, the so-called SSRI or SSNRI should be used. Benzodiazepines (e.g. Valium) may be helpful in chronic agitation.

However, it should be noted that all benzodiazepines can have a paradoxical effect. This is a reversal of the desired effect. The medication does not have a dampening effect but a stimulating one.

In addition, benzodiazepines are addictive when used regularly. Weaker neuroleptics (e.g. Atosil, or dipiperone) are more suitable for the treatment of agitation. In addition to the drug approach, it is important to regularly encourage and challenge existing mental abilities.

Especially at the beginning of dementia, regular training can help to slow down the development. As the mental capacity progressively declines, the patients’ need for care and the demands on their relatives increase. Drugs can improve the symptoms of dementia considerably more potent.

There are various drug-based approaches that have been shown to slow down the overall dementia development (so-called antidementia drugs). Typical drugs here are: In addition, numerous other drugs are used, depending on the accompanying symptoms. If hallucinations occur in addition, ideally low-dose neuroleptics (e.g. Risperdal ®) are used.

In the case of additional depressive symptoms, antidepressants are used. Therapeutic care must be taken to ensure that some antidepressants can intensify the dementia symptoms. For this reason, the so-called SSRI or SSNRI should be used.

Benzodiazepines (e.g. Valium) may be helpful in chronic agitation. However, it should be noted that all benzodiazepines can have a paradoxical effect. This is a reversal of the desired effect.

The medication does not have a dampening effect but a stimulating one. In addition, benzodiazepines are addictive when used regularly. Weaker neuroleptics (e.g. Atosil, or dipiperone) are more suitable for the treatment of agitation.

In addition to the drug approach, it is important to regularly encourage and challenge existing mental abilities. Especially at the beginning of dementia, regular training can help to slow down the development. As the mental capacity progressively declines, the patients’ need for care and the demands on their relatives increase.

Memantine (e.g. Akatinol Memantine ®),
Piracetam (e.g. Nootrop ®)
Rivastigmine (e.g.

Exelon ®)

Galantamine (e.g. Reminyl ®)

Whether dementia will become curable depends on how one understands the question. Will it be possible to cure existing dementia? At this point in time, the answer to this question can be answered with relative certainty in the negative.

Can dementia be prevented from progressing? Or can the process be stopped in the early stages? In this case the question is not so easy to answer.

There are numerous forms of dementia. Depending on the cause of the dementia, appropriate treatment options must therefore be found. Alzheimer’s dementia in particular is the subject of intensive research.

Every person has a natural need for employment, this also applies to dementia patients. Activity protects against loneliness. In addition, still existing abilities can be trained.

This strengthens the patient’s self-confidence. It is important, however, that the patient is not overburdened by the occupation. Therefore, it should be decided individually how to employ the dementia patient.

In any case, it makes sense to consider the stage of dementia. In the early stages of dementia, memory training can still be fun, but if the dementia progresses further, the patient often feels insecure very quickly. It should also play a role in what the patient used to like to do.

Not every patient likes to do handicrafts, for example. In principle, hobbies such as painting, handicrafts or light manual work, including gardening, are well suited to keep dementia patients busy. This also applies to cooking or baking together.

However, one must be very careful that patients do not injure themselves on kitchen utensils. Movement is also beneficial for the patients. Regular accompanied walks are possible. In addition, familiar music is a good form of activity; this applies to listening to music or singing together. It is simply important to respond individually to the patient and his needs.