She explained that the patient had dementia or Alzheimer’s, and she felt uncomfortable treating them. I decided to educate her about caring for patients with Alzheimer’s.
Once again I’m unable to sleep due to worry. Just two days ago my father had a psychotic episode and hit my fragile, cancer-stricken mother. I look at the shell of a man he has become, yet I remember my loving father - a quiet, gentle, caring man. He had gifted hands. As a young man, he made guitars from scratch and was a woodworker. On the weekends he played the Spanish guitar in his band. Those days are a distant memory. He now has Alzheimer’s disease. I miss the routine when he visited for coffee and helped me with my garden. This summer I had no garden. I am mourning him while he is still alive.
For months I have toyed with the idea of writing an article for RDH. I wanted to write about something I’m passionate about, something very close to my heart. My father came to mind. Several months ago, I took a part-time position with a general dentist in Coram, Long Island. During my first week I saw several patients with Alzheimer’s. With every patient, I took a deep breath and thought of my father. After each patient, I missed the man my father had been even more. At the end of the day, I wiped my tears in private and was grateful that I was the hygienist caring for these patients.
I consider my years in geriatric training in nursing homes during the early 1980s a gift. I worked with a young dentist named Dr. Martin Cukier, who had the vision to provide dental care in nursing homes. He started a business out of his house. I went to five nursing homes a week with a dentist and mobile dental unit to provide service to residents. Dr. Cukier later bought Mobile Health, now Dentserv. After four years I became attached to my patients and found it difficult to leave them, but it was time for me to move on.
Now here I am 21 years later, working with another hygienist who said, “That patient has checked out.”
“What?” I replied. “I don’t understand what you’re talking about?”
She explained that the patient had dementia or Alzheimer’s, and she felt uncomfortable treating them. I decided to educate her about caring for patients with Alzheimer’s. My suggestions are in the related sidebar.
Take a deep breath and appreciate your day-to-day life with your loved ones before they become just memories.
For more information on Alzheimer’s disease, go to the following Web sites: http://www.alz.org/login.htm or http://alzfdn.org. RDH
Author’s suggestions for caring for patients with Alzheimer’s disease
■Medical history - Call the caregiver two weeks in advance and request an updated list of medical treatment, diagnoses, and medication. Mail the caregiver a new medical history form. While two weeks may seem far in advance to you, for the caregiver it is short because he/she is busy providing round-the-clock care. Find out as much as you can about the patient’s interests and past.
■Introduction - When they arrive at the dental office, step into the reception room, introduce yourself, shake hands and escort both caregiver and patient to the operatory. Do not reprimand them if they are a few minutes late. They may have needed to be driven by a third person or a service. Be kind. You are a stranger to them. Would you hand over your loved one to a stranger? I hope not.
■Seating - Ask the patient to take your hand or elbow when guiding them to the chair. Be gentle and speak softly and slowly. They may have dementia but they aren’t deaf.
■Attention span - These patients are like three year olds with short attention spans. Schedule a one-hour appointment slot to allow for the extra time in seating and handling.
■Treatment - Keep everything as simple as possible. Limit actual treatment time to 30 minutes. Do not fully recline patients because they sometimes feel as if they are falling or out of control. Do not use the ultrasonic scaler. The water flow may overwhelm them, and too much activity will confuse them.
Before picking up a scaler, take a deep breath and slow down. Be gentle and do the best you can. Treat every patient like a family member.
Keep the door closed to limit outside noise and interruptions. Try talking about their hobbies, sports, pets, and family. Do not leave the patient unattended. If you must leave the room, have someone replace you.
■Home care instructions - These depend on the stage of Alzheimer’s. I usually recommend an electric toothbrush with two heads. Both caregiver and patient need to be educated, so demonstrate in both their mouths, and give both of them home care items.
Do the dentures have the patient’s name or ID number? Alzheimer’s patients have a tendency to lose things. Most dental labs can ID dentures within 24 hours. Demonstrate denture maintenance. Give short and to the point written instructions.
■Dismissal - Escort both the patient and caregiver to the reception area. Repeat both their names, shake their hands, and say goodbye.