Compliance with CBT referral in nursing home residents diagnosed with depression: Results from a feasibility study.

Objectives: Patient-level factors that influence compliance with a recommendation for CBT in nursing home residents diagnosed with depression were identified. Methods: Within a cluster-randomized trial on stepped care for depression in nursing homes (DAVOS-study, Trial registration: DRKS00015686), participants received an intake interview administered by a licensed psychotherapist. If psychotherapy was required, patients were offered a referral for CBT. Sociodemographic characteristics, severity of depression, loneliness, physical health, antidepressant medication, prior experience with psychotherapy, and attitudes towards own aging were assessed. A binary regression determined predictors of compliance with referral. Results: Of 123 residents receiving an intake interview, 80 were recommended a CBT. Forty-seven patients (58.8 %) followed the recommendation. The binary logistic regression model on compliance with recommended CBT was significant, χ2(9) = 21.64, p = .010. Significant predictors were age (Odds Ratio (OR) = 0.9; 95 % Confidence Interval (CI) = 0.82, 0.99; p = .024) and depression (OR = 1.33; 95 % CI = 1.08, 1.65; p = .008). Conclusion: Within the implemented setting compliance rate was comparable to other age groups. Future interventions should include detailed psychoeducation on the benefits of psychotherapy on mild depressive symptoms in older age and evidence-based interventions to address the stigma of depression. Interventions such as reminiscence-based methods or problem-solving could be useful to increase compliance with referral, especially in very old patients (80+). Language barriers and a culturally sensitive approach should be considered when screening residents.

Effectiveness of exercise interventions to improve long-term outcomes in people living with mild cognitive impairment: a systematic review and meta-analysis.

Although exercise guidelines now recommend exercise for patients with MCI, the long-term effects of exercise in patients with MCI has not been reviewed systematically. The aim was to assess (1) the effectiveness of exercise and physical activity (EXPA) interventions in improving long-term patient-relevant cognitive and non-cognitive outcomes in people with mild cognitive impairment, (2) how well the included trials reported details of the intervention, and (3) the extent to which reported endpoints were in line with patient preferences that were assessed in patient workshops. Following PRISMA guidelines, we performed a systematic review and meta-analysis including randomized controlled trials. A total of ten studies were included after searching in six electronic sources from 1995 onwards. There is a trend that 6 + -month EXPA interventions improve global cognition 12 months after initiation. Evidence on long-term effects of EXPA interventions on non-cognitive health outcomes could not be meaningfully pooled and the individual studies reported mixed results. Workshop participants considered freedom from pain and stress, mood, motivation and self-efficacy to be important, but these outcomes were rarely addressed. Too little information is available on intervention details for EXPA programs to be replicated and confidently recommended for patients with MCI. PROSPERO registration in December, 2021 (CRD42021287166).

[Non-pharmacological Therapies of Dementia - an Update]. / Nicht pharmakologische Therapien bei Demenz.

Non-pharmacological Therapies of Dementia - an Update Abstract: Non-pharmacological interventions for people with dementia are intended to improve quality of life and well-being, alleviate psychopathological and behavioral symptoms, and also offer caregivers support and opportunities to promote resilience. Against the background of the multiple failures in the field of pharmacological-therapeutic research, these approaches have become increasingly important. This is an up-to-date overview of the most important non-drug interventions for people with dementia and related recommendations for therapeutic use according to the current state of research and the recommendations of AWMF S3 guideline "dementia". The most important interventions from this therapeutic spectrum are cognitive stimulation to maintain cognitive functioning, physical activation, and creative therapeutic offers to promote communication skills and social participation. In the meantime, access to these diverse psychosocial interventions has also been supplemented by digital technology. What these interventions have in common is that they are based on the individual cognitive and physical resources of those affected, improve quality of life and mood, and promote participation and self-efficacy. In addition to psychosocial interventions, nutrition-related approaches ("medical food") and non-invasive neurostimulation have recently also shown potential in the context of non-drug therapy for people with dementia.

[Non-pharmacological interventions for people with dementia]. / Nichtmedikamentöse Interventionen für Menschen mit Demenz.

BACKGROUND: Non-pharmacological interventions for people with dementia are intended to improve quality of life and well-being, alleviate psychopathological and behavioral symptoms, and also offer caregivers support and opportunities to promote resilience. Against the background of the multiple failures in the field of pharmacological-therapeutic research, these approaches have become increasingly important. OBJECTIVE: An up-to-date overview of the most important non-drug interventions for people with dementia and related recommendations for therapeutic use. MATERIAL AND METHODS: Narrative review taking into account the current state of research and the recommendations of the Working Group of (German) Scientific Medical Societies (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF) S3 guideline "Dementia". RESULTS AND CONCLUSIONS: The most important interventions from this therapeutic spectrum include cognitive stimulation to maintain cognitive functioning, physical activation and creative therapeutic activities to promote communication skills and social participation. In the meantime, access to these diverse psychosocial interventions has also been supplemented by digital technology. What these interventions have in common is that they are based on the individual cognitive and physical resources of those affected, improve quality of life and mood, and promote participation and self-efficacy. In addition to psychosocial interventions, nutrition-related approaches ("medical food") and non-invasive neurostimulation have recently also shown potential in the context of non-drug therapy for people with dementia.

Effectiveness of exercise and physical activity interventions to improve long-term patient-relevant cognitive and non-cognitive outcomes in people living with mild cognitive impairment: a protocol of a systematic review and meta-analysis.

INTRODUCTION: Mild cognitive impairment (MCI) is a clinical syndrome characterised by persistent cognitive deficits that do not yet fulfil the criteria of dementia. Delaying the onset of dementia using secondary preventive measures such as physical activity and exercise can be a safe way of reducing the risk of further cognitive decline and maintaining independence and improving quality of life. The aim is to systematically review the literature to assess the effectiveness of physical activity and exercise interventions to improve long-term patient-relevant cognitive and non-cognitive outcomes in people living with MCI, including meta-analyses if applicable. METHODS AND ANALYSIS: We will systematically search five electronic databases from 1995 onward to identify trials reporting on the effectiveness of physical activity and exercise interventions to improve long-term (12+ months) patient-relevant cognitive and non-cognitive outcomes in adults (50+ years) with MCI. Screening procedures, selection of eligible full-texts, data extraction and risk of bias assessment will be performed in dual-review mode. Additionally, the reporting quality of the exercise interventions will be assessed using the Consensus on Exercise Reporting Template. A quantitative synthesis will only be conducted if studies are homogeneous enough for effect sizes to be pooled. Where quantitative analysis is not applicable, data will be represented in a tabular form and synthesised narratively. People living with MCI will be involved in defining outcome measures most relevant to them in order to assess in how far randomised controlled trials report endpoints that matter to those concerned. ETHICS AND DISSEMINATION: Results will be disseminated to both scientific and lay audiences by creating a patient-friendly video abstract. This work will inform professionals in primary care about the effectiveness of physical activity and exercise interventions and support them to make evidence-based exercise recommendations for the secondary prevention of dementia in people living with MCI. No ethical approval required. PROSPERO REGISTRATION NUMBER: CRD42021287166.

General practitioners' communication on complementary and integrative medicine for cancer patients: Findings from an analysis of consultations with standardised patients.

OBJECTIVE: Our aim was to explore whether general practitioners (GPs) communicate with cancer patients on complementary and integrative medicine (CIM) in a patient-centred and case-specific manner. METHODS: We designed two cases of standardised breast cancer patients and allocated 29 GPs to hold a consultation either with Case 1 or Case 2. Case 1 presented with fears of possible physical side effects of hormone treatment. Case 2 feared a loss in social functioning because of nausea and emesis as possible side effects of chemotherapy. Consultations were audiotaped and analysed using the Roter Interaction Analysis System (RIAS). We analysed whether recommended CIM treatments and GPs' focus on psychosocial or medical and therapy-related content differed according to whether they were counselling Case 1 or Case 2. RESULTS: In consultations with Case 1, GPs rather focused on medical and therapy-related content and most often recommended mistletoe, diets and sports. In contrast, GPs focused on psychosocial content and they most often recommended methods of self-care when counselling Case 2. CONCLUSION: The GPs in our sample reacted case-specifically to the patients' interest in CIM. Such responsive and patient-centred communication is a valuable resource but is often time-consuming. Adequate training and reimbursement should therefore be considered for GPs.

[Non-pharmacological interventions in dementia: an overview with special consideration of digital offerings]. / Nichtpharmakologische Interventionen bei Demenz.

Non-pharmacological interventions such as cognitive therapy, physical activity, and creative art approaches are important components of appropriate care for persons with dementia and their relatives. Although relationships and interpersonal interactions undoubtedly play an important role in all these activities, digital technologies have increasingly established themselves in this area in recent years. The following article describes non-pharmacological interventions for people with dementia (based on the German AWMF S3 dementia guideline), and additionally provides examples of selected digital approaches for this particular target group. As the aim of the interventions is to support persons with dementia in living autonomously and maintaining societal and cultural participation, all the interventions share a consideration for individual resources and the promotion of available potential. Empirical evidence on digital activities remains scarce, so it is not yet possible to make clear recommendations. When using them, it should therefore be borne in mind that although they may represent a valuable supplement, they can never replace human attention. Furthermore, limitations in their practical application, such as unfamiliarity when using digital technologies or excessive demands of cognitively limited users, as well as important ethical aspects (e. g., data protections, personality rights, dignity and self-determination in old age) should not be ignored.

Depression in the nursing home: a cluster-randomized stepped-wedge study to probe the effectiveness of a novel case management approach to improve treatment (the DAVOS project).

BACKGROUND: Depression is the second most common psychiatric illness in old people. Up to 30% of nursing home residents have minor or major depression. Although depressive disorders in old age can be improved and even cured with adequate therapy, they often go unnoticed in nursing home residents and remain untreated. This highlights a striking deficit in health care and might result not only in lower quality of life among those concerned but also in poor physical functioning, premature mortality, and increased hospitalization rates. METHODS: The aims of the interdisciplinary research project DAVOS are to implement an innovative and stepped structural case management program to improve depression treatment for nursing home residents by a modularized intervention and to assess it in terms of its effectiveness. Intervention modules are in line with recommendations given by the German national treatment guidelines for depression (S3 guidelines). Ten nursing homes in Frankfurt, Germany, will participate in the project, which aims to recruit a study population of 380. The recruitment will continue throughout the trial (open cohort). Persons (>60 years) who live in a nursing home, have no medical diagnosis of dementia, and can provide their informed consent to participate are eligible for inclusion in the study. Residents with a clinical diagnosis of dementia, alcohol or substance-related disorders, or other serious psychiatric illnesses will be excluded. DAVOS is a controlled cluster-randomized study that employs a stepped-wedge design. DISCUSSION: Our main hypothesis is that the implementation of the intervention will lead to a decline in the prevalence of depression and a reduction in depression symptoms among the home residents. In addition, we expect the intervention to have a positive impact on secondary outcomes such as level of functioning, quality of life, and social participation. The project's results can make an important contribution toward improving the health care of nursing home residents who have late-life depression. TRIAL REGISTRATION: DRKS, DRKS00015686 , Oct. 10, 2018.

Art museum-based intervention to promote emotional well-being and improve quality of life in people with dementia: The ARTEMIS project.

ARTEMIS (ART Encounters: Museum Intervention Study) is an art-based intervention designed especially for people with dementia and their care partners that involves a combination of museum visits and artistic activity. This paper reports the results of a randomized wait-list controlled study on the influence of the ARTEMIS intervention on the emotional state, well-being, and quality of life of dementia patients. People with mild-to-moderate dementia (n = 44) and their care partners (n = 44) visited the Frankfurt Städel Museum once a week on six pre-arranged occasions. The intervention consisted of six different guided art tours (60 minutes), followed by art-making in the studio (60 minutes). Independent museum visits served as a control condition. A mixed-methods design was used to assess several outcomes including cognitive status, emotional well-being, self-rated aspects of quality of life, and subjective evaluations by informal caregivers. In a pre-post-assessment, we found significant improvements in participants' self-rated quality of life (t = -3.15, p < .05). In a situational assessment of emotional well-being immediately before and after each of the museum sessions, we were able to demonstrate statistically significant positive changes with medium effect sizes (dcorr = .74-.77). Furthermore, the total Neuropsychiatric Inventory score as well as the affective (depressed mood and anxiety) and apathy subscales were significantly lower after the ARTEMIS intervention (tNPI total = 2.43; tNPI affective = 2.24; tNPI apathy = 2.52; p < .05). The results show that art museum-based art interventions are able to improve the subjective well-being, mood, and quality of life in people with dementia. This promising psychosocial approach deserves further attention in future studies and consideration in community-based dementia care programs.

Colorectal cancer stage at diagnosis in migrants versus non-migrants (KoMigra): study protocol of a cross-sectional study in Germany.

BACKGROUND: In Germany, about 20% of the total population have a migration background. Differences exist between migrants and non-migrants in terms of health care access and utilisation. Colorectal cancer is the second most common malignant tumour in Germany, and incidence, staging and survival chances depend, amongst other things, on ethnicity and lifestyle. The current study investigates whether stage at diagnosis differs between migrants and non-migrants with colorectal cancer in an area of high migration and attempts to identify factors that can explain any differences. METHODS/DESIGN: Data on tumour and migration status will be collected for 1,200 consecutive patients that have received a new, histologically verified diagnosis of colorectal cancer in a high migration area in Germany in the previous three months. The recruitment process is expected to take 16 months and will include gastroenterological private practices and certified centres for intestinal diseases. Descriptive and analytical analysis will be performed: the distribution of variables for migrants versus non-migrants and participants versus non-participants will be analysed using appropriate χ2-, t-, F- or Wilcoxon tests. Multivariable, logistic regression models will be performed, with the dependent variable being the dichotomized stage of the tumour (UICC stage I versus more advanced than UICC stage I). Odds ratios and associated 95%-confidence intervals will be calculated. Furthermore, ordered logistic regression models will be estimated, with the exact stage of the tumour at diagnosis as the dependent variable. Predictors used in the ordered logistic regression will be patient characteristics that are specific to migrants as well as patient characteristics that are not. Interaction models will be estimated in order to investigate whether the effects of patient characteristics on stage of tumour at the time of the initial diagnosis is different in migrants, compared to non-migrants. DISCUSSION: An association of migration status or other socioeconomic variables with stage at diagnosis of colorectal cancer would be an important finding with respect to equal health care access among migrants. It would point to access barriers or different symptom appraisal and, in the long term, could contribute to the development of new health care concepts for migrants. TRIAL REGISTRATION: German Clinical Trials Register DRKS00005056.