Innovative Non-Pharmacological Management of Delirium in Persons with Dementia: New Frontiers for Physiotherapy and Occupational Therapy?

BACKGROUND: Delirium and dementia are two of the most common geriatric syndromes, which requires innovative rehabilitation approaches. AIM: We aimed at determining which occupational therapy and physiotherapy interventions are applied with older people with delirium and dementia in different care settings. We also identified the assessment tools that were used. MATERIALS AND METHODS: We conducted a literature search for scientific articles published from 2012 to 2022 (PubMed, MEDLINE, AMED and CINAHL) with adults aged >65 years including experimental study designs with randomized or non-randomized intervention, exploratory studies, pilot studies, quasi-experimental studies, case series and/or clinical cases. Studies that did not use interventions that could be classified as occupational therapy or physiotherapy were excluded. RESULTS: After applying the exclusion criteria, 9 articles were selected. The most widely used assessment to define dementia was the MMSE (N = 5; 55.5%), whereas the CAM (N = 2; 22.2%), CAM-ICU (N = 2; 22.2%) and RASS (N = 3; 33.3%) were the most widely used to define delirium. The rehabilitation interventions that were most frequently performed were early mobilization, inclusion of the caregiver during treatment, modification of the environment to encourage orientation and autonomy, the interprofessional systemic approach and engaging persons in meaningful activities. CONCLUSIONS: Despite the growing evidence on its effectiveness, the role of physiotherapy and occupational therapy interventions in the prevention and treatment of people with dementia and delirium is still emerging. More research is needed to investigate if effective occupational therapy programs known to reduce the behavioral and psychological symptoms in people with dementia are also useful for treating delirium and specifically delirium superimposed on dementia. Regarding physiotherapy, it is crucial to know about the amount and timing of intervention required. Further studies are needed including older adults with delirium superimposed on dementia to define the role of the interprofessional geriatric rehabilitation team.

COVID-19 and Everyday ICT Use: The Discursive Construction of Old Age in German Media.

BACKGROUND AND OBJECTIVES: Media discourses have the power to construct and perpetuate positive and negative aging images and influence public and individuals' attitudes. This study aims to critically examine the media portrayal of older persons' everyday information and communication technology (EICT) usage during the first and second waves of the coronavirus disease 2019 pandemic. RESEARCH DESIGN AND METHODS: A total of 51 articles published in 3 leading German newspapers between March 2020 and November 2020 were identified from the LexisNexis Academic database. Data were analyzed employing critical discourse and thematic analysis. RESULTS: EICT use was associated with youthful, consumption-orientated, and active lifestyles, while nonuse was constructed as failures on the policy or individual level. The pandemic seemed to have acted as an amplifier, further exacerbating and perpetuating stereotypical, dichotomous, but also empowering aging images. DISCUSSION AND IMPLICATIONS: Neoliberal rational and binary distinctions of active users and nonusers opened and encouraged critical discussions on positive aging trends, the concept of the third and fourth ages, and aging-and-innovation discourses. Moreover, the crucial educative role of the media in raising awareness about power imbalances and reducing EICT-related ageism is stressed.

The applicability and feasibility of occupational therapy in delirium care.

PURPOSE: To perform a narrative review of studies on the applicability and feasibility of occupational therapy in persons with delirium by analyzing evaluation and procedural methods in the therapeutic settings. METHODS: Starting from the international classification of disability, the focus was to understand if and how occupational therapy as a multi-component intervention can reduce the duration and intensity of delirium to prevent future disabilities. This review also includes scientific studies demonstrating the benefits of occupational therapy in terms of increased functional and occupational outcomes. Finally, the evaluation modalities and the therapeutic procedures performed by the occupational therapist have been analyzed. RESULTS: The non-pharmacological treatments occupational therapists perform in people with delirium in intensive care settings are supported by scientific evidence. CONCLUSIONS: There is preliminary evidence of the benefit of including occupational therapy in early stages of rehabilitation in acute care to prevent and treat delirium. Nevertheless, further studies are necessary to define the different aspects of the multidisciplinary approach that is common in geriatric practice, primarily determining the adequate timing, and intensity of interventions as well as its appropriate settings.

Developing dementia-friendly pharmacies in Austria: a health promotion approach.

The need for integrated, accessible and person-centred care for people with dementia to foster quality of life and facilitate life in the community has been voiced by health policy. Pharmacies have the potential to provide easily accessible information and support for people with dementia, caregivers and the public. The 'Dementia-friendly Pharmacy' programme aimed at re-orienting community pharmacy in Austria, focusing on stronger inclusion of professional counselling into core services. It followed principles of health promotion and person-centred care, aiming at empowering all actors involved, and at fostering quality of life. Methodologically, the programme was based on participatory health research, thus involving all relevant actors and consolidating their perspectives on issues related to dementia care. In the course of the programme, a workshop series covering topics relevant for dementia care in community pharmacy, as well as prototypes for small-scale projects were developed, and measures were taken for securing sustainability. Findings related to programme development and implementation encompass pharmacy staff's motivation to participate in the programme, counselling knowledge and skills development, experience with building community partnerships and cross-organizational development and sustainability. Furthermore, effectiveness of the programme has been established. These findings are discussed against the background of re-orienting pharmacies.

An interdisciplinary statement of scientific societies for the advancement of delirium care across Europe (EDA, EANS, EUGMS, COTEC, IPTOP/WCPT).

BACKGROUND: Delirium is a geriatric syndrome that presents in 1 out of 5 hospitalized older patients. It is also common in the community, in hospices, and in nursing homes. Delirium prevalence varies according to clinical setting, with rates of under 5% in minor elective surgery but up to 80% in intensive care unit patients. Delirium has severe adverse consequences, but despite this and its high prevalence, it remains undetected in the majority of cases. Optimal delirium care requires an interdisciplinary, multi-dimensional diagnostic and therapeutic approach involving doctors, nurses, physiotherapists, and occupational therapists. However, there are still important gaps in the knowledge and management of this syndrome. MAIN BODY: The objective of this paper is to promote the interdisciplinary approach in the prevention and management of delirium as endorsed by a delirium society (European Delirium Association, EDA), a geriatrics society (European Geriatric Medicine Society, EuGMS), a nursing society (European Academy of Nursing Science, EANS), an occupational therapy society (Council of Occupational Therapists for European Countries, COTEC), and a physiotherapy society (International Association of Physical Therapists working with Older People of the World Confederation for Physical Therapy, IPTOP/WCPT). SHORT CONCLUSION: In this paper we have strongly promoted and supported interdisciplinary collaboration underlying the necessity of increasing communication among scientific societies. We have also provided suggestions on how to fill the current gaps via improvements in undergraduate and postgraduate delirium education among European Countries.

OA53†"dementia friendly pharmacies" a community based health promotion project.

BACKGROUND: Inspired by the Ottawa Charter for Health Promotion, which is a major point of reference also for the "Compassionate Communities", we would like to propose that communities consolidate various settings like schools, workplaces, and health care organisations like community pharmacies, all of which might be included in a compassionate communities approach. AIM: We aim at enabling community pharmacies to offer informal consulting and support for people with dementia and their informal caregivers. Furthermore we want to support pharmacies to reach out in the community through various activities. By this means the project seeks to contribute to de-stigmatising dementia. METHOD: The project is based on the approach "Participatory Health Research" (Hockley, Froggatt, Heimerl 2013; Wright et al . 2010). The core elements of the approach are participation, action and reflection. Approximately 40 staff (almost exclusively women) in 18 community pharmacies actively participates in the project, i.e. needs assessment, interactive workshops, practice projects and evaluation. People with dementia and their informal care givers are included in the needs assessment and in different steps of the programme. RESULTS: Community pharmacy staff raised several issues, closely related to communication, counselling and providing advice in a community pharmacy setting: They believe further development of professional practice to be important, since dementia care will become a more prominent issue for the community pharmacy. Moreover, a high frequency of contact with people living with dementia and their caregivers was reported by the majority of staff. Professional competencies related to dementia care are a key issue, and community pharmacy personnel viewed their practice with a critical eye: Communicating with disoriented persons poses some challenges, as does communicating with caregivers. CONCLUSION: In the still ongoing project the raised issues are being dealt with in practice projects that are performed by the pharmacies with the support of the project staff. Several projects reach out to the community through self-help groups, cinema performances, public presentations and discussions. Informal care givers have engaged in direct contact with the included pharmacies and become part of selected practice projects. People with dementia have been included in the needs assessment and the design of the project logo.

Identification of citrullinated alpha-enolase as a candidate autoantigen in rheumatoid arthritis.

Antibodies against citrullinated proteins are highly specific for rheumatoid arthritis (RA), but little is understood about their citrullinated target antigens. We have detected a candidate citrullinated protein by immunoblotting lysates of monocytic and granulocytic HL-60 cells treated with peptidylarginine deiminase. In an initial screen of serum samples from four patients with RA and one control, a protein of molecular mass 47 kDa from monocytic HL-60s reacted with sera from the patients, but not with the serum from the control. Only the citrullinated form of the protein was recognised. The antigen was identified by tandem mass spectrometry as alpha-enolase, and the positions of nine citrulline residues in the sequence were determined. Serum samples from 52 patients with RA and 40 healthy controls were tested for presence of antibodies against citrullinated and non-citrullinated alpha-enolase by immunoblotting of the purified antigens. Twenty-four sera from patients with RA (46%) reacted with citrullinated alpha-enolase, of which seven (13%) also recognised the non-citrullinated protein. Six samples from the controls (15%) reacted with both forms. Alpha-enolase was detected in the RA joint, where it co-localised with citrullinated proteins. The presence of antibody together with expression of antigen within the joint implicates citrullinated alpha-enolase as a candidate autoantigen that could drive the chronic inflammatory response in RA.

Lipid-dependent subcellular relocalization of the acyl chain desaturase in yeast.

The degree of acyl chain desaturation of membrane lipids is a critical determinant of membrane fluidity. Temperature-sensitive mutants of the single essential acyl chain desaturase, Ole1p, of yeast have previously been isolated in screens for mitochondrial inheritance mutants (Stewart, L.C. and Yaffe, M.P. (1991). J. Cell Biol. 115, 1249-1257). We now report that the mutant desaturase relocalizes from its uniform ER distribution to a more punctuate localization at the cell periphery upon inactivation of the enzyme. This relocalization takes place within minutes at nonpermissive conditions, a time scale at which mitochondrial morphology and inheritance is not yet affected. Relocalization of the desaturase is fully reversible and does not affect the steady state localization of other ER resident proteins or the kinetic and fidelity of the secretory pathway, indicating a high degree of selectivity for the desaturase. Relocalization of the desaturase is energy independent but is lipid dependent because it is rescued by supplementation with unsaturated fatty acids. Relocalization of the desaturase is also observed in cells treated with inhibitors of the enzyme, indicating that it is independent of temperature-induced alterations of the enzyme. In the absence of desaturase function, lipid synthesis continues, resulting in the generation of lipids with saturated acyl chains. A model is discussed in which the accumulation of saturated lipids in a microdomain around the desaturase could induce the observed segregation and relocalization of the enzyme.