Christine Thomas1,2, Juliane Spank3, Sarah Weller3, Gerhard W Eschweiler4. 1. Klinik für Psychiatrie und Psychotherapie für Ältere, Zentrum für Seelische Gesundheit, Klinikum Stuttgart - Krankenhaus Bad Cannstatt, Prießnitzweg 24, 70374, Stuttgart, Deutschland. c.thomas@klinikum-stuttgart.de. 2. Universitätsklinik für Psychiatrie und Psychotherapie, Tübingen, Deutschland. c.thomas@klinikum-stuttgart.de. 3. Klinik für Psychiatrie und Psychotherapie für Ältere, Zentrum für Seelische Gesundheit, Klinikum Stuttgart - Krankenhaus Bad Cannstatt, Prießnitzweg 24, 70374, Stuttgart, Deutschland. 4. Universitätsklinik für Psychiatrie und Psychotherapie, Tübingen, Deutschland.
Abstract
BACKGROUND: Cognitive impairment is common among older patients in German hospitals (40%). Dementia, other brain diseases and frailty significantly increase the risk of delirium and pose great challenges to interdisciplinary and interprofessional teams. Delirium prevention is achievable but requires complex interdepartmental strategies with specific components for timely recognition of the individual delirium risk, to carry out structured and sustained implementation of appropriate measures for delirium prevention as well as prompt etiological diagnostics and immediate treatment when delirium occurs. OBJECTIVE: The present work aims to shed light on the role of interprofessional and interdisciplinary collaboration in evidence-based, nonpharmacological delirium prevention programs. MATERIAL AND METHODS: Narrative review of international best practice programs. RESULTS: Nonpharmacological prevention of delirium is effective but requires differentiated risk identification, regular delirium screening and daily targeted cognitive activation and sleep promotion. This can only be achieved in close interprofessional collaboration and is mostly carried out interdepartmentally by specialized teams. DISCUSSION: Interprofessional multicomponent programs for delirium prevention hold the potential to reduce delirium and complication rates in older high-risk patients in regular care, thereby improving treatment and long-term quality of life. Additional interprofessional delirium prevention teams are deployed in different settings simultaneously and provide regular training on optimal delirium management. Demonstration of the effectiveness of cross-setting programs requires large multicenter studies and is therefore particularly laborious.
BACKGROUND: Cognitive impairment is common among older patients in German hospitals (40%). Dementia, other brain diseases and frailty significantly increase the risk of delirium and pose great challenges to interdisciplinary and interprofessional teams. Delirium prevention is achievable but requires complex interdepartmental strategies with specific components for timely recognition of the individual delirium risk, to carry out structured and sustained implementation of appropriate measures for delirium prevention as well as prompt etiological diagnostics and immediate treatment when delirium occurs. OBJECTIVE: The present work aims to shed light on the role of interprofessional and interdisciplinary collaboration in evidence-based, nonpharmacological delirium prevention programs. MATERIAL AND METHODS: Narrative review of international best practice programs. RESULTS: Nonpharmacological prevention of delirium is effective but requires differentiated risk identification, regular delirium screening and daily targeted cognitive activation and sleep promotion. This can only be achieved in close interprofessional collaboration and is mostly carried out interdepartmentally by specialized teams. DISCUSSION: Interprofessional multicomponent programs for delirium prevention hold the potential to reduce delirium and complication rates in older high-risk patients in regular care, thereby improving treatment and long-term quality of life. Additional interprofessional delirium prevention teams are deployed in different settings simultaneously and provide regular training on optimal delirium management. Demonstration of the effectiveness of cross-setting programs requires large multicenter studies and is therefore particularly laborious.
Authors: César Aldecoa; Gabriella Bettelli; Federico Bilotta; Robert D Sanders; Riccardo Audisio; Anastasia Borozdina; Antonio Cherubini; Christina Jones; Henrik Kehlet; Alasdair MacLullich; Finn Radtke; Florian Riese; Arjen J C Slooter; Francis Veyckemans; Sylvia Kramer; Bruno Neuner; Bjoern Weiss; Claudia D Spies Journal: Eur J Anaesthesiol Date: 2017-04 Impact factor: 4.330
Authors: Jennifer K Burton; Louise E Craig; Shun Qi Yong; Najma Siddiqi; Elizabeth A Teale; Rebecca Woodhouse; Amanda J Barugh; Alison M Shepherd; Alan Brunton; Suzanne C Freeman; Alex J Sutton; Terry J Quinn Journal: Cochrane Database Syst Rev Date: 2021-07-19