Cohousing for people living with dementia: The Modena experience

AbstractBackgroundSocial isolation, caregiving burden and costs, loss of quality of life related to increasing disability, loss of agency and personhood, are some of the main unmet needs for people with dementia (PwD) and their caregivers. Objective: In order to support people with dementia and their caregivers we implemented a cohousing model. 5 PwD were encouraged to live together. Caregivers were supported in the care according to person centred approach.MethodParticipation in the project (supported by Modena City Council and local Alzheimer association, had been on a voluntary basis. The only exclusion criteria for PwD had been bedridden .Each PwD has his own bedroom with personal belongings and furniture, while the dining and living room are furnished according to prosthetic environment principles. Caregivers turn up in order to both maintain familial environment and reduce global care burden, while formal caregivers, provided by social service and employed by relatives, contribute to PwD care. According to carers expressed needs, voluntaries and an occupational therapist have been engaged to weekly involve PwD in leisure activities and psychosocial intervention. A granted psychologist is available to support Caregivers. A cost analysis, PwD and caregiver quality of life evaluation and caregiving burden were checked. Two control groups of PwD living at home with relatives or family assistant were considered in order to evaluated this cohousing model effectiveness. The first control group was supported by local dementia association. PwD were follow by a memory clinic in cohousing group and in both control groups.ResultA significant cost reduction was found in cohousing group (1879 €/month vs 2502€/month and 2662€/month in control groups). Moreover caregiving burden reduction and an improved PwD and caregivers quality of life were found in cohousing group.ConclusionThis is the first cohousing experience for PwD, in our Country. Relatives improved caregiving experience, reduced financial burden, isolation and time spent for assistance. PwD reduced the risk of institutionalization and improved their quality of life. According to this study results another cohousing experience was open 6 month ago by our community social services

The Management of Dementia in Primary Care

High-quality in-home primary healthcare services are pivotal for people with dementia and their families to avoid inappropriate hospital admissions and premature nursing home placement, which are associated with worsened quality of life of both the person with dementia and his family and financial burden

Delirium onset within a palliative care programme: nursing care for the patient and family

Delirium is a neurocognitive syndrome correlated with increased risk of hospitalization, functional and cognitive impairment, and mortality. Patients under palliative treatment regime are at higher risk of developing the syndrome due to their debilitated physical condition. In this context delirium is one of the most frequent complications, affecting around 85% of people at the end of the life. It augments the distress of the expiring individual and their family, aggravating suffering and compromising the quality of the life of the terminally ill people. The aim is to prevent the incidence of delirium identifying people at risk. If an episode of delirium occurs, it is essential to identify it with specific clinical assessment tools, to assess and to treat reversible causes in combination with enviromental, psychological and pharmacological intervention to control the symptoms. The close supporting role of the nurse within the family group confers them a fundamental role in the recognition and management of delirium. It is essential to analyse the peculiarities of assistance for patients under palliative treatment affected by delirium, together with their family. To provide personalized treatment that offers support, relief and hope, considering the person as a whole within the family setting, nurses can use the taxonomy of Nanda international classification of nursing diagnosis (Nanda-I), Nursing outcomes classification (Noc) and Nursing interventions classification (Nic)

P2‐254: RELATION OF SERUM 25‐HYDROXYVITAMIN D TO PULSE PRESSURE IN ALZHEIMER'S DISEASE

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Interest in hearing loss in geriatric medicine: a survey of members of the <em>Societa' Italiana Geriatria Ospedale e Territorio</em> (SIGOT)

Hearing loss is a common condition in older people. Increasing research has shown that this condition is associated with a higher risk of several health problems. The aim of this survey made among the members of the Societa' Italiana Geriatria Ospedale e Territorio (SIGOT) is to explore how far hearing loss is known in the Italian geriatric community and how to develop a collaboration with other services. A short survey (taking approximately 5 min to complete) was freely available on the SIGOT website and disseminated using social channels. The questionnaire was available during the whole year of 2021. The questionnaire specifically addressed general characteristics/ demographics, general attention to hearing loss problem in older people and relationships with the National Health System, and personal opinions regarding hearing loss. A total of 122 participants (mainly females and aging between 61-70 years) from all Italian Regions were included. The SIGOT members answered that they consider hearing loss as clinically relevant is always important (55.7%). Unfortunately, many members had not audiological centers or specialists available. Moreover, 38.5% of SIGOT members reported that the possibility of correction of hearing loss with prostheses or cochlear implants in older people is very good for older patients and that in 87.7% a significant improvement in quality of life was observed. The interest in hearing loss problems in older people perceived by the SIGOT members is elevated, but some barriers, particularly in the availability of other specialists and in the services given by National Health System are still very limited

&quot;Delirium Day&quot;: A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

L’impatto della crisi pandemica da Covid-19 sulla popolazione geriatrica

Le persone anziane hanno rappresentato la fascia di popolazione più colpita dall’epidemia da Covid-19 a causa della maggiore vulnerabilità legata all’età, alle condizioni di fragilità, alla comorbilità e alla presenza di problematiche quali i disturbi cognitivi ed alterazioni dello stato mentale. La vulnerabilità clinica della popolazione geriatrica è aggravata dal fenomeno sociale dell’ageismo in base al quale le persone anziane sono discriminate e non considerate meritevoli nè di attenzione nè di trattamenti utilizzando semplicemente il criterio dell’età avanzata come per esempio la possibilità di poter usufruire di un trattamento di terapia intensiva. La possibilità di utilizzare gli strumenti della valutazione multidimensionale geriatrica che prevede anche il coinvolgimento del caregiver, permette oggi di poter individuare il trattamento più appropriato per il paziente geriatrico in vari contesti assistenziali compresa la possibilità delle cure palliave. Per questi motivi nel presente contributo viene affrontata la necessità di mettere in campo un processo decisionale per l’accesso alle cure e viene affrontato il tema dell’assistenza agli anziani durante l’epidemia all’interno delle strutture residenziali con alcune considerazioni sui rischi di ageismo e di abuso a cui questa stessa popolazione è facilmente esposta