Interventi non farmacologici per la prevenzione del delirium in reparti per acuti - Alessandro Morandi

Interventi non farmacologici per la prevenzione del
            delirium in reparti per acuti
                           Alessandro Morandi
     Dipartimento di Riabilitazione, Fondazione Camplani (Cremona)
        Istituto di Ricerca, Parc Sanitari Pere Virgili (Barcellona)
                            29 Novembre 2019

1- Cognitive impairment
2- Sleep deprivation
3- Immobility
4- Visual impairment
5- Hearing impairment
6- Dehydration

2016

DELIRIUM INCIDENCE

HELP PROGRAM INTERVENTIONS

HELP PROGRAM INTERVENTIONS

HELP PROGRAM INTERVENTIONS

What’s the best approach for delirium
     prevention and management?

The most recent evidence-based guidelines,
published in March 2019, and recent
consensus statements recommend the
prioritization of multicomponent
nonpharmacological approach for the
prevention and treatment of delirium

               Network SIG. Risk Reduction and management of delirium.
               https://www.sign.ac.uk/sign-157-delirium.html

Interdisciplinary team

Physical therapy    Occupational therapy

Interdisciplinary team

Physical therapy    Occupational therapy

Mobility in the acute hospital
Author                           Cohort of patients                 Time of mobilizaione
Callen BL,. Geriatr Nurs. 2004   118 medical patients with mean     Median value of only 5.5 min of
                                 age 74.4 years                     ambulating in the hallways at
                                                                    daytime
Brown CJ, et al. J Rehabil Res   47 male medical patients with      Using accelerometer-based
Dev. 2008                        mean age 73.9 years                technology: 3.7% of their total
                                                                    time standing and/or walking
Pedersen MM, et al. J Gerontol   48 ambulatory medical patients     4.6% (66 min) of their total time
A Biol Sci Med Sci. 2013         with mean age of 84.7 years        standing and/or walking

Villumsen M, et al. J Aging Phys 100 geriatric patients with mean   5.8% (83 min) of their total time
Act. 2015                        age 84 years                       standing and/or walking
Ostir GV, et al. J Am Geriatr    224 patients with mean age of      Active 80 min the first 24 h of
Soc. 2013                        76.1 years admitted to an Acute    hospital stay
                                 Care for Elders hospital

Australasian J on Aging 2019

JAGS 2018

Prehabilitation in frailty older adults
• Inclusion of physical exercise in prehabilitation
  programs for older frail adults undergoing scheduled
  surgery
• Regarding delirium, we are beginning to observe
  positive effects of prehabilitation programs with a
  reduction in delirium incidence 110, although more
  studies are needed

Milder DA, et al. The role of prehabilitation in frail surgical patients: A systematic review. Acta Anaesthesiol Scand. 2018.
Janssen TL, et al. Multimodal prehabilitation to reduce the incidence of delirium and other adverse events in elderly patients
undergoing elective major abdominal surgery: An uncontrolled before-and-after study. PLoS One. 2019.

Interdisciplinary team

Physical therapy    Occupational therapy

1

What is the current evidence?         7

                                Lancet 2009

                  2018

Activity based Occupational Therapy intervention for delirium
superimposed on dementia in nursing home settings: a feasibility study

Christian Pozzi OT, MSc1,2, Alessandro Lanzoni OT3,9, Elena Lucchi PsyD2,4,
Isabella Salimbeni MD5, Luc Pieter DeVreese MD, PhD6, Giuseppe Bellelli7,
MD, Andrea Fabbo8, MD, Alessandro Morandi MD, MPH,2,4

                                       In Press Ageing Clin Exp Research 2019

Efficacy of occupational therapy
• Reduction in the duration of delirium
• Better functional outcomes at discharge
• Progress through range of motion, sitting,
  standing, walking, ADLs.

 29/01/2020                                      19

BMC Geriatrics
    2019

The interdisciplinary Delirium Champion

• “The role of each society is not only to endorse
  delirium knowledge and education among
  health care providers but also to increase
  awareness in the community and the healthcare
  stakeholders”
• “Collect information on the economic costs of
  such implementations since it has been shown
  that delirium programs can significantly reduce
  health care costs in patients with delirium”

                                  Morandi et al. BMC Geriatrics 2019

Grazie per l’attenzione
morandi.alessandro@gmail.com
European Delirium Association 2020
                        Barcelona
                      November 12-13

www.europeandeliriumassociation.org