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Background: Community Occupational Therapy in Dementia in Italy (COTID−IT) is a feasible and effective treatment that aims improving the quality of life and well−being of people with dementia and caregivers. The implementation of the program in the national context has not been studied yet. Aim: The objective of this study is to identify barriers and facilitators in the Italian implementation of the program. Methods: We designed a quantitative cross-sectional survey. A questionnaire was developed to collect descriptive data regarding the respondents, the perceived barriers and facilitators regarding the application of COTiD and possible actions to promote the implementation process. Results: The questionnaire was sent to all 90 Italian OTs trained in the use of COTiD−IT from 2013 to 2020. 50 people responded (61%). Barriers to the implementation of the COTID−IT included lack of knowledge about Occupational Therapy and the COTID−IT program by other health professionals. In addition, the scarcity of economic funds invested in home rehabilitation is experienced as another significant barrier. Facilitators were found to be the presence of an interprofessional team interested in the COTID−IT program and occupational therapy and the fact that COTID−IT is supported by scientific evidence. The creation of national and regional inter professional education and support groups, the availability of online resources are seen as opportunities to better implement the COTID−IT program. Conclusions: Implementation of psychosocial interventions is complex. OTs in Italy should be increasingly included within health policies and care programs of people with dementia to promote the use of COTID−IT. Further studies are needed to detail the policy and methodological actions that OTs should take in the future to disseminate and consolidate this intervention.

Objective: Multi-component interventions can reduce delirium incidence. Occupational therapy (OT) has been effective in the management of dementia. We designed a real-world feasibility study of an OT intervention in the management of delirium superimposed on dementia (DSD). Methods: We included a convenient sample of 22 patients older than 65 years of age with delirium and moderate dementia admitted to a nursing home (NH). The OT procedures were standardized according to the level of agitation or sedation of the patient and based on a structured OT evaluation. The Canadian Occupational Performance Measure (COPM) was used to evaluate the proxy perception of performance in the daily activities at baseline and at delirium resolution. Results: The mean age was 86.45 ± 6.46 years. The first daily treatment was delivered in the entire sample, while the second was delivered in 63.46% on day 1, 72.72% on day 2, 25% on day 3, 66.67% on day 4, 100% on days 5 and 6. The main time of the first daily treatment varied, day 1 through day 6, from 14.8 ± 8.5 to 20 ± 0 min; while the second daily treatment, in the same period, from 3.9 ± 6.7 to 20.1 ± 0 min. The mean time of the first treatment varied day 1 through day 6 from 14.8 ± 8.5 to 20 ± 0 min, while the second treatment from 3.9 ± 6.7 to 20.1 ± 0 min. The COPM proxy performance and proxy satisfaction increased from delirium onset to delirium resolution. Conclusions: This is the first study to report the feasibility of an OT intervention for the management of DSD in a NH setting. The results are important to support future trials on delirium management in a setting often understudied and underrepresented.

To assess the applicability in Italy of a community-based occupational therapy program (COTID) on occupational performance of persons with dementia and their caregivers. Prospective cohort study: twenty-seven older persons with mild-to-moderate dementia living in the community and their primary caregivers were included. Ten sessions of occupational therapy over 5 weeks were delivered. Main outcome measures were the level of performance and satisfaction perceived by people with dementia during the participation in significant activities assessed with the Canadian Occupational Performance Measure (COPM); caregiver burden assessed with the sense of competence questionnaire (SCQ). The average age of the population was 80.59 ± 8.46 in persons with dementia and 57.78 ± 13.47 in the caregivers. There was a significant improvement in the caregivers’ burden in the SCQ (pre treatment 77.19 ± 13.27 vs 82.56 ± 12.57 post treatment; p= .005). Persons with dementia showed a significant improvement in the COPM performance (4.56 ± 1.44 vs 6.68 ± 1.59; p= .000) as well as in the satisfaction (5.08 ± 1.84 vs 7.04 ± 1.71; p= .000). No significant variations were registered in the overall cognitive functions, behavioral and psychological symptoms of dementia, daily functioning, depressive symptoms, perceived quality of life and global health of people with dementia. There was also no difference in the quality of life, global health, depression or burden in the caregivers. The study shows that the COTID program is applicable in the Italian context. The findings suggest a positive effect on patients and caregivers providing a preliminary support for the program implementation at a national level.

The aim of this study is to describe the predictive factors of driving cessation at 6-month follow-up in older patients discharged from a rehabilitation setting and evaluated by an occupational therapist in a multidisciplinary team. Of 95 patients, at 6-month 27.4% ceased to drive. The reasons for driving cessation were a patients’ voluntary choice (42.3%) or a choice of their family (23.1%), and only in 34.6% of the patients the license was revoked by a medical commission. In a multivariate analysis greater functional impairment—measured with the Timed Up and Go test—(OR 12.60, CI 2.74–57.89; p< 0.01) was the only predictor of driving cessation. This study shows that the ability to walk safely and independently is a significant predictor of driving cessation. The simple assessment of this factor using the TUG might be an easy screening tool to prompt a second level evaluation to accurately identify unsafe driving.