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Abstract. This study develops a screening method for older patients based on nursing procedure to predict complications associated with cognitive impairment during a hospital stay. This multicenter diagnostic cohort study among older hospitalized patients was carried out in eight primary-care hospitals. Following admission of the patients, trained nurses conducted a structured interview and the Mini-Cog as gold standard for cognitive status; complications during the hospital stay were also monitored. In a second step, the structured interview combined with the Mini-Cog revealed whether there was any abnormality in the interview, making it possible to validly and reliably as well as sensitively and specifically identify patients with a pronounced cognitive impairment who may likely suffer from complications during a hospital stay.

Die Selbsterhaltungstherapie (SET) stellt die Anpassung der Lebensumstände von Menschen mit Demenz (MmD) an deren aktuelle Selbstund Weltvorstellungen, Ressourcen und Bedürfnisse ins Zentrum psychosozialer Interventionen. Seit über 20 Jahren ist die SET Teil der Behandlungsund Betreuungsprogramme in Kliniken und in stationären Wohnbereichen. Hierbei wird besonderer Wert auf die Einbeziehung der Angehörigen und anderer Bezugspersonen in die (teil-)stationäre Behandlung und Planung der Versorgung (Anpassung der Lebensumstände) nach der Entlassung gelegt. Diese Einbeziehung ist Voraussetzung für die Nachhaltigkeit der Behandlung und soll auch die Betreuenden unterstützen. Wie aktuell die GHoSt-Studie und auch eigene Erfahrungen zeigen, werden derzeit weder die Rechte der stationär behandelnden MmD noch die Rechte von deren Angehörigen auf Information, Beratung, geeignete Umgangsformen und Planung der gesellschaftlichen Teilhabe ausreichend berücksichtigt. Die Implementierung des SET-Konzeptes kann dazu beitragen, dass die speziellen Bedürfnisse von MmD und deren Angehörigen besser in die Behandlung und Betreuung von MmD integriert werden.

BACKGROUND/OBJECTIVES Delirium is a common neurobehavioral complication in hospitalized patients with a high prevalence in various clinical settings. Prevention of delirium is critical due to its common occurrence and associated poor outcomes. Our objective was to evaluate the efficacy of multicomponent interventions in preventing incident delirium in hospitalized patients at risk. DESIGN Systematic review and meta-analysis. SETTING Hospital. PARTICIPANTS We included a study if it was a randomized controlled trial and was evaluating effects of coordinated non-pharmacologic multicomponent interventions in the prevention of delirium. MEASUREMENTS We performed a systematic literature search in PubMed and CENTRAL (PROSPERO: CRD42019138981; last update May 24, 2019). We assessed the quality of included studies by using the criteria established by the Cochrane Collaboration. We extracted the measured outcomes for delirium incidence, duration of delirium, length of hospital stay, falls during hospital stay, discharge to institutional care, and inpatient mortality. RESULTS In total, we screened 1,027 eligible records and included eight studies with 2,105 patients in the review. We found evidence of an effect (ie, reduction) of multicomponent interventions on the incidence of delirium (risk ratio = .53; 95% confidence interval = .41-.69; I2 = 0). We detected no clear evidence of an effect for delirium duration, length of hospital stay, accidental falls, and mortality. Subgroup analyses did not result in findings of substantial effect modifiers, which can be explained by the high homogeneity within studies. CONCLUSION Our findings confirm the current guidelines that multicomponent interventions are effective in preventing delirium. Data are still lacking to reach evidence-based conclusions concerning potential benefits for hard outcomes such as length of hospital stay, return to independent living, and mortality. J Am Geriatr Soc 68:1864-1871, 2020.

Background: Music training has been found to be beneficial for young and healthy participants but the associations between musical training and the cognitive functioning of elderly participants have not been reported consistently. We examined whether lifetime musical training is associated with neuropsychological performance in a memory clinic population of older patients. Methods: A total of 478 patients (54.2% female, mean age 73.70 ± 6.22, mean Mini Mental State Examination score 25 ± 3) were included in the cross-sectional analyses. All patients were referred to the memory clinic due to cognitive impairments. During the course of diagnosis, all patients underwent neuropsychological tests using the CERAD neuropsychological assessment battery. Patients provided information on whether they ever learned to play an instrument for at least five years in their life. Results: Neuropsychological test results differed based on musical training ( p = .042). Overall, there were no differences in any domains of cognitive functioning, other than that patients with musical training performed worse on word list memory ( p = .008). However, this relationship varied based on the extent of cognitive impairments. Patients who were cognitively unimpaired (Mini Mental State Examination score 27–30) and had musical training showed better word list learning, whereas patients with cognitive impairments (Mini Mental State Examination score < 27) and musical training performed worse in word list learning ( p = .042) and word list recall ( p = .045). Discussion: Overall, there was little evidence of associations between specific neuropsychological test results and musical training. Only in cognitively unimpaired patients was there evidence that musical training had beneficial associations. In patients with cognitive impairment, there were suggestions of negative associations with verbal memory. Future research should longitudinally investigate the beneficial effects of musical training in people with and without cognitive impairments.

OBJECTIVES To determine whether the Mini-Cog can be applied by nursing staff to hospitalized elderly patients for cognitive impairment associated risk stratification. METHODS This explorative prospective multicenter cohort study was carried out among 2522 patients aged 70 and older, hospitalized due to physical illness in eight hospitals in Rhineland-Palatinate, Germany. All patients were asked to conduct the Mini-Cog at the day of admission and were clustered into low-performance, intermediate-performance, and good-performance categories by trained nursing staff and two experienced geronto-psychiatrists as gold standard. Complications in the course of the treatment were monitored. RESULTS The Mini-Cog was conducted in 1398 (54%) out of 2522 eligible patients. Mini-Cog scores assessed by nursing staff differed from the gold standard in 327 cases (23.9%). According to the area under the curve (AUC), nursing staff identified cognitively low-performing patients almost as well as the geronto-psychiatrists (AUC = 0.862; 95% CI, 0.83-0.89; P

Objectives:Dementia and cognitive impairment are associated with higher rates of complications and mortality during hospitalization in older patients. Moreover, length of hospital stay and costs are increased. In this prospective cohort study, we investigated the frequency of hospitalizations caused by ambulatory care-sensitive conditions (ACSCs), for which proactive ambulatory care might prevent the need for a hospital stay, in older patients with and without cognitive impairments.Design:Prospective cohort study.Setting:Eight hospitals in Germany.Participants:A total of 1,320 patients aged 70 years and older.Measurements:The Mini-Cog test has been used to assess cognition and to categorize patients in the groups no/moderate cognitive impairments (probably no dementia) and severe cognitive impairments (probable dementia). Moreover, lengths of hospital stay and complication rates have been assessed, using a binary questionnaire (if occurred during hospital stay or not; behavioral symptoms were adapted from the Cohen-Mansfield Agitation Inventory). Data have been acquired by the nursing staff who received a special multi-day training.Results:Patients with severe cognitive impairments showed higher complication rates (including incontinence, disorientation, irritability/aggression, restlessness/anxiety, necessity of Tranquilizers and psychiatric consults, application of measures limiting freedom, and falls) and longer hospital stays (+1.4 days) than patients with no/moderate cognitive impairments. Both groups showed comparably high ACSC-caused admission rates of around 23%.Conclusions:The study indicates that about one-fourth of hospital admissions of cognitively normal and impaired older adults are caused by ACSCs, which are mostly treatable on an ambulatory basis. This implies that an improved ambulatory care might reduce the frequency of hospitalizations, which is of particular importance in cognitively impaired elderly due to increased complication rates.

BackgroundCaregiver burden is one of the most common reasons for hospitalization of patients with dementia. However, changes of location are not recommended for patients with dementia and associated with negative outcomes for patients with dementia. As there is yet a lack of outpatient treatment options, this study explores psychiatric day clinic treatment as option for patients with dementia by comparing characteristics of voluntarily treated patients with dementia and their respective informal caregivers between an inpatient and day clinic setting.MethodsA total of 92 patients with dementia (56 inpatient, 36 day clinic) and their informal caregiver provided information on psychosocial and clinical characteristics (Mini-Mental-Status-Test, Neuropsychiatric Inventory, Bayer Activities of Daily Living, Barthel Index, Geriatric Depression Scale-30, Beck’s Depression Inventory-II, caregiver burden, Short Form Health Survey-36) at the beginning of treatment and at follow-up (n = 48 patient caregiver dyads) six months after discharge.ResultsPatients with dementia did not differ in disease severity, neuropsychiatric symptoms, and depression depending on treatment setting. However, the higher the Bayer activities of daily living score, the more likely treatment in day clinic was. Caregivers from patients with dementia in the inpatient setting were younger and reported more financial burden, whereas caregivers from patients with dementia in the day clinic reported lower physical health and more burden due to practical caring responsibilities. Longitudinal data indicated no differences in characteristics of patients with dementia and caregivers depending on treatment setting, despite caregivers from patients in the day clinic reporting more depressive symptoms after six months.ConclusionDay clinic treatment for voluntarily treated patients with dementia might be an alternative to inpatient settings. Patients with dementia do not substantially differ depending on treatment setting, rather characteristics of the caregivers were associated with placement in inpatient or day clinic setting. The needs of caregivers deserve special attention when considering treatment for patients with dementia.