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Im Mittelpunkt von DemStepCare stand die bedarfsgerechte, personenzentrierte und leitlinienorientierte Optimierung der ambulanten Versorgung von Menschen mit Demenz und deren Angehörigen. Nach Auswahl und Einschreibung der Patientinnen und Patienten durch deren hausärztlich Praxis führten Case-Managerinnen eine strukturierte Beurteilung der häuslichen Versorgungssituation durch. War diese stabil, erhielt die betroffene Familie eine Beratung über regionale Hilfsund Versorgungsmöglichkeiten. Im Falle eines erhöhten Versorgungsrisikos übernahmen die Case-Managerinnen zentrale Aufgaben bei der Organisation und Koordinierung zusätzlicher Versorgungsangebote und boten eine bedarfsgerechte kontinuierliche Begleitung an. Bei (drohenden) Versorgungskrisen konnte kurzfristig und vorübergehend eine aufsuchende multiprofessionelle Krisenambulanz in Anspruch genommen werden. Die dort verorteten Pflegeexpertinnen für kognitive Störungen und Demenz versuchten in enger fachärztlicher und sozialdienstlicher Kooperation durch zeitnahe Diagnostik und konsekutive Abfolge primär nicht-medikamentöser Interventionen sowie die Betreuung der oft sehr belasteten Angehörigen, eine ambulante Stabilisierung der Versorgungssituation zu erreichen und eine stationäre Aufnahme zu vermeiden. Der Beitrag beschreibt den Ablauf der Versorgung und gibt Einblicke in das Projekt DemStepCare sowie eine kurze Auswahl qualitativer Einzelerfahrungen anhand von beispielhaften Aussagen aller am Projekt Beteiligten.

Ziel dieses Übersichtsartikels ist eine Auswertung altersspezifischer Innovationsfondsprojekte. Von den insgesamt 557 geförderten Projekten weisen 17,1 % einen altersspezifischen Fokus auf. Ein zusätzlicher psychotherapeutischer Fokus liegt bei 2,1 % der altersspezifischen Förderprojekte vor. Häufige gemeinsame Elemente der Versorgungsinnovationen umfassen dabei eine interdisziplinäre Denkweise unter Einbezug der hausärztlichen Praxis sowie einer koordinierenden Person, deren zentrale Aufgaben das Schnittstellenmanagement und das Abstimmen von Versorgungsleistungen umfasst. Die Angehörigen der Patientinnen und Patienten werden deutlich seltener direkt miteinbezogen. Es ist erfreulich, dass altersspezifische Projekte im Innovationsfonds vertreten sind und gleichzeitig ist deren Anteil in Anbetracht der demografischen Entwicklung zu gering. Die massive Unterrepräsentation von psychischen Erkrankungen und den entsprechenden Behandlungsangeboten bedürfen einer Änderung und konstruktiver Lösungen in Zukunft.

Informal caregivers of people living with dementia (PwD) are at increased risk for the development of stress-related physical and mental illness. Nevertheless, because of differing resilience, they show interindividual differences in their ability to cope. Particularly during the COVID-19 pandemic, with the associated pandemic control measures and pandemic-related changes to daily life, resilience might be further challenged, and stress might consequently increase. Therefore, we review the evidence on informal caregivers’ experience during the COVID-19 pandemic regarding effects of the pandemic control measures on (a) the caregiver’s health, (b) the care recipient’s health, (c) the stability of the care situation, and (d) coping in daily life. We conclude with implications on how to strengthen resilience and reduce stress in terms of environmental, social, and individual resources.

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.

Beim Neuro-Update-Seminar am 5. und 6. April in Berlin prasentierten namhafte Experten — wie schon zwei Wochen zuvor in Mainz — die wichtigsten Studienergebnisse des vergangenen Jahres in kompakter Form. Das bewahrte Format fand dieses Jahr bereits zum elften Mal statt. Lesen Sie ausgewahlte Highlights zu Fortschritten in den Indikationen Multiple Sklerose, Morbus Parkinson, Migrane sowie akuter Schlaganfall.

Die Selbsterhaltungstherapie (SET) ist ein (neuro)psychologisch fundiertes Konzept zur Behandlung und Betreuung von Menschen mit Demenz. Sie wurde von Barbara Romero an der Klinik fur Psychiatrie und Psychotherapie der TU Munchen vor zirka 30 Jahren entwickelt. Fur das Konzept liegen sowohl empirische Hinweise fur eine gute Effektivitat bezuglich der Symptomreduktion und Verbesserung der Alltagsfunktionen bei Demenzpatienten als auch bezuglich der Verringerung von Depressivitat und Belastung bei Angehorigen vor — bei gleichzeitiger Steigerung der Inanspruchnahme niederschwelliger ambulanter Hilfeleistungen. Seit etwa 20 Jahren ist die SET Teil der Behandlungsprogramme in immer zahlreicheren Krankenhausern und wird durch die Krankenkassen finanziert: dies zeigt die Verstetigung dieses Ansatzes.

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.

Comparability of measures of quality of life in dementia and in other diagnostic groups, such as mild cognitive impairment, normal aging, or other diseases, is highly desirable. However, the impact of cognitive deficits and impaired insight on applicability and validity of generic instruments is sparsely studied.Sixty patients with dementia [38 women; age: mean (SD) = 78.7 (6.4) years; Mini-Mental State Examination (MMSE): mean (SD) = 20.2 (6.0)] recruited as part of the start-modem study, a multicenter care research study in Germany, completed the generic instrument SF-36 and the specific instrument Quality of Life-Alzheimer's Disease (QOL-AD).QOL-AD self-rating scores [mean (SD) = 32.8 (5.9)] and SF-36 subscales indicated moderate to good quality of life in the total group. Reliability and validity of five subdomains of the SF-36 were poor in subgroups of patients with impaired insight or with MMSE scores less than 17 (Cronbach's α0.7, no significant correlation to the QOL-AD). In contrast, for patients with both adequate insight and MMSE score greater than 16 (n = 33; 55%) Cronbach's α of the subdomains of the SF-36 ranged between 0.920 and 0.676. Seven of the eight subdomains correlated significantly with the QOL-AD self-rating and composite score in this group of patients (0.355 ≤ r ≤ 0.709).Despite the impact of insight and cognition on self-rated quality of life, we found reliable and valid data for a broad spectrum of patients with dementia. According to the present data, the SF-36 is suitable for dementia patients with both insight into their deficits and an MMSE score greater than 16.

Hintergrund und Fragestellung: Bei der Versorgung von Patienten mit Demenzerkrankungen besitzen Psychoedukation und professionelle Unterstutzung betreuender Angehoriger unstrittig einen hohen Stellenwert. Im Rahmen eines hausarztbasierten Versorgungsansatzes ging vorliegende Untersuchung der Frage nach, ob eine professionelle psychosoziale Beratung der betroffenen Familien – zeitnah zur Demenzdiagnose – das Risiko fur Depressionen der betreuenden Angehorigen reduziert. Patienten und Methodik: 42 Patienten mit diagnostizierter Demenz und ihre betreuenden Angehorigen nahmen an der prospektiven, randomisierten Studie und der Nachuntersuchung nach 18 Monaten teil. 29 Patienten erhielten zeitnah der Diagnosestellung eine psychosoziale Beratung. Neben Informationsvermittlung uber die Erkrankung wurde uber lokale Hilfsangebote informiert, der aktuelle Hilfebedarf ermittelt und ggf. entsprechende Unterstutzung vermittelt. Eine Kontrollgruppe erhielt als Standardbehandlung eine ausfuhrliche Informationsbroschure zum Thema Demenz, inklusive der Adressen moglicher Anlaufstellen. Primares Zielkriterium war die Depressionsrate der Angehorigen nach 18 Monaten. Ergebnisse: Die durchgefuhrte Beratung wurde von 95,8 % der Angehorigen als „sehr hilfreich“ oder „hilfreich“ bewertet. Auch die Hausarzte bewerteten die Zusammenarbeit mit den Beratungsstellen als sehr positiv und hilfreich. Wahrend vor der Intervention die Depressionsraten in den Gruppen statistisch gleich verteilt waren, zeigte sich nach 18 Monaten eine signifikant hohere Depressionsrate in der Kontrollgruppe gegenuber der Beratungsgruppe. Folgerungen: Trotz kleiner Fallzahlen liefert die randomisierte Studie eine erste Evidenz dafur, dass eine fruhe psychosoziale Beratung bei Angehorigen von Patienten mit Demenz protektiv gegen die Entwicklung einer Depression wirkt. Fruhzeitige, individualisierte psychosoziale Beratung betroffener Familien verbessert die Qualitat der ambulanten, hausarztbasierten Demenzversorgung und kann moglicherweise zur Aufrechterhaltung der hauslichen Versorgung beitragen.