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Primary prevention of delirium
9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S1–S6
as well as present some of the latest results of our randomized controlled intervention trials aimed at management of impaired muscle health related disorders. All the speakers are fellows of the European Academy for Medicine of Ageing (EAMA) and experts in the field of muscle health, functional performance and ageing. http://dx.doi.org/10.1016/j.eurger.2013.07.055 S 006
Primary prevention of delirium K.J. Kalisvaart a , R. Vreeswijk a , M. Baden a , M. Tillemans a,b , E. Roelof c,d a Kennemer Gasthuis, Haarlem, The Netherlands b Stichting Apotheek der Haarlemse Ziekenhuizen (SAHZ), Haarlem, The Netherlands c University of applied science Utrecht faculty of health care, Utrecht, the Netherlands d University medical center Utrecht, Utrecht, The Netherlands Delirium is the most important neuro-psychiatric problem among elderly admitted to general hospitals. With an average incidence above 25% and increasing to almost 90% in the ICU population. It is a serious and potentially preventable mental condition. It is therefore important to recognise patients at risk for delirium on admittance to the hospital, so primary preventive programs can be started. Many of the risk factors are well-known, both predisposing and precipitating factors. Some of these risk factors have been combined to make predictive models for delirium. Much further work is needed to determine and examine specific risk factors and their value in models for the prediction of delirium in different patient groups. Based on recent knowledge on predisposing and precipitating risk factors for delirium, interventions have been proposed to influence the detrimental effects of these factors and thus prevent (primary prevention) or to reduce its duration and severity (secondary prevention). Relatively few interventions have been evaluated and supported by good quality clinical trials. Some of the trials support multicomponent intervention strategies consisting of nursing, medical and sometimes pharmacological components. In this symposium we will provide the latest data on riskassessment, targeting patients at risk and existing models for prevention of delirium. We will show the work we did on the development of a very simple and highly effective Delirium Risk Assessment Score model (DRAS) and show the data on its use in different patient groups (surgical, cardiology and stroke) and the positive effect of a multicomponent intervention program, after identifying risk patients, on incidence, duration and severity of delirium. http://dx.doi.org/10.1016/j.eurger.2013.07.056 S 007
E-health for support of older people at home: Past, present and future M. Vandewoude a , M. D’Angelantonio b , I. Saez c , W. Keijser d a University of Antwerp, Antwerpen, Belgium b HiMsa, Health Information Management, Brussels, Belgium c Badalona Serveis Assistencials, Barcelona, Spain d Scientific Coördinator HOME SWEET HOME Project (HiMsa) Health Information Management, Brussels, Belgium Introduction.– Epidemiological and healthcare marketplace challenges make it unfeasible to keep servicing older citizens with the same intensity known to current social care and healthcare. Moreover, modern seniors aim to extend their independent life while being certain they are provided with an equivalent level of safety, as they would enjoy in a protected environment such as a nursing
S3
home. This includes having access to direct communication with their loved ones even when they live far away. As many older people with chronic diseases are well off with selfmanagement, services facilitating self-management in the home setting can reduce the inappropriate use of expensive resources. Increasing evidence based e-health solutions, growing European Internet coverage, and the increasing IT-usage competences of the current and future older generation, promise an unprecedented paradigm shift in e-health applications. Methods.– Pragmatic controlled clinical trials (a) investigating the effects of home assistance services on independent living of over 20,000 European elderly in five pan-European multi-centre ehealth projects (DREAMING, RENEWING HEALTH, HOME SWEET HOME and United4Health and Smartcare) and (b) validating transferability which should allow a more reliable extrapolation of results obtained in pilot sites to different contexts in terms of demographics, population density and distribution between urban and rural areas, care delivery network organisation, etc. Learning topics.– This symposium will provide state of the art knowledge and hand-on experience on the following topics: – concept of economically sustainable home assistance services to extend older people’s independent living; – evidence-based and comprehensive examples of services supporting older people in their daily activities and allow caregivers and family to assess remotely their ability to stay independent; – overview of real life pilot sites and deployment sites across Europe, including Belgium, Ireland, Italy, Spain, Denmark and other European Member States; – various perspectives relevant to implementing e-health services, such as: public authorities, cultural and organizational barriers, assessment procedures (MAST), clinical challenges, innovative multi-disciplinary care-pathways and multi-disciplinary teamwork; – outcomes of several European randomized clinical trials providing credibility to the use of e-health in elderly care;– lessons learned in introducing, implementing and deploying e-health systems. http://dx.doi.org/10.1016/j.eurger.2013.07.057 S 008
Correlates of frailty, prediction of functional decline and preventative approaches – selected results from the lausanne cohort 65+ (lc65+) study (switzerland) (lausanne) and the longitudinal urban cohort ageing study (lucas) (Germany) U. Dapp a , J. Anders a , B. Santos-Eggimann b , L. Seematter-Bagnoud b a Research department, Albertinen-Haus, centre of geriatrics and gerontology, scientific instution at Hamburg University, Hamburg, Germany b Institute of social and preventive medicine Lausanne University Hospital, Lausanne, Switzerland Overall introduction.– Longitudinal studies have been designed to investigate prospectively, from their beginning, the pathway leading from health to frailty and to disability. Knowledge about determinants of healthy ageing and health behaviour (resources) as well as risks of functional decline is required to propose appropriate preventative interventions. The functional status in older people is important considering clinical outcome in general, healthcare need and mortality. Part I.– Results and interventions from lucas (longitudinal urban cohort ageing study). Authors.– J. Anders, U. Dapp, L. Neumann, F. Pröfener, C. Minder, S. Golgert, A. Daubmann, K. Wegscheider,. W. von Renteln-Kruse.
as well as present some of the latest results of our randomized controlled intervention trials aimed at management of impaired muscle health related disorders. All the speakers are fellows of the European Academy for Medicine of Ageing (EAMA) and experts in the field of muscle health, functional performance and ageing. http://dx.doi.org/10.1016/j.eurger.2013.07.055 S 006
Primary prevention of delirium K.J. Kalisvaart a , R. Vreeswijk a , M. Baden a , M. Tillemans a,b , E. Roelof c,d a Kennemer Gasthuis, Haarlem, The Netherlands b Stichting Apotheek der Haarlemse Ziekenhuizen (SAHZ), Haarlem, The Netherlands c University of applied science Utrecht faculty of health care, Utrecht, the Netherlands d University medical center Utrecht, Utrecht, The Netherlands Delirium is the most important neuro-psychiatric problem among elderly admitted to general hospitals. With an average incidence above 25% and increasing to almost 90% in the ICU population. It is a serious and potentially preventable mental condition. It is therefore important to recognise patients at risk for delirium on admittance to the hospital, so primary preventive programs can be started. Many of the risk factors are well-known, both predisposing and precipitating factors. Some of these risk factors have been combined to make predictive models for delirium. Much further work is needed to determine and examine specific risk factors and their value in models for the prediction of delirium in different patient groups. Based on recent knowledge on predisposing and precipitating risk factors for delirium, interventions have been proposed to influence the detrimental effects of these factors and thus prevent (primary prevention) or to reduce its duration and severity (secondary prevention). Relatively few interventions have been evaluated and supported by good quality clinical trials. Some of the trials support multicomponent intervention strategies consisting of nursing, medical and sometimes pharmacological components. In this symposium we will provide the latest data on riskassessment, targeting patients at risk and existing models for prevention of delirium. We will show the work we did on the development of a very simple and highly effective Delirium Risk Assessment Score model (DRAS) and show the data on its use in different patient groups (surgical, cardiology and stroke) and the positive effect of a multicomponent intervention program, after identifying risk patients, on incidence, duration and severity of delirium. http://dx.doi.org/10.1016/j.eurger.2013.07.056 S 007
E-health for support of older people at home: Past, present and future M. Vandewoude a , M. D’Angelantonio b , I. Saez c , W. Keijser d a University of Antwerp, Antwerpen, Belgium b HiMsa, Health Information Management, Brussels, Belgium c Badalona Serveis Assistencials, Barcelona, Spain d Scientific Coördinator HOME SWEET HOME Project (HiMsa) Health Information Management, Brussels, Belgium Introduction.– Epidemiological and healthcare marketplace challenges make it unfeasible to keep servicing older citizens with the same intensity known to current social care and healthcare. Moreover, modern seniors aim to extend their independent life while being certain they are provided with an equivalent level of safety, as they would enjoy in a protected environment such as a nursing
S3
home. This includes having access to direct communication with their loved ones even when they live far away. As many older people with chronic diseases are well off with selfmanagement, services facilitating self-management in the home setting can reduce the inappropriate use of expensive resources. Increasing evidence based e-health solutions, growing European Internet coverage, and the increasing IT-usage competences of the current and future older generation, promise an unprecedented paradigm shift in e-health applications. Methods.– Pragmatic controlled clinical trials (a) investigating the effects of home assistance services on independent living of over 20,000 European elderly in five pan-European multi-centre ehealth projects (DREAMING, RENEWING HEALTH, HOME SWEET HOME and United4Health and Smartcare) and (b) validating transferability which should allow a more reliable extrapolation of results obtained in pilot sites to different contexts in terms of demographics, population density and distribution between urban and rural areas, care delivery network organisation, etc. Learning topics.– This symposium will provide state of the art knowledge and hand-on experience on the following topics: – concept of economically sustainable home assistance services to extend older people’s independent living; – evidence-based and comprehensive examples of services supporting older people in their daily activities and allow caregivers and family to assess remotely their ability to stay independent; – overview of real life pilot sites and deployment sites across Europe, including Belgium, Ireland, Italy, Spain, Denmark and other European Member States; – various perspectives relevant to implementing e-health services, such as: public authorities, cultural and organizational barriers, assessment procedures (MAST), clinical challenges, innovative multi-disciplinary care-pathways and multi-disciplinary teamwork; – outcomes of several European randomized clinical trials providing credibility to the use of e-health in elderly care;– lessons learned in introducing, implementing and deploying e-health systems. http://dx.doi.org/10.1016/j.eurger.2013.07.057 S 008
Correlates of frailty, prediction of functional decline and preventative approaches – selected results from the lausanne cohort 65+ (lc65+) study (switzerland) (lausanne) and the longitudinal urban cohort ageing study (lucas) (Germany) U. Dapp a , J. Anders a , B. Santos-Eggimann b , L. Seematter-Bagnoud b a Research department, Albertinen-Haus, centre of geriatrics and gerontology, scientific instution at Hamburg University, Hamburg, Germany b Institute of social and preventive medicine Lausanne University Hospital, Lausanne, Switzerland Overall introduction.– Longitudinal studies have been designed to investigate prospectively, from their beginning, the pathway leading from health to frailty and to disability. Knowledge about determinants of healthy ageing and health behaviour (resources) as well as risks of functional decline is required to propose appropriate preventative interventions. The functional status in older people is important considering clinical outcome in general, healthcare need and mortality. Part I.– Results and interventions from lucas (longitudinal urban cohort ageing study). Authors.– J. Anders, U. Dapp, L. Neumann, F. Pröfener, C. Minder, S. Golgert, A. Daubmann, K. Wegscheider,. W. von Renteln-Kruse.