International psychogeriatrics
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Randomized Controlled Trial
Rivastigmine in the treatment of delirium in older people: a pilot study.
Delirium is common in the elderly and is associated with high mortality and negative health outcomes. Reduced activity in the cholinergic system has been implicated in the pathogenesis of delirium. Cholinesterase inhibitors, which increase cholinergic activity, may therefore be beneficial in the treatment of delirium. ⋯ The numbers of patients who screened positive for delirium was very small and as a result the sample size was too small to make any meaningful inferences about treatment of delirium. Despite the small numbers included in the study, there are some indicators that rivastigmine may be safe and effective in treating delirium.
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Delirium frequently accompanies acute illness. With treatment of the illness, some individuals recover from delirium while for others the symptoms persist. It is not understood why some individuals improve but others do not. The purpose of this paper is to review systematically what is known about the factors associated with the persistence of delirium. ⋯ Preliminary findings suggest that some factors may identify those at risk for persistent delirium; however, more research is needed.
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Although advance directives may seem useful instruments in decision-making regarding incompetent patients, their validity in cases of dementia has been a much debated subject and little is known about their effectiveness in practice. This paper assesses the contribution of advance directives to decision-making in the care of people with dementia, with a special focus on non-treatment directives and directives for euthanasia. ⋯ Ethics and actual practice are two "different worlds" when it comes to approaching advance directives in cases of dementia. It is clear, however, that the use of advance directives in practice remains problematic, above all in cases of advance euthanasia directives, but to a lesser extent also when non-treatment directives are involved. Although generally considered valid, their effectiveness seems marginal. Further empirical research into the (potential) value of advance directives in dementia care is recommended.
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Delirium exemplifies the interface between medicine and psychiatry. The mainstay of treatment of delirium are the antipsychotic drugs. These are efficacious and safe for the treatment of delirium. In the last decade the use of second generation antipsychotics has been advocated at the expense of the classical drugs, particularly haloperidol. We thus aimed to compare the outcome of delirium treatment in a large, university-affiliated general hospital. ⋯ The present study adds to the growing body of evidence favoring risperidone as the drug of choice for the treatment of delirium. However, due to the limitations inherent in a retrospective analysis, prospective large-scale trials are needed to support this recommendation.
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An interdisciplinary symposium on dementia care improves student attitudes toward health care teams.
Interdisciplinary teams are sometimes used in the provision of health care to populations who present with complicated needs, such as older adults experiencing dementia. Moreover, there is an international consensus that health care students should receive training in interdisciplinary care. ⋯ The findings suggest that, after the symposium, participants reported more positive overall attitudes about health care teams, and about the quality of care provided by such teams and the teamwork to achieve good patient care. Participants also displayed a decrease in their beliefs about how essential physicians are as leaders of health care teams. These results affirm the use of a brief interdisciplinary educational approach in changing student attitudes about the use of health care teams. Students who develop more positive attitudes about working on an interdisciplinary health care team recognize the team's value and therefore may be more receptive to and effective in working as professional team members in the future.