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Background The Tailored Activity Program (TAP) effectively manages Behavioral and Psychological Symptoms of Dementia (BPSD), yet its feasibility across the hospital-to-home care continuum for people living with dementia (PLwD) has not been tested. Objective To assess the feasibility of TAP-Continu-A-Mente intervention for managing BPSD in PLwD transitioning from hospital to home, either following a short-stay observation or a memory clinic evaluation. Secondary aims were to evaluate changes in PLwD BPSD, caregiver distress and sense of competence, healthcare use, dyad satisfaction. Methods This single-arm interventional feasibility study enrolled 50 dyads (PLwD and caregivers) at IRCCS San Gerardo Hospital (Monza, Italy). PLwD inclusion criteria were age ≥65, dementia diagnosis, Neuropsychiatric Inventory (NPI) ≥6 in at least one item, independence in at least two basic activities of daily living, fluency in Italian. The intervention consisted of eight sessions over three months (two in hospital and six at home) delivered by occupational therapists. The primary outcome was the proportion of dyads completing the program (dyad retention). Secondary outcomes, assessed at baseline and four months, included NPI, Clinical Frailty Scale (CFS), motor-functional status (Katz Index, TUG), caregiver self-efficacy (SCQ), and dyad satisfaction. Results PLwD had a median age of 81 (Q1–Q3: 77–86), and 52% were female. Patient baseline median CFS was 6 (Q1–Q3: 6–7), and 78% received ≥12 hours/day of caregiver assistance. Caregivers were mostly female (76%) with a median age of 59 (Q1–Q3: 55.5–74). Dyad retention was 84% (42/50), with dropouts mainly older females. Among completers, NPI total scores decreased at follow-up (frequency x severity 42.5 vs 20.5, and caregiver distress 21 vs 14; p < 0.001), while SCQ score increased (52 vs 65; p < 0.001). CNS-active medication use increased overall, from 1 to 2. Katz Index declined from 4 to 3, whereas TUG remained stable (15.5 vs 16.3). No institutionalizations occurred, and one hospitalization was recorded. More than half of patients and caregivers rated their experience as 5/5. Conclusions TAP-Continu-A-Mente was a feasible hospital-to-home model of care for PLwD with BPSD. The observed reductions in NPI scores should be considered hypothesis-generating, warranting further investigation. Trial registration The study protocol was approved by the Ethics Committee “Comitato Etico Brianza” (approval no. 4173, 12.01.2023).

Background Delirium is a geriatric syndrome that presents in 1 out of 5 hospitalized older patients. It is also common in the community, in hospices, and in nursing homes. Delirium prevalence varies according to clinical setting, with rates of under 5% in minor elective surgery but up to 80% in intensive care unit patients. Delirium has severe adverse consequences, but despite this and its high prevalence, it remains undetected in the majority of cases. Optimal delirium care requires an interdisciplinary, multi-dimensional diagnostic and therapeutic approach involving doctors, nurses, physiotherapists, and occupational therapists. However, there are still important gaps in the knowledge and management of this syndrome. Main body The objective of this paper is to promote the interdisciplinary approach in the prevention and management of delirium as endorsed by a delirium society (European Delirium Association, EDA), a geriatrics society (European Geriatric Medicine Society, EuGMS), a nursing society (European Academy of Nursing Science, EANS), an occupational therapy society (Council of Occupational Therapists for European Countries, COTEC), and a physiotherapy society (International Association of Physical Therapists working with Older People of the World Confederation for Physical Therapy, IPTOP/WCPT). Short conclusion In this paper we have strongly promoted and supported interdisciplinary collaboration underlying the necessity of increasing communication among scientific societies. We have also provided suggestions on how to fill the current gaps via improvements in undergraduate and postgraduate delirium education among European Countries.

Background: Delirium and dementia are two of the most common geriatric syndromes, which requires innovative rehabilitation approaches. Aim: We aimed at determining which occupational therapy and physiotherapy interventions are applied with older people with delirium and dementia in different care settings. We also identified the assessment tools that were used. Materials and methods: We conducted a literature search for scientific articles published from 2012 to 2022 (PubMed, MEDLINE, AMED and CINAHL) with adults aged >65 years including experimental study designs with randomized or non-randomized intervention, exploratory studies, pilot studies, quasi-experimental studies, case series and/or clinical cases. Studies that did not use interventions that could be classified as occupational therapy or physiotherapy were excluded. Results: After applying the exclusion criteria, 9 articles were selected. The most widely used assessment to define dementia was the MMSE (N = 5; 55.5%), whereas the CAM (N = 2; 22.2%), CAM-ICU (N = 2; 22.2%) and RASS (N = 3; 33.3%) were the most widely used to define delirium. The rehabilitation interventions that were most frequently performed were early mobilization, inclusion of the caregiver during treatment, modification of the environment to encourage orientation and autonomy, the interprofessional systemic approach and engaging persons in meaningful activities. Conclusions: Despite the growing evidence on its effectiveness, the role of physiotherapy and occupational therapy interventions in the prevention and treatment of people with dementia and delirium is still emerging. More research is needed to investigate if effective occupational therapy programs known to reduce the behavioral and psychological symptoms in people with dementia are also useful for treating delirium and specifically delirium superimposed on dementia. Regarding physiotherapy, it is crucial to know about the amount and timing of intervention required. Further studies are needed including older adults with delirium superimposed on dementia to define the role of the interprofessional geriatric rehabilitation team.

Key summary points Aim To perform a narrative review aiming at evaluating the applicability and feasibility of occupational therapy in people with delirium. Findings In this article, the current evidence of the role of occupational therapy for the prevention and management of people with delirium across different settings of care (intensive care units, rehabilitation facilities, and nursing homes) is described. Overall, the article summarizes the results of various studies, supporting the feasibility and efficacy of non-pharmacological approaches conducted by occupational therapists. Message Though further studies are required to confirm initial evidence, there is reason to believe that occupational therapy may be an effective approach to help the management of delirious people across various settings of care. Occupational therapy may therefore be included in the early stages of rehabilitation management for people with delirium. Purpose To perform a narrative review of studies on the applicability and feasibility of occupational therapy in persons with delirium by analyzing evaluation and procedural methods in the therapeutic settings. Methods Starting from the international classification of disability, the focus was to understand if and how occupational therapy as a multi-component intervention can reduce the duration and intensity of delirium to prevent future disabilities. This review also includes scientific studies demonstrating the benefits of occupational therapy in terms of increased functional and occupational outcomes. Finally, the evaluation modalities and the therapeutic procedures performed by the occupational therapist have been analyzed. Results The non-pharmacological treatments occupational therapists perform in people with delirium in intensive care settings are supported by scientific evidence. Conclusions There is preliminary evidence of the benefit of including occupational therapy in early stages of rehabilitation in acute care to prevent and treat delirium. Nevertheless, further studies are necessary to define the different aspects of the multidisciplinary approach that is common in geriatric practice, primarily determining the adequate timing, and intensity of interventions as well as its appropriate settings.

Background: The COVID-19 pandemic has resulted in a health care emergency in Europe since the first wave in 2020. Several challenges have arisen for occupational therapists, as well as all the health care professionals. The aim of this study was to determine what occupational therapists have changed to adapt their therapeutic processes for this catastrophic situation. Method: An online survey was developed and sent in conjunction with the Council of Occupational Therapy for European Countries (COTEC) to European national associations of occupational therapists. Results: The study was based on a sample of 65 occupational therapists who worked with people with COVID-19. More than half of the occupational therapists (54.8%) had changed departments. The main needs patients expressed (n = 136) during hospitalization were to have social contacts (30.9%), and the main clinical complaints (n = 144) were motor impairment and fatigue (35.4%) and depression (25.7%). The most frequently reported goal (n = 141) was recovery of physical performance and fatigue management (32.6%). Among the emotions mentioned by occupational therapists, negative emotions (76%) were the most common. Conclusion: European occupational therapists demonstrated flexibility and resilience to deal with clinical and organizational challenges during the COVID-19 emergency.

Background Nonpharmacological approaches have been identified as first line treatments for the behavioral and psychological symptoms (NPS) of persons living with dementia (PLWD). Methods This is a single‐arm study to evaluate the feasibility of the TAP approach to promote continuity of care between hospital (S. Gerardo hospital ‐ Italy) and community. Inclusion criteria were presence of NPS; autonomy in activities of daily living (Katz’s index ≥ 2); presence of caregiver. On recruitment, PLWD underwent a multidimensional assessment, Clinical Frailty Scale (CFS), Neuropsychiatric Inventory (NPI), Katz’s Index, Timed‐Up‐and‐Go‐test (TUG), number of drugs taken by the patient and caregiver’s sense of competence (SCQ questionnaire). After recruitment, the dyad PwD+caregiver received 8 TAP sessions performed by two occupational therapists, at hospital (two sessions) and at home (6 sessions). Follow‐up was set after 4 mouths. The attrition rate (% of dropouts) was the primary outcome. Results 51 patients identified as potentially eligible, 21 declined to participate in the project. Currently, 30 dyads have been recruited, with 16 having completed the follow‐up. Overall, there were 6 (20%) dropouts. The mean patient’s age was 81 ±4.8 years. The median CFS patient’s score was 6 and half of patients were taking more than 7 medications per day. Wilcoxon signed‐rank test was conducted on the 16 dyads. From baseline to follow‐up (median, IQR 75%‐25%), there was a significant reduction in the NPI total score (NPI baseline = 17 (10.7‐33.2) NPI follow‐up 15.7 (8‐2 – 24.0), p = .002), caregiver distress (NPI caregiver distress baseline = 9.5 (6.0‐17.0); NPI caregiver distress follow‐up 6.5 (2.2‐11.5); p = .003) and TUG score (TUG baseline = 18.0 (13.0 – 35.5); TUG follow‐up 13.4 (10.5‐21.5); p = .007). Moreover, there was a significant decrease in the SCQ scale (SCQ baseline = 49.0 (44.0‐64.5) SCQ follow‐up 43.0 (36.5‐56.5); p = .001). No patient experiences hospital admissions at follow‐up while 3 patients had accessed emergency department. Conclusions Preliminary data are very promising and in line with what was hypothesized in the clinical trial design phase. TAP may be a valuable aid in monitoring the BPSDs of PLWD and avoiding re‐hospitalizations.

ObjectiveMulti-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).MethodsWe 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.ResultsThe 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.ConclusionsThis 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.

Objective To assess the applicability in Italy of a community-based occupational therapy program (COTID) on occupational performance of persons with dementia and their caregivers. Methods 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). Results 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. Conclusions 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.

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.

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.