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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.

There has been noticeable research emphasis on the effects of museum-based programs as valuable community support for people with dementia and their primary caregivers. This umbrella review outlines the effects of museum-based community programs on health-related aspects of people with dementia and their primary caregivers and aims to synthesise existing evidence of museum-based programs and give directions for practice and implementation research. An umbrella review was undertaken following the guideline of the Joanna Briggs Institute (JBI). Therefore 6 databases (CINAHL Complete, PubMed, Medline Complete, SocINDEX, Psych & Behav Sci and the Cochrane Database for Systematic Reviews) were searched for systematic reviews and meta-analyses in April/May 2023 and as a follow-up in October 2023. The results were critically appraised by three reviewers. A total of five systematic reviews and one meta-analysis were identified. Due to the heterogeneity of the primary studies no consistent statistically robust proof of effects of museum-based community programs currently exists. Qualitative studies support the effects towards improvement of quality of life, mood and other noncognitive parameters. While the heterogeneity of study designs prevents a critical evaluation of the effects and therefore a reliable comprehensible analysis, the results from different studies, including randomized controlled trials, support museum-based programs as a valuable resource for participation in day to day care and social prescribing. For future research adapted and extended methodological considerations and approaches, such as mixed methods designs are recommended.

The need for integrated, accessible and person-centred care for people with dementia to foster quality of life and facilitate life in the community has been voiced by health policy. Pharmacies have the potential to provide easily accessible information and support for people with dementia, caregivers and the public. The ‘Dementia-friendly Pharmacy’ programme aimed at re-orienting community pharmacy in Austria, focusing on stronger inclusion of professional counselling into core services. It followed principles of health promotion and person-centred care, aiming at empowering all actors involved, and at fostering quality of life. Methodologically, the programme was based on participatory health research, thus involving all relevant actors and consolidating their perspectives on issues related to dementia care. In the course of the programme, a workshop series covering topics relevant for dementia care in community pharmacy, as well as prototypes for small-scale projects were developed, and measures were taken for securing sustainability. Findings related to programme development and implementation encompass pharmacy staff’s motivation to participate in the programme, counselling knowledge and skills development, experience with building community partnerships and cross-organizational development and sustainability. Furthermore, effectiveness of the programme has been established. These findings are discussed against the background of re-orienting pharmacies.

Zusammenfassung Hintergrund In den vergangenen Jahren wurde die Wirkung museumsbasierter Angebote für Menschen mit Demenz und ihre primären Betreuungspersonen als gemeindenahe Unterstützungsmöglichkeiten zunehmend beforscht. Fragestellung und Ziel Der Umbrella Review führt aktuelle Ergebnisse zur Wirkung museumsbezogener Angebote auf Menschen mit Demenz und ihre primären Betreuungspersonen zusammen und Ieitet Implikationen für die Praxis und die Versorgungsforschung ab. Methode und Material Nach den Leitlinien des Joanna Briggs Institute (JBI) wurde ein Umbrella Review auf Basis systematischer Reviews und Metaanalysen erstellt. Die Ergebnisse der systematischen Literaturrecherche in CINAHL Complete, PubMed, Medline Complete, SocINDEX, Psych & Behav Sci sowie die Cochrane Database for Systematic Reviews (April/Mai 2023; Follow-up: Oktober 2023) wurden durch 3 Reviewerinnen kritisch bewertet. Ergebnisse Es wurden 5 systematische Reviews und eine Metaanalyse identifiziert. Aufgrund der Heterogenität der primären Studien gibt es derzeit keine konsistenten, statistisch robusten Nachweise zur Wirksamkeit museumsbasierter Angebote. Statistische Tendenzen und qualitative Studien deuten auf eine positive Wirkung auf die Lebensqualität und Stimmung und diverse andere nichtkognitive Parameter hin. Diskussion und Fazit Die Heterogenität der bestehenden Forschungsarbeiten und -designs lässt keine statistisch belastbare Aussage zur Wirkung gemeindenaher, museumsbasierter Angebote zu. Die auf eine positive Wirkung hindeutenden Ergebnisse, die auch in diversen randomisierten kontrollierten Einzelstudien berichtet werden, sprechen für Museen als Ressource für Partizipation und für ihre Berücksichtigung im Rahmen des Social Prescribing. Für die weitere Forschung werden angepasste und erweiterte methodische Überlegungen und Ansätze wie Mixed-Methods-Designs empfohlen.