[Sleep disorders in dementia patients]

Conducive environments reduce sleep disturbances and improve sleep quality: a quality improvement project

AIM

The current implementation project aimed to improve patients' sleep quality in a hospital by implementing targeted interventions to reduce sleep disturbances.

METHODS

The Silent Night project was implemented in two general units of an academic tertiary hospital. The project comprised three phases: preimplementation, implementation, and postimplementation. Patient surveys were administered to obtain patients' perspectives on the sources of noise disturbances at night. Noise-monitoring machines were installed in two wards to obtain objective data on noise levels at night. Concurrently, data were collected on noise-generating activities that were observed.

RESULTS

The overall quality of sleep reported by patients improved by 17% (from 73.5 to 88.9%). Patients' survey reported reduced noise disturbances from direct care activities, environmental noise and medical equipment alarms. The mean noise level in the orthopedics unit reduced significantly from 57.04 to 55.22 dB with a corresponding decrease in noise generating activities by 60% (from 362 to 144). In the geriatric unit, the mean noise level increased from 51.36 to 53.12 dB but is within the National Environmental Agency's permissible noise level of 55 dB even though the noise generating activities reduced significantly by 92.2% (from 954 to 74).

CONCLUSION

The 'Silent Night' project has successfully reduced noise disturbances generating from environment and nursing care activities and improved patients' sleep quality in the hospital. Sharing sessions regarding sources of noise and the 'Silent Night' poster promoted the awareness of noise disturbances in healthcare professionals, visitors, and patients.

[Treatment with psychotropic agents in patients with dementia and delirium : Gap between guideline recommendations and treatment practice]

BACKGROUND AND OBJECTIVES

Psychiatric symptoms in dementia and delirium are associated with a substantially reduced quality of life of patients and their families and often challenging for professionals. Pharmacoepidemiological surveys have shown that, in particular, patients living in nursing homes receive prescriptions of psychotropic agents in significant higher frequency than recommended by current guidelines. This article focuses on a critical appraisal of this gap from the point of view of German healthcare services.

MATERIAL AND METHODS

Narrative review with special reference to the German dementia guideline from 2016 and recently published practice guidelines for delirium in old age in German and English language.

RESULTS

The indications for use of psychotropic agents, especially antipsychotics, are defined narrowly in the German dementia guideline. According to this guideline for several psychopathological symptoms evidence based recommendations cannot be given, currently. For delirium several practice guidelines related to different treatment settings have been published recently. Comparable to the German dementia guideline they recommend general medical interventions and nonpharmacological treatment as first line measures and the use of psychotropic agents only under certain conditions. These guidelines differ to some extent regarding the strength of recommendation for psychopharmacological treatment.

CONCLUSION

The guidelines discussed here advocate well-founded a cautious prescription of psychotropic agents in patients with dementia and delirium. This contrasts to everyday practice which is characterized by significantly higher prescription rates. This gap may explained partially by a lack of evidence-based recommendations regarding certain psychopathological symptoms. Most notably, however, epidemiological data disclose an unacceptable rate of hazardous overtreatment with psychotropic agents, especially in long-term care of persons with dementia. In this situation counteractive measures by consequent implementation of the principles of good clinical practice in geriatrics are required urgently.