[Recommendations for the diagnostic and therapy of behavioural and psychological symptoms of dementia (BPSD)].

INTRODUCTION: The «Recommendations for the Diagnosis and Treatment of Behavioral and Psychological Symptoms of Dementia (BPSD)¼ were developed in parallel with the Swiss National Dementia Strategy 2014-2019 under the auspices of the Swiss Society for Geriatric Psychiatry and Psychotherapy (SGAP) and mark the beginning of a series of recommendations for geriatric psychiatric disorders. They depict the evidence-based state of knowledge about diagnostics and therapy, based on the clinical experience of the experts, and are designed for interprofessional and interdisciplinary use. The non-pharmacological intervention options and pharmacotherapy are discussed in detail. This paper is the revised version of the 2014 publication and compiles the development in this area for everyday clinical practice.

[Recommendations for the Diagnosis and Therapy of Psychotic Disorders in the Elderly]. / Empfehlungen für die Diagnostik und Therapie psychotischer Erkrankungen im Alter.

Recommendations for the Diagnosis and Therapy of Psychotic Disorders in the Elderly Abstract. Psychotic disorders in the elderly cover a wide range of causes and manifestations. They often occur as part of a depression, dementia, substance abuse or delirium. While psychosis can occur with a first manifestation in advanced age, many patients with chronic psychotic disorders reach a high age. Many elderly individuals are also affected by cognitive impairment and somatic conditions, making a third-party history most relevant. The associated changes in life and the complexity of the individual situation needs to be integrated into the diagnosis and treatment. The presented recommendations have been developed under the lead of the Swiss Society of Old Age Psychiatry (SGAP) in collaboration with the Swiss Association of Nurses (SBK) and the subcommittees for gerontological and psychiatric nursing of the association of nursing science (VFP) as well as further professional societies. We aim to make current knowledge concerning diagnosis and treatment available to the interprofessional teams working in in- and outpatients' settings.

[Nursing development at the Solothurn hospitals. Towards clinically oriented nursing expertise and practice development]. / Pflegeentwicklung der Solothurner Spitäler. Unterwegs zu klinisch orientierter Pflegeexpertise und Praxisentwicklung.

At the Solothurn Hospitals (soH), 13 academically educated nurses are responsible for the development of nursing care with the goal to improve patient-oriented, effective, appropriate, and economic care. The strategy contains three priorities: a) expert care of single patients in demanding situations, b) sustained application of organisational methods such as primary nursing, nursing process, and skill/grade mix, and c) design and management of practice development projects related to specific patient groups. A first evaluation with qualitative and quantitative methods showed that the exemplary care of single patients by expert nurses was evaluated as positive for the patients as well as for the teams on two wards by nurses who were interviewed. After the introduction of primary nursing, the application rate was 81 to 90 % and the introduction of fall prevention methods in geriatric rehabilitation decreased the fall rate from 8.2 to 5.5 per 1000 patient days. A comparision with the literature shows that the expert nurses of soH perform both, working at the bedside and being responsible for practice development projects, as specialised Advanced Practice Nurses (APNs). APNs at the Solothurn Hospitals work also as generalists when organisational methods need to be consolidated. Their successes depend from their integration into the hierarchy and both, into the nursing as well as into the interprofessional teams. Competencies in Transformational Leadership also are essential at all management levels.

Growing up with bilateral hippocampal atrophy: from childhood to teenage.

The respective roles of the medial temporal lobe (MTL) structures in memory are controversial. Some authors put forward a modular account according to which episodic memory and recollection-based processes are crucially dependent on the hippocampal formation whereas semantic acquisition and familiarity-based processes rely on the adjacent parahippocampal gyri. Others defend a unitary view. We report the case of VJ, a boy with developmental amnesia of most likely perinatal onset diagnosed at the age of 8. Magnetic resonance imaging (MRI), including quantitative volumetric measurements of the hippocampal formation and of the entorhinal, perirhinal, and temporopolar cortices, showed severe, bilateral atrophy of the hippocampal formation, fornix and mammillary bodies; by contrast, the perirhinal cortex was within normal range and the entorhinal and temporopolar cortex remained within two standard deviations (SDs) from controls' mean. We examined the development of his semantic knowledge from childhood to teenage as well as his recognition and cued recall memory abilities. On tasks tapping semantic memory, VJ increased his raw scores across years at the same rate as children from large standardisation samples, except for one task; he achieved average performance, consistent with his socio-educational background. He performed within normal range on 74% of recognition tests and achieved average to above average scores on 42% of them despite very severe impairment on 82% of episodic recall tasks. Both faces and landscapes-scenes gave rise to above average scores when tested with coloured stimuli. Cued recall, although impaired, was largely superior to free recall. This case supports a modular account of the MTL with episodic, but not semantic memory depending on the hippocampal formation. Furthermore, the overall pattern of findings is consistent with evidence from both brain-damaged and neuroimaging studies indicating that recollection requires intact hippocampal formation and familiarity relies, at least partly, on the adjacent temporal lobe cortex.

[Movement support based on Kinaesthetics and the development and improvement of body perception, movement abilities and functional independency of elderly nursing home residents]. / Die Bewegungsunterstützung nach Kinästhetik und die Entwicklung und Förderung von Körperwahrnehmung, Bewegungsfähigkeiten und funktioneller Unabhängigkeit bei alten Menschen.

This case study examined whether the movement support based on Kinaesthetics furthers the body perception, movement abilities and functional independency of elderly nursing home residents with movement restrictions. Two elderly nursing home residents who showed a strong dependence (Barthel-Index II; 20-60 points) after a stroke and who were not previously cared based on Kinaesthetics took part in the study. A four months follow-up with pre-test, Kinaesthetics interventions, and monthly evaluations (n = 4) was carried out. The data was gathered by means of observation. Structured observation was used in order to assess the functional independence by means of Barthel-Index and unstructured observation was used for qualitative information by means of Kinaesthetics assessment from. In addition, the care personnel kept a diary over the development of the participants during the study. Both cases showed clear improvement of the information processing, body perception, and the movement abilities. However, Barthel-Index showed only a little increase in functional development in case A (from 30 to 40 points). Based on the Kinaesthetics concepts, case A however showed a higher level of functional development. The score of case B on the Barthel-Index increased cleary from 55 to 95 points. Movement support based on principles of Kinaesthetics if used consistently, continuously, and adapted to the situation of the assisted person can increase the body perception, movement abilities, and the functional independence of patients in old age. Barthel-Index is not sensitive enough to detect small development in functional status, whereas with Kinaesthetics assessment form it is possible. Besides of quantitative scales it is recommended to use qualitative measures that focus more on qualitative progress and on the way how the level of score is achieved.