Case report: Interdisciplinary Approach to Managing Behavioural and Psychological Symptoms of Dementia and Delirium in Acute Care

Andrea Staglianò¹Sara Visconti¹Roberto Lucifora^1*Marta Aber Rizzo¹Elena Page^2,3Maria Cristina Ferrara^2,4Elena Pinardi^2,4Beatrice Tonus⁴Annalisa Sironi⁴Flavia Sandi⁴Alberto Finazzi^2,4Chukwuma Okoye^1,4Paolo Mazzola^1,2,4*Giuseppe Bellelli^1,2,4

• ¹Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
• ²Centro Studi Dipartimentale sulla Medicina della complessità e Cure Palliative "Virgilio Floriani", Milano, Italy
• ³Universita degli Studi di Genova, Genoa, Italy
• ⁴University of Milano-Bicocca, Milan, Italy

Behavioural and Psychological Symptoms of Dementia (BPSD) and delirium are common in acute hospital settings. Although non-pharmacological approaches are recommended as first-line interventions, BPSD and delirium are still often managed with physical restraints and psychotropic medications, which may prolong hospital stays and increase the risk of falls, institutionalisation, and readmissions. We describe four cases of older adults with dementia admitted to an Acute Geriatric ward for acute medical conditions, each presenting with a predominant behavioural symptom: agitation, aggression, apathy, and wandering, respectively. Symptom management was based on a structured, non-pharmacological, interdisciplinary approach involving medical doctor, case manager, occupational therapist, registered nurses, healthcare support workers, and volunteers. This care model enabled the individualisation of care plans according to each patient's needs, promoted the preservation of functional independence, reduced the use of psychotropic medications, and facilitated discharge. While these cases obviously cannot provide definitive conclusions on the efficacy of the adopted model, they suggest that multidisciplinary, integrated, non-pharmacological and pharmacological approaches to BPSD and delirium may improve patient's outcomes and well-being in hospital settings.