Delirium Updates: Pathophysiology and Biomarkers; Strategies to Manage DTs; and Delirium in Patients With Cancer

Depression remains one of the most common mental health problems in older adults. It not only causes suffering, but is associated with decreased quality of life, decreased functioning, increased suicide, increased medical morbidity, and increased all-cause mortality. A variety of treatments are available although each has special issues. Antidepressants have been the first line treatment especially in primary care. The efficacy of antidepressants, however, appears to be reduced in older adults (Nelson et al 2008; Tedeschini et al 2011). As a consequence, finding moderators that help to identify those patients most likely to benefit from treatment is timely. Dr Nelson will review a prior meta-analysis of second generation antidepressants in older adults and present a new patient-level analysis of moderators of outcome. Psychotherapy also appears to be effective in older depressed adults (Mackin and Arean 2005; Cuijpers et al 2006); however, these reviews illustrate that the control group in prior trials has often been a wait list control, another active treatment or a treatment-as-usual group. The number of trials using an appropriate attention control has been quite limited. Dr. Huang will present a new updated systematic review and meta-analysis of psychotherapy trials in older depressed adults with special attention paid to the use of adequate controls. Controlled trials of antidepressants find a relatively high rate of response to placebo and the non-specific supportive aspects of clinical management. In certain subgroups, response to placebo is as high as response to active treatments. While this has sometimes been attributed to methodologic problems, another line of evidence suggests that the non-specific interventions patients receive during placebo treatment is essentially a form of supportive psychotherapy (Fawcett et al 1987; Miller et al 1999). Dr. Hermida will present the findings of a workgroup that reviewed the evidence for the efficacy of clinical management and the elements that are required for clinical management. At the conclusion of this program the participant will be familiar with the evidence for available treatments in late life depression and will also be able to perform the basic elements of clinical management. Faculty Disclosures: Adriana P. Hermida, MD Nothing to disclose Alice X. Huang, MD Nothing to disclose J C. Nelson, MD Consultant: Avanir ad board Consultant: Bristol Myers Squibb consultant and ad board Consultant: Cenestra Health ad board Consultant: Corcept consultant Consultant: Dey Pharma consultant Consultant: Eli Lilly consultant and ad board Consultant: Forest consultant Consultant: Labopharm consultant Consultant: Lundbeck consultant and international speaker Consultant: Medtronic data safety monitoring board Consultant: Merck consultant Consultant: Otsuka data safety monitoring board Consultant: Pfizer data safety monitoring board Consultant: Sunovion consultation Research Support: NIMH various research projects Other: HRSA training grant DELIRIUM UPDATES: PATHOPHYSIOLOGY AND BIOMARKERS; STRATEGIES TO MANAGE DTS; AND DELIRIUM IN PATIENTS WITH CANCER Jose Maldonado, MD; Richard G. Key, MD; Barbara Kamholz, MD Duke University, Durham, NC Stanford University, Palo Alto, CA Memorial Sloan Kettering, New York, NY Abstract: Delirium is a very serious but unfortunately frequent problem among the elderly, particularly those who are frail. A better understanding of the pathophysiology of delirium will enable the audience to improve the prediction and management of this increasingly recognized late life disorder. Updates from the 2nd annual meeting of the American Delirium Society on Delirium is a very serious but unfortunately frequent problem among the elderly, particularly those who are frail. A better understanding of the pathophysiology of delirium will enable the audience to improve the prediction and management of this increasingly recognized late life disorder. Updates from the 2nd annual meeting of the American Delirium Society on S10 Am J Geriatr Psychiatry 21:3, Supplement 1 2013 AAGP Annual Meeting the pathophysiology of delirium as well as very new findings regarding investigations into biomarkers of delirium will be presented. The management of delirium in cancer patients can require significant skill and a good sense of the benefits vs the risks inherent in this patient group, and it will be also be presented. This topic has not been presented before at AAGP. Faculty Disclosures: Barbara Kamholz, MD Nothing to disclose Richard G. Key, MD Nothing to disclose Jose Maldonado, MD Nothing to disclose DEMENTIA KNOWLEDGE TRANSLATION INITIATIVES FROM CANADA: PUTTING KNOWLEDGE TO ACTION FOR DEMENTIA CARE IN PRIMARY CARE, DRIVING AND LONG-TERM CARE Dallas Seitz, MD; Mark J. Rapoport, MD; David Conn, MB; Kenneth Le Clair, MD Queen’s University, Kingston, ON, Canada Sunnybrook Health Sciences Centre, Toronto, ON, Canada Baycrest Centre, Toronto, ON, Canada Abstract: Knowledge translation (KT) is the application of research findings to clinical practice settings. Dementia is a complex chronic illness requiring knowledge and skills from a broad range of providers and backgrounds to achieve optimal outcomes. Geriatric psychiatrists have expertise in many areas of dementia care. However, given the rapidly increasing numbers of older adults with dementia, and the limited numbers of geriatric mental health practitioners, geriatric psychiatrists will increasingly be called upon to develop collaborative models of care to support other healthcare practitioners. Application and dissemination of best practices will need to use evidence-based KT strategies to achieve the greatest impact for patients and providers. Canada has a long tradition of KT and collaborative mental health care delivery and a unique healthcare system that poses both challenges and opportunities for KT activities in geriatric mental health. This session will begin by providing an overview of national initiatives for KT in dementia care in Canada. The Canadian KT frameworks will be introduced along with an overview of a national initiative the Canadian Dementia Knowledge Translation Network. A dementia guideline implementation project, the Primary Care Dementia Assessment and Treatment Algorithm (PC-DATA) will be discussed as an example of an integrated dementia care program illustrating collaboration between geriatric mental health and primary care. Results from the Driving and Dementia in Ontario project will provide an overview of the development of knowledge tools to help physicians decide whether to report individuals with dementia or mild cognitive impairment to driving authorities. Finally, the development of guidelines and several knowledge tools to support best practices in behavioral symptoms of dementia in the long-term care setting will be illustrated through the activities of the Canadian Coalition for Seniors Mental Health. Through this session attendees will gain an appreciation of several aspects related to KT science and learn about innovative methods for providing collaborative care using examples from Canada. This symposium is sponsored by the Canadian Academy of Geriatric Psychiatry. Knowledge translation (KT) is the application of research findings to clinical practice settings. Dementia is a complex chronic illness requiring knowledge and skills from a broad range of providers and backgrounds to achieve optimal outcomes. Geriatric psychiatrists have expertise in many areas of dementia care. However, given the rapidly increasing numbers of older adults with dementia, and the limited numbers of geriatric mental health practitioners, geriatric psychiatrists will increasingly be called upon to develop collaborative models of care to support other healthcare practitioners. Application and dissemination of best practices will need to use evidence-based KT strategies to achieve the greatest impact for patients and providers. Canada has a long tradition of KT and collaborative mental health care delivery and a unique healthcare system that poses both challenges and opportunities for KT activities in geriatric mental health. This session will begin by providing an overview of national initiatives for KT in dementia care in Canada. The Canadian KT frameworks will be introduced along with an overview of a national initiative the Canadian Dementia Knowledge Translation Network. A dementia guideline implementation project, the Primary Care Dementia Assessment and Treatment Algorithm (PC-DATA) will be discussed as an example of an integrated dementia care program illustrating collaboration between geriatric mental health and primary care. Results from the Driving and Dementia in Ontario project will provide an overview of the development of knowledge tools to help physicians decide whether to report individuals with dementia or mild cognitive impairment to driving authorities. Finally, the development of guidelines and several knowledge tools to support best practices in behavioral symptoms of dementia in the long-term care setting will be illustrated through the activities of the Canadian Coalition for Seniors Mental Health. Through this session attendees will gain an appreciation of several aspects related to KT science and learn about innovative methods for providing collaborative care using examples from Canada. This symposium is sponsored by the Canadian Academy of Geriatric Psychiatry. Faculty Disclosures: David Conn, MB Nothing to disclose Kenneth Le Clair, MD Nothing to disclose Mark J. Rapoport, MD Nothing to disclose Dallas Seitz, MD Nothing to disclose Am J Geriatr Psychiatry 21:3, Supplement 1 S11