Prophylactic effect of exogenous melatonin and melatonin receptor agonists of postoperative delirium in elderly patients

Li‑shan Jiang, Lan lai, Yan‑jun Chen, Ke Liu, Qi‑hong Shen Springer Nature. https://doi.org/10.1007/s40520-023-02564-y

Postoperative delirium (POD) is characterized by an acute confusional state following surgery, and its occurrence varies depending on the type of procedure. Typically associated with attention deficits and altered consciousness, POD is linked to a range of negative outcomes, including increased postoperative complications, higher mortality rates, longer hospital stays, and long-term cognitive decline. The causes of POD are multifactorial and complex. This meta-analysis, published on September 30, 2023, in Aging Clinical and Experimental Research, examines the potential preventive effect of melatonin and melatonin receptor agonists (MMRAs) on postoperative delirium (POD) in older patients. The analysis includes studies up until February 28, 2023, sourced from four databases: PubMed, Web of Science, Cochrane Library, and Embase. The findings suggest that patients treated with MMRAs experienced a lower incidence of POD compared to the placebo group. Indeed, the perioperative use of melatonin was shown to significantly decrease the occurrence of POD in elderly patients, indicating its potential for preventing this condition.

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Supporting social prescribing in primary care by linking people to local assests

Tierney, S., Wong, G., Roberts, N. et al. BMC Med https://doi.org/10.1186/s12916-020-1510-7

Social prescribing is an approach that connects patients with non-medical community resources to address social determinants of health, such as loneliness, financial difficulties, and housing issues. It aims to reduce reliance on general practitioners (GPs) by linking patients to local support networks through connector schemes led by link workers or care navigators. The UK has been a leader in integrating social prescribing into healthcare, and this study examines how these schemes function, for whom, and under what conditions.

The study highlights two key factors for successful social prescribing: buy-in and connection. Buy-in requires acceptance from patients, healthcare professionals, and community groups, with challenges including poor communication, short-term funding, and long wait times. Establishing and maintaining connections ensures patients receive meaningful support, reducing GP visits and enhancing collaboration between healthcare providers and community organizations. The study also applies social capital and patient activation theories, suggesting that as patients build supportive networks, they gain confidence in managing their well-being, ultimately reducing dependence on medical services. Policy recommendations include improved recruitment and training for link workers, better integration into primary care, sustained funding, and tailored approaches based on individual patient needs.

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