The relationship between objective cognitive performance and physical frailty has been explored in the recent literature and cognitive frailty has emerged as a strong field of study in psychogerontology. However, less is known about the relationship between subjective cognitive status and physical frailty. The aim of this communication is to present the relationships found between subjective cognitive decline and physical frailty in the third wave of the Compostela Aging Study, the first in which frailty status has been studied.

Cognitive and neuropsychological, functional, and affective assessment was conducted with persons over 50 years of age with subjective memory complaints in the health area of Santiago de Compostela. 149 participants who completed the third wave of the study and who did not present dementia or other serious pathologies were selected. Mild Cognitive Impairment (MCI) was diagnosed according to the current criteria in a special meeting of the research team. In the participants without MCI, the intensity and severity of their complaints were assessed according to the Subjective Cognitive Decline (SCD) criteria. Physical frailty was assessed following the frailty phenotype as described by Fried et al.

Only 4 participants (2.7%) presented physical frailty (3, 4 or 5 criteria in the frailty phenotype). Of those presenting physical pre-frailty (1 or 2 criteria), 36 were MCI (23.8%), 33 SCD (21.9%) and 36 controls. Finally, 40 participants (26.5%) presented no frailty criteria (8 with MCI, 13 with SCD and 19 controls). Participants with SCD and pre-frailty were of intermediate age and they had more years of education than the group with MCI and pre-frailty, although these differences were not significant. They have significantly more symptoms of depression (GDS) and worse mental health status (GHQ-12) than participants without frailty and pre-frailty controls, and more symptoms of anxiety (GAD-7) than participants without frailty.

The relationship between subjective memory complaints and frailty could help to establish groups at special risk of cognitive impairment in phases prior to objective cognitive decline, being these groups particularly optimal targets for preventive intervention. However, a detailed characterization of these subgroups is still required.

It is well known that geriatric patients are at increased risk of developing comorbid medical and psychiatric conditions, and a large proportion of them are admitted to psychiatric liaison units (LPUs). The aim of this study is to determine which clinical differences between age groups (65- 74 years and ≥75 years) are statistically significant to potentially warrant special attention when referring to an LPU.

This is an observational, cross-sectional and comparative multicentre study. We collected data from 165 patients (≥65 years) admitted to 7 Spanish general hospitals and referred to each LPU from different departments. Data were collected over a period of one and a half months. Psychiatric examinations were performed during the patients' stay in the wards. The sample was divided into two age groups of patients and a comparative analysis was done.

We obtained a sample of 165 patients with a mean age of 76.03 years (42.10% < 75 years, 57.83% ≥ 75 years). We analysed several variables between two age groups: the youngest (65- 74 years) and the oldest (≥75 years). In the younger group (mean age 69.87 years), the mean Barthel index before admission was 93.23 (52.1% with independent ambulation) and at the time of our first assessment was 54.62, before 82.71 of the older group (mean age 80.63). The mean Lawton index was 4.44 (6.35 for the older group) and the Charlson index was 6.38 (5.6 for the older group). 21.11% reported falls in the last 6 months, compared to 27.6% in the older group. The most common reason for referral was anxiety/depression symptoms in both groups (52.12% and 56.53%) and agitation (24.46% in the older group). After the LPU visit, the main diagnoses were adjustment disorder in both groups (25.3% and 25.53%) and delirium in the older group (23.4%). Antidepressants and benzodiazepines were the most common psychotropic drugs prescribed before the LPU visit, and benzodiazepines were the most common drugs discontinued after the LPU visit in both groups.

Clinical differences were found between two age groups (65-74 years and ≥75 years) at LPU, which could allow professionals to improve their attention and interventions.

All older adults, including those already living with dementia, should be provided with adequate knowledge about dementia and be aware of how to navigate the social resources available to them. The purpose of this study was to develop a practical program to help older adults living in the community learn about cognitive decline and how to use related social resources.

Program participants included attendees of a community center for dementia support in a major Japanese city, as well as the residents of a large housing complex in the local area. Within the cohort, there were participants who willingly disclosed to having dementia. The program began in February 2021 and was held once a month for a total of 15 hour-long sessions. A participant survey was administered at each session to gather the demographic information of participants and their understanding of the program. Additionally, the staff conducted recorded verbal discussions about the program, which were then reviewed using thematic analysis.

The program structure was as follows: (1) participants decided the theme; (2) the first half of each session comprised lectures, while the second half included discussion and group work; and (3) rules for discussion were established (do not interrupt, do not unilaterally deny what people say, maintain confidentiality). The average number of participants per session was 12.1. Survey results indicated that 70.5% of participants were female and, in terms of age, the largest number of attendees were 81-90 years old (48.5 ). Most participants “understood the program content well” (72.5%) and indicated that “they would strongly like to participate again” (64.2%). The recorded participant discussions about the program were suggested, after review, to be more superficial as a result of Japanese people's particular attitude of not wanting to bother others.

Participants were highly satisfied with the program and were able to help develop a practical program for people living with dementia to learn effectively. A challenge was that participants had a “do not want to bother others” mindset, which could inhibit them from expressing their true wishes and make them less likely to use social resources.

Although people who attempted suicide tend to repeat suicide attempts, there is a lack of evidence on the association between psychiatric service factors and suicide reattempt among them.

We used a nationwide, population-based medical record database of South Korea to investigate the use of psychiatric services before and after the index suicide attempt and the association between psychiatric service factors after the index suicide attempt with the risk of suicide reattempt.

Among 5,874 people who had attempted suicide, the all-cause mortality within 3 months after the suicide attempt was 11.6%. Among all subjects who attempted suicide, 30.6% of them had used psychiatric services within 6 months before the suicide attempt; 43.7% of them had used psychiatric services within 3 months after the suicide attempt. Among individuals who had visited clinics following attempted suicide, the cumulative incidence of suicide reattempt over a mean follow-up period of 5.1 years was 3.4%. About half of suicide reattempts occurred within 1 year after the index suicide attempt. Referral to psychiatric services within 7 days was associated with a decreased risk of suicide reattempt (adjusted hazard ratio, 0.51; 95% confidence intervals, 0.29-0.89).

An early psychiatric referral within 1 week after a suicide attempt was associated with a decreased risk of suicide reattempt.

The pathways to diagnosis for people living with rare types of dementia are poorly understood. In Wales, a predominantly rural country, only 53% of people living with dementia have received a formal diagnosis of any form of dementia compared to 71% in England (Welsh Government, 2018). Some practitioners believe that a number of Welsh communities remain fearful of statutory services, particularly the large bilingual population who tend to access dementia services between 4.3 and 7.3 years later than monolinguists (Hedd Jones, 2018). This inevitably impacts on the numbers of people diagnosed with rarer forms of dementia and their ability to locate and negotiate appropriate pathways to access an accurate diagnosis. This study investigated the experience of people using these pathways to understand how a rare dementia diagnosis is delivered in Wales.

Ten semi-structured interviews were conducted with people living with a rare dementia or caring for a person with a rare dementia. These interviews considered the onset of symptoms, the experience of using healthcare services to receive a diagnosis and the support provided following diagnosis. The interview data was mapped across individual pathways and a thematic analysis was undertaken to explore shared perspectives.

A diagnosis of rare dementia was illustrated as a journey with five potentially recurring landmark points (initial contact, initial referrals, provider referrals, private referrals and diagnosis). Despite some identical diagnoses, no participants followed the same pathways with private healthcare often used to gain a degree of control over a pathway, if the person had the financial means to access this. Two themes were identified throughout the landmark points (involvement and dispute). Involvement illustrated the need to have a degree of control over the pathway whilst dispute acknowledged the overwhelming feeling that accessing a diagnosis often felt like a personal battle between those affected and health services, or between different aspects of health services themselves.

Whilst the experiences illustrated the unstructured pathways to a rare dementia diagnosis, these experiences will support services in Wales and countries with similar populations to consider how structured pathways can result in a timelier diagnosis and more supportive experiences.

Case conferences are described as a goal-oriented, systematic method that team members can use to develop person centred treatment actions for a particular care problem. However, not all case conferences have proven to be effective. The Norwegian Targeted Interdisciplinary Model for the Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) is an effective multicomponent model based on case conferences that informs approaches to behavioural and psychological symptoms in residents with dementia. Our aim was to explore how TIME case conferences structured based on cognitive behavioural therapy (CBT) contributed to person-centred actions and how the specific structure of the TIME may have contributed to the effectiveness of the model.

We used video observation of six case conferences. Videos in research provide extended opportunities for studying in detail the complexity of interactions that take place in social groups. We analysed these videos by iteratively watching them and performing a thematic cross-case analysis of their transcripts. Based on Habermas’s theory of communicative action, we emphasized what was talked about in the case conferences, and the display of communication between the participants in the case conferences.

Our findings showed that the theoretical principles behind the TIME, including both person- centred care and the inductive structure of CBT, reflected many aspects of Habermas’s theory of communicative actions. In particular, the TIME case conferences emphasized the lifeworld perspective for both residents, staff, and contributed to what Habermas labelled communicative rationality as a means to develop shared understanding among staff and create person-centred action.

One causal assumption of how and why the TIME case conferences contributed to the effectiveness of the TIME in reducing BPSD in nursing homes is that the specific inductive structure of the case conferences with the column technique based on the ABC method together with PCC emphasized the importance of the lifeworld for both the resident and the staff. Even though case conferences have been highlighted as useful, it is not indifferent how these case conferences are structured and conducted.

The Dementia Action Plan for Wales (UK), published in 2018, includes aims for improving assessment and diagnosis, as well as suggestions for what might characterise services that provide optimal support. Wales is a largely rural country, a factor shown previously to impede access to services. Suitable support for people living with rarer dementias is also limited, which may be further exacerbated by living in a rural area. This a relatively unexplored area of research.

This study explored diagnosis and post-diagnostic support experiences of people affected by dementia across Wales, as well as exploring any differences as a function of type of dementia (typical/rare), and rurality (rural/urban). Further, it sought to gain insight and recommendations from people living with dementia and their carers around how the process may be improved for people in Wales.

A survey was developed using a range of both closed- and open-ended questions. It explored respondents’ experiences guided by the aims of the Dementia Action Plan for Wales around diagnosis and post-diagnostic support. The survey was shared online, open to anyone living with, or caring for someone living with dementia in Wales.

71 respondents completed the survey (people with dementia, n=10; carers/family members, n=61), living in rural/semi-rural (n=37) and in urban/suburban (n=34) areas, and experiences from people affected by both rare (n=17) and typical (n=49) dementias are reported (plus n=5 with no specific diagnosis). The results identified several challenges in the provision of support, indicating that there is some way to go before realising the ambition of Wales becoming a dementia-friendly nation. There are, however, examples of satisfaction with services and testimonials of good practice.

The results of this work highlight areas to target within the Dementia Action Plan for Wales to improve support, and more broadly provide recommendations for improving policy and practice, based on the experiences and wishes of people with lived experience.

Identifying the risks of completed suicide in suicide survivors is essential for policies supporting family members of suicide victims. We aimed to determine the suicide risk of suicide survivors and identify the number of suicides per 100,000 population of suicide survivors, bereaved families of traffic accident victims, and bereaved families with non-suicide deaths.

This was a nationwide population-based cohort study in South Korea. The data were taken from the Korean National Health Insurance and Korea National Statistical Office between January 2008 and December 2017. The relationship between the decedent and the bereaved family was identified using the family database of the National Health Insurance Data. Age and gender were randomly matched 1:1 among 133,386 suicide deaths and non-suicide deaths. A proportional hazard model regression analysis was conducted after confirming the cumulative hazard using Kaplan-Meier curves to obtain the hazard ratio (HR) of completed suicide in suicide survivors.

Using 423,331 bereaved families of suicide victims and 420,978 bereaved families of non-suicide deaths as the control group, HR of completed suicide in suicidal survivors was found to be 2.755 [95% confidence limit (CL): 2.550-2.977]. HR for wives committing suicide after husbands' suicide was 5.096 (95% CL: 3.982-6.522), which was the highest HR among all relationships with suicide decedents. The average duration from suicide death to suicide of family members was 25.4 months. Among suicide survivors, the number of suicides per 100,000 people was 586, thrice that of people in bereaved families of traffic accident victims and in bereaved families of non-suicide deaths.

The risk of completed suicide was three times higher in suicide survivors than in bereaved families with non-suicide deaths, and it was highest in wives of suicide decedents. Thus, socio-environmental interventions for suicidal survivors must be expanded.

Depression and anxiety persist in a large number of patients after stroke. Anxiety affects around one third of patients during the first year. Nowadays, this phenomenon receives significantly less attention compared to other psychological problems, and poor psychological services after the onset of the disease were reported in previous studies. Some patients have access to specialized rehabilitation units (“Integrated Continuing Care Unit, UCCI”) that can ameliorate anxiety and significantly improve health-related quality-of-life (QoL), avoiding depression and improve patients' functional disability.

To analyze the associations between anxiety/depression symptoms and QoL in patients with chronic stroke, during and after discharge from UCCI.

An observational, longitudinal and descriptive study was carried out with patients with a clinical history of stroke discharged from hospitals in Portuguese central area, aged ≥65 years, without dementia diagnosis. Patients were observed at admission at the rehabilitation unit, discharge, and 6 and 12 months after discharge, and data were collected through a protocol composed of several self- completion instruments, namely the Hospital Anxiety and Depression Scale (HADS) and Stroke Specific Quality-of-Life Scale (SS-QoL). Data on clinical and demographic variables were collected and analyses performed to describe associations with HADS scores. Data were collected from August/2020 to July/2022 and analyzed using SPSS®,V.26.0.

A cohort of 154 stroke patients was assessed (M/F ratio=1.8, age 75±9 years). Anxiety scores were 6.8(4.8) (6 months) and 5.8(4.1) (12 months). Depression scores were 8.7(5.3) (6 months) and 8.1(4.7); (12 months). Anxiety total score at 6 months was significantly related (p<0.05) with 3 domains of SS- QoL (Personality, Social Role and Work/Productivity). However, no differences were found at 12 months. Depression was significantly related with all domains of SS-QoL except Vision (p<0.05).

HADS score for anxiety were normal (0-7) at 6 and 12 months; however, depression remain in the Borderline abnormal classification (8-10), 6 and 12 months after stroke, which appear to have a negative impact in almost all SS-QoL domains of patients with chronic stroke. The current study highlights the need to prevent depression symptoms after stroke as this can negatively affect the functional recovery of the entire ongoing rehabilitation process.

The aim of this study was to examine the potential contribution of Death Cafés to the creation of a society that is inclusive of death, which is necessary for ACP, through an analysis of the motivations and orientations of Death Cafés hosts to run Death Cafés.

Interviews were conducted with 16 host of Death Cafés. Interview transcripts were segmented, coded and categorized, focusing on motivations and orientations for running Death Cafés.

Motivation for running Death Cafés were categorized into four categories: “The bereavement experience of the host”, “The identity crisis of the host”, “Dissatisfaction with a society in which death is taboo”, and “Unlocking new possibilities for Buddhist temples”

The orientation of Death Cafés was categorized into two categories. Namely, “Personal growth” and “Community development”.

Attitudes towards the attendees with grief were categorized in two categories. “Not mentioned” and ” Welcome participation/refer to more appropriate projects “.

The characteristics of the host and venue were categorized as “Buddhist monk and/or Buddhist temple” and “Other”.

The relationship between these four factors was examined. When the host's bereavement experience was the motivation for starting the Death Cafés, they tended to regard death as an overwhelming experience and to run an individually oriented Death Cafés with the intention of personal growth. When the motivation for starting the Death Cafés was dissatisfaction with a society that considered death a taboo subject, attitudes towards death tended to be neutral and the café tended to be socially oriented with the intention of community development. Where the motivation for starting the Death Cafés was to expand the possibilities of the Buddhist temple, which was one of the subcategories of “Community development”, attitudes towards death were neutral and café tended to be both individual and socially oriented.

Death Cafés held in Buddhist temples may have the potential to contribute to the creation of a death-inclusive society in Japan and could be an ACP implementation strategy.

Most people living with dementia do so at home, comprising approximately 30 million people globally. Despite extensive research on psychotropic medication use in long-term care settings, there has been little comparative research looking at psychotropic use in people living with dementia at home.

The study aim was to systematically review the literature to identify factors associated with psychotropic medication use in people living with dementia at home.

The PROSPERO-registered review was conducted using PRISMA guidelines. A comprehensive search of four databases (2010 to 2020) was undertaken for the systematic review to identify empirical studies. A combination of MESH search terms for dementia, community-dwelling, and psychotropic medications were used. Suitable data were subject to meta-analysis using Comprehensive Meta-Analysis to calculate raw data to event rates and pooled, adjusted event rates for different modifier sub-analyses. Thematic analysis was utilised to synthesise emergent factors and a meta-analysis undertaken on suitable data.

The search identified 619 articles of which 39 met inclusion/exclusion criteria. Use of psychotropics ranged from 18.7% for anxiolytic/hypnotics, to 26.9% for antipsychotics and 33.1% for antidepressants. Thematic analysis suggested that psychotropic prescribing was associated with a range of patient and environmental factors, including, but not limited to: (i) age (<75yr; >90yr); (ii) gender (being male); (iii) more advanced functional decline; and (iv) living alone. There was a conspicuous absence of data pertaining to carer and prescriber factors. Significant associations were identified in the meta-analysis between psychotropic use and respite in full-time care or hospitalisation as well as co-morbid psychiatric illness.

The reasons for psychotropic prescribing in this population remain poorly understood. Significant associations and knowledge gaps identified here generate opportunities for further research and development of targeted interventions to improve care and meeting the needs of this population group. This includes cautionary trigger questions for prescribers including: What am I treating? Who am I treating? How will I measure response? How can I ensure that psychotropics initiated in respite/hospital are used short-term only?

Informal carers (unpaid family members and friends), are critical to millions worldwide for the ongoing delivery of health and well-being needs. However, the physical and mental wellbeing of caregivers is often poor including low levels of physical activity, frequently owed to contributing factors such as lack of time, lack of support and motivation. Thus, accessible evidence-based tools to facilitate physical activity for carers are urgently needed.

The aim of this study was to co-design and develop a novel mobile app to educate and support carers in the undertaking of regular physical activity. This is achieved via integration of the transtheoretical model of behaviour change and UK physical activity guidelines across 8 weeks of use.

We co-designed a mobile app, “CareFit,” by directly involving caregivers, health care professionals, and social care professionals in the requirements, capturing, and evaluation phases across a number of Agile Scrum development sprints. Requirements for CareFit were grounded in a combination of behavioural change science and UK government physical activity guidelines.

Participants identified different barriers and enablers to physical activity, such as a lack of time, recognition of existing activities, and concerns regarding safely undertaking physical activity. Requirements analysis highlighted the importance of simplicity in design and a need to anchor development around the everyday needs of caregivers (eg, easy-to-use video instructions, reducing text). Our final prototype app integrated guidance for undertaking physical activity at home through educational, physical activity, and communication components.

Integrating government guidelines with models of behavioural change into a mobile app to support the physical activity of carers is novel and holds future promise. Integrating core physical activity guidelines into a co-designed smartphone app with functionality such as a weekly planner and educational material for users is feasible acceptable and usable. Here we will document the latest developments on the project including an ongoing national study currently taking place in Scotland to test the prototype with 50 carers.

Dementia is currently the seventh leading cause of death and one of the major causes of disability and dependency among elderly. In Taiwan, there are at least 300,000 people live with dementia. However, only 1.64% of people with dementia received palliative care. In this paper, we describe a real-world experience of palliative care for people with advanced dementia.

Case report.

Mrs. H, A 90-year-old illiterate woman, was referred to Home Care team after several admissions for urinary tract infection. Her past medical history included cerebral infarction with left hemiparesis 4 years ago. Over one year prior our first visit, her family had begun to notice a problem with her recent memory. Thorough investigation for dementia was arranged. She scored 11/30 on the Mini-Mental State Examination. Mixed Alzheimer’s and vascular dementia was impressed.

The Home Care service consisted of a once-monthly visit by physician and nurse. In the first year of service, we delivered active directed treatment for dementia. We also discussed nonpharmacological approaches for dealing with physical and behavior symptoms in each visit.

Then Mrs. H was hospitalized again due to fever and abdominal pain. Abdominal aortic aneurysm was diagnosed along with urinary tract infection. She had hypoactive delirium for two months after discharge. Meanwhile, Home Care team arranged a family meeting to discuss prognosis and appropriateness of palliative care. In the following two years, we focused on deprescribing and interventions for pain, dyspnea, eating problem, infection, and agitation to promote Mrs. H’s comfort and quality of life. Psychological support was crucial to facilitate continuity in carer and care setting. Mrs.H did not have burdensome transition anymore and passed away peacefully at home as her preference.

The need for palliative care in dementia is anticipated to increase over the next decades in Taiwan. In the patient presented, Home Care team acknowledged and offered palliative care to help her to live as comfortably as possible until death and to help carers cope during the course. A multidisciplinary health care is highly recommended for complex needs in dementia.

Dementia is associated with a high burden of disease, impacting patients, families and society. Nevertheless, related epidemiological data is becoming outdated, given the difficulties of implementing costly and laborious fieldwork surveys. Data is also difficult to retrieve from health and social services’ information systems. Overall, we must improve the feasibility and validity of case definition regarding dementia and the assessment of caregivers’ consequences. The 10/66 Dementia Research Group diagnostic algorithm is a cross-culturally valid method(1). A ‘short 10/66’ was also validated(2), but not in Portugal. We intend to assess its feasibility and validity in Portuguese samples, using REDcap (a browser-based, metadata-driven software) in mobile devices. Additionally, we aim to assess dementia family caregivers’ subjective burden and psychological distress, contrasting primary care and hospital outpatient settings.

A multicentre mixed-methods study will be conducted on fifty dyads of older people with dementia and their caregivers, plus 150 dyads of ‘controls’ and their close family members, as informants. The ‘short 10/66’ will be administered. Dementia caregivers’ assessments include the Zarit Burden Interview and Self-report Questionnaire. Quantitative analyses will estimate the sensitivity and specificity of the ‘short 10/66’ dementia case definition. Semi-structured qualitative interviews will be conducted with participants and research assistants, exploring their experiences with the assessment process; thematic analysis will then be used.

We expect this study to facilitate the diagnosis of dementia and data collection in health/social services on a routine basis, which will potentially improve the feasibility and decrease the costs of epidemiological surveys and allow for prevalence monitoring in Portugal.

Self-perceptions of aging seem to be a key variable to understand physical and mental health (see the systematic review conducted by Tully-Wilson et al., 2021). Following Levy’s (2003) stereotype embodiment theory, negative attitudes towards aging originate as aging stereotypes (e.g., “older people are frail”; Warmoth et al., 2016) during childhood. They are internalized and reinforced in adulthood, both consciously and below conscious awareness, becoming aging self-stereotypes in old age and affecting self-perceptions of aging (Levy, 2003). Kordnat et al. (2016) developed an implicit association test (IAT; Greenwald et al., 1998) to assess implicit age stereotypes for specific life domains (health and family domains) across the life span and found positive stereotypes towards older people for family domain and negative for health domain. However, the associations between implicit age stereotypes and adults’ psychological distress have been scarcely analyzed. The aims of this communication are: a) to present the preliminary data of the validation of the implicit association test (IAT, Greenwald et al., 1998) to measure implicit aging stereotypes and b) to explore the relationship between implicit aging stereotypes and older adults’ psychological distress (loneliness, guilt associated with self-perception as a burden, and anxiety and depressive symptoms).

The IAT used is an adaptation of the IAT developed by Kordnat et al. (2016). The IAT explores the relationship between the categories of sickness/health and old/young age. The task has a target category that consists of: a) a set of 6 words of physical and mental sickness (e.g., frail, weak, sad, lonely) and 6 words of physical and mental health (e.g., healthy, energetic, happy, in company); and b) 6 photos of old people and 6 photos of young people.

Preliminary results of the implicit aging stereotypes task associations with older adults’ psychological distress in 100 community dwelling older adults will be presented.

Findings will be discussed. The implicit (below awareness) assessment of the aging stereotypes with the IAT in older adults could provide a better understanding of the role of aging stereotypes in older adults’ psychological distress, avoiding the weaknesses of assessing the construct through self-report measures.

Despite the high prevalence of anxiety and depression, many family carers of people living with dementia are not able to access timely psychological support due to various barriers such as lack of respite care and a shortage of skilled therapists. Online treatments have the potential to improve access, and also scalability, reducing inequalities in access to care. This uncontrolled feasibility study aimed to evaluate whether it is feasible to deliver internet- delivered guided self-help Acceptance and Commitment Therapy (iACT4CARERS) within primary and secondary care services in the UK, and whether the intervention is acceptable to family carers of people living with dementia.

Family carers of people living with dementia presenting with mild to moderate anxiety or depression were recruited through healthcare services and public advertisements. Participants were offered eight, guided, self-help online ACT sessions adapted for the needs of family carers. Participants were also allocated a therapist who responded to questions to support their completion of each weekly session. Participants completed questionnaires assessing anxiety, depression and other outcomes before and after the intervention. They were also invited to attend an individual semi-structured interview to provide feedback on iACT4CARERSE at the end of the study.

Seventy-nine participants attended the screening session over six months, and 33 eligible participants (age range 47-85) received iACT4CARERS. Further, 70% of participants completed seven or all eight sessions, and 27% of participants were lost to follow-up, but none of the reasons for early withdrawal was related to the intervention. There was preliminary evidence of improvements in anxiety, depression and psychological flexibility, particularly in anxiety, which demonstrated an average reduction of 26% on the GAD7 anxiety scale. The results of qualitative interviews suggested that iACT4CARERS is acceptable to family carers. Positive carer experiences were particularly facilitated by the relatedness of the contents, increased feelings of connectedness and the user-friendliness of the online platform.

The feasibility study provided evidence for the feasibility and acceptability of iACT4CARERS. This feasibility study led to an ongoing full-scale randomised controlled trial testing the clinical and cost effectiveness of iACT4CARERS. Recent developments of the iACT4CARERS project will be discussed.

Reliable and consistent social support are associated with the mental health and well-being of persons with severe mental illness, including bipolar disorder (BD). Yet the COVID-19 pandemic and associated social distancing measures (e.g., shelter-in-place) reduced access to regular social contacts, while social media use increased concomitantly.

For this study, we had two goals. First we report descriptive information regarding social media use (SMU) by persons with BD during COVID-19 (all platforms). Specific to Facebook, we next developed and tested a hypothesized model in order to identify direct and indirect associations between BD symptoms, social support, loneliness, life satisfaction, and social media use. Responses were collected during the global spread of the Delta variant and prior/concurrent with the Omicron variant, 20 months after the World Health Organization declared COVID-19 a global pandemic.

Over eight weeks, participants were recruited using social media advertising micro- targeted to adults with BD. On average, participants were 53.96 years of age (SD = 13.22, range 20-77 years), they had completed 15.40 years of education (SD = 4.28) and were diagnosed with BD 19.60 years ago (SD = 10.31). Path analysis was performed to develop and test our hypothesized model.

Almost all participants (93%) reported having both Facebook and LinkedIn accounts; 91.1% reported regular use of either or both. During the pandemic, most (60.8%) reported accessing social media several times a day; 36% reported using social media more often since the emergence of COVID-19. Specific to Facebook, the model we hypothesized differed somewhat from what emerged. The resulting model suggests that symptoms of depression predict loneliness and inversely, social support and life satisfaction. Social support predicts social Facebook use whereas passive Facebook use predicts life satisfaction. Symptoms of depression emerged as indirect predictors of SMU via social support.

Our findings suggest that the operational definition of passive-active SMU requires further analysis and refinement. In contrast to theory, passive Facebook use appears positively correlated with well-being among certain populations. Longitudinal data collection over multiple points is required to identify associations between BD symptoms, social media use and well-being over time.

Previous research has suggested that negative self-perceptions of aging and lower sense of control were significantly associated with worse physical and mental health, including physical limitations and feelings of guilt for perceiving oneself as a burden. However, no study has analyzed the associations of these variables when jointly considered and assessed the potential differences in the associations between people aged 40 to 59 years and people aged 60 years and older. The objective of this study was to assess the potential differences in the associations mentioned above between people aged 40 to 59 years and people aged 60 years and older.

Participants were 377 people over 40 years (206 aged 40 to 59 years and 171 participants aged 60 years and older) who answered an online survey. The association between negative self-perceptions of aging, perceived control, physical limitations, and guilt for perceiving oneself as a burden was tested through path-analyses, with differences between age groups tested through multigroup analysis.

Significant differences between age groups were obtained. The results suggest that the influence of negative self-perceptions of aging on guilt for perceiving oneself as a burden is indirect through lower sense of control in participants aged 40 to 59 years; in participants aged 60 and over, negative self-perceptions of aging had a direct and indirect effect on guilt through greater physical limitations.

Negative self-perceptions of aging seem to be a relevant variable to understand feelings of guilt for perceiving oneself as a burden in both middle-aged adults and older adults. However, this study documents potential differences in the correlates of guilt for perceiving oneself as a burden between participants aged 40 to 59 years and individuals aged 60 years and older. Specifically, the results suggest that the associations between negative self-perceptions of aging and guilt for perceiving oneself as a burden are modulated by lower sense of control in middle-aged and by greater physical limitations in older adults. These results support the relevance of social and cognitive processes related with aging for understanding feelings of guilt for perceiving oneself as a burden.