Summary: Globally, older adults grow faster than the rest of the population (United Nations et al., 2019). Ecuador predicts 2054 this group will represent 18% of the population. Cognitive and functional impairment affects quality of life of individuals and their families. Conditions such as dementia have increased, with almost 100,000 people affected in Ecuador.

Pharmacological treatments have modest efficacy for these problems (Buckley & Salpeter, 2015). In developed countries there are efforts to use non-pharmacological interventions (Klimova et al., 2016). In this context, computer-based cognitive interventions are considered a therapeutic tool to treat neurocognitive disorders. Benefit of using technology is that interventions are more accessible, flexible (Maldonado, 2016) and cost- effective (Gooding et al., 2016). Herrera et al. (2012) summarize a superiority outcomes over conventional cognitive rehabilitation in many aspects. Among them, use of portable devices allows bringing interventions to rural areas or homes (Brando et al., 2017).

In Spain, work is being done on it and there are studies associated with its usability and effectiveness. GRADIOR computer-based neuropsychological rehabilitation is a program for people with neurological etiologies. This one stands out from the rest, as it is exclusively for professionals. Allowing them to design, supervise and adapt the cognitive intervention based on their decisions, subsequent to the assessment of other cognitive, emotional and social aspects involved in the rehabilitative process, not only based on the Objectives results on the patient’s performance (Toribio-Guzmán et al., 2018).

This has led to the demand for a Neuropsychological Rehabilitation program that is accessible, parameterizable and adapted to the population of ECUADOR.

To meet this need, a doctoral thesis is being carried out in collaboration with CENTRO MAIOR Ecuador Centro de Especialidades del Adulto Mayor. Spanish program of Neuropsychological Rehabilitation has been tested in its population.

The study has been divided into different phases. A qualitative phase with focus group Methods in which health professionals from Ecuador participated. A phase of adaptation of the Spanish program to the Ecuadorian culture and currency. It is now in experimental phase (35 participants) with MCI and Mild Dementia. It is proposed to present the study, with a clinical case.

Summary: Lamotrigine is an antiepileptic and mood stabilizing drug. Among its adverse effects, the induction of mania has been described. We present the case of a 59-year-old man diagnosed with epilepsy since youth, with perictal psychotic symptoms effectively treated with haloperidol. The patient was treated with lamotrigine for over five years and presented symptoms of mania after two years of receiving it at moderate doses and being free of seizures. The symptoms improved with the lamotrigine switch. Previous cases of lamotrigine-induced manic symptoms have been predominantly observed in individuals with mood disorders, with only a few reported in children undergoing treatment for epilepsy. Further studies are necessary to elucidate the potential risk factors and the neurobiological mechanisms.

Objectives: To determine if and when to continue clozapine in patients with clozapine-induced thrombocytopenia.

Methods: A case report and literature review of a geriatric patient with Parkinson’s disease (PD) psychosis, on longstanding treatment with clozapine with recent development of thrombocytopenia, is presented.

Results: 85-year-old male with a history of PD complicated with sialorrhea, constipation, levodopa-induced dyskinesia, rapid eye movement sleep behavior disorder, neurocognitive impairment, and PD psychosis who follows up with the Emory Brain Health Center. Medications include carbidopa-levodopa, clozapine, donepezil, and rasagiline. He reports distressing delusional jealousy and egodystonic visual hallucinations. He has tried multiple antipsychotics with insufficient response. He has been on clozapine for nearly 10 years with moderate efficacy. His current dose is 62.5mg daily. Absolute neutrophil counts have been normal, but he developed thrombocytopenia. Though he had normal platelets at baseline, his platelets fell to 134,000/μL and have gradually decreased within a year, most recently to 82,000/μL. He has been asymptomatic without easy bleeding or bruising. His clozapine dose has remained the same with ongoing laboratory monitoring. He follows with his primary care doctor and was referred to hematology.

Conclusions: The literature on clozapine-induced thrombocytopenia is limited. Incidence is variable and ranges from 0.083%-8.2% in larger samples. Most cases occur within the first 18 weeks of clozapine initiation. It is generally transient and self-resolving, usually lasting under 13 weeks, though a case report noted it to last up to 40 months. It is imperative to have hematologic baselines. The manufacturer recommends discontinuing the drug when platelet counts fall below 100,000/μL, resuming therapy when they return to normal, and permanently discontinuing if this reoccurs. UK guidelines recommend that if platelet counts fall below 50,000/μL, clozapine should be discontinued, with monitoring frequency increased. Therapy can be resumed once platelet counts normalize and if asymptomatic. Special caution must be taken in geriatric patients who are prone to fall and balance-related injuries.

Objectives: Swallowing dysfunction is a significant health concern among older individuals, prompting widespread efforts to prevent it. While articulation training using repeated syllables is a common approach, maintaining motivation and habituating to the practice can be challenging, particularly for those facing mental hurdles.

In contrast, the ancient practice of sutra chanting, which has been embraced for centuries, holds potential for improving well-being by offering mental tranquility through the recitation of meaningful Buddhist words, including non-daily vocabulary. While the health benefits of these vocalization techniques remain understudied, they are believed to have positive effects from a geriatric medicine standpoint.

Methods: Our intervention program consisted of 60-minute sessions held at a temple per week for 7 weeks, including homework tasks. Sessions involved group Discussions, preparatory exercises, multiple recitations of the Heart Sutra with loud voices, and talks by a Buddhist priest. This one-arm intervention study targeted older community residents. Pre- and post- assessments, including mental health questionnaires and measurements of swallowing and oral function, were conducted. Paired t-tests were used to compare the data. Post-intervention interviews were conducted by a psychologist and a priest. This study was approved by the Ethics Committee of Taisho University.

Results: Eighteen participants, with an average age of 76.1 ± 8.2 years (8 males, 10 females), showed significant improvements in maximum phonation time, hyoid bone displacement during swallowing, tongue pressure, and mental health. Interview narratives revealed improvements in mental well-being attributed to sutra chanting, including the alleviation of death anxiety and attainment of mindfulness.

Conclusions: The study suggests that the sutra-chanting program, consisting of immersive temple experiences, exposure to Buddhist priest talks, and training in breathing techniques and vocalization through sutra chanting, may contribute to improved mental and physical health.

Overview: In Canada, 30 % of seniors experience social isolation, which is associated with cognitive decline. Studies suggest that co-viewing videos with positive emotional content promotes communication and social engagement (Ansaldo et al., 2021). Seniors spend approximately 4 hours per day watching television. It is important to explore the impact of this fact on communication and global behavior in seniors and their proxies.

Objectives: To identify the emotions experienced by dyads, and the parameters modulating them, as well as communication.

Methods: 19 dyads of elderly individuals watched 20 videos with positive emotional content. During co-viewing, facial expressions, heartbeat and respiratory rates were measured. After each video, participants completed a questionnaire measuring emotions (PANAS), and a semi- structured interview. Quantitative and qualitative analyses were conducted.

Results: Significant results in favor of positive emotional valence for each video were observed following quantitative analyses (t-test) of the PANAS; participants primarily felt enthusiastic, interested, and inspired. Analyses of semi-structured interviews confirm that dyads experienced positive emotions particularly with nature, animals, and children related videos. Most of the dyads perceived co-viewing as a means to promote communication and evoke memories. Machine learning supported analysis show a correlation between screen content type, and participants’ engagement as reflected by pupil dilation, and respiratory ratestabilization.

Discussion: The use of adapted video content encourages person-centered communication and empathy, thereby contributing to the maintenance of social engagement among the elderly.

Conclusions: These results provide evidence for the benefits of using adapted video content to promote communication in old age and point to innovative avenues in the study of co-viewing effects on communication and engagement in individuals living with major neurocognitive disorders.

Objectives: Patients with mild cognitive impairment (MCI) employ compensatory cognitive processes to maintain independence in day-to-day functioning as compared to patients with Alzheimer’s dementia (AD). The dorsolateral prefrontal cortex (DLFPC) supports cognitive compensation in normal aging and MCI. Using Paired Associative Stimulation combined with Electroencephalography (PAS-EEG) we have previously shown that patients with AD have impaired DLPFC plasticity compared to healthy control (HC) individuals. The aim of this study is to examine whether DLPFC plasticity in individuals with MCI is preserved compared to those with AD and HC, serving as a potential mechanism underlying cognitive compensation in MCI.

Methods: We analyzed a combined cross-sectional data of 47 AD, 16 MCI, and 40 HC participants from three different studies that assessed their DLPFC plasticity using PAS-EEG. PAS-EEG assesses DLPFC plasticity via the induction of Long Term Potentiation (LTP)-like activity, thereby referred to as PAS-LTP. Using multiple regression, we compared PAS-LTP in MCI to PAS-LTP in AD and HCs, after adjusting for age andgender.

Results: Among the 47 participants with AD (mean [SD] age = 75.3 [7] years), 29 were women and 18 were men; among the 16 participants with MCI (mean [SD] age = 74.8 [6] years), 11 were women and 5 were men; and among the 40 HCs (mean [SD] age = 76.4 [5.1] years), 22 were women and 18 were men. After adjusting for age and gender, there was an impact of diagnostic group on PAS-LTP [F (2,95) = 4.19, p = 0.018, between-group comparison η2 = 0.81]. Post-hoc comparisons showed that participants with MCI had a higher PAS-LTP (mean [SD] = 1.31 [0.49]) than those with AD (mean [SD] = 1.09 [0.28]) (Bonferroni corrected p = 0.042) but not different from PAS-LTP in HCs (mean [SD] = 1.25 [0.33]) (Bonferroni corrected p = 1.0).

Conclusions: Our findings indicate that plasticity is preserved in the DLPFC among individuals with MCI, supporting the hypothesis that DLPFC plasticity contributes to cognitive compensation towards delaying progression to AD. Thus, further enhancement of longer preservation of DLPFC plasticity in individuals with MCI could further delay the onset of AD in this population.

Introduction: Throughout the course of the dementia, patients generally need a guardian to protect their rights due to the severity of their mental disabilities. The laws and procedures for guardianship for people with disabilities have been updated in several countries based on the UN Convention on the Rights of Persons with Disabilities promulgated in 2006.

Objectives: To compare the law and procedures for guardianship for people with mental disabilities of twelve countries from six continents.

Methods: Narrative review searching for civil codes/guardianship procedures, date of promulgation, scope of the guardian authority, preferred guardian, duration of the guardianship.

Results: Most countries predominantly promulgated their laws after the year 2000, being half of them updated after 2006. Most countries have two types of guardianship scopes: one concerning financial affairs and the other concerning personal affairs (such as welfare and medical care). Generally, guardianship concerning financial matters is the first to be established. In addition, most countries maintain the ward’s right to vote. In five out of twelve countries, there is an order of preference for choosing the guardian, being the spouses and adult children the preferred guardians. All these countries have the possibility of temporary guardianship. Three countries have a maximum period for guardianship with the possibility of renewal, while all others have indefinite time for guardianship duration. Only France explicitly grants the right to the ward to make medical decisions within guardianship procedures. Brazil’s Civil Code restricts guardianship to financial matters, whereas the Civil Procedure Code requires judges to define the scope of guardianship’s authority for each of the activities of the civil life. Since both codes hold equal authority, judges typically determine the extent of guardianship on a case- by-case basis.

Conclusions: Half of the nations have updated their laws after the promulgation of the UN Convention on the Rights of Persons with Disabilities.

Dementia is expected to increase worldwide and further Discussion concerning the rights of people with dementia is still needed. Although there is no ideal legal framework, the comparison of procedures from different countries may lead to valuable insights for further Discussions andassessments.

Introduction: Recurrent major depressive disorder (MDD) has been associated with cognitive impairment and hippocampus atrophy. Additionally, in older adults it is related to increased dementia risk, as well as being dementia’s prodromal syndrome.

Case Report: A 68-year-old female patient, with a history of MDD beginning in 2014, has been under the care of the Psychogeriatrics service at HC-UFMG. In 2015, she was 60-year-old and underwent her first MRI scan. At that time, the Medial Temporal Atrophy Score (MTA) was 2 and she had a treatment resistant depression (TRD). She began multimodal treatments, including ECT, achieving only partial remission. Since then, the patient had recurrences of depression without the remission of cognitive impairment. In 2021, her MTA Score was still 2 with TDR symptoms. Currently, she is on Venlafaxine 150mg, Mirtazapine 30mg, Lithium 300mg, Olanzapine 5mg, Clonazepam 0.25mg and maintenance ECT every 45 days. The patient remains with cognitive impairment that leads to disabilities but had not significantly progressed. On the other hand, the main impact in functionality is related to depressive symptoms, especially to the loss of interest and apathy.

Discussion: This case stands out due to the combination of hippocampal atrophy at a relatively young age and severe depression with cognitive impairment that has not progressed to dementia in 9 years. Severe depression can lead to significant cognitive deficits, as well as, hippocampus atrophy. While depression is related to hippocampus atrophy, it has not been related to TRD in a review study with Voxel-Based Morphometry. Conversely, Alzheimer’s Disease is related to MTA ≥2 scores, as well as depressive symptoms. MTA 2 in a person of 60 years of age is not considered normal. When combined with cognitive impairment, these findings are generally related to neurodegeneration. Since both MTA and cognitive deficits were relatively stable, the hypothesis of a cognitive impairment and hippocampus atrophy due to depression were more likely.

Conclusions: MDD leads to cognitive impairment in older adults, as well as hippocampus atrophy. Nevertheless, depression and age are important risk factors for dementia and, therefore, a progression to dementia due to a neurodegenerative disease is still possible.

Background: The Cognitive Domains and Functional Assessment Questionnaire (CDFAQ) assess cognitive and functional decline based on the DSM-5 criteria for Neurocognitive Disorders. Its accuracy has been assessed and was translated and validated into English. The informant version (CDFAQ-IV) is a 30-item questionnaire that assesses six cognitive domains with 5 items each: Complex Attention (CA), Executive Functions (EF), Learning and

Memory (LM), Language (L), Perceptual-Motor (PM) and Social Cognition. The development of CDFAQ-IV was based on theDSM-5 cognitive domains, but its factor analysis has not been done yet.

Objectives: To perform a Confirmatory Factor Analysis of the CDFAQ-IV to assess the six-factor cognitive domain model.

Methods: Older adults and their informants were invited to participate in this study. The CDFAQ-IV was applied in 292 older adults’ informants. We used the JASP for a Confirmatory Factor Analysis based on Lavaan R Packages. The confirmatory factor analysis was chosen to manual six-factor model. This study was approved by the ethics committee of UFMG.

Results: Concerning model fitness in the confirmatory factor analysis the X2 was significant (p < .001), standardized root mean square residual (SRMR) was .059 (accepted < .08) and the goodness of fit index (GFI) .984 (accepted > .9). However, the root mean square error of approximation (RMSEA) was marginal to the accepted fitness .066 (accepted < .06) and the comparative fit index CFI was .839 under the accepted cutoff (accepted > .9).

Conclusions: The six-factor model of the showed a good fit for three parameters, marginal for one and negative for the CFI. These results point to a convergence of the questionnaire and factors the DSM-5 cognitive domains. These are still preliminary results and we aim to increase our sample to further assess the confirmatory factor analysis.

Summary: Disorders related to progressive cognitive decline constituting an important cause of global death and disability-adjusted life years because conditions are also associated to impairment of several brain functions, psychological and behavioral changes, regardless of economic status. Brain-derived neurotrophic factor (BDNF) is a neurotrophin highly relevant in memory, learning and neuroplasticity processes in adults. The amount of plasma BDNF has been considered to partly reflect its secretion in the brain. Its deficiency is associated with affective disorders and neurodegenerative pathologies such as Alzheimer disease and Parkinson’sdisease.

The aim of this study was to identify quantifiable biomarkers (serum levels of BDNF) and clinical marker (state of depression and anxiety) that allow early detection of cognitive impairment risk. We made an analytic and transversal study with a representative sample (n:307) of the population over 50 years old in the south of Chile (X region). We determine the cognitive condition of the population by applying cognitive functionality tests, such as the minimental status examination (MMSE) test and identify demographic and psychosocial characteristics that constitute impairment cognitive risk. Subsequently, we determined depression status (scale of Yesavage) and anxiety status (Beck inventory), and finally we made a quantitative determination of human BDNF at the blood level using ELISA technique.

Our results revealed that 26.7% of the participants exhibited some degree of cognitive impairment, being higher in women (55.7%) with average age of 70,7. A 18,2% of subjects manifested indicators of depression and 33,2% have a very hight level of anxiety. The correlation analysis revealed a significant positive correlation between MMSE test (p < 0.001) and both BDNF plasma levels (p < 0.001) and education level (p < 0.001) scores. The results additionally indicated a negative correlation between cognitive functions and age range/anxiety state, suggesting low age level/hight level of anxiety in subjects with more pronounced cognitive decline (p < 0.001),. In consistent, the results of our study point towards decreases plasma BDNF levels and hight levels of anxiety in cognitive impairment subjects compared with cognitive normal subjects, which may be due to the early and middle stages of neurodegeneration process.

Objectives: To estimate the proportion of older adults in primary care screening positive for depression and identify associated factors.

Methods: A cross-sectional study was conducted involving 1,639 older adults (aged ≥ 60 years) from fourteen primary care units in a city of São José dos Campos in the state of Sao Paulo, Brazil, between December 2023 and April 2024. Depression was assessed using the Patient Health Questionnaire (PHQ-2), with a score ≥ 3 being considered to indicate the presence of depression. Logistic regression analyses were carried out to evaluate associations between sociodemographic characteristics (sex, age, marital status and employment) and health related variables (any chronic disease, alcohol consumption, and tobacco use) with a positive PHQ-2 score.

Results: The mean age of the 1,639 participants was 68.6 (SD ± 6.2; range: 60– 95). The prevalence of a positive PHQ-2 score was 20.5%. Women, those with chronic diseases, and current smokers were more likely to have a positive score, (OR: 1.72; 95% CI: 1.33 –2.23, p < 0.000), (OR: 3.13; 95% CI: 1.50–6.56, p: 0.002), and (OR: 1.55; 95% CI: 1.10– 2.18, p: 0.011), respectively. Those who had a job or a partner were less likely to have a positive score, (OR: 0.60; 95% CI: 0.37–0.97, p: 0.036) and (OR: 0.71; 95% CI: 0.55– 0.92, p < 0.010), respectively. There were no significant associations between age and alcohol consumption and screening positive for depression.

Conclusions: Mental health services in primary care typically serve as the initial interface between the community and healthcare services. A substantial proportion of older adults screened positive for depression, which was particularly associated with being female, not having a partner, being unemployed, chronic diseases, and tobacco use. Despite the cross-sectional nature of this study, the results suggest that these factors may play a significant role in the development of depression in this population, and underscores the importance of considering these factors when designing interventions and prevention strategies aimed at the mental health ofolderadults.

Background: There are no approved treatments for Alzheimer’s disease psychosis (ADP). Xanomeline, a brain- penetrant M1/M4 preferring muscarinic receptor agonist, showed antipsychotic efficacy in placebo-controlled trials in subjects with AD [Bodick NC et al. 1997; DOI: 10.1001/archneur.1997.00550160091022]. Despite promising efficacy, further development of xanomeline was limited by cholinergic adverse events. The investigational antipsychotic xanomeline and trospium combines xanomeline with trospium, an FDA-approved muscarinic receptor antagonist that does not measurably cross the blood-brain barrier. Trospium acts to mitigate the peripheral procholinergic side effects of xanomeline, providing a strategy for using xanomeline to stimulate brain muscarinic receptors with a decreased side effect burden. Unlike available antipsychotics, xanomeline and trospium have no direct dopamine D2-blocking activity, and as such, its safety and tolerability profile is different.

Methods: The phase 3 ADEPT-1 trial is a double-blind, flexible-dose, placebo-controlled randomized withdrawal study to evaluate the safety and efficacy of xanomeline and trospium in decreasing the risk of relapse in subjects with ADP. Subjects aged 55-90 years with moderate to severe psychosis associated with mild to severe AD (Mini- Mental State Exam score range 8-22) will be enrolled into the study. Subjects will receive single-blind xanomeline and trospium for 12 weeks. Each subject will be flexibly titrated to the maximum dose of xanomeline and trospium 200 mg xanomeline/20 mg trospium/day. At the end of the single-blind treatment, eligible responders will be randomized to either continue xanomeline and trospium or be switched to matched placebo for a 26-week double- blind treatment period. A responder is defined as a subject with a ≥40% decrease (improvement) on the Neuropsychiatric Inventory- Clinician: Hallucinations + Delusions (NPI-C: H+D) score compared with baseline (day 1) and a Clinician Global Impression–Change (CGI-C) score of 1 or 2 (very much improved or improved).

Results: The primary endpoint of the study, time from randomization to relapse during the double-blind, randomized withdrawal treatment, will be evaluated by survival analysis using Kaplan-Meier Methods. The study started in August 2022 and will randomize approximately 200 subjects.

Conclusions: The trial design of the ADEPT-1 study is an efficient way to assess the potential for xanomeline and trospium to provide clinically meaningful benefit in preventing the return of ADP in patients who have responded to xanomeline and trospium.

Objectives: In an era marked by a 100-year life expectancy, nearly everyone may eventually become a caregiver to a family member or someone close, yet caregiver support remains insufficient in Japan. Outside the government’s comprehensive community-based integrated care system, Buddhist temples are notable for supporting caregivers of individuals with dementia at home. To evaluate the rationale, feasibility, strengths, and fairness of using temples as a community resource within a community-based integrated care system, it is crucial to critically analyze views from secular healthcare professionals familiar with these activities. This study aims to explore the characteristics and potential of caregiver cafés hosted in Buddhist temples from the perspective of staff members involved in secular community- based integrated care system.

Methods: Initially, a preliminary questionnaire survey was administered to 13 priests at Jodo Shu temples that host caregiver cafés to ascertain the current status of these cafés and explore potential collaboration routes with public organizations for future research. Subsequently, semi-structured interviews were conducted with 15 staff members from public organizations involved in community-based integrated care, such as community-based integrated support centers, social welfare councils, and NPOs, who participate in caregiver cafés at Buddhist temples.

Results: All temples were found to cooperate with public institutions involved in community- integrated care. Thematic analysis led to the identification of 20 subcategories from 150 discourses. These subcategories, which had similar content, were further consolidated into a single category and ultimately grouped into four major categories: temples as social resources, temples and priests leveraging their strengths, familiar temples open to the community, and fair temples.

Conclusions: The findings suggested that temples have significant potential to integrate into community-based care systems and play crucial roles in supporting Japan’s super-aged society.

Objectives: Depression is the second most prevalent mental illness among the elderly. Nonetheless, treatment- resistant depression (TRD) is prevalent among the elderly; one-third of elderly patients with major depressive disorder (MDD) who received antidepressant treatment failed to achieve remission. Although there have been several studies regarding the associations between MDD and increased mortality and suicidal risk, studies between TRD and mortality/suicidal risk in the elderly still remains limited. In this national cohort study, we examined the association between TRD, non-TRD MDD, and non-depression with all-cause mortality, accident mortality, and suicide mortality.

Methods: For this retrospective longitudinal analysis on the entire population, the National Health Insurance Research Database of Taiwan, which comprises claims data from a lifetime insurance program and provided comprehensive medical inpatient and outpatient information categorized by ICD-9-CM and ICD-10. The National Mortality Registry offered information regarding mortality resulting from all causes, natural causes, suicide, and accidents. A cohort of ≥60-year-old patients, including both those with and without MDD, was observed between January 2003 and December 2017. Individuals were classified as TRD if they had undergone aminimum of two distinct antidepressant trials within the current episode’s two-year duration and dose, as documented in the prescribing records. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were calculated for mortality risk utilizing Cox regression models.

Results: Among those >60 years old, after adjusting with sex and comorbidities, TRD was associated with increased risk of suicide (aHR 7.4, 95% CI [5.6-9.8]; MDD without TRD 4.4 [4.1- 4.6], compared with non-MDD group). Simliar risk of accident mortality was observed among three groups (TRD aHR 1.3 [0.9-1.9]; MDD without TRD 0.9 [0.9-1.0], compared with non-MDD group). Surprisely, TRD might presented lower mortality risk of natural mortality than the non- MDD group (TRD aHR 0.8 [0.7-0.8]; MDD without TRD 0.9 [0.8-0.9], compared with non- MDD group).

Conclusions: The suicide mortality among elderly patients with TRD is higher in comparison to non-MDD patients; nevertheless, accident mortality does not appear to have increased and the natural mortality rate is reduced. The lower mortality may reflect patient selection, and the contributing factors need further evaluation.

Objectives: Domestic squalor (DS) is related to physical problems, living alone, problems for their family and neighbors, and mental illness, the most common of which is dementia. Early intervention for DS is important; however, Methods to detect and treat older adults with DS remain unclear. This study aimed to clarify the Methods of early intervention in older adults with DS.

Methods: The Initial-phase Intensive Support Team for Dementia (IPIST) is a multidisciplinary outreach team that provides intensive initial assessment and support for people living at home with suspected dementia in Japan. We distributed a questionnaire to 50 IPISTs that had reported experience of dealing with many complex cases’’ in our previous nationwide survey, asking them to provide detailed information on two complex cases’’ that were extremely difficult to approach or link to medical or long-term care. The questionnaire consisted of questions regarding sociodemographic characteristics, clinical assessments, referral sources, and reasons for complexity. We compared the results of the questionnaire between cases with and without DS (DS+ vs. DS-) and between cases with DS who lived alone and those who lived with family (DS+ living alone vs. DS+ living withfamily).

Results: We received responses from 33 IPISTs and collected data from 70 complex cases. DS was selected as the reason for complexity in 24 cases. Fourteen DS+ cases lived alone. DS+ cases referred by the family (8.3%) were significantly fewer than DS- cases (54.3%). In DS+ cases, the most common referral sources were neighbors and welfare commissioners. The proportion of cases having self-neglect were significantly more in DS+ (87.5%) than in DS- (13.0%). DS+ cases living alone were significantly younger (mean ± SD; 72.9 ± 7.3) than those living with family (80.0 ± 6.7). Family members living with DS+ cases also had issues including mental illness or maltreatment.

Conclusions: This study revealed that most older adults with DS experience self-neglect and a lack of supportive family members. A comprehensive approach to both older adults with DS and their families is important for early intervention, and therefore IPISTs that have a multidisciplinary team with an outreach function would be useful.

Objectives: Family members are the primary source of support for the growing number of people living with dementia (PLWD) worldwide. However, caring for a person living with dementia can have detrimental impacts on the carer quality of life (QoL). This review of systematic reviews was aimed at exploring the factors associated with the QoL of family carers of PLWD and interventions aimed at improving theirQoL.

Methods: Several health-related databases (PUBMED, Psychinfo, Google Scholar and COCHRANE) were consulted in November 2022. Nineteen systematic reviews were included, and their Methodsological quality was assessed via AMSTAR-2.

Results: Nineteen systematic reviews published from 2014 to 2022 were included, of which three assessed the factors associated with the QoL of carers and 16 assessed the impact of interventions on family carer QoL and other outcomes. Several intrinsic and extrinsic factors associated with carer QoL were identified and included dementia symptoms and its care demands, provision of formal support, relationship quality between carer and PLWD, carer physical and mental health, positive psychological traits, and age-specific needs. Systematic reviews of interventions showed promising, yet modest and heterogeneous effects, with no one-fits-all strategy that can improve the QoL of all carers. For this reason, person-centred and outcome-focused approaches have been called for, as well as more qualitative studies exploring the negative as well as positive experiences of QoL among carers. Evidence also points out to the importance of using dementia specific QoL scales instead of generic QoL scales so that relevant caregiving aspects affecting carer QoL can be considered

Conclusions: Evidence suggests the need for a person-centred approach to improving carer QoL, considering individual and contextual needs as well as the continuum and progressive nature of dementia care. Future research should be focused on understanding how to best implement and measure person-centred care approaches to carer QoL, including cost- effectiveness. More qualitative studies are necessary to explore carer negative and positive experiences of QoL.

Background: Most people living with dementia rely on their family members for the care and support they need. However, unpaid care can lead to multiple negative impacts on the wellbeing and mental health of carers.

Objectives: The Objectives of this study was to evaluate the effects of iSupport-Brasil (an online, psychoeducational program) on perceptions of burden and on the mental health of informal caregivers of people living with dementia.

Methods: A randomized controlled trial was carried out from January 2023 to April 2024 in Brazil. A total of 162 individuals were randomly allocated to an intervention group (IG) (n = 77) or a control group (CG) (n = 85). The IG had free access to the iSupport-Brasil platform for three months. Simultaneously, the CG participants were provided with a link to access the Brazilian Alzheimer’s Association website and a copy of the “Care Guide for Older People”, published by the Brazilian Ministry of Health. Pre- and post-intervention assessments were carried out using measures of burden (a single-item Burden Scale and the Zarit Burden Interview – ZBI), and of anxiety and depressive symptoms (Hospital Anxiety and Depression Scale - HADS).

Results: Based on an intention-to-treat analysis, a reduction in anxiety symptoms was observed for the IG (p = 0.02). Based on a per-protocol analysis, significant reductions in burden (p <0.01) and anxiety symptoms (p < 0.01) were found for the IG. No significant effects were found for depressive symptoms, although scores decreased. For the CG, the regression model indicated that, on average, burden and depressive symptoms worsened somewhat, but this result was not statistically significant.

Conclusions: The iSupport-Brasil program was effective in reducing perceptions of burden and anxiety symptoms among informal caregivers in Brazil. Therefore, we recommended that informal caregivers of people living with dementia use this program to help them broaden their interpersonal coping strategies and improve their emotional health, in addition to using mainstream long-term care support services.

Background: There is a dearth of research on the health and psychosocial support needs of unpaid carers in low- and middle-income countries, where approximately 80% of all people living with a disability or functional impairment and who may need support with their activities of daily living currently reside.

Objectives: To explore the variables associated with having the perception of psychosocial or health support needs among a sample of unpaid carers of people living with a disability and/or functional impairment inChile.

Methods: This is a cross-sectional analysis of a nationwide, population-based survey involving sociodemographic, care, and mental health related data of 1,900 individuals aged 13 and older who reported being the primary carer for someone with care needs in their household (adults or older persons). Univariate and multivariate logistic regression analyses were used.

Results: Being widowed/divorced, providing more hours of care, more personal care tasks, with an increased level of perceived difficulty, were independently linked with higher odds of having psychosocial or health support needs. Experiencing (most of the time) low interest/depressive mood, low energy, and anxiety, were associated with 0.6-, 0.9-, and 0.7-times higher odds of having unmet psychosocial and healthcare needs, respectively, compared to experiencing these a few times. Having low sense of control most of the time led to 2.6 higher odds of having psychosocial or health support needs compared to those who felt this way only afewtimes.

Conclusions: Variables related to the care provision and mental health, which could be improved with the receipt of more formal support, were the strongest factors related with unmet psychosocial and healthcare needs.

Objectives: The study aims to: (i) develop a clinical post-fall assessment tool for older adults in long-term care (LTC) settings; (ii) validate the tool’s effectiveness and usability; and (iii) assess the practical application and impact of the tool within LTC units.

Methods: The three-phase study employed a sequential exploratory mixed-Methods framework. Phase I: Tool development comprised a comprehensive literature review and a qualitative study of semi-structured interviews with nine healthcare professionals. Phase II: Validation adopted an embedded design, where qualitative perceptions from 18 professionals through two focus groups informed iterative improvements and a quantitative questionnaire (a Likert scale and open-ended questions) assessed the tool’s effectiveness and user experience. Phase III: Implementation encompassed a retrospective and prospective longitudinal study, focusing on fall incidence, communication efficacy, and usability, to gauge the tool’s real-world impact.

Results: From Phase I, a mnemonic checklist was developed and structured into five sections: patient characteristics, fall description, primary and secondary assessments, and post-fall management—selected for clinical practicality. In Phase II, focus group insights prompted refinements to the tool, while follow-up questionnaires indicated the tool’s substantial utility in enhancing practice (65%), communication (69%), usability (71%), and satisfaction (76%). Responses highlighted key challenges such as resistance to change and workload, contrasting with facilitators like availability and uniformity. The need for training and a period of adaptation were viewed as factors that could compromise use. In Phase III, the tool showed greater utility for identifying fall-related complications and managing falls, with a notable preference among all nurses, regardless of experience level, particularly those with less than 5 years of experience.

Moreover, a comparison of falls over two three-month periods—one without the tool and one with it—revealed that the tool enhanced communication between doctors and nurses. This improvement led to quicker notification of doctors and more efficient transfers of patients to the emergency room when necessary.

Conclusions: Our tool aims to improve comprehensive post-fall assessments for older adults in LTC settings, facilitating improved communication and decision-making among healthcare professionals. With its usability and practical design, this mnemonic checklist shows great potential for wide adoption in enhancing patient care practices.

Objectives: Caregiving can be a daunting and isolating experience, especially when supporting a loved one with Dementia The Objectives of this intervention was to provide a series of educational sessions available to caregivers to help educate them on strategies to enhance their well-being and interactions with a loved one living with dementia.

Methods: The Caregiver Literacy Series is a compilation of 18 webinar sessions with therapeutic workbooks designed to help caregivers understand the nature of specific dementia-related issues and designed to help the caregiver build some personal strategy to help better manage their caregiving role. Based upon a Framework that uses the Perceived Self-Efficacy Theory, each webinar provides educational materials, and resources and is designed to help build an action plan for the caregiver. Topics include “What is Caregiving?”, “Caregiving and Compassion Fatigue and Self-Care” and topics address coping and communication strategies. The webinar sessions were administered monthly and semi-monthly to consumers through a local Alzheimer’s Association network in the rural Midwest of the United States.

Results: Feedback from consumers who have used the materials suggest that the materials have provided some measure of information and helpful educational materials. The workbooks have also been an effective tool to help guide and empower the caregivers.

Conclusions: The Caregiver Literacy Series provides some effective and needed materials to help equip caregivers living with a loved one that has Dementia or Alzheimer’s disease with some measure of health literacy and empowers them to feel some sense of empowerment and comfort in the process.