People with dementia are more prone to premature nursing home placement after hospitalization due to physical and mental deconditioning which makes care-at- home more difficult. This study aimed to evaluate the effect of a post hospital discharge transitional care program on reduction of nursing home placement in people with dementia.

A matched case-control study was conducted between 2018 and 2021. A transitional care program using case management approach was developed. Participants enrolled the program by self-enrolment or referral from hospitals or NGOs. Community-dwelling people with dementia discharged from hospitals received a four- week residential care at a dementia care centre with intensive nursing care, physiotherapy and group activities promoting social engagement, followed by eight- week day care rehabilitation activities to improve their mobility and cognitive functioning. They were matched on a 1:5 ratio by age and sex to people with dementia discharged from a convalescent hospital who did not participate in this program for comparison. The study outcome was nursing home admission, measured three months (i.e. post-intervention), six months, and nine months after hospital discharge. Multinomial logistic regression was conducted to investigate factors associated with nursing home placement at each measurement time-point.

361 hospital admission episodes (n=67 interevntion, n=294 control) were examined. The regression results showed that participants in the intervention group were significantly less likely to be admitted to nursing home three months (OR = 0.023, 95% CI: 0.003-0.201, p = .001) and six months (OR = 0.094, 95% CI: 0.025-0.353, p = .001) than the controls after hospital discharge, but the intervention effect did not sustain nine months after hospital discharge. Longer hospital length of stay, and hospital admission due to dementia, mental disturbances such as delirium, or mental disorders IPA_Abstract_PDP_20230119_clean 2 such as schizophrenia significantly predicted nursing home admission three months and six months after hospital discharge.

The transitional care program could help reduce nursing home placement in people with dementia after hospital discharge. To sustain the intervention effect, more continual support after the intervention as well as family caregiver training would be required.

Lately, there is a growing interest around person-centred care in long- term care. Providing care that meets the wishes and needs of residents is essential but also challenging. Studies on implementing person-centred care point to a gap between theory and practice and argue that education is important in reducing this gap. What is not yet clear is how this education should be organized. The theory of care ethics states that a moral-relational attitude is necessary in order to achieve this. This attitude is not achieved by only focusing on formal knowledge but can be found in the care staff's implicit and experiential knowledge. Therefore, we examined how care staff can learn about person-centred care in a moral- relational way using their own experiences.

In 2020-2022, we conducted an action research in two care home locations. Care staff started by collecting their experiences on the ward. Afterwards, they reflected on these experiences in order to learn more about good and person-centred care. This study reports on the evaluation of the study (after year one and two) in interviews (n=17) in which care staff shared perspectives on working with experiences. The transcripts of the interviews have been thematically analysed.

Care staff stated that working with experiences increased awareness, giving them feelings of more control and pleasure in their work. Sharing experiences also created more context, providing care staff with guidelines for doing the right thing for the resident. This richer context was created due to the freedom they had to share their subjective experience, which worked empowering. Care staff also felt that it is necessary to reflect on experiences. Using their own experiences spoke directly to the imagination, through which they felt recognized and acknowledged.

Working with experiences in the daily care routine contributes to moral-relational learning and providing person-centred care to residents. This requires a different view of learning, in which primarily the experiential and tacit knowledge of care staff, and a communitive space for moral-relational learning.

Late-life suicide is the most serious consequences of late-life depression (LLD). Nevertheless, suicidal behavior is complex and hard to predict. With the help of MRI scans and machine learning algorithm, we aim to examine the neural signatures of suicidality in patients of LLD.

We recruited 83 patients of LLD with a mean age of 68.8 years, where 48 were suicidal (26 with suicidal ideation and 22 with past suicide attempts). Cross-sample entropy (CSE) analysis was employed to analyze the resting-state function MRI data. Three-dimensional CSE volume in 90 region-of-interest of the brain in each participant was input into convolutional neural networks (CNN) to test the classification accuracy of suicidality.

After six-fold cross-validation, we found several regions in the default mode, fronto-parietal, and cingulo-opercular resting-state networks to have a mean accuracy above 75% to predict suicidality. Moreover, the models with right amygdala and left caudate provided the most reliable accuracy in all cross-validation folds, signifying their unique roles in late-life suicide.

Our results provide potential targets for intervention or biomarkers in late-life suicide. More research must be conducted to consolidate our results with scalable implementation in clinical setting.

During the spread of infectious diseases, social isolation increases among the elderly with cognitive impairment. The telephone may be a traditional but realistic and reliable tool to prevent social isolation. We report here a pilot study to examine the effects of regular telephone communication on elderly people with cognitive decline living in urban areas.

Seventeen elderly people (including four males) who attended a session for recruiting participants for a class using the board game “Go” in Tokyo were paired and talked on the phone once a week about Go issues and other interests during the 3-month class period, starting January 2022. At the end of the class in April 2022, a self-administered questionnaire (5 items, 4-point scale) and semi-structured interview were conducted. The Ethics Committee of the Tokyo Metropolitan Institute of Gerontology approved the study, and the participants’ written consent was obtained.

The participants’ mean age was 80.1 ± 5.5 years, and the mean score of the Montreal Cognitive Assessment, which screens for mild cognitive impairment, was 21.3 ± 3.1, with 16 subjects (94.1%) scoring below the cut-off value of 25. The percentages of “agree” or “somewhat agree” responses indicated that the telephone interaction was “enjoyable” (94.1%), “had a positive effect” (88.2%), and they “would like to talk on the phone sometimes in the future” (76.5%). In the interviews, the positive responses were “(Because I was looking forward to the phone call so eagerly) I couldn't wait for the phone call,” “I enjoyed playing Go,” “It was easy to talk about Go because it was a common topic,” “We talked about things other than Go,” and “I want to go out with my pair partner,” while others were “I was careful about what talk about” and “It was difficult to maintain psychological distance from my pair partner.”

The results suggest that telephone communication may be effective for preventing social isolation among the elderly with cognitive impairment. We believe that promoting telephone interaction during normal times between residents in the community with common interests will build supportive relationships and lead to a Dementia-friendly society.

Loneliness is experienced by many older people and associated with depressive symptoms. Childhood adverse events have been found to be a predictor of loneliness in young adults. We would like to investigate whether childhood traumatic events are associated with loneliness in older people with depression. We also explored what kinds of traumatic events are more related to loneliness and whether family support will modify the association of interest.

Older adults (≧60 years) with history of major depressive disorder were enrolled from outpatient clinics. Participants cannot be diagnosed as dementia. They received a series of questionnaires, including cumulative illness rating scales, Hamilton depressive and anxiety rating scales (HDRS and HARS), Geriatric depression scale(GDS), Childhood Trauma Questionnaire(CTQ), Chinese version of the family adaptation, partnership, growth, affection and resolve(APGAR), and Mini-mental status examination.

Fifty-four participants were enrolled. The average age was 68.8 years and female predominance (83.7%) with mean educational year of 10.4. Univariate analysis was performed first using LS score as dependent variable, and only those variables with p value less than 0.2 were put into multiple linear regression. In the multiple regression model, age, gender, education, GDS, HDAS were entered as covariates and CTQ was treated as independent variable. The results showed that CTQ score was positively associated with LS (ß=0.565, p<0.001). The family support, presented as APGAR score, was not modified the results. In the explore analysis, physical neglect, emotional abuse, emotional neglect also showed positively associated with loneliness in the participants; however, physical abuse and sexual abuse did not have the same findings.

Childhood adverse events may be positively associated with loneliness in older people with depressive disorder after adjusting for confounders. We should pay more attention on the childhood traumatic events in these patients. In addition, physical neglect, emotional abuse, emotional neglect rather than physical abuse and sexual abuse seemed to have more impact on the loneliness in these participants. However, some limitations, such as small sample size, recall bias of childhood events, difficulty of recall physical and sexual abuse, and other latent confounders, should be considered before making a final conclusion.

Older age bipolar disorder (OABD) is commonly defined as bipolar disorder in individuals aged 60 or more. General principles of pharmacotherapy in guidelines for treating OABD are greatly like those for younger adults. We aimed to investigate prescription changes among OABD patients discharged from two public mental hospitals in Taiwan from 2006 to 2019.

OABD patients discharged from the two study hospitals, from 1 January 2006 to 31 December 2019 (n = 1072), entered the analysis. Prescribed drugs at discharge, including mood stabilizers (i.e., lithium, valproate, carbamazepine, and lamotrigine), antipsychotics (i.e., second- and first-generation antipsychotics; SGAs & FGAs), and antidepressants, were investigated. Complex polypharmacy was defined as the use of 3 or more agents among the prescribed drugs. Temporal trends of each prescribing pattern were analyzed using the Cochran-Armitage Trend test.

The most commonly prescribed drugs were SGAs (72.0%), followed by valproate (48.4%) and antidepressants (21.7%). The prescription rates of SGAs, antidepressants, antidepressants without mood stabilizers, and complex polypharmacy significantly increased over time, whereas the prescription rates of mood stabilizers, lithium, FGAs, and antidepressants plus mood stabilizers significantly decreased.

Prescribing patterns changed remarkably for OABD patients over a 14- year period. The decreased use of lithium and increased use of antidepressants did not reflect bipolar treatment guidelines. Future research should examine whether such prescribing patterns are associated with adverse clinical outcomes.

People are staying in the workforce longer with the employment rates of older adults rising considerably over the years. Particularly, the higher education sector is known to have an aging workforce where a large proportion of staff is older than 55 years. Psychological capital, which refers to an individual’s positive psychological state of development, includes four core dimensions: self-efficacy, hope, optimism and resilience. Understanding of the impact of psychological capital on wellbeing and mental health of working middle-aged to older adults is limited. This paper will present the survey outcomes on psychological capital, wellbeing and mental health of middle-aged and older university staff.

Data were collected using established Psychological Capital Questionnaire (PCQ), Psychological Well-Being Scale (PWBS) and Positive Mental Health (PMH) tool.

The mean age of 29 survey respondents was 55.37 years (SD=4.26) with the majority being female (27; 90%) and, on average, worked at the university for 8.35 years (SD=5.92). Total mean scores for PsyCap, PWBS and PMH were 111.77 (SD=16.15); 231.37 (SD=36.15); and 31.43 (SD=4.58) respectively. PsyCap was moderately correlated with PMH (r=.546) and PWBS (r=.481) as well as PWBS subscales on positive relationships (r=.483), self-acceptance (r=.450) and environmental mastery (r=.558).

While limited by the small sample size, this study provides preliminary evidence that psychological capital can potentially positively influence well-being and mental health and that program focusing on improving psychological capital can be considered to improve well-being and mental health of middle-aged and older staff working in the higher education sector.

Ageing and dementia affect many aspects of life, including intimate relationships, sex and sexual expression. Older people, including those living with dementia, can have sexual relationships and form new ones. Their sexual and physical health, quality of life, and psychological well-being can be improved by respecting their intimacy and sexuality expression preferences. However, due to ageism and stigma, healthcare professionals often ignore the sexual feelings and needs of those with dementia living in long-term care. Discussions with stakeholders and literature show limited attention paid to understanding the sexual preferences of people living with dementia in health and social care. In 2020, the Intimacy and Sexuality Expression Preference (ISEP) tool was developed for use in long-term care to gather information on intimate and sexual expression preferences of older people, including those living with dementia, to assist in care provision. The ISEP tool was trialled in a Queensland, Australia, nursing home with 14 older residents. This presentation will share insight into the use of the ISEP tool and how it informs the development of ‘ISEP: A Practical User Guide’. This guide provides information on how to (a) use the ISEP tool for assessment; (b) interpret and integrate findings into care (i.e., identify a potential course of action); and (c) evaluate outcomes. Illustrative examples will be included. It will inform how preferences for the expression of sexuality can be practically addressed to improve care practices and care outcomes (i.e., satisfaction and quality of life) for people with dementia.

Older patients (≥65yo) admitted to general hospitals have increased in the past years. This resulted in an increase in hospitalization periods, health costs, and morbi-mortality rates in this group of patients.

Previous evidence points that the reduced time to referral (TTR) to Consultation-Liaison Psychiatry Units (CLP) leads to a reduced length of stay (LOS) in GH improving long-term prognosis of medical conditions.

This study aims to explore whether a prior disability in older patients leads to delay the search for psychiatric help. And to explore whether early referral to CLP is associated with reduced LOS in general hospitals.

This is an observational, cross-sectional, multicentre study. We obtained a complete data set from a sample of 152 patients (≥65 years old) admitted to 7 general hospitals in Spain referred to CLP unit for 1,5 months.

Mean age of the sample was 76.3 (±6.4). TTR was 14.5 (±18.0) days. LOS was 26.7 (±22.4) days, and length of stay after consultation was 12.3 (±10.3) days. Barthel Index before admission was 87.3 (±18.0) and Lawton&Brody Index before admission was 5.3 (2.7). We found a significant positive association of Barthel Index (r=0.17, p=0.042) and Lawton&Brody Index (r=0.20, p=0.014) before admission with TTR, which indicates that patients with a worse clinical status were attended earlier. Similarly, antecedents of both falling episodes (r=-0.2, p= 0.013) and walking difficulties (r=-0.24, p= 0.003) were associated with shorter TTR. TTR in Medical Departments was 11.7 (±15.0) days and in Surgical Departments was 24.0 (±22.8) days (t=-3.5, p= 0.001). TTR showed a highly significant positive correlation with LOS (r=0.89, p<0.0001) and a more discrete positive correlation with length of stay after consultation (r=0.20, p=0.016).

We confirm that a shorter TTR to CLP was related to a shorter LOS. Also, patients in medical wards had shorter TTR. In contrast to our hypothesis, we found that a higher disability prior to hospitalization led to earlier referral to CLP, meaning that these patients were assessed and treated earlier leading to better long- term prognosis and lower health costs.

Patients with hoarding disorder (HD) show difficulty discarding items due to the perceived need to save the items and to distress about discarding them, which causes domestic squalor (DS), especially in young people. In older people, dementia also causes DS. In this case series, we report five cases of older people with DS and compare DS due to HD with DS due to dementia.

Case 1 was an 82-year-old female who showed hoarding symptoms in her 60s. She was diagnosed with late-onset HD. Case 2 was a 73-year-old female who showed hoarding symptoms in her 10s. She was diagnosed with early-onset HD. Cases 1 and 2 showed difficulty discarding. Case 1 went to the dump site to collect items that had been discarded by her family. Case 2 strongly refused to throw away items that were considered unnecessary by her family. However, cases 1 and 2 could continue to live at home with nonpharmacological treatment, such as limiting shopping items and getting items from friends and discarding items with their family step by step. Case 3 was a 56-year-old male who showed hoarding symptoms in his 50s. Case 4 was a 72-year-old female who showed hoarding symptoms in her 60s. Cases 3 and 4 were diagnosed with behavioral variant frontotemporal dementia. Case 5 was a 67-year-old female who showed hoarding symptoms in her 60s. She was diagnosed with dementia with Lewy bodies. Case 3-5 did not feel distressed that their family discard their items in their absence. However, despite adjustments to their living environment, they could not continue to live at home and were admitted to a nursing home.

In this case series, although cases with DS due to HD showed difficulty discarding items, they could continue to live at home. However, in cases with DS due to dementia, although their house was easily cleaned, they cloud not continue to live at home due to impairment of their daily activities. Therefore, it is important not to miss HD in older people, and DS due to dementia may be a sign they have difficulty living at home.

Deaths from suicide often incur a misclassification. Suicide is in fact subject to stigma and shame; in some countries it is even criminalized. Furthermore, there are situations in which the intentionality of the suicidal behavior is really equivocal or there was a desire to disguise the death by suicide, for example for insurance reasons. In many cases, it can be difficult to ascertain if death was due to a deliberate act (such as not taking life-saving medication or overdosing on them; an accident or a voluntary fall, etc.). Suicide deaths involving older adults are particularly prone to under-reporting. The advanced age of the deceased may imply less investigative interest than a death in childhood or from medical complications. In addition, there are cases in which it is really difficult to classify the type of death. The following story may underline such a difficulty.

Angela was 81 years old. A childless widow, sufficiently independent, was a guest in a nursing home for about a year; she was there - she said - mainly to fight her loneliness. However, in the nursing home she felt even lonelier than at home.

Her house was sold shortly before entering her residence. She felt very frightened by the pandemic, which she followed for long hours on television: she had begun to say aloud that she didn't want to be intubated, and that there was no more oxygen for anyone anyway. Everybody would have died soon. She was given sedatives to calm her down, but in one occasion a nurse saw her holding the pills in her mouth and then spitting them down the toilet. Her roommate got sick and was taken away. Angela kept asking about her, receiving no answer. She was noticed having difficulties falling asleep and although she showed no signs of infection or disease, she was heard saying that her days were over. One day, she told the nurse that she had finally figured out what to do. A few days later, she was found dead during lunchtime, apparently suffocating on a piece of turkey.

How an individual is informed of the traumatic loss of a loved one can influence the grieving process and quality of life for survivors. Objective: this qualitative survey aimed to explore how age influences the experience and feelings of those who have received communication of this type of death from a professional figure.

30 people recruited through the use of social networks and word of mouth participated in the study. The participants were divided into three groups according to the age variable (1 group: 10 participants up to 35 years old; 2 group: 10 participants aged between 45 and 55 years; 3 group: 10 participants aged 60 and over) who have received notification of the death of a loved one from police officers or health care professionals. The data was collected through an ad hoc questionnaire, completed online. The thematic analysis technique used Atlas.ti software 8.

the following four key themes were identified: (a) how the communication took place; (b) reactions; (c) support; and (d) coping strategies.

it is possible that advanced age confers greater resilience and coping strategies through life experiences to mitigate the stressful impact of communicating an unexpected and violent death.

Informed consent practices in healthcare are a fundamental element of patient-centred care; however, the traditional written description of the medical procedure for obtaining informed consent seems to have several limitations. Aim: This research aimed to evaluate the effects of an alternative method of obtaining informed consent, based on a short informative video for patients waiting to undergo a coronary angiography procedure in Italy.

The study involved 40 participants, 28 males and 12 females (mean age: 68.55, SD = 13.03), equally divided into two groups, one that received video informed consent and the other the traditional written one. Each group was asked to fill out two questionnaires, one created ad hoc by the authors to measure the level of understanding of the information provided and the perception of usefulness of informed consent, and the other the DASS-21 scale, able to assess anxiety, depression and stress levels.

Comparing the results of the two groups showed that informed consent via video enabled participants to better understand the information provided, as well as feel more confident in their subjective understanding of it, while perceiving informed consent via video as more useful than the traditional one. Video informed consent did not lead to higher levels of anxiety, depression, or stress among participants.

it can be hypothesized that video formats could represent a more useful and understandable alternative to traditional informed consent in the coronary angiography procedure sector.

Caregiving can be a daunting and isolating experience, especially when supporting a loved one with Dementia The objective 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.

The Caregiver Literacy Series is a compilation o 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.

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 caregiver.

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.

The purpose of this article is to review all the interventions that researchers have used to reduce ageist attitudes in the population.

We performed a literature search using PubMed database including the following MeSH terms: (“Ageism”[Mesh] OR “ageism”[tiab] OR “Age discrimination”[tiab]) AND (intervention* [tiab] OR therapy * [tiab] OR training* [tiab] OR prevention* [tiab]). 257 studies were found and only 18 were selected based on their language (only Spanish and English ones were included) and according our inclusion criteria.

To date, most widely strategies used in previous studies included: Intergenerational contact, education or both. Other techniques such as performing arts (theater and cinema), museums exhibitions and the simulation of activities for the elderly have been also studied with successful results. Likewise, two of the articles mentioned mindfulness and cognitive behavioral therapy as a preventive ageism strategy have not been demonstrated yet.

Different interventions have been tried to reduce ageist attitudes. The greatest benefits have been seen with the combination of intergenerational contact and population education. Ageism is an important problem that concerns today's society; further studies focused on strategies to reduce ageist attitudes in the general population are needed.

The study aimed to examine the effect of social prescribing on improving cognitive performance among community-dwelling older adults, and to explore the potential association between social support and the change of cognitive performance.

One hundred and eighteen older adults from Changtang community participated in the study and were followed up for three months. Cognitive function was assessed with Hong Kong Brief Cognitive test (HKBC) at baseline and 3-month follow-up. Pre- and post-social prescribing difference in cognitive performance was examined with paired t-test. Multivariate regression analysis was used to explore the potential factors of social support associated with the change of cognitive function.

Compared with baseline measurement (25.4±4.1), the total score of HKBC improved significantly after three-month social prescribing (26.5±3.6; t=-3.300，P=0.001). Multivariate regression analysis showed that baseline level of social support utilization was associated with the change of cognitive performance. The lower the utilization of social support at baseline, the more the change of cognitive performance due to social prescribing (β= -0.25, 95%CI = - 0.88 ~ -0.05).

Social prescribing may have a beneficial effect on cognitive function for community older adults. The utilization of social support may be one of the factors associated with its effect on cognitive performance.

The COVID-19 pandemic has been a mass bereavement event disrupting social functioning of individuals in the general population, restricted and changed end-of-life, mourning and grief processes. In these circumstances grief may become pathologic and complicated grief (CG) may rise. The vulnerability of elders to CG in times of loss and bereavement in the COVID-19 context has been hardly studied. The current study aimed to examine grief processes, complicated grief and their relationship with protective and vulnerability factors among adults and elders (45 years old and above) who experienced loss at the time of the COVID-19 pandemic. Methods: A total of 113 adults aged 45 and above were included in the analytic convenience sample. Quantitative data was collected by self-reported questionnaires of CG, resilience, well-being, state anxiety and negative engagement with hostile world scenarios (HWS). Additionally, qualitative data on grief experiences was collected in semi-structured interviews of 9 participants.

Factor analysis results supported prior identified factors of CG among the aged. Multivariate analysis and stepwise regression identified factors associated with CG: female gender, state anxiety and negative engagement with HWS were identified as vulnerability factors whereas resilience emerged as a protective factor. Thematic analysis identified two main themes among participants: (1) COVID-19 as an emotional accelerator and (2) Support from social resources in COVID-19 times.

Findings add to our understanding of complicated grief among adults and elders in epidemic times. A unique and novel finding is the relationship found between negative engagement with HWS and complicated grief. This highlights the importance of examining how individuals facing adversities in general and loss in particular, perceive their ability to cope with life hardships. Furthermore, further research for establishing diagnostic criteria of CG for the aged is recommended.

There is great concern about the care of the older adults in institutions, especially in recent years. One of the reasons is the cases of elder abuse, not only highlighted by academic and scientific sources, but also by the media. Humanization, respect, empowerment and non-infantilization are key elements to promote good treatment in nursing homes (López et al., 2021).

The aim of this study was to evaluate the care in nursing homes using the Professional good care scale in nursing homes (Pérez-Rojo et al., 2021).

The sample for this study consisted of 269 employees working in different older adults nursing homes in Spain (182 nursing aides and 87 other nursing home professionals: nurses, occupational therapists, psychologists, physiotherapists, social workers, sociocultural animators, speech therapists). The employees' evaluations of themselves (their own performance) and their own evaluation of their coworkers in the nursing home (the overall good care in the nursing home) in these two groups of professionals (nursing aides and nursing home staff that care residents) were assessed and compared. T-test were used for data analyses.

The results showed no significant differences between the two groups of professionals when they considered their own performance.

However, statistically significant differences were found when they considered the overall performance in their residency in humanization (p<.001), non-infantilization (p<.001) and in the overall score of the good care scale (p<.001). Good care in nursing homes was significantly perceived as less frequent among nursing aides.

It is important for the evaluation of good care of older adults by the staff to assess both their perception of themselves and their assessment of their coworkers. Good care is the result of a complex construct in which a wide range of factors converge. Therefore, it is essential to contemplate the most accurate assessment of it. To evaluate and promote good care, it seems appropriate to assess the overall performance of all the employees of the nursing home and not only the assessment that each one makes of the treatment he/she gives to the older adults with whom he/she works.

Effective risk identification and assessment is important to help inform personalised care decisions, positive risk management, policy making and clinical practice in dementia. This mixed-method systematic review identified key components of risk assessment for people with dementia living within the community and care homes, examined attitudes towards risk identification and risk assessment, and appraised existing risk assessment tools.

Systematic searches of eight databases on two platforms (EBSCO, OVID) and grey literature databases (Open Grey, Base) were conducted. Studies were systematically screened for inclusion based on predetermined eligibility criteria and quality assessed using the Mixed Methods Appraisal Tool. Findings were tabulated and synthesised using thematic synthesis.

Twenty studies consisting of qualitative and mixed-method designs were included in the review. Five overarching themes emerged from the synthesis: Conceptualisation of risk - individual perceptions of risk, including how different individuals define, construct, and identify risk situations. Components of risk –key elements included in risk and safety assessments. Contributors to risk –factors that impact the risk level and how risk assessments are conducted. Perspectives on risk assessment –how individuals assess risk and approaches to risk management. Risk reduction –strategies to mitigate risk following an assessment.

Our review found differences in how risk is conceptualised between people with dementia, their family carers, and healthcare professionals, with views being shaped by media perceptions, personal experiences, sociocultural influences, dementia knowledge and severity. We found that mobilisation both inside and outside of the home is the most frequently identified risk factor. Our findings show people with dementia and carers are generally risk- tolerant, while healthcare professionals adopt risk-averse approaches that reflect organisational requirements and ensure safety. We found factors that disrupt daily routines, living and caring arrangements, medication management, and unclear care pathways contribute towards adverse risk events. Few studies considered people with dementia’s insight into the risk being assessed.

Accurate risk assessment and effective communication strategies are needed to enable risk- tolerant practices and ensure these approaches can be evaluated effectively. We did not find any instrument which to date had been shown to be widely acceptable and useful in practice.