Late life suicide is an international public health crisis, yet the mechanisms underlying late life suicide risk are far less understood compared to younger age groups. Executive dysfunction is widely documented in late life depression (LLD), and cognitive flexibility and inhibition are specifically hypothesized as vulnerabilities for suicide risk. There is some evidence that LLD patients with suicidal ideation or attempt suicide have worse executive dysfunction than LLD patients that do not; however, it is unknown whether these differences exist in Passive Suicidal Ideation (PSI), which may be an important early stage of suicide risk. Delineating the mechanisms of risk for PSI in LLD is a crucial direction for late life suicide research. The purpose of our study was to examine whether cognitive flexibility and inhibitory ability are neurocognitive markers of PSI. The secondary purpose of our study was to determine if neurocognitive differences due to PSI are mediated by volumetric differences in the prefrontal cortex.

Forty community-dwelling middle- and older-aged adults with LLD (18 with PSI, 22 without) completed a neurocognitive battery that assessed cognitive flexibility, inhibitory ability, as well as other neurocognitive domains, and underwent structural neuroimaging.

The PSI group performed significantly worse on cognitive flexibility and inhibitory ability, but not on other neurocognitive tasks which included other measures of executive function. The PSI group had a larger left mid-frontal gyrus (LMFG) than those without PSI, but there was no association between LMFG and cognitive flexibility or inhibitory ability, nor was there statistical evidence of mediation.

Our findings implicate a unique neurocognitive signature in LLD with PSI: poorer cognitive flexibility and poorer inhibitory ability not better accounted for by other domains of cognitive dysfunction and not mediated by volumetric differences in the prefrontal cortex. Volumetric brain differences in the LMFG appear unrelated to differences in cognitive flexibility and inhibitory ability, which suggests two specific but independent risk factors for PSI in middle- and older-aged adults.

Frailty is a common clinical syndrome in older adults that carries an increased risk for poor health outcomes. Early identification of frailty may help optimizing quality of care. Fried's frailty criteria are often used as the gold standard of frailty. However, it takes too much time and the availability of a hand grip strength meter to measure these criteria in daily practice. Screening instruments for frailty such as the Groningen Frailty Indicator (GFI) and the Tilburg Frailty Indicator (TFI), are available. However, it is not yet certain whether the usual cut-off values are applicable to older psychiatric patients.

To determine internal consistency, sensitivity, specificity and area under the curve (AUC) of the receiver operating characteristic-curve (ROC- curve) of the GFI and TFI using validated cut-off values, and to determine the optimal cut-off value in older psychiatric patients.

Baseline data of an ongoing prospective cohort study were used. In this study GFI, TFI and Fried-criteria were determined in hospitalized and non-hospitalized psychiatric patients over 65 years old.

A total of 145 participants were enrolled, 90 of which were hospitalized and 55 were non-hospitalized. Median age of participants was 75.2 (SD =7) years, 108 were female. Prevalence of frailty according to Fried-criteria was 29.7%. Internal consistency (Cronbach's alpha) of the GFI was 0.76 and TFI = 0.75. Using the validated cut-off value and the Fried- criteria as reference, sensitivity of the GFI (≥4) was 0.95 (95% CI 0.83 - 0.99) and specificity 0.27 (95%CI 0.19 - 0.37). Sensitivity of the TFI (≥5) was 0.98 (95% CI 0.86 - 1.00) and specificity 0.31 (95% CI 0.23 - 0.41). The optimum cut-off value for both the GFI and TFI was ≥8. The AUC of the ROC-curve of GFI and TFI were 0.82 (95% CI 0.75 - 0.90) and 0.79 (95% CI 0.72 - 0.87), respectively.

We found an acceptable internal consistency and AUC of both the GFI and the TFI in older psychiatric patients. Increasing the cut-off values of both GFI and TFI seems necessary to lower the amount of false positives in this population.

To demonstrate the clinical and diagnostic insights provided through administration of a simple pen and paper exercise as part of Geriatric assessment and what this offers to understanding cognitive impairment in our patients.

A retrospective file review was conducted to select illustrative case studies of de-identified patients who presented for Geriatric assessment. Each patient had been administered a brief selection of visual tasks, in addition to the Mini-Mental State Examination (MMSE) and medical/radiological investigations required to inform diagnosis. The visual tasks of interest in this paper consisted of copying a 3D box, drawing a clock face, and drawing ‘ramparts’.

Comparisons of results were made across numbers of different clinical conditions, providing qualitative insights to inform diagnosis. Results varied across different conditions, as will be demonstrated in this paper. Results on these tasks were sometimes surprising, and unrelated to verbal testing. Examples will be presented of task performances which informed diagnoses such as Posterior Cortical Atrophy.

The addition of these simple pen and paper tasks to the standard MMSE can help inform clinical diagnostic decisions. The low verbal demands of these tasks facilitates examination of patients with impaired language functioning. The tests are quick and repeatable, and patients are generally willing to attempt this even when they are uncooperative with further questioning. This approach adds little time commitment but can offer valuable insights, particularly into executive, visuospatial and constructional abilities.

The prevalence and associated factors related to psychotic symptoms in older adults are understudied. The objectives were to assess the prevalence, incidence and factors associated with psychotic symptoms in a representative Greek sample of community living older adults.

This study includes older adults aged ≥ 65 years participating in the Hellenic Longitudinal Investigation of Aging and Diet. The analysis is based on n=1,904 participants with available data at baseline and n=947 participants at the 3-year follow-up. The presence of delusions and hallucinations in the past month was assessed on the grounds of the 17 symptoms of the Columbia University Scale for Psychopathology in Alzheimer's Disease and of the 14 symptoms of the Neuropsychiatric Inventory Questionnaire. An affirmative answer to any of these 31 symptoms defined the presence of psychotic symptoms. A comprehensive neuropsychological assessment for probable diagnosis of dementia and physical comorbidity was carried out by neurologists. Study factors included age, education, marital status, widowed in the past year, occupation, hearing impairment and number of chronic comorbidities. Penalized logistic regression analyses were carried out to assess the socio-demographic and clinical factors associated with the prevalence and incidence of psychotic symptoms.

The past-month prevalence of any psychotic symptom was 1.9% and 1.0% when excluding cases of dementia. The prevalence of any delusion and hallucination was 1.5% and 0.7%, and 0.8% and 0.3% when excluding cases with dementia. Paranoid delusions were the most prevalent. The incidence at the follow-up of any psychotic symptom was 2.1% and 1.3% when excluding dementia. Individuals not married had twice the odds and, farmers/breeders had three times the odds than public servants/teachers/executives of experiencing psychotic symptoms. Hearing impairment and the number of comorbidities increased the odds of the presence of psychotic symptoms. In addition to age and recent widowhood, these factors remained significantly associated with the presence of psychotic symptoms in cases without dementia.

Dementia was not related to over half of the cases observed with psychotic symptoms. Paranoid delusions were the most prevalent. Socio-economic and health status factors are significant predictors of psychotic symptoms.

To review the various available clinical models of care delivery for patients with persistent delusional disorder (PDD) in community and economically evaluate the REACT model of safe care delivery- REACT’s Assertive and Prudent- Model of Safe Care (RAP–MoSC).

REACT (Response Enhanced Assessment Crisis and Home Treatment Team) is the only bespoke crisis and home treatment team for older adults with mental health problems in the whole of Wales available only for the residents of Cardiff and Vale of Glamorgan through Cardiff and Vale University Health Board..

It was set up on 28 February 2012. The cases of PDD in REACT service since its inception to 31 Dec 2016 were studied in relation to the assertive and prudent health care model. The economic evaluation of this service model for PDD patients was studied in detail.

The RAP-MoSC model is economically effective in avoiding patients getting admitted to hospital under Mental Health Act by managing them safely in the community.

During the period between 28 February 2012 and 31 December 2016 there were 44 patients with a diagnosis of PDD in REACT’s case load. Only 3 patients got admitted to mental health assessment ward with the average length of stay period of 120 days. 41 patients were safely managed in the community with REACT with an average length of stay period of 21 days in REACT.

A PDD patient will cost NHS £21,000 if admitted to a mental health bed. If the patient is managed in the community with RAP-MoSC model of care the cost will be £1533.

REACT saved £793,548 by avoiding 41 PDD patients being admitted into hospital during an episode of delusional intensification in the period February 2012 to December 2016. PDD patients need under the RAP-MoSC model a bespoke MDT approach with better communication between secondary mental health and primary care services. Assertive and Prudent Clinical leadership is needed to sustain the RAP-MoSC in the community. Clinical reflections of this model of care will be presented in the conference.

On reflection REACT found that the key points in working with PDD are;

• Using a ‘foot in the door approach’

• Mental health professionals introducing themselves as Health professionals

• Remote prescribing

Sleep disturbance is a common symptom in elderly people. However, the associated risk factors have not been completely clarified. We examined possible risk factors associated with sleep disturbance in a community-based Japanese cohort study.

1521 community-dwelling individuals aged 65 years or older were selected from a consecutive series at a cohort study from 2016 to 2018 in Arao city, where located at south part of Japan. In this survey, the clinical valuables were collected as follows: age, sex, occupational status, education, lifestyle information, medical history, EuroQoL(EQ)-5D (a score of health-related quality of life [QOL]), Barthel index (a score of performance in activities of daily living), a score of Geriatric Depression Scale (GDS) and a score of Mini-Mental State Examination (MMSE). Sleep disturbance was assessed by the Pittsburgh Sleep Quality Index (when the global score was 6 or over, sleep disturbance was determined to be present). Multiple logistic regression analysis was used to examine the association between clinical valuables and sleep disturbance. This research was supported by AMED (Japan Agency for Medical Research and Development) under Grant Number JP18dk0207025h0003 and has been approved by the research ethics committee of Kumamoto University. Informed consent was obtained from all participants and their family members.

Multiple logistic regression analysis revealed that Parkinson disease (Odds ratio[OR]=5.59), living alone (OR=1.93), liver disease (OR=1.89), hyperlipidemia (OR=1.36), higher score of GDS (OR=1.14), lower scores of both EQ-5D index (OR=1.11) and Barthel index (OR=1.03) were significantly associated as risk factors with sleep disturbance. Unexpectedly, lower score of MMSE was not a significant risk factor.

These results suggest that several physical illnesses, solitude, depressive symptoms and lower QOL, but not cognitive impairment, might be crucial risk factors associated with sleep disturbance in elderly population.

The practice of assisted dying is increasingly being discussed in a growing number of countries and is progressively regarded as a last-resort option for those suffering from severe and irreversible diseases. Recently, euthanasia in patients with psychiatric disorders and dementia has taken a prominent place in the public debate, since little is known about the prevalence and practice of euthanasia in these particular cases. Remaining a controversial subject, this study aims to describe the evolution and characteristics in reported euthanasia cases, focusing in dementia patients and the perspective from different countries regarding the nature of suffering, the voluntariness of the request and the role of the physician in the process.

A non-systematic review was performed, searching Pubmed/MEDLINE and Google Scholar for articles using the keywords dementia, euthanasia and assisted dying. Resultant articles were cross-referenced for other relevant articles not identified in the initial search.

Physicians consider less likely to perform euthanasia in patients with dementia, compared to patients with a severe and life-limiting somatic illness such as cancer. Both physicians and members of the general public acknowledge difficulties in the assessment of the voluntariness of the request and the extent of suffering of patients with advanced dementia, considering that communication is compromised. While euthanasia on the grounds of unbearable suffering caused by dementia remains a comparatively limited practice, its prevalence has risen and is related to loss of dignity or the knowledge that the lasting memory of their loved ones will be of the decomposed version of oneself.

It is likely that the number of euthanasia requests from patients suffering from dementia and/or accumulation of health problems related to old age will continue to grow. The question of how policy makers and care providers should respond to these requests is, therefore, highly relevant, as welll as the development of practice guidelines, if medical staff is to respond adequately to these delicate requests.

Japan has become an aging society rapidly, and the percentage of the population over 65 was about 28.1% (around 36 million people) in 2018 in Japan. Then, the number of residents in nursing home has been also increasing.

Many residents in nursing home are receiving pharmacotherapy, and drug-related falls are a major problem at the institution. Fall due to medication sometimes occurs and results in serious consequences.

Then, the aim of this study was to identify the incidence of falls and its association with medication.

The Japan Adverse Drug Event (JADE) study for nursing home is a series of cohort studies. The JADE study for nursing home is a prospective cohort study that was conducted at 4 nursing home for elder people in Japan.

Based on the validated methodology, trained psychologists, medical doctors reviewed all charts to identify ADEs (Adverse Drug Events, injuries due to medication), suspected to being associated with medication. Simultaneously, we collected all falls regardless of drug association.

After collecting these events, 4 medical doctors independently made a secondary review. This study was approved by the institutional review boards of the Kyoto Prefectural University of Medicine.

We enrolled 459 residents, which yielded 3315 resident-months of observation time. The mean (SD) age was 85.8 (7) years and 344 (75%) were female. We identified 655 falls in 196 residents (39.6%) during the study period (incidence: 16.9 per 100 resident-months). 568 falls (86.7%) in 166 residents were related to ADEs. Among them, 10.9% (62/568) were accompanied by injuries, and 2.6% (15/568) of them resulted in fracture. The most common class of drugs associated with falls was benzodiazepine hypnotics (23.2%, 132/568) and atypical antipsychotics (17.4%, 99/568).

The frequency of falls in nursing homes in Japan was comparable to other countries (L. Z, Rubenstein, 1996). Since significant portion of them were associated with medication, careful monitoring of medication is required.

A single moderate or severe TBI is associated with accelerated brain aging and increased risk for dementia. Despite the high rate of falls that result in brain injury in older adults, numerous factors such as genetic predisposition to Alzheimer’s disease, sex, education, age are also known to affect multiple age-sensitive neuroimaging markers.

Here we use the “brain age” metric being tested by the global consortium, Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA), that employs machine learning to predict a person’s age from multiple age-sensitive imaging markers (e.g., hippocampal volume, regional cortical gray matter thickness, intracranial volume (ICV)), while also taking into account their sex and educational level. We will discuss results from brain injured patients ( n = 60; age range: 20-75 years) and healthy age-matched controls (n = 20 (20-75 years). We will compute the “brain age gap” – between a person’s actual chronological age and that predicted from their brain scan – and test relations between this measure and injury characteristics.

In our pilot work, we predicted a person’s age from their MRI scan with a mean absolute error of about 5 years. ENIGMA’s current best model includes: (1) non-normalized brain volumetric measures as predictors including ICV, (2) separate models for males and females, (3) use of a large age range (12-80), and (4) Gaussian process regression (GPR).

This “overall” marker of accelerated brain aging offers a metric that taps diverse sources of information, weighted by their relevance to brain aging, and is associated with decreased functionality in older adults.

Opioid use is particularly concerning among older adults. In Canada, those aged 65 years and older have the highest hospitalization rates due to opioid poisonings. Despite the current opioid crisis and the aging population, few studies have evaluated the factors associated with opioid use among seniors.

To examine the factors associated with prescription opioid use among community-dwelling older adults.

The sample includes 1657 people aged 65 and over recruited in primary care clinics from 2011 to 2013 in a large health administrative region of Quebec (Canada) and participating in the ESA-Services study, a longitudinal study on aging and health service use. The presence of chronic diseases was identified through self-reported health survey data and physician diagnostic codes (ICD-9/-10) from health administrative data. Psychological distress was measured using the Kessler Psychological Distress (K10) scale and dichotomised into low (scores 10 - 15) versus moderate, high, and very high distress (scores 16 - 50). Opioid prescriptions were identified using the provincial pharmaceutical drug registry for those covered under the public drug insurance plan. Sociodemographic variables were collected from the ESA-Services survey. Logistic regression analyses were carried out to examine the factors associated with opioid use up to a 4-year period following the baseline interview.

31.9% of participants used opioids in this sample. Factors associated with opioid use included: female sex (OR=1.24, 95%CI: 1.01-1.53), annual household income of <$25,000 (OR=1.25, 95%CI: 1.01-1.55), level of social support (OR=0.85, 95%CI: 0.73-0.99), and presence of pain/discomfort (OR=1.66, 95%CI: 1.34-2.04). Furthermore, participants with ?3 chronic physical conditions also reporting anxiety and/or depression were 3.63 (95%CI: 1.83-7.18) times more likely to use an opioid than those with 0-2 chronic physical conditions and no anxio-depressive disorder. Moreover, those with moderate, high, and very high psychological distress were more likely to use an opioid than those with low psychological distress.

Our findings suggest that, among other factors, physical and psychiatric multimorbidity is strongly associated with prescription opioid use among community-dwelling older adults.

Personality and emotions have not been studied as thoroughly as cognition in old age. Recent research suggests personality changes across the entire life span, through middle age and even into old age. Thus, the previous assumption of stability in personality traits from early adulthood has been challenged and novel approaches to the study of personality development have emerged.

The aim of this presentation is to describe the effects of the ageing process in personality and emotions.

A non-systematic review of the literature was performed on PubMed, PsycINFO and Web of science using selected keywords.

When older adults compare their current and past selves, they usually perceive a subjective growth in personality. Descriptive research suggests that the big five personality characteristics (neuroticism, extraversion, openness, agreeableness and conscientiousness) remain generally stable over the lifespan, despite variations in life experiences. Some studies revealed age-related linear decrease in extraversion. One of the studies found that hearing impairment, already identified as a significant risk factor for social isolation, was related to this decline in extraversion. Although levels of neuroticism tends to go down over the course of adulthood, the increased vulnerabilities that accompany old age may amplify neurotic traits, increasing worries about physical health and memory, common features of depression in the elderly. Emotions, relative to more neutral knowledge and skills, increase in later years. Elderly have better control over emotions than do younger adults, they reason more flexibly about emotion-laden dilemmas and remember emotionally charged information better than neutral facts. Older people also rely more often on emotion-focused forms of coping, as opposed to active, problem-solving approaches.

Core features of personality seem to remain relatively stable throughout adulthood and any marked change in mood or social behavior may indicate a disorder. However, more subtle reordering of personal priorities and shifts in coping styles are common with normal ageing. The richness of emotional processing in older persons runs counter to the generally declining patterns seen in many cognitive and physical skills.

As a psychological being, quality of life is one of the most important part to human. Many things could affect one’s quality of life, in elderly, Dementia is one of them. In 2013 approximately there were 960.000 people with dementia (PWD) in Indonesia. Caregiver who take care of PWDs’ daily activity have an important role and maybe prone to stress, guilty feeling, anger and sad due to hardship of caregiving the PWD. Therefore caregivers’ quality of life is substantial as PWDs’ quality of life.

This study objective was to know the relationship of quality of life people with dementia and their caregiver in Indonesia.

A descriptive-analytic study was conducted in RSUPN Dr. Ciptomangunkusumo Hospital Jakarta. Eighty four subjects were participated (42 PWD and 42 caregivers). PWD subjects were interviewed using questionnaires EQ-5D and severity of dementia measured using MMSE. Meanwhile caregivers’ QOL was measured using WHOQOL-BREF. Data was analyzed using binary correlation between PWD and Caregivers’ quality of life.

There was no correlation of PWD physical health and caregivers’ quality of life. However there was strong correlation between quality of health PWD and caregivers’QOL notably in environmental domain (r = 0.839). And there were also a strong correlation between PWD severity of dementia and caregiver’s QOL inphysical domain (r = 0.946). Some of caregivers’ factor influencing quality of life were age (r = 0.805), duration of caregiving each day (r = 0.362) and experience of caregiving (r = 0.927)

Study found that the quality of health PWD had a strong correlation with caregiver’s QOL specifically in environmental domain.Internal factors related to caregiversQOL were age, duration of caregiving each day and experience of caregiving. Future study should be focused on objective measurement of quantify health quality.These findings suggest that caregivers’ quality of life also an essential part in managing dementia.

It's been proved that cognitive stimulation has direct effects over the improvement of general cognitive functions in people with cognitive impairment. People older than 50 are progressively familiar with computers and mobile devices, opening an opportunity for computer based online cognitive stimulation programmes.

To compare the efficacy of face to face cognitive stimulation (FFCS) with online home delivered cognitive stimulation (OCS) regarding adherence, number of sessions, cognitive function and mood.

Participants were enrolled in a public memory clinic; 51 patients with cognitive decline were assigned to two groups: 27 received FFCS in a group format and 24 received OCS with the assistance of a carer. Both face to face and online interventions where designed and supervised by a trained Occupational Therapist. Pre and post assessments were carried out by a Clinical Psychologist with the Mini Mental State Exam (MMSE), the clock test, and the brief Geriatric Depression Scale. No differences were found between groups in age (69.65±9.74 years), cognitive function (MMSE=24.63±3.67), gender (55% women) and education. The treatment consisted of 32 sessions of CS held twice a week during 4 months.

Data was analysed with nonparametric statistics and between group effect sizes were calculated. The FFCS participants completed 29.19 ± 1.73 sessions while the OCS group completed 26.00 ± 10.64 sessions (p < .000). All the participants in the FFCS group (100%) and 14 of the OCS group (58%) finished the treatment (p < .000).

Between group effect size favoured the FFCS intervention for MMSE (dc = 0.36). No between group differences were found for mood (dc = −0.5) or the clock test (dc = 0.13).

FFCS is better accepted by patients than OCS, with higher rates of adherence and less dropouts. FFCS leads to better results in the preservation of cognitive capacity.

Primary Health Care (PHC) has an essential role in the early detection of people with cognitive impairment (CI). Rowland Universal Dementia Assessment Scale (RUDAS) is a brief cognitive test, appropriate for people with minimum completed level of education and easily adaptable to multicultural contexts. For these reasons it could be a good instrument for dementia screening in PHC. It comprises the following areas: recent memory, body orientation, praxis, executive functions and language.

The objective of this study was to analyse the viability of RUDAS, as an instrument for the screening of CI in PHC. RUDAS viability in PHC was checked, and it's psychometric properties assessed: Reliability, Sensitivity, Specificity, Positive and Negative Predictive Value were studied. RUDAS was compared to Mini Mental State Exam (MMSE) as a “gold standard”.

RUDAS was administered to 150 participants older than 65 years, randomly selected from seven PHC physicians’ consultations in O Grove Health Center. The test battery also included Katz, Barthel and Lawton Indexes, MMSE and the Geriatric Depression Scale. For each instrument administration time, difficulties perceived while administration and participant's collaboration were recorded. RUDAS was administered again within one month to assess test-retest reliability. For dementia clinical diagnosis, patients were classified following the Clinical Dementia Rating (CDR) scale based on clinicians’ criteria and health records.

RUDAS application was brief (7,58±2,10 minutes) and well accepted. RUDAS’ area under Receiver Operating Characteristic (ROC) curve was 0.965 (95% Confidence Interval (CI) = 0.91-1.00) for an optimal cut-off point of 21.5, with sensitivity of 90.0%, and a specificity of 94.1%. RUDAS did not correlate with depression. Education, socioeconomic status and urban or rural context did not contribute any variance to RUDAS total score.

RUDAS is a valid instrument to assess CI in PHC. It is easily applicable and appears to be culturally fair and free from educational level and language interference in bilingual contexts. However, longitudinal studies to determine its sensitivity to change in cognitive function over time are needed.

The nosology and etiological underpinnings of very late -onset schizophrenia-like psychosis (VLOSLP) have remained controversial. This case report highlights its diagnostic complexity.

A 64-year-old woman, with a previous history of hypertension, diabetes, mild cognitive decline, right grade-4 hemiparesis as sequelae of an ischemic-stroke (three years before), started persecutory and partition delusions. After six months, the delusions were accompanied by complex visual hallucinations (scenic, lilliputian and holocampine), elementary auditory, tactile, olfactory, and gustatory hallucinations, causing a profound daily life impact, consequently she was hospitalized. Neither negative symptoms nor formal thought disorders were present. Electroencephalography and laboratorial evaluations were unremarkable (including thyroid function, folic acid, cyanocobalamin, infectious serologies and anti-gliadin/transglutaminase antibodies). Neuroimaging displayed subcortical microvascular lesions in the left centrum semiovale, bilateral thalamic and basal ganglia lacunes. Neuropsychological examination revealed mild/moderate impairment in working-memory, sustained-attention, executive functions, abstract thinking, and visuospatial abilities. Mini-mental state examination (MMSE) scored 20/30. Clozapine was started. As psychotic symptoms ameliorated cognitive deficits also improved (MMSE score: 25/30). She was discharged with residual symptoms.

Late-life psychosis implies a thorough investigation, bringing about challenges in diagnosis. Several medical causes, including neuroinflammatory/immunologic, were ruled out. This two-stage progression, with partition delusions and multimodal hallucinations, in the absence of formal thought disorder and negative symptoms is typical of VLOSP. It is arguable to ascribe our patient’s psychosis to a previous vascular dementia or to VLOSLP. Almost half of VLOSLP patients may develop dementia. It is still debatable whether this propensity is a true characteristic of VLOPSL or reflects an initial misdiagnosis. Some neuropathological studies suggest a restricted limbic tauopathy underlying VLOSP. Notwithstanding, cognitive impairment is common in VLOSLP, including in those patients who do not develop dementia. Neuroimaging studies evidence that lacunar infarction in the basal ganglia alongside chronic white matter small vessels ischemic disease, may underlie the pathophysiology of psychosis via a disruption in the frontal-subcortical pathways. Nevertheless, cases of post-stroke psychosis usually resolve in few months. In conclusion, the neurobiological underpinnings of VLOSLP are complex and multifaceted. More systematized studies using biomarkers and neuroimaging are needed so clinicians can perform a more accurate diagnosis of VLOSLP.

The Geriatric Anxiety Inventory (GAI) is a widely used self-report measure of anxiety symptoms in older adults. Much research has been conducted on the psychometric properties of the GAI in various populations and using different language versions. Previous reviews of this literature have examined only a small proportion of studies in light of the body of research currently available and have not evaluated the methodological quality of this research. We conducted a systematic review of the psychometric properties of the GAI.

Relevant studies (N = 30) were retrieved through a search of electronic databases (Pubmed, PsycINFO, CINAHL, EMBASE and Google Scholar) and a hand search. The methodological quality of the included studies was assessed by two independent reviewers using the ‘‘COnsensusbased Standards for the selection of health status Measurement INstruments’’ (COSMIN) checklist.

Based on the COSMIN checklist, internal consistency and test reliability were mostly rated as poorly assessed (62.1% and 70% of studies, respectively) and quality of studies examining structural validity was mostly fair (60% of studies). The GAI showed adequate internal consistency and test-retest reliability. Convergent validity indices were highest with measures of generalized anxiety and lowest with instruments that include somatic symptoms. A substantial overlap with measures of depression was reported. While there was no consensus on the factorial structure of the GAI, several studies found it to be unidimensional.

The GAI presents satisfactory psychometric properties. However, future efforts should aim to achieve a higher degree of methodological quality.

Unwanted loneliness is a public health issue due to its high prevalence among elderly people (20-40%) and its relation with morbidity and mortality. There is no clear strategy for addressing this problem given the diversity of needs and resources people with feelings of loneliness have.

Identify the needs and resources of elderly people with chronic conditions and feelings of loneliness by comparing the patient’s outlook with that of their primary healthcare professional.

Observational, cross-sectional, descriptive pilot study using theoretical convenience sampling at 5 health facilities in Barcelona (Spain), performed between October and May 2020. Of 159 people selected, 42 were identified to have feelings of loneliness (UCLA < 30) who agreed to participate in the study and their care needs were analysed using the Camberwell Assessment of Need for the Elderly (CANE) questionnaire. A descriptive and comparative analysis (Kappa coefficient and discrepancy percentage) of needs was performed using the outlook of the patients and their healthcare professionals. Data was analysed using SAS assuming a 5% significance level. A qualitative analysis was also performed to understand the relation between the feeling of loneliness and needs across 24 care areas (environmental, social, psychological, and physical). The study was approved by the IDIAP Jordi Gol Healthcare Ethics Committee (19/138-P).

The needs perceived focused on physical health, distress, companionship, and relationships (30% to 41.7%). Professionals showed a severe lack of knowledge regarding housing, home care, relationships, and social services (22% to 48%). The qualitative analysis revealed the relation between the feeling of loneliness and the irreversible losses of those close to the patient, along with insufficient support and understanding during the aging process, and feelings of abandonment and guilt. Meanwhile, other notable aspects include the need of independence and resistance towards starting activities requiring commitment and travel. Caring for others and mobility and sensory restrictions act as extra barriers.

This study enables the needs of people with feelings of loneliness to be identified. Discrepancies between them and their healthcare professionals were recorded, in turn providing direction regarding which areas need to be improved when designing patient-focused primary healthcare approaches.

Neurodegenerative diseases (ND) are the most important cause of dependency in the world. The care of these patients is mostly assumed by their families. As a result, their family quality of life (FQoL) may be affected, decreasing their well-being, and modifying their habits and normal functioning. FQoL is a multidimensional concept, composed of different aspects that determine the life situation of each family, being these components both objective and subjective. Thus, the FQoL will depend on being able to access to support services that respond to the individual needs of all members and that this is adequate to adapt the environment and lifestyle to the demands of the disease. Public administrations are responsible for covering the socio-health support needs of people with ND and their families.

The objective of this research is to analyse whether the currently available social services are in accordance with the Family Life Quality model.

A descriptive analysis of the support offered by the public services of the Autonomous Community of Castilla y León (Spain) to people with ND and their families has been carried out, analysing its correspondence with the dimensions of the Quality of Family Life Survey of Brown and collaborators (2006): health of the family, financial well-being, family relationships, informal support, support from care services, the influence of values, leisure and community interaction.

The research results suggest that 1) most public services are aimed exclusively at the care of the person with ND; 2) these supports address the needs of the financial well-being, family relations and community interaction dimensions; 3) these are mainly aimed at supporting the situation when the illness worsens; 4) the limited specific services for families support them in the enjoyment of leisure and financial well-being.

The public welfare system of Castilla y León does not consider the family of people with ND as the target of its support services, but the person with ND declared as a dependent. Thus, it does not offer support services aimed at satisfying some needs linked to the dimensions of the FQoL model.