My presentation will not deal with dementia, as my co-presenter will fully cover this subject of paramount importance when we talk about mental health in older age. However, there is far more in relation to mental health issues. The absolute and proportional number of individuals who will reach older in the next few decades is staggering, particularly in the Global South. How come someone could reach old age enjoying high levels of well-being and mental health if they have been faced with all sorts of risk factors alongside their life courses? Low educational levels, deprivation, lack of access to social and health services, ill-trained professionals, prejudice…The combination of all of them result in depression, loneliness, and use of drugs (including alcohol). There is also to consider the gender dimension, the plight of immigrants (some of whom are illegal and out of the radar), climatic changes leading to insecurity, and in some countries a staggering number of individuals who age deprived of liberty. Add to that, wars, and horrors; for each death, you will add traumatized family members and close friends suffering the silent pain that those losses represent. Violence is increasingly trivialized and a country does not have to be 'officially’ in a war for such experiences to occur - they have their own internal 'wars’ fueled by political greed, drug trafficking, and militias. For some it has never been so rosy to age, but for the majority of our populations (and not only in the global South) it is tough.

Dementia is a critical global health issue affecting more than 55 million people, and this number is projected to rise to nearly 80 million by the end of the decade. It is the seventh leading cause of death, disproportionately affecting women, with most cases occurring in low- and middle- income countries (LMICs). The economic burden of dementia is immense, with annual costs estimated at $1.3 trillion in 2019, expected to more than double by 2030. Half of these costs are due to informal care, primarily provided by women, who face significant impacts on their physical and mental health.

Despite its severity, dementia receives insufficient attention. In May 2017, recognizing dementia as a public health priority, the World Health Assembly approved the Global Action Plan on the Public Health Response to Dementia 2017-2025, which serves as a comprehensive blueprint for policymakers, international, regional, and national partners, and the WHO. The plan addresses the issue through seven strategic areas: policy; awareness; risk reduction; diagnosis, treatment, care and support; strengthening health information systems, and research. However, significant gaps remain in diagnostics, national dementia plans, and research. To facilitate the monitoring of the global action plan, WHO has created the Global Dementia Observatory (GDO), a portal that collects national data on 35 key indicators across the seven strategic areas of the global action plan. Complementing the Observatory, WHO launched a Knowledge Exchange Platform, a repository of best practice examples aimed at fostering mutual learning and multidirectional exchange among regions, countries, and individuals, to facilitate global action. The GDO serves as a monitoring and accountability tool, guiding countries in policy implementation and progress tracking. To meet the 2025 targets, accelerated efforts are needed, emphasizing national responses, equitable access to services, and inclusion of people with dementia. Renewed political commitment and robust health information systems are essential to guide effective planning and action.

The mental health of older people in Latin America has become increasingly significant due to population ageing and changes in social structures across the region. Older adults in the region, as in many parts of the world, face significant challenges that can impact their mental health, including poverty, social isolation, limited access to healthcare, and the stigma associated with both mental health issues and ageing.

Access to mental healthcare services in the region is particularly limited for older adults, with a shortage of geriatric specialists and mental health professionals trained to address their specific needs. Changes in family structures, and the lack of support received by informal caregivers, can influence the availability and quality of informal support and caregiving networks, affecting both older people and caregivers’ mental health.

While the mental health of older people in Latin America is a subject that is gaining attention, significant gaps persist in terms of healthcare access, social support, and effective policy implementation. We will explore some of the key factors influencing the mental health of older adults in the region, alongside the current efforts and challenges in developing innovative policies and programs aimed at promoting their mental health and well-being.

This presentation illuminates the imperative role of geriatric psychiatry amidst an ever- changing healthcare paradigm and the rising prevalence of older adults with mental health challenges and neurocognitive disorders that drive an escalation in health care spending. Utilizing a holistic approach to assessment and treatment, the field of geriatric psychiatry has the transformative potential to streamline care costs and elevate the quality of mental health services for older adults and individuals with dementia.

Exploring diverse healthcare frameworks such as the value-based care model in the US and global payment systems such as those in the Veterans Administration and other socialized medical environments, the lecture advocates for the implementation of integrated geriatric mental health care models. Through an evidence-based analysis of models such as Collaborative Care, Care Ecosystem and Alzheimer’s Dementia Care (ADC), the presentation highlights the central role of geriatric mental health care in driving improvements in care quality while reducing overall healthcare expenditures.

Drawing from personal insights and professional experiences, the speaker offers a nuanced perspective on the journey towards comprehensive geriatric mental health integration within healthcare system environments. By championing innovation and advocating for integrated care practices, the presentation aims to inspire attendees to embrace a proactive stance in designing and implementing progressive and interdisciplinary geriatric mental health solutions on a global scale.

Imagine living with dementia. What would your day look like? What would be your living experiences? What is the range of possible experiences? Despite diverse research aims-such as managing agitation, observing dressing habits, reporting on bathing practices, or examining the engaging potential of various stimuli-studies converge on common themes. These themes and study procedures offer guiding principles and practical examples for enhancing the daily lives of individuals with dementia. In this presentation, I will review various such studies that, despite their differing goals, reveal consistent patterns. We will explore the feasibility of implementing these principles and the requirements for successful integration. This analysis suggests the need for a fundamental shift in care premises, indicating that significant improvements in the quality of life for individuals with dementia can become possible. However, it also underscores the infrastructural limitations that may hinder this progress. Furthermore, it will illustrate how progress necessitates paradigm shifts that fundamentally revise the planning, training, and provision of care. This is an invitation for each of you to step forward, develop, and implement those changes, allowing us to learn from each other’s experiences and collectively improve dementiacare.

Closing Keynote:

Alzheimer’s disease (AD) therapeutics are advancing at a rapid rate. After a 17-year hiatus with no new drugs approved worldwide, there have been approvals of disease modifying agents in 2021 and 2023 by the US Food and Drug Administration (FDA) and an additional agent is under review by the FDA. Lecanemab is approved in the US, China, and South Korea and is under review by many other countries. Widespread availability of anti-amyloid monoclonal antibodies is likely over the next few years. Appropriate use of these agents requires substantial healthcare infrastructure to ensure patient benefit and safety. Administration of monoclonal antibodies in countries where healthcare systems are less robust is challenging. Advances in the global treatment of Alzheimer’s disease require an improved understanding of the neurobiology of Alzheimer’s disease; the development of drugs that are accessible, efficacious, and safe; the creation of international clinical trial infrastructure to recruit more representative populations; education strategies to ensure the correct use of new drugs by clinicians; and implementation approaches that are culturally appropriate to inform patients about the availability of treatment and their proper use. Conduct of clinical trials and development of clinical trial site networks has many advantages including education about AD and clinical trials, learning strategies to rigorously generate robust clinical data, patient education opportunities, revenue generation, recruitment of diverse global populations, and interactions with biotechnology companies with improved collaboration and understanding of industry-based careers. Drug development for Alzheimer’s disease addresses a global problem and requires a globalsolution.

The International Psychogeriatric Association (IPA) has been steadfast in its commitment towards advancing human rights of older persons since the release of its 2011 White Paper which expanded the focus of the Capacity Task Force to prioritize human rights. Through partnerships with the World Psychiatric Association Section Old Age Psychiatry (WPA-SOAP), Capacity Australia, International Longevity Centre Canada (ILC Canada), Canadian Coalition Against Ageism (CCAA), and Rights of Older Persons Australia (ROPA), IPA members have emerged as global leaders in advocating for integration of human rights-based mental health care for older persons. Advocacy efforts have spanned grassroots and global strategies. At the grassroots level, IPA has championed the seamless integration of human rights principles into clinical practice, demonstrating a commitment to action. Globally, IPA has engaged in advocacy for a United Nations (UN) convention on the rights of older persons, notably through active participation in UN Open Ended Working Group on Aging (OEWGA). This symposium showcases a diverse array of papers exemplifying these dual approaches. Papers on grassroots strategies include: (i) “Walking the Talk:20 Ways to Embed Human Rights in Everyday Clinical Practice” (Carmelle Peisah) provide practical guidance for clinicians; (ii) “The UN Decade’s and our own efforts to address ageism” (Liat Ayalon); (iii) Actualizing human rights of older persons with severe mental Illness (Anne Wand). Papers highlighting global strategies include: (i) “Our role and impact with the OEWGA/OHCHR /WHO” (Kiran Rabheru) illustrating how our advocacy has urged healthcare organizations and multilateral bodies such as the UNOEWGA, World Health Organization (WHO), and Office of UN High Commissioner for Human Rights (OHCHR) to prioritize the human rights agenda for older persons; (ii) Is a new treaty critical for policy making? A lawyer’s perspective (Andrew Byrnes); (iii) “The Global Alliance for Rights Based Care and Support (GARBCS)’’ (Carlos de Mendonça Lima) underscoring the transformative potential of collaborative efforts in fostering a rights-based approach to care. Established to address challenges faced by older individuals worldwide, GARBCS promotes optimal mental health, combats ageism, and fosters collaboration among member organizations, aligning with UN Decade of Healthy Ageing and WHO’s focus areas. Founding Members include AAGP, CHeBA, ILC-Canada, IPA, WDP, WFMH, WFP, WPA, and WONCA, organisations led by many of our IPA members.

Objectives:

1. 1. To understand the challenges faced by older persons worldwide;

2. 2. To engage clinicians in becoming human rights champions;

3. 3. To understand current global efforts at advocacy for the human rights of older persons.

Walking the Talk: 20 Ways to Embed Human Rights in Everyday Clinical Practice- Carmelle Peisah

Summary: This presentation will illustrate translational significance and practical implementation of the United Nations Convention on the Rights of Persons with Disabilities (CRPD), the primary international human rights framework. Articles from the Convention most relevant to the practice of old age psychiatry include: (i) Article 12: Equal recognition before the Law including the right to equal legal capacity, the support in exercising that legal capacity, and the right to be safeguarded against undue influence and abuse; (ii) Article 14: Liberty and security of the person; (iii) Article 16: Freedom from exploitation, violence and abuse; Article 19: Living independently and being included in the community; (iv) Article 22: Respect for privacy; (v) Article 23: Respect for home and the family, and relationships on an equal basis with others; and (vi) Article 25: Equitable access to health. Clinicians will be provided with practical ways to implement each of these relevant Articles in their everyday practice.

Is a new treaty on the human rights of older persons critical for effective policy making? A lawyer’s perspective- Andrew Byrnes

Objectives:

1. 1. To inform participants of the latest developments relating to a new treaty on the human rights of older persons

2. 2. To highlight the potential positive contribution of such a new treaty in terms of policymaking

3. 3. To explore through two case studies how the absence of such a treaty has skewed policymaking in relation to older persons and their rights

Summary: The development of a new United Nations treaty on the human rights of older persons or in older age has been under Discussion at the United Nations and elsewhere for more than a decade. One of the major advantages of a thematic treaty on the rights of older persons is said to be its potential contribution as a clear, comprehensive and coherent framework for policy making at the national level. Advocates argue that other thematic UN treaties – on discrimination against women, children and the rights of persons with disabhave had this effect, as have regional treaties including those that address the rights of older persons in the Inter-American and African human rights systems. This presentation will explore the potential policy contributions that a new treaty could make by considering recent examples from Australia in which the lack of a comprehensive and coherent international framework on the human rights of older persons led to flawed analysis and policy making. The examples are the Royal Commission into Aged Care Quality and Safety and the drafting of the proposed new “rights-based” Aged Care Act (2023-2024), and the proposal for a national Human Rights Act put forward by the Australian Human Rights Commission (2023) and the Australian Parliamentary Joint Committee on Human Rights (2024). The presentation will argue that, had policymakers had such a framework available to guide their deliberations, a better, more rights-complaint outcome would have resulted.

Actualising human rights of older persons with severe mental illness A/Prof Anne Wand1,2,3

1. 1. Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney

2. 2. School of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New SouthWales

3. 3. Older Peoples Mental Health, Sydney Local Health District

People living with severe mental illness experience greater morbidity and premature mortality compared to their peers who do not have mental illness. As articulated by the Convention of the Rights of Persons with Disabilities, persons living with mental illness have an equal right to access high quality health care including towards the end of life, and the right to determine what kind of care they want. These rights sit alongside the rights to live independently and be included in the community, and respect for home and the family. Too often though, these rights are not actualised.

Geriatric psychiatry has an important role in advocacy for older people living with severe mental illness to enjoy equitable rights to autonomy in decision making in areas of accommodation, consent to healthcare, and expressing wishes and preferences towards the end of life. Where capacity is lacking, clinicians may assist to maximise the older person’s participation in decision making, including through supported decision making. This presentation will use examples of recent work conducted in public older persons mental health services in Sydney Australia to illustrate advocacy for older people living with severe mental illness to enjoy equal rights to autonomy of decision making and access to quality physical healthcare, including care towards the end of life (advance care planning), and supported accommodation placement (pathways to community living initiative).

Conclusions: Often the only health professional engaging with an older person with severe mental illness, mental health clinicians have an opportunity and, arguably, an obligation to advocate for their consumers to actualise their human rights.

The UN Decade’s and our own efforts to address ageism- Liat Ayalon

Ageism is defined as stereotypes, prejudices, and discrimination towards people because of their age. It can be directed towards people of any age and be either positive or negative. However, its negative impact, especially on older persons is well documented. Given its substantial impact, it is one of four pillars identified by the UN Decade as essential to tackle to achieve a world for all ages. The UN Global Report on Ageism proposed three evidence-based strategies to reduce ageism. In this presentation, I will illustrate one such strategy, which consists of a 90-minute educational workshop. The workshop was delivered to 318 Israeli adolescents (aged 11 to 15, 73.9% females) to increase their familiarity with the concept, reduce their negative ageist stereotypes, and increase their inclination to become social activists via social media. We found an improved familiarity with the concept ‘ageism’, while adolescents drew upon concepts such as discrimination and racism to define ageism. Following the intervention, a diverse range of age-related stereotypes emerged, signaling a shift toward more positive perceptions, with notable growth in positive age stereotypes, especially among females. Finally, about two-thirds of created memes (online visual and textual social messages) targeted ageism against older persons, 18.98% promoted an age-inclusive world, and 17.15% addressed ageism towards children and young persons. Implications for reducing ageism in adolescence and for measuring social change arediscussed.

Our role and impact with the Open-Ended Working Group on Aging (OEWGA), the Office of the High Commissioner for Human Rights (OHCHR), and the World Health Organization (WHO)- Kiran Rabheru

1. 1. Highlight the Collaborative Efforts of Key International Organizations:

Illustrate the critical role of the International Psychogeriatric Association (IPA), World Psychiatric Association (WPA), and other organizations in working with UN bodies to advance the human rights of older people.

1. 2. Emphasize the Importance of Increased Engagement and Advocacy:

Discuss why deeper engagement from mental health professionals and advocacy groups is necessary to influence global policies and initiatives that protect and promote the rights of older persons.

1. 3. Demonstrate the Impact of International Cooperation:

Provide examples of how collaboration with the UN Open-Ended Working Group on Aging, the Office of the High Commissioner for Human Rights, and the World Health Organization has led to tangible improvements in the lives of older persons, particularly those with mental health conditions.

Summary: In an increasingly interconnected world, the role of international organizations such as the International Psychogeriatric Association (IPA) and the World Psychiatric Association (WPA) has become vital in promoting the human rights of older people. This talk will explore how these organizations collaborate with key UN bodies, including the Open-Ended Working Group on Aging, the Office of the High Commissioner for Human Rights, and the World Health Organization, to address the unique challenges faced by older persons, especially those who live with mental health conditions. By engaging more deeply with these global efforts, we can enhance

scientific advocacy, develop comprehensive policies, and implement effective interventions that safeguard the rights and well-being of older persons. This presentation will underscore the necessity of cross-sector engagement and international cooperation in fostering an inclusive world where the human rights of older people are fully actualized and protected.

>The Global Alliance for Rights Based Care and Support (GARBCS)- Carlos Augusto de Mendonça Lima, Gabriel Ivbijaro, Helen Lavretsky, Kiran Rabheru

Our world is rapidly aging, with scientific and medical advancements extending lifespans without necessarily enhancing the quality of those additional years. Older persons form a non- homogeneous group with varying levels of intrinsic capacity and functional abilities. Yet, universally, individuals in their later years aspire to preserve dignity, maintain control and independence, foster social inclusion, uphold justice and equality, receive respect for their identity, and pursue good health, security, engagement, and independence throughout their lives. They are entitled to timeless human rights and should receive rights-based care and support just like anyone else in society. Unfortunately, ageism, as defined by the World Health Organization, is pervasive and has a significant negative impact on the lives of older individuals. This discrimination, based on age, affects how people think, feel, and act towards older people. A human rights-based approach to health specifically aims at realizing the right to health and other health-related human rights. These rights are translated into clinical practice as social determinants of health. Their implementation is mainly dependent of fair distribution of money, power and resources at global, national and local levels. Planning health care for older persons should be guided by human rights standards and principles. The final aim of such an approach could be empowering rights-holders to effectively claim their health rights. Elimination of all forms of stigma and discrimination is at the core of a Human- Rights based care for older adults.

A meeting was held during the WPA World Congress in Vienna, Austria, 2023. The attendees unanimously acknowledged that there is a significant amount of work yet to be undertaken in championing the well-being of older individuals. This includes advocating for their dignity, human rights, and health promotion. There is a shared commitment to fostering optimal brain health, resilience, and overall well-being among older adults, addressing their diverse needs encompassing mental, emotional, cognitive, physical, and spiritual dimensions. It was agreed that there is a need to bring together a stakeholder alliance that is coalesced around strengthening the human rights and dignity of older persons. The concept of a Global Alliance for Human-Rights Based Care and Support for Older Persons was born with goals:

1. 1. Strengthen collaboration among member organizations for impactful messages, optimizing mental health, generating knowledge, and driving person-centered, evidence-based change.

2. 2. Enhance visibility and impact across education, research, media, policy, advocating for global awareness, resources, and policies addressing mental health, prioritizing rights, combating ageism, and integrating care, education, andresearch.

3. 3. Propose transformative changes during the UN Decade of Healthy Aging, aligned with WHO’s focus areas, combating ageism, fostering age-friendly communities, ensuring person-centered integrated healthcare, and expanding access to long-term care.

4. 4. Identify strategic opportunities for advancing Sustainable Development Goals (SDGs) across diverse age demographics, addressing how ageism hinders global Objectives.

5. 5. Ensure a unified communication strategy for care and support for older persons, emphasizing clear terminology within global initiatives.

With the rapidly aging population worldwide, the psychiatric care of older adults faces increasingly complex challenges. Geriatric psychiatry must adapt to address the rising prevalence of depression, anxiety, and cognitive impairments with innovative and effective treatments. Neuromodulation in geriatrics encompasses a variety of innovative treatments designed to help manage symptoms of various neurological and psychiatric conditions common in older adults. This symposium will explore the mechanisms, clinical applications, safety, and up-to-date research in Electroconvulsive Therapy (ECT), Transcranial Magnetic Stimulation (TMS), Transcranial Direct Current Stimulation (tDCS), and cannabinoid therapies in older adults.

ECT, conducted under anesthesia, induces seizures via small electric currents through the brain. It is proven to be safe and efficacious in severe depression, catatonia, agitation, aggression in dementia, and other neuropsychiatric conditions especially in the elderly. TMS is a non-invasive procedure that applies electromagnetic pulses to stimulate nerve cells in specific areas of the brain, thought to change neural activity and is FDA-approved for treatment resistant depression. tDCS, employing low direct current via scalp electrodes, is being increasingly explored for depressive disorders and cognitive disorders. Cannabinoids, activating cannabinoid receptors, emerge as a promising option for dementia-related agitation.

In this symposium, Dr. Georgios Petrides will present updated research on the effectiveness of ECT to treat agitation in patients with dementia. Dr. Adriana Hermida will review theTMS literature and share clinical outcomes from Emory University. Dr. Maria Lapid will discuss tDCS effectiveness in depression among older adults. Dr. Brent Forester will examine cannabinoids’ role in dementia-related agitation, including ongoing clinical trials with dronabinol.

The learning Objectives for this session is to understand the principles, applications, benefits, and potential side effects of various neuromodulation techniques and cannabinoids in geriatric care. By the end of the presentation, attendees should be able to explain the mechanisms of action of ECT, TMS, tDCS, and cannabinoids, identify the conditions they can treat, and discuss their relevance and effectiveness in geriatric psychiatry. Furthermore, attendees should be able to compare these techniques and make informed decisions about their use in clinical practice.

Population ageing is occurring rapidly in India with the proportion of older adults (aged 60 years and above) estimated to reach 20% by the year 2050 from the existing 10%. The prevalence of mental health problems in older adults is also expected to increase significantly due to population ageing. Nearly 20% of older adults have at least one mental health condition including the subsyndromal conditions. The data from National Mental Health Survey (NMHS), Longitudinal Ageing Study of India (LASI) and the recent LASI-Diagnostic Assessment of Dementia have estimated the national prevalence of Psychiatric disorders like depression and dementia. 30.2% of older adults have significant depressive symptoms and 8.3% have major depressive disorder. The prevalence of dementia is estimated as 7.4% with an estimate of 8.8 million persons with dementia in 2016 and projected increase to 16.8 million in 2036.

More than 90% of older adults with mental health problems in India remain undiagnosed and untreated. Access to non-pharmacological interventions for older adults with mental health conditions as well as their caregivers are very limited. Mental health problems in older adults are often considered as normal for ageing by older adults, family caregivers as well as health care professionals. Dedicated and specialized clinical services for geriatric mental health care is not available in most of the mental health care institutions.

This symposium will present a critical review of the progress in geriatric mental health care services across India by summarizing the initiatives to promote geriatric mental health care and training. The need for comprehensive psychosocial care and psychiatric rehabilitation along with the acute geriatric mental health care will be addressed by experts involved in geriatric mental health care and training.

The symposium will have the following presentations.

1. 1. Geriatric mental health care in India- scope, challenges and innovative initiatives: Prof. Sivakumar Palanimuthu Thangaraju, Professor of Psychiatry & Head, Geriatric Psychiatry Unit, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India

2. 2. A review of the initiatives for the training to promote the workforce for geriatric mental health care in India: Prof. Krishna Prasad Muliyala, Professor of Psychiatry & Head, Psychiatric Rehabilitation Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India

3. 3. Psychosocial interventions for geriatric mental health care- Scope and challenges: Prof. Thirumoorthy A, Professor & Former Head, Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India

The 2017-2025 WHO Global Action Plan on the response to dementia emphasizes the necessity of developing approaches to sustain physical, mental, and social wellbeing in people with dementia, their careers, and families. Since the publication of this Global Action Plan, there has been some progress, particularly regarding physical and mental well-being, while less progress has been made on social well-being, a well-being dimension whose importance was particularly highlighted during the COVID-19 pandemic. In human beings’ social connection is established through communication. Hence, communication disabilities in the context of dementia negatively impact social well-being. This Symposium is constructed around three complementary approaches to enhancing social well-being in persons living with dementia.

The first presentation by Prof Yves Joanette approaches the concept of social wellbeing as per the WHO Global Action Plan for dementia, and the WHO Decade of Healthy Ageing plan. It will discuss links between social inclusion and communication, reminding the audience that communication can be affected even when cognitive impairments are hardly visible, insidiously crumbling social life since the very first stages of the illness, while pointing the tendency to isolating PLWD from the rest of the society (e.g., long-term care), particularly in pandemic periods.

The second intervention by Dr Marcelo Shapira will share his team’s Multidisciplinary and Sociosanitary Approach to Dementia Care and Social Well-Being, proposing a gerontological perspective to interventions at the person’s home, including pharmacological and non- pharmacological approaches to BPSD, a co-managing approach addressing complex situations, while learning from the person’s experience.

The third intervention by Pr. Ana Inés Ansaldo will address challenges to social wellbeing in the context of the vicious circle of uncommunication in dementia, and links with BPSD. It will develop the concept of emotionally grounded communication and its importance to preserve well-being through the continuum of dementia care. A presentation of pilot data on an intersectoral research project on the psychophysiological, verbal, nonverbal and markers of emotional communication will follow, followed by an overview of the COMPAs study as means to support person-centered care.

Intervention 1 – Social wellbeing as a central piece for the WHO Global Action Plan as well as for sustaining well-being in healthy aging - Yves Joanette, Professor, Faculty of Medicine, University of Montreal, Lab Director, CRIUGM, Montréal, Québec, Canada Member of the WHO Dementia Plan Advisory Committee and Former Chair, World Dementia Council

Intervention 2– Multi-disciplinary and Socio-health Approach to Dementia Care and Social Well-being: Experiences that Improve Management -Dr. Maria Sol Rossi

Intervention 3 – Human Expertise and Artificial Intelligence: Empirical and Clinical Evidence on the Role of Emotional Communication in Social Well-Being of Persons Living with Dementia - Ana Inés Ansaldo, Professor, Faculty of Medicine, University of Montreal, Director of the Neuroplasticity Communication and Ageing Lab, CRIUGM, Montréal, Québec, Canada.

Background: Limited knowledge exists about the association between Parkinsonism or Parkinson’s disease (PD) and cognitive impairment and dementia in Latin America.

Objectives: The study aimed to determine the cross-sectional and prospective associations between Parkinsonism and PD with cognitive impairment and dementia in a large multi-country cohort in Latin America.

Methods: The 10/66 is a prospective, observational cohort study. This population-based cohort study was based in six Latin American countries: Cuba, Dominican Republic, Puerto Rico, Venezuela, Mexico, and Peru. The study includes 12,865 participants from six countries, including residents aged 65 years and living in urban and rural catchment areas. Exposures included diagnosed Parkinsonism and PD defined according to the United Kingdom Parkinson’s Disease Society Brain Bank diagnostic criteria. Cognitive impairment was the main outcome measure for cross-sectional analysis and dementia was used to measure the prospective association with the exposures. Logistic regression models were used to explore the association between Parkinsonism/PD with cognitive impairment at baseline. Competing risk models were used to assess the prospective association between Parkinsonism/PD with incident dementia accounting for competing risk of mortality. Individual country analyses were combined via fixed-effect meta-analysis.

Results: At baseline, the prevalence of cognitive impairment in people with Parkinsonism and PD was 30% and 26.2%, respectively. Parkinsonism (OR 2.2 (95%CI 1.9 – 2.6)) and PD (1.9 (95%CI 1.4 – 2.4)) were individually associated with baseline and incident cognitive impairment after accounting for age, sex, and education, after pooling. In competing risk models, the pooled sub- hazard ratios for dementia in the fixed effect metanalysis were 1.5 (95%CI 1.2 – 1.9) for parkinsonism and 1.5 (95%CI 1.0 – 2.2) for PD.

Conclusions: Parkinsonism and PD were cross-sectionally associated with cognitive impairment and prospectively associated with incident dementia in Latin America. Routine screening for cognitive impairment and dementia with validated tools in PD patients may aid earlier detection of those at greater risk ofadverseoutcomes.

Demographic transition and changes in the population structure has contributed to global challenges related to population ageing. World Health Organization (WHO) has proposed global strategy and action plan on ageing and health to address the challenges related to population ageing. Despite the decline in intrinsic capacity, provision of appropriate environmental support can help in improving the functional ability and promoting Healthy ageing. India and Brazil are large countries with rapid population ageing with significant needs and challenges to promote Healthy Ageing. Both countries have significant differences in the cultural and socio-economic factors related to population ageing and rich history of traditional/alternative medicine interventions (such as Yoga and Ayurveda in India). Older adults have multiple comorbidities of physical and mental health issues with many of them seeking treatment from alternative systems of medicine. Holistic approach with integrated care will be helpful in older adults to promote healthy ageing. This symposium will summarize the holistic approach to healthy ageing in the global context with specific focus on the perspectives from India and Brazil.Mental health experts from India and Brazil with expertise in Geriatric Psychiatry and Integrative Medicine will be the presenters for the symposium.

The symposium will have the following presentations

1. 1. Holistic approach to Healthy ageing: Global Perspectives: Prof. Sivakumar Palanimuthu Thangaraju, Professor of Psychiatry & Head, Geriatric Psychiatry Unit, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India

2. 2. Lifestyle interventions through Integrative medicine to promote Healthy Ageing: Indian Perspective: Prof. Shivarama Varambally, Professor, Department of Psychiatry & Former Head, Department of Integrative Medicine, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India

3. 3. Scope for Traditional medicine and Holistic approach to Promoting Healthy Ageing in Brazil: Dr Bernardo Viana, Assistant Professor of Psychiatry, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil

Objectives: Dementia presents a growing public health challenge globally and its impact is significantly pronounced in low and middle-income countries (LMICs), including those in Latin America. This symposium aims to present recent findings on the prevalence, impact, and underlying factors of cognitive impairment and neuropsychiatric symptoms in aging populations across Latin America, with a focus on culturally and regionally specific research findings.

Methods: The symposium will consolidate data from the 10/66 Dementia Research Group, which has conducted extensive research across various Latin American countries. We integrate results from multiple investigations with over 12,000 elderly participants from six Latin American countries, utilizing cross-sectional and longitudinal Methodsologies. These studies employ the 10/66 Dementia Research Group protocols, among other internationally recognized diagnostic tools, to assess dementia, neurodegeneration and neuropsychiatric symptoms.

Results: The symposium will delve into critical yet not well-understood topics. The audience will be first introduced to emerging trends of dementia prevalence and incidence in Latin America and the interaction with different risk factors particular to the region. Second, we will discuss findings from a comprehensive analysis focusing on the prevalence and impact of cognitive impairment and incident dementia in parkinsonism and Parkinson’s Disease. The third presentation will focus on the prevalence of neuropsychiatric symptoms across cognitively unimpaired, dementia, and Parkinson’s’ disease, emphasizing the need to implement systematic screening Methods for early detection from a clinical and public health perspective. The final talk will present data exploring the influence of genetic ancestry alongside social and environmental factors as predictors of dementia risk in Latin America.

Conclusions: The findings presented underscore the complex interplay of genetic, social, and environmental factors in the etiology and progression of neurodegenerative and neuropsychiatric conditions in Latin America. The symposium will highlight the critical need for comprehensive public health strategies and enhanced research focus to better understand and address these issues within aging populations.

Objectives: Population ageing will lead to a dramatic increase in dementia prevalence globally. Recent evidence suggests a decline in dementia incidence in HIC due to increasing education levels and improvements in cardiovascular health. Although, most of the increase will occur in low and middle-income countries (LMICs), there are no recent estimates of dementia prevalence and incidence in LMICs. The present study aimed to examine new trends on dementia prevalence and incidence in Latin-America and associations of socioeconomic determinants and cardiovascular risk factors.

Methods: Sample size included older adults from Latin America (Cuba, Dominican Republic [DR], Puerto Rico [PR], and Mexico) drawn from the 10/66 Dementia Research Group study. We compare wave 1 (2003–2006) with wave 3 (2016 – 2019) of 10/66 studies. The main outcome was dementia prevalence relative to previous waves. Dementia diagnosis was determined according to the 10/66 dementia criteria. All the 10/66 waves used the same standardized assessments and protocols.

Results: Comparing the first wave (2003 - 2006) with the third wave (2016 - 2019) in four Latin American countries – Cuba, the Dominican Republic, Mexico, and Peru – reveals significant trends in dementia prevalence. Preliminary data suggest an increase in the Dominican Republic, Mexico, and Peru, while Cuba slightly declined, from 12.4 percent in Wave 1 to 10.1 percent in Wave 3. In contrast, the Dominican Republic’s age-adjusted prevalence rose from 11.5 percent to 13.6 percent, Peru from 9.2 percent to 16.8 percent, and Mexico from 8.3 percent to 17.1 percent. Despite, improvements in levels of education, increases in dementia prevalence were associated with higher rates of cardiovascular disease and cardiovascular risk factors, including diabetes, hypertension, obesity and heart disease in the later-born cohorts. Self-reported stroke is also rising.

Conclusions: The increasing prevalence of dementia in LAC underscores the urgent need for targeted health interventions. Prevention strategies should emerge as a key focus in the battle against dementia in Latin America. Addressing modifiable risk factors can significantly impact the incidence and prevalence ofdementia.

Objectives: Studies in PD have traditionally focused on motor features, however, interest in non-motor manifestations has increased resulting in improved knowledge regarding the prognosis of the disease. Although several studies have explored the incidence of dementia in PD cohorts, these studies have been conducted mainly in reference centers in high-income countries (HIC). In this study we aimed to analyze the prevalence of cognitive impairment in people with parkinsonism and PD and its association with incident dementia in a population- based study, of elderly from six Latin American countries.

Methods: This report consists of the analysis of data from a follow-up of 12,865 elderly people aged 65 years or older, carried out by 10/66 Dementia Research Group. Residents of urban and rural areas, from six low and middle- income countries (Cuba, Dominican Republic, Puerto Rico, Venezuela, Mexico and Peru). Exposures include parkinsonism and PD defined according to the UK Parkinson’s Disease Society Brain Bank diagnostic criteria. Cognitive impairment was the main exposure and dementia was measured through the dementia diagnosis algorithm from 10/66 DRG.

Results: At baseline, the overall prevalence of cognitive impairment was 14% (n = 1,581), in people with parkinsonism and PD, it was of 30.0% and 26.2%, respectively. Parkinsonism and PD were individually associated with prevalent and incident dementia after controlling for age, sex, and education. The pooled odds ratios from a fixed-effects meta-analysis were 2.2 (95% CI: 1.9 – 2.6) for parkinsonism and 1.9 (95% CI: 1.4 – 2.4) for PD. Regarding incident dementia, the pooled sub-Hazard ratio estimated using a competing risk model was 1.5 (95% CI: 1.2 –1.9) for parkinsonism and 1.5 (95% CI: 1.0 – 2.2) forPD.

Conclusions: Parkinsonism and PD were associated cross-sectionally with the presence of cognitive impairment, and prospectively with incident dementia in elderly people in the community population of Latin America studied. Systematic screening for cognitive impairment and dementia with valid tools in PD patients may help with earlier detection of those at highest risk for adverse outcomes. Identifying modifiable risk factors could potentially lead to efficient interventions even in advanced stages of PD.

Objectives: Because of the continued transition to older populations, various strategies have been developed to estimate the social impact and burden of health care. Regarding mental health, a strategy in the elderly is the measurement of neuropsychiatric symptoms (NPS), these include a wide range of behavioral and psychological manifestations. These are more frequent in the presence of some diseases, such as neurodegenerative syndromes, among which dementias and Parkinson’s disease (PD) stand out. The present study seeks to analyze the frequency of NPS, its relationship with the presence or absence of neurodegenerative syndromes and some characteristics of the elderly and caregivers.

Methods: This is an analysis of data from 12,865 elderly people evaluated within the protocols of the Dementia Research Group 10/66 in 6 Latin American countries (Cuba, Dominican Republic, Puerto Rico, Mexico, Venezuela and Peru). The presence or absence of parkinsonism, dementia and parkinsonism plus dementia (PDD) was identified through previously validated and published Methods. The NPS were assessed using the 12-symptom questionnaire version of the Neuropsychiatric Inventory. Other characteristics such as age, sex and education, in patients and caregivers; socioeconomic status, disability and comorbidities in the elderly; relationship with the elderly, needs and care-burden were assessed in careers.

Results: The most frequent symptoms were depression and sleep disorders in the four groups (without non-NDS neurodegenerative syndromes, parkinsonism, dementia and PDD, ranging from 23% to 49%. About a third of the elderly with parkinsonism, half of those with dementia, and 3 out of 5 of the elderly with PDD had 3 or more NPS. The odds ratios (OR) of each NPS measure by multivariate logistic regression models shown OR from 1.4 to 1.9 in the presence of parkinsonism; between 1.7 and 9.3 in the presence of dementia; and between 1.9 and 10.2 in the presence of PDD.

Conclusions: From a clinical and public mental health perspective, it is necessary to implement systematic Methods for NPS screening, as well as develop support strategies for families and caregivers, mainly of those with neurodegenerative syndromes.

Objectives: Leveraging the non-monolithic structure of Latin America, which represents a large variability in social determinants of health (SDoH) and high levels of genetic admixture, we aim to evaluate the relative contributions of SDoH and genetic ancestry in predicting dementia risk in Latin American populations

Methods: Community-dwelling participants aged 65 and older (N = 3808) from Cuba, Dominican Republic, Mexico, and Peru completed the 10/66 protocol assessments. Dementia was diagnosed using the cross-culturally validated 10/66 algorithm. The primary outcome measured was the risk of developing dementia. Multivariate linear regression models adjusted for SDoH were used in the main analysis.

Results: We observed extensive three-way (African/European/Native American) genetic ancestry variation between countries. Individuals with higher proportions of Native American (>70%) and African American (>70%) ancestry were more likely to exhibit factors contributing to worse SDoH, such as lower educational levels (p <0.001), lower SES (p < 0.001), and higher frequency of vascular risk factors (p < 0.001). In unadjusted analysis, American individuals with predominant African ancestry exhibited a higher dementia frequency (p = 0.03) and both Native and African ancestry predominant groups showed lower cognitive performance relative to those with higher European ancestry (p < 0.001). However, after adjusting for measures of SDoH, there was no association between ancestry proportion and dementia probability, and ancestry proportions no longer significantly accounted for the variance in cognitive performance (African predominant p = 0.31 [–0.19, 0.59] and Native predominant p = 0.74 [–0.24, 0.33]).

Conclusions: The findings suggest that social and environmental factors play a more crucial role than genetic ancestry in predicting dementia risk in Latin American populations. This underscores the need for public health strategies and policies that address these social determinants to reduce dementia risk in these communities effectively.

Substance use disorders (SUDs) among older adults represent a growing but often overlooked public health crisis. This presentation explores the prevalence, impact, and management of SUDs in later life, focusing on alcohol, cannabis, and opiate use, as well as misuse of over the counter (OTC) medications.

Aging populations are increasingly at risk of developing SUDs due to factors such as chronic pain, mental health disorders, and social isolation. The physiological changes associated with aging also alter drug metabolism and increase susceptibility to adverse effects. Despite being the most common SUD in older adults, alcohol misuse often goes undetected. Cannabis use is rising among seniors due to changing legal landscapes, presenting both potential therapeutic benefits and risks. Opiate dependency often stems from chronic pain management, necessitating best practices for opiate use and alternatives. Additionally, misuse of OTC medications, such as sleep aids and pain relievers, is a growing concern.

Effective management of SUDs in older adults requires a multidisciplinary approach, integrating medical, psychological, and social support. Key principles include comprehensive assessment, personalized treatment plans considering comorbidities and polypharmacy, behavioral interventions, and ongoing education for healthcare providers on age-specific SUD challenges and management. Addressing SUDs in older adults is crucial for improving quality of life and reducing healthcare costs. This presentation aims to highlight the significance of early detection, appropriate intervention, and the importance of a holistic approach to managing SUDs in the aging population.

The Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders (CDDR) and Non-Substance Uses Addictions in Old Age (NSUAOA)- Carlos Augusto de Mendonça Lima, M.D., MSci., DSci.

The Eleventh Revision of the World Health Organization’s International Classification of Diseases (ICD-11) represents major, comprehensive revision of the ICD in the last 30 years, and incorporates major advances in scientific evidence, best clinical practices and health information systems The Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders (CDDR), led by the WHO Department of Mental Health and Substance Use, constitutes the most broadly international, multilingual, multidisciplinary and participative revision process ever implemented for a classification of mental disorders.

The CDDR are an integral part of ICD-11, and have been developed specifically for the ICD-11 mental, behavioural and neurodevelopmental disorders chapter, providing substantially more detailed information needed to understand and apply this part of the classification.

A major improvement in the ICD-11 CDDR is the consistency of structure and information across major categories. The information provided for the main disorder categories in the CDDR is organized under the following headings:

• Essential features

• Additional clinical features

• Boundary with normality

• Course features

• Developmental presentations

• Culture-related features

• Sex- and/or gender-related features

• Boundaries with other disorders and conditions (differential diagnosis).

Yet we regret thar age was not considered in this list of headings. This is a missing opportunity to provide specific care for older persons and develop research to study the potential influence of the ageing process on the clinical features of mental health conditions. This is particularly true in the case of NSUAOA, an area that has been particularly neglected besides the increase of the number of older adults in the global population.

At this lecture, it will be presented the CDDR criteria to classify the NSUAOA.

Non-Substance Addictions in Later Life in Emerging Crisis Dr. M.S. Renuka Prasad, BSc, MBBS, FRC Psych. (UK), DGM (UK), FRCPC, DFCPA, DFAPA

The generation known as “baby boomers” is the fastest growing segment of our society globally. Substance Use Disorders among this group is a growing health problem universally. Non-Substance Use Addiction is not far behind, but is getting far less attention, in spite of its impact on these individuals and their families, which could be devastating, but cannot be underestimated. This presentation aims to assess the epidemiology, impact and treatment of Non-Substance Use Addictions, like Gambling, Internet addiction in Later Life. Evaluated studies, indicate this cohort of these individuals are at higher risk of substantial negative impact socially, along with other medical and psychiatric comorbidities.

The current treatment models to address this new wave of older individuals, with Non- Substance Use Addiction behavior, are inadequate. The field of Geriatric Psychiatry, Geriatric Addiction Medicine, Social Services all must come together to address this emerging health concern.