The novel South London and Maudsley Brain Health Clinic (SLaM BHC) leverages advances in remote consultations and biomarkers to provide a timely, cost-efficient and accurate diagnosis in mild cognitive impairment (MCI).

To describe the organisation, patient cohort and acceptability of the remote diagnostic and interventional procedures.

We describe the recruitment, consultation set-up, the clinical and biomarker programme, and the two online group interventions for cognitive wellbeing and lifestyle change. We evaluate the acceptability of the remote consultations, lumbar puncture, saliva genotyping, and remote cognitive and functional assessments.

We present the results of the first 68 (mean age 73, 55% female, 43% minoritised ethnicity) of 146 people who enrolled for full remote clinical, cognitive, genetic, cerebrospinal fluid and neuroimaging phenotyping. A total of 86% were very satisfied/satisfied with the remote service. In all, 67% consented to lumbar puncture, and 95% of those were very satisfied, all having no significant complications. A total of 93% found taking saliva genotyping very easy/easy, and 93% found the cognitive assessments instructions clear. In all, 98% were satisfied with the Cognitive Wellbeing Group, and 90% of goals were achieved in the Lifestyle Intervention Group.

The SLaM BHC provides a highly acceptable and safe clinical model for remote assessments and lumbar punctures in a representative, ethnically diverse population. This allows early and accurate diagnosis of Alzheimer's disease, differentiation from other MCI causes and targets modifiable risk factors. This is crucial for future disease modification, ensuring equitable access to research, and provides precise, timely and cost-efficient diagnoses in UK mental health services.

Research on schizophrenia and life expectancy has mainly focused on premature mortality.

This study investigates factors associated with longevity in patients with schizophrenia receiving long-term care and identifies shared traits among these individuals.

A retrospective cross-sectional study analysing the clinical records of 138 patients with schizophrenia who died between 2015 and 2017 in a psychiatric long-term care facility was conducted. Longevity was defined by life tables drawn from the national health database. Variables were compared between longevity and control groups to determine predictors of longer lifespans. Cluster analysis was employed to identify shared traits among individuals with longevity. Causes of death by age were compared.

In the long-term care setting, of the 138 participants, 45 were in the longevity group. This group had more males, lower antipsychotic doses, but more mobility issues. Significant predictors of longevity included older age at onset, longer length of stay, lower activities of daily living scores and a hypertension diagnosis. Cluster analysis revealed two patterns, suggesting that poorer health indicators did not necessarily lead to shorter lives. Fatalities caused by pneumonia were associated with a higher age, compared to those from cancer and choking.

Addressing modifiable risk factors enhances life expectancy in patients with schizophrenia, especially for males, while the age at onset may play a significant role. An integrated long-term care model with close monitoring and timely provision of mental and general healthcare may help extend lifespans. Further research is needed to balance long-term residential care and community-based care for elderly patients with schizophrenia.

No significant relationships.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized with ritualized behavior, difficulties in communication/ social interaction, restricted interests, and sensitivity to external stimuli. The ASD has gained attention in recent years, however it’s still difficult in geropsychiatric setting to identify high-functioning ASD, especially when patients’ coping mechanisms are successful. Not to determine high-functioning ASD structure in older age can lead to wrong diagnosis and inappropriate treatment trials.

The aim of this presentation is to emphasize the importance of the evaluation of ASD-structure in old-age-psychiatry through the case study of a 65-years-old man.

One case report from the inpatient unit of a psychiatric clinic in Lower Saxony, Germany will be presented.

Case: The patient was referred to our acute-psychiatric-ward due to delusional thoughts, depressive symptoms and lorazepam dependency. Delusional disorder was diagnosed in the outpatient-setting since he had interpreted some external stimuli in an eccentric way. During the therapeutic process, some features of high-functioning ASD such as social difficulties, dislike of change and repetitive/restrictive habits were prominent. Developmental history of the patient and the Autism-Spectrum-Quotient-50 also supported the clinical diagnosis of the ASD. Delusional disorder was excluded, and the therapy organized according to the structure characteristics of the high-functioning ASD which yielded to significant amelioration of depressive symptoms and increased perceived life quality of the patient.

Although coping mechanisms of the patients can be successful, identifying high-functioning ASD-structure even in an old-age can be quite helpful in diagnostic/therapeutic processes. An elaborate discussion of the subject through contemporary literature will be presented.

No significant relationships.

Falls are a significant cause of injury in older adults who are disproportionately at higher risk due to multiple factors such as, mobility issues, co-morbidities and polypharmacy. There are several evidence-based interventions that can be implemented to reduce the risk of – and manage falls.

Assess whether Woodlands Hospital has implemented the standards set by NICE guidelines on the management of Falls in Older People.

Retrospective audit of patients admitted to Woodlands Hospital from 1st June to 1st December 2018. 113 patient records were analysed to determine; was an falls risk assessment completed on admission, did patients ’at risk of falls’ have individualized interventions in place, was a falls risk assessment completed weekly at MDT, following a fall, were patients checked for signs of fracture before moved, was a medical examination completed and were neurological observations completed in patients with observed head injury or where it could not be excluded?

100% of patients had individualised interventions to reduce risk of falls and 97.3% of patients had an assessment of risks completed on admission. 60.3% of patients were checked for signs of fracture. 78.3% of patients had a physical examination within 12 hours. 75% of patients had neurological observations completed.

Risk assessment for falls and individualized interventions for patients at risk of falls were completed at a high standard. There remains scope for improvement of review of risk of falls during weekly MDT, documentation of checking for signs of fractures and neurological examination. The outcomes were relayed to the unit and plans to re-audit in September 2021.

No significant relationships.

Octogenarians of today are better educated, and physically and cognitively healthier, than earlier born cohorts. Less is known about time trends in mental health in this age group. We aimed to study time trends in the prevalence of depression and psychotropic drug use among Swedish 85-year-olds.

We derived data from interviews with 85-year-olds in 1986–1987 (N = 348), 2008–2010 (N = 433) and 2015–17 (N = 321). Depression diagnoses were made according to the Diagnostic and Statistical Manual of Mental Disorders. Symptom burden was assessed with the Montgomery-Åsberg Depression Rating Scale (MADRS). Information on psychotropic drug use, sociodemographic, and health-related factors were collected during the interviews.

The prevalence of major depression was lower in 2015–2017 (4.7%, p < 0.001) and 2008–2010 (6.9%, p = 0.010) compared to 1986–1987 (12.4%). The prevalence of minor depression was lower in 2015–2017 (8.1%) compared to 2008–2010 (16.2%, p = 0.001) and 1986–1987 (17.8%, p < 0.001). Mean MADRS score decreased from 8.0 in 1986–1987 to 6.5 in 2008–2010, and 5.1 in 2015–2017 (p < 0.001). The reduced prevalence of depression was not explained by changes in sociodemographic and health-related risk factors for depression. While psychoactive drug use was observed in a third of the participants in each cohort, drug type changed over time (increased use of antidepressants and decreased use of anxiolytics and antipsychotics).

The prevalence of depression in octogenarians has declined during the past decades. The decline was not explained by changes in known risk factors for depression. The present study cannot answer whether changed prescription patterns of psychoactive drugs have contributed to the decline.

COVID-19, was declared a pandemic by World Health Organisation on March 11, 2020. Older people with dementia or those with multimorbidity are more vulnerable to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the development of COVID-19. Given absence of a vaccine or treatment, prevention is the fundamental aspect of COVID-19 control. This requires early identification of contagious people with COVID-19 and isolation keeping them apart from non infected group of people. Early identification of infection in elderly with dementia or functional psychiatric condition is often difficult, due to difficulty in obtaining history or evaluating medical symptoms.

1) To establish the current standards of interventions provided at the unit to control COVID-19, with current recommendation by Government guidance. 2) To address difficulties in early identification of people of COVID-19 in Old Age Psychiatry wards. 3) To introduce sustainable interventions aimed at controlling COVID-19 risk, targeted to this group.

Trust guidance for COVID-19 testing on the ward and guidance of isolation were reviewed. Literature review of currently available scientific evidence for testing for controlling COVID-19 was conducted.

We have created a bi-weekly mass testing guidance for Old Age Psychiatry inpatient wards with clear guidane of when to start isolation and when to stop isolation.

There is no specific interventions to target older adult within our service currently and it was felt that it is necessary to develop a sustainable mass testing programme for this group of people for control of COVID-19.

Artificial intelligence and machine learning are increasingly being researched within the field of psychiatry to find out what use it might be. With this review, therefore, we would like to assess what literature, if any, exists that answers the question of whether this technology can be useful for providing dementia care. We also wanted to consider the ethical questions of autonomy, consent and privacy when working with this vulnerable group of patients.

To identify and appriase the literature to assess the existing research landscape of the area of machine learning and AI, relating to the care of people with dementia.

A literature search was conducted, searching the PsychInfo, Medline, PubMed and Embase databases. We assessed the quality of the research and considered what overall findings there were in the existing literature.

619 papers were identified, of which 28 related to the use of AI in the care of people with dementia. The papers were divided into categories to show the utility and effectiveness these technologies may have: 1: to alert caregivers to problems 2: to facilitate activities for people with dementia 3: to help plan care for people with dementia 4: to consider the ethical implications of the use of artificial intelligence and machine learning

Despite a paucity of literature in the area, existing studies show potential, if used well, for technologies to be a useful addition to care of people with dementia. The experience of patients and their carers must be integral to their development and use.

Sexual violence (SV) is an important public health concern which may induce important and long lasting mental health problems. However, studies on SV and its mental health impact on older adults and more specifically gerontopsychiatric patients are currently lacking.

This study aims to contribute to a better understanding of the prevalence, risk factors and mental health impact of SV in a gerontopsychiatric patient population.

Between July 2019 and March 2020 100 patients (66%F, 34%M) participated in a face to face interview on health, sexuality and wellbeing during their admission at an old age psychiatry ward in one general hospital and two psychiatric hospitals across Flanders, Belgium. Participation rate was 58%. Interviews were performed by a psychiatric trainee and especially trained master students in medicine.

58% (65%F; 42%M) of the participants were sexually victimised during their life, 45% (51%F, 33%F) experienced hands-off SV, 43% (48%F, 33%M) sexual abuse with physical contact and 16% (6%M, 21%F) was raped. 7% were sexually victimised in the past year. Compared with non-victimized respondents, hands-on SV victims (incl. rape) described more symptoms of depression (p=0.007) and anxiety (p=0.003) and reported lower resilience (p=0.022).

SV appears to be common in the gerontopsychiatric population and is linked to even worse mental health outcomes. These findings confirm the long-lasting mental health impact of SV and highlight the importance of attention to (sexual) trauma in mental health care in old age.

No significant relationships.

Cognitive deficits, behavioral disorders, neuropsychiatric symptoms (BNS) are characteristics in Alzheimer’s disease (AD). Morover, elderly patients often take multiple medications for their several chronic health conditions. Shared decision making is essential to deprescribing unnecessary or harmful medications in older adults. For these reasons, it may be useful to develop multiple strategies intervention not pharmacologically based and to raise the living standards of the patients, the healthcare professionals and the relatives directly or indirectly involved.

To show application of the Agorà model in AD to improve the performance levels, to decrease the aggressive behaviours and wandering episodes.

Twelve inpatients (79-95 ys) affected by AD, were included in our observational study, recruited in Social Cooperative “Il filo di Arianna”, We have applied in our patients the Agorà model (from the Gentlecare model).Were administered following scales: in inpatients: NPI; CDR, MMSE; in caregovers: CBI; at baseline (T0), after three (T1), six (T2) twelve months (T3). For statistical evaluation we used the EZAnalyze Version 3.0 software, on Excel.

At T0 all patients showed high levels of behavioral and aggression disorders. After T3 with Agorà Model, there has been a significant reduction of previous levels. In addition, an improvement in CBI data was observed in caregivers.

The application of the Agorà model has triggered better performance levels in AD. Moreover, it determined a decrease of behavioural disorders, promoted higher levels of participation in the everyday care activities, improved family wellbeing and participation to the assistance activities, reduced health care professionals turnover and burnout levels.

No significant relationships.

Olfactory hallucinations have been described since the 19th century as a particular, often unpleasant smell at the beginning or during the spell. The olfactory cortex are involved in temporal lobe epilepsy.

The aim was analyze the relationship between the olfactory hallucinations and the previus diagnosis of epilepsy.

In this study, we present a clinical case and review the current literature showing the relationship between smell and epilepsy.

A 69-years-old woman, with a medical history of epilepsy, went to the emergency department describing a recent episode of seizure, self-limited in time, after a sensation of an unpleasant smell in bed. A medical history of osteoarthritis, cholecystectomy and essential tremor is described. No unknown drug allergies. The neurological examination shows dysarthric speech, tremor in the right upper limb, isochoric and reactive pupils, preserved sensitivity and strength, and a positive Romber’s sign. The physical examination, blood test and vital signs were normal. The head CT scan showed signs of ischemic leukoencephalopathy, without acute ischemic or hemorrhagic lesions. The patient was medicated with 1000 mg of valproate daily, which was suspended a month ago due to an alteration in liver transaminases. Treatment with diazepam 10 mg daily was prescribed and referred for consultation. The sense of smell changes over time for anormal aging process, affecting abilitiesto detect, identify and discriminate odors.Several neurodegenerative diseases presentcertain alterations that help us determine yourorigin and progression (Vaughan and Jackson, 2014).

Olfactory auras occurs before a seizure of the temporal lobe. Repeated stimuli in limbic regions can produce changes in the piriform cortex, with increased excitability and in epileptic discharges.

No significant relationships.

Although the incidence of psychotic disorders among older people is substantial, little is known about the association with subsequent dementia. We aimed to examine the rate of dementia diagnosis in individuals with very late-onset schizophrenia-like psychosis (VLOSLP) compared to those without VLOSLP.

Using Swedish population register data, we established a cohort of 15 409 participants with VLOSLP matched by age and calendar period to 154 090 individuals without VLOSLP. Participants were born between 1920 and 1949 and followed from their date of first International Classification of Diseases [ICD], Revisions 8–10 (ICD-8/9/10) non-affective psychotic disorder diagnosis after age 60 years old (or the same date for matched participants) until the end of follow-up (30th December 2011), emigration, death, or first recorded ICD-8/9/10 dementia diagnosis.

We found a substantially higher rate of dementia in individuals with VLOSLP [hazard ratio (HR): 4.22, 95% confidence interval (95% CI) 4.05–4.41]. Median time-to-dementia-diagnosis was 75% shorter in those with VLOSLP (time ratio: 0.25, 95% CI 0.24–0.26). This association was strongest in the first year following VLOSLP diagnosis, and attenuated over time, although dementia rates remained higher in participants with VLOSLP for up to 20 years of follow-up. This association remained after accounting for potential misdiagnosis (2-year washout HR: 2.22, 95% CI 2.10–2.36), ascertainment bias (HR: 2.89, 95% CI 2.75–3.04), and differing mortality patterns between groups (subdistribution HR: 2.89, 95% CI 2.77–3.03).

Our findings demonstrate that individuals with VLOSLP represent a high-risk group for subsequent dementia. This may be due to early prodromal changes for some individuals, highlighting the importance of ongoing symptom monitoring in people with VLOSLP.

Many interventions to reduce the use of seclusion and restraint have been suggested in the last decades. Evidence-based interventions in old age psychiatry are different from those in general psychiatry. A common database for psychiatric hospitals introduced in 2004 allowed to examine the use of seclusion and restraint over 16 years under routine conditions.

A registry for coercive measures in the Federal State of Baden-Wuerttemberg has been available since 2015, and comprises all 32 hospitals licensed to admit involuntary patients. A study group had collected data prospectively since 2004 from a subsample of these hospitals. We analyzed the mean percentage of patients subjected to coercive measures and the mean cumulative duration of these interventions in ICD-10 diagnostic groups in psychiatric hospitals from 2004 to 2019 among a total of 1,038,239 admissions.

The proportion of cases affected by coercive measures dropped significantly from 28.4 to 10.5% in patients with ICD-10 F0 disorders, while rates in patients with other diagnoses decreased insignificantly from 7.0 to 5.4%. The cumulated duration of coercive measures per affected case also dropped significantly among patients with F0 disorders, while changes in patients with other diagnoses remained insiginficant.

The use of coercive measures in patients with organic disorders could be reduced by about 50% in a State of 11 million inhabitants within 15 years, while in contrast no substantial reduction occurred among all other diagnostic groups. Specific interventions to reduce coercive interventions seem to be particularly successful for this patient group.

None.

• • Appreciate that patient-centred care builds on providing individualised care for the dying person to meet their needs and wishes

• • Understand the collaborative role of psychiatry in assessing the aetiology and appropriate response to patients presenting with problems of loss, grief, anxiety, depression, hopelessness, suicidal ideation, personality change and confusion

• • Recognise that maintaining hope and living with hope is a way for terminally ill patients to endure and cope with their suffering

None.

While videoconferencing, telementoring, and peer support have been shown to enhance services in some instances, there has been no research investigating the use of these technologies in supporting professionals managing clients with dementia. The objective of this research was to evaluate expansion of an old age psychiatry consultation service and pilot test a model to improve medical supervision and clinical governance for staff within regional and remote areas using remote information technology.

The design was a mixed methods (qualitative and quantitative) evaluation using before, mid-point and post-implementation semi-structured interviews and questionnaires to examine orientation, acceptance, and impact underpinned by theoretical approaches to evaluation. Education evaluations used a Likert style response template. Participants were 18 dementia service staff, including staff from linked services and old age psychiatrists. Qualitative interviews addressed the pilot implementation including: expectations, experiences, strategies for improving the pilot, and perceived impact on work practice and professional development opportunities.

There was high satisfaction with the program. The case conference process contributed to perceived improved outcomes for clients, family, and staff. Clinicians perceived improvement in family carer and staff carer stress and their confidence in managing clients with behavioral and psychological symptoms of dementia (BPSD). Thematic analysis indicated that the pilot enhanced professional development, decreased travel time, and improved team cohesion.

Given the increasing aging population in regional, rural, and remote areas, initiatives using videoconferencing and telementoring will help to develop a confident and skilled workforce. This pilot program was found to be acceptable and feasible. Potential benefits for clients and family carers should be examined in future resesarch.