We explored the relationship between neighbourhood and social participation among older adults using a Living Environments and Active Aging Framework. This prospective cohort study used baseline data from the Canadian Longitudinal Study on Aging (CLSA) with a 3-year follow-up. Three aspects of social participation were the outcomes; walkability and greenness at baseline were exposure variables. The sample consisted of 50.0% females (n=16,735, age 72.9± 5.6 years). In males, higher greenness was associated with lower loneliness and less variety in social activities. No significant associations between greenness and social participation were found in females. High walkability was related to a higher variety of social activity and higher loneliness in males but not females, and less desire for more social activity in both sexes. Greenness and walkability impact social participation among older adults. Future research should include sex and gender-based analyses.

Objectives: Insomnia, defined by sleep initiation or maintenance difficulties, is linked to fatigue, depression, and chronic diseases. Though non-pharmacological treatment approaches are preferred, drugs like benzodiazepines and Z drugs are commonly prescribed, despite significant risks. Hypnotics, used by 9% of the general population and 11.9% of older women, can lead to severe side effects, especially among the elderly, including falls and increased mortality. This study aims to assess sleep quality, hypnotic use, and their impact on mortality among Brazilian older adults.

Methods: Using data from 8,004 cases from the Brazilian Longitudinal Study of Aging and sleep measures were collected from the first wave (2015–2016), and mortality data from the second wave (2019–2021). A cox hazard model was performed to analyze self-reported sleep quality (Likert scale from very poor to very good, and one yes/no question evaluating whether the individual had restful sleep for the most part of the past week) and sleeping pill use (past month frequency) in relation to mortality risk. Covariates included age, sex, marital status, education, income, comorbidities, smoking, alcohol consumption, and physical activity level.

Results: We found no association between self-reported sleep quality or experiencing restful and mortality risk after 4-6 years. On the other hand, when compared to individuals who did not take sleeping pills during the past month, hazard ratios (HR) for death were, respectively, 1.79 (1.11–2.88, p = 0.016) and 1.31 (1.03–1.65, p = 0.026) for those who took medication 1–2 times a week and those who took medication 3 or more times a week. Taking sleeping pills less than once a week had no association with mortality. While the top 3 mortality causes for individuals who did not use sleeping pills were stroke, myocardial infarction and diabetes, the top 3 causes for heavy users were myocardial infarction, lung cancer and chronic obstructive pulmonarydisease.

Conclusions: Insomnia must be adequately treated, but awareness of medication risks is vital. This study highlights higher mortality risk with frequent sedative-hypnotic use in older adults. Warranting non-drug treatments and careful hypnotic use could enhance health outcomes.

Wilkins’s Finch Nesospiza wilkinsi is endemic to Nightingale Island (2.5 km2), Tristan da Cunha. It feeds on the woody fruits of the Island Tree Phylica arborea and in 2017 had a population of 120 breeding pairs. In 2021 it was uplisted from “Endangered” to “Critically Endangered” following damage to P. arborea woodland during severe storms in 2019. During a brief visit to Nightingale in February 2024, we confirmed that the finch population in the area of storm-damaged woodland has decreased by up to 75%, but the density in other areas was similar to that prior to 2019. Extrapolating from the 2017 survey, we estimated the current population to be 60–90 breeding pairs. Surveys of P. arborea structure in the storm-affected area indicated that some large trees had survived, despite being flattened, that recruitment of new trees is occurring, and that fruit loads on surviving trees are similar to those in 2017. Satellite imagery from 2005 showed similar woodland loss during another severe storm in 2001 to that experienced in 2019, indicating that the finch has survived similar events in the past. Coupled with the successful release of a biological control agent to limit the impact of the introduced brown soft scale Coccus hesperidum on Phylica fruit production, the future prospect for Wilkins’s Finch is less bleak than previously thought. However, the risk that global warming is increasing the frequency of severe storms remains a concern. Planting more woodland patches in sheltered areas would help to offset future storm damage.

Objectives: Intravenous ketamine (IVK) and intranasal esketamine (ESK) are increasingly used in treatment- resistant depression (TRD). There is limited data on head-to-head comparison as well as few reports on effects across age groups.

Methods: A retrospective chart review was conducted with patients from a specialized TRD program who received acute courses of IVK (6 infusions) (n = 113) or ESK (8 intranasal insufflations) (n = 35) between February 2017 and May 2023. Clinical response (defined as 50% decrease in mood scores) and symptomatic improvement were assessed using Beck Depression Inventory (BDI). An analysis was conducted between patients younger or older than 60 years.

Results: In IVK, patients under 60 (n = 57; 58.1% female; mean age 44.4 (± 9.8)) had 22.8% response (BDI at infusion 1: 30.4 (± 9.70); infusion 6: 21.2 (± 10.9). Patients over 60 (n = 56; 49.6% female; mean age 73.2 (± 7.6)) response rate was 26.8% (BDI infusion 1: 24.9 (± 11.0); infusion 6: 19.0 (± 11.6). There was a statistically significant reduction in BDI scores between baseline and the end of the acute course (p < 0.0001). No difference between the two age groups was observed (p = 0.1165). For ESK patients under 60 (n = 22; 68.1% female; mean age 44.0 (± 8.3)), response rate was 22.78% (BDI at infusion 1: M = 30.4, SD = 9.70; and at infusion 6: M = 21.2, SD = 10.9). In older patients (n = 13; 69.2% female; mean age 72.6 ± 7.4 years)) response rate was 30.8% (BDI at infusion 1: M = 24.9, SD = 11.0; at infusion 6: M = 19.0, SD = 11.6). BDI score decline between baseline and end of the acute course was statistically significant (p < 0.0001). No difference between the two age groups was observed (p = 0.5420). No statistical difference was found in patients > 60 between IVK and ESK (p = 0.31) as well as in patients < 60 etween IVK and ESK (p = 0.4632).

Conclusions: Antidepressant response and reduction of depressive symptoms was similar between IVK and ESK, with no difference between young and old populations.

Objectives: The aim of this study was to identify core and bridge symptoms between emergent neuropsychiatric symptoms and sleep disturbance in dementia-risk older adults with depressive symptoms in nursing homes using network analysis, and to further compare the structural differences in symptom networks between subthreshold depressive and depressive groups.

Methods: A total of 853 older adults in nursing homes participated in this study. We used the Mild Behavioral Impairment (MBI) and the Pittsburgh Sleep Quality Index (PSQI) to assess the severity of emergent neuropsychiatric symptoms and sleep disturbances, respectively, and the analyses also generated a network model of the MBI-PSQI in the sample and examined subthreshold depressive and depressive groups’ potential differences between network structure and connectivity.

Results: The core symptom in the global MBI-PSQI network of older adults with depressive symptoms in nursing homes was MBI8’’ (Lack of pleasure experience: 8.340), and the bridge symptom was PSQI7’’ (Daytime Dysfunction: 3.894). The edges connecting the nodes MBI2’’ (Lost curiosity in usual interests) and MBI3’’ (Decreased social initiative) in the global MBI-PSQI network has the strongest weight (0.798). Compared to the global network, for participants in the depression group, MBI8’’ (7.647) remains the most core symptom, and PSQI7’’ (4.028) serves as a critical bridge symptom between emergent neuropsychiatric symptoms and sleep disturbances. However, in the subthreshold depression group, the MBI-PSQI network structure exhibits distinct characteristics, with MBI2’’ (5.563) being revealed as the most significant symptom, closely followed by MBI8’’ (5.453). Furthermore, the bridge symptom connecting emergent neuropsychiatric symptoms to sleep disturbances shifts to PSQI4’’ (Sleep Efficiency: 1.386). Intriguingly, the strongest edge in both the global network and the subgroup network is MBI2-MBI3.

Conclusions: There is an association between emergent neuropsychiatric symptoms and sleep disturbance in dementia-risk older adults with depressive symptoms in nursing homes. In addition, heterogeneity in the network structure of subthreshold depression and depression, with shifts in core and bridge symptoms, providing directions for designing novel and targeted interventions.

Objectives: Effectiveness of psychotherapy depends on patients’ adherence to between-session homework (HW) to practice therapeutic skills. mHealth apps can offer continuing reminders, although frequent reminders overwhelm or burden patients and therefore are ineffective. Predicting likelihood of completing daily HW and sending contextual reminders has the potential to improve HW adherence and therefore improvesymptoms.

Methods: Depressed older participants (N = 51) undergoing psychotherapy provided daily active ratings on mood, anhedonia, stress and pain via an mHealth app. Data on activity, mobilization, sociability and sleep passively were also recorded via device sensors (e.g., microphone, accelerometer, GPS etc.). Using active and passive mHealth data, we developed predictive models of daily home-work completion status using a naïve semi-supervised deep learning algorithm. Prediction accuracy was determined via time-dependent cross-validation.

Results: Study participants had a mean (SD) age of 71.4 (7.76) years, mean (SD) of 14.9 (2.93) years of education, mean (SD) BIS/BAS total of 22.6 (3.36), mean (SD) MADRS total score of20.4 (6.04) and 88.2% were of female gender, 29.4% were single, 83.8% were of non-Hispanic ethnicity, 58.8% belonged to Caucasian race and 38.2% practiced Catholic religion. With 4700 person-days HW completion response, our models show an AUC of 84.7% (sensitivity = 76.2%; specificity = 80%) estimated by cross-validation.

Conclusions: This paper demonstrates the feasibility of predicting adherence to psychotherapy in depressed older adults using actively and passively collected mHealth data. Digital interventions based on such predictive models can potentially increase adherence to psychotherapy and thereby improve its effectiveness without increasing the user notification burden.

Summary: Melatonin serves as an endogenous synchronizer of biological rhythms. Age-related changes are evident with a significant reduction in melatonin observed in 24-hour secretion. Melatonin exerts a significant cytoprotective action by buffering free radicals and reversing inflammation. However, few studies have explored the association between physical activity and melatonin level. In this study, we compared melatonin level and actigraphy-derived sleep and activity indicators in older adults across two levels of exercise habit (sedentary-to- light exercise and moderate -to-vigorous exercise), as well as the association of these indicators with melatonin levels. We recruited 104 participants (aged 57– 84 years) who wore a wristwatch device to monitor their activity (MotionWatch 8; CamNtech, Cambridge, UK) for 14 days. Circadian rhythms were estimated using cosinor analysis, lag 1440 mins correlation coefficient, interdaily stability, and non-parametric analysis. Saliva samples were collected every 30 mins from 18:00 pm till one hour before usual bedtime, and maximum melatonin level during this period. A 5-minute Psychomotor Vigilance Task (PVT) was used to evaluate attention. Habits of physical activities were self-reported. Melatonin level was not significantly different between participants with sedentary- to-light and moderate-to-vigorous exercise habits. Analysis showed that participants who had moderate-vigorous exercise habit were older (p = 0.04), having longer sports time (p < 0.001) and WASO (p = 0.02), more occurrence of daytime naps (intradaily variability) (p = 0.05), more fragmentated 24-h sleep-wake cycle (interdaily stability, p = 0.01), and less regular 24h rhythm (lag 1140 mins correlation, p = 0.04). They also showed shorter response time (p = 0.05), and a smaller number of lapses (p = 0.04) in PVT. Regression analysis results showed that weekly exercise time is positively associated with melatonin level. Additionally, a later start hour of M10 is associated with 5.95 pg/ml increase in melatonin level. In consistent, exercise in older adults did not promote a robust sleep- wake cycle but is related to better cognitive function and higher melatonin levels.

Objectives: To evaluate the effect and safety of Cannabidiol (CBD) on behavioral and psychological symptoms in elderly with Vascular dementia (VD).

Methods: Double- blind, randomized, placebo-controlled clinical trial involving elderly patients with VD at the psychogeriatrics and vascular dementia outpatient clinic at Hospital das Clínicas de Ribeirão Preto. The intervention evaluated was the use of CBD 300mg/day compared to placebo. The instruments used are: Neuropsychiatric Inventory, Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression Scale, Side Effects Scale, Mini- Mental State Examination, Brief Cognitive Screening Battery, Katz Index of Independence in Activities of Daily Living, Lawton Instrumental Activities of Daily Living Scale, Informant Questionnaire on Cognitive Decline in the Elderly, Zarit Burden Inventory. The included participants were assessed at the beginning of the study (baseline assessment), in the first, second and fourth weeks after the start of the clinicaltrial.

Results: 30 participants were included. The mixed ANOVA with repeated measures showed that there is an effect of the interaction time and group (F (2.12; 59.43) = 4.02; p < 0.05; ηp2 = 0.13) on the total score of the brief scale psychiatric assessment and neuropsychiatric inventory (F (1.58; 44.31) = 3.61; p =0.05; ηp2 = 0.11). The mixed ANOVA of repeated measures showed no effect of the interaction of time and group for the mini-mental state examination, brief cognitive screening battery. Adverse effects were mild and transient, and similar to the placebo group.

Conclusions: In this study, cannabidiol reduced psychological and behavioral symptoms in patients with vascular dementia. Future studies with larger samples are needed to confirm the findings. (F(1.58;44.31) = 3.61; p =0.05; ηp2 = 0.11). The mixed ANOVA of repeated measures showed no effect of the interaction of time and group for the mini-mental state examination, brief cognitive screening battery. Adverse effects were mild and transient, and similar to the placebo group.

Introduction: Late-life depression (LLD) is associated with cognitive deficit with risk of future dementia. By examining the entropy of the spontaneous brain activity, we aimed to understand the neural mechanism pertaining to cognitive decline in LLD.

Methods: We collected MRI scans in older adults with LLD (n = 32), mild cognitive impairment [MCI (n = 25)] and normal cognitive function [NC, (n = 47)]. Multiscale entropy analysis (MSE) was applied to resting-state fMRI data. Under the scale factor (tau) 1 and 2, reliable separation of fMRI data and noise was achieved. We calculated the brain entropy in 90 brain regions based on automated anatomical atlas (AAL). Due to exploratory nature of this study, we presented data of group-wise comparison in brain entropy between LLD vs. NC, MCI vs. NC, and LLD and MCD with a p-value below 0.001.

Results: The mean Mini-Mental State Examination (MMSE) score of LLD and MCI was 27.9 and 25.6. Under tau 2, we found higher brain entropy of LLD in left globus pallidus than MCI (p = 0.002) and NC (p = 0,009). Higher brain entropy of LLD than NC was also found in left frontal superior gyrus, left middle superior gyrus, left amygdala and left inferior parietal gyrus. The only brain region with higher brain entropy in MCI than control was left posterior cingulum (p-value = 0.015). Under tau 1, higher brain entropy was also found in LLD than in MCI in right orbital part of medial frontal gyrus and left globus pallidus (p-value = 0.007 and 0.005).

Conclusions: Our result is consistent with prior hypothesis where higher brain entropy was found during early aging process as compensation. We found such phenomenon particular in left globus pallidus in LLD, which could be served as a discriminative brain region. Being a key region in reward system, we hypothesis such region may be associated with apathy and with unique pathway of cognitive decline in LLD. We will undertake subsequent analysis longitudinally in this cohort

Key words: resting-state fMRI, Late-life depression, Brain entropy, globus pallidus, cognitive decline

Introduction: Aging is a global phenomenon that can be explained, in short, by improvements in living conditions, which leads to an increase in life expectancy, combined with a reduction in recorded fertility rates. In this sense, it is understood that due to some biopsychosocial determinants, some individuals live much longer than the rest of the population, as is the case of elderly centenarians and this is the focus of this study. It is known that the COVID-19 pandemic scenario was challenging for the elderly population. In this sense, the study aims to analyze the production of national and international knowledge of research articles on the COVID-19 pandemic for centenarian elderly people

Methods: This is an integrative literature review, carried out in six stages: selection of the research question; literature search; categorization of studies; evaluation of studies included in the review; interpretation of results and presentation of the review. The research question was developed according to the PICO strategy. The population refers to elderly centenarians (P); the intervention concerns the COVID-19 pandemic scenario (I); the comparison group is not applicable in this study (C) and the outcome refers to bibliographical productions about elderly centenarians from 2020 onwards (O). The search strategy was carried out on the PubMed/MEDLINE and LILACS platforms. The articles found were exported to the Mendeley Desktop program to exclude duplicates. Soon after, they were transported to a spreadsheet in Microso Excel®. After that, the articles were analyzed, categorized and organized in a table format to facilitate the Discussion of the results found. The data obtained so far is controversial regarding mortality and resilience of centenarians to SARS-CoV-2. These results are justified, in part, due to the uniqueness of each elderly person who can respond in a unique way to SARS- CoV-2. Results: After applying the search criteria, 18 articles were selected for full reading. After that, according to the established inclusion criteria, eight articles were selected for this review. Studies were found from Italy, Germany, Brazil, Belgium, Canada, China and France. The mortality/resilience of centenarians to SARS-CoV-2 was the most discussed topic among the publications. The relationship between the Spanish flu pandemic in 1918 and the COVID-19 pandemic in 2020 was also addressed in three publications. Supercentenarians (>110 years old) were the subject of study in two publications. Analyzes of immunological and/or genetic studies were also found. Supercentenarians appear to possess some kind of resilience against SARS- CoV-2. The most accepted hypothesis to justify this fact is the association between exposure to the Influenza virus, which caused the Spanish flu pandemic in 1918, and resilience to SARS-CoV- 2. Only one of the studies found took place in Brazil.

Conclusions: The topic deserves to be better addressed, as considering the potential increase in the number of centenarians in the future, the lessons learned from the COVID-19 pandemic should help the management and care of this population in the event of a new infectious disease.

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

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

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

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

Introduction: Dementia continues to be a global health concern owed to its increasing prevalence and coupled with physical and psychological burden. It is also the most feared diagnosis amongst older adults which may contribute to underdiagnosis. Pre-assessment counselling (PAC) may reduce fear and increase diagnoses when people with suspected cognitive impairment are empowered with choice and feel in control of their diagnosis journey.

Methods: This study recruited 10 clinicians from an NHS memory clinic in England, UK, and, using semi-structured interviews, sought to understand the mechanisms and effectiveness of PAC.

Results: Using reflective thematic analysis, 3 themes were found. 1. The person with dementia (PwD) is central in their diagnosis journey. 2. Candid conversations build strong therapeutic alliances. 3. Patients are more than their diagnoses.

Discussion: Clinicians emphasized the importance of timely diagnosis for the wellbeing of PwD, while also recognizing the need for patient-centred and collaborative approaches. Additionally, the study highlighted the significance of empowering PwD in decision-making processes, fostering resilience through comprehensive support, and addressing stigma through candid conversations to improve diagnostic outcomes and enhance patient engagement in dementia care. The study indicates that PAC is effective in enabling timely diagnoses, but there is a lack of dedicated appointments in NHS Trusts where PwD are empowered to manage their dementia journey and subsequent care.

Objectives: 1) To evaluate interest, logistics, and content for a curriculum to promote well-being in older adults by gathering data through surveys of nursing home populations. 2) To design a curriculum syllabus that can be carried out and shared by analyzing our survey data and combining it with evidence-based practices from the literature including positive psychiatry approaches and elements of different psychotherapies.

Methods: Long-term and short-term care patients from Budd Terrace and A.G. Rhodes nursing homes were recruited to participate in a survey. Categorical frequency calculations were used to evaluate participant interest and logistical preferences. Ranked scores and distribution columns were used to evaluate course content.

Results: 100 participants completed the survey. 55.1% expressed interest in attending this type of course. For class length, frequency, duration, and size, average preference was for 30 minutes, once a week, 2– 4 weeks, and 6–10 people, respectively. Between pillars, in order of priority, preferences were: meaning in life (ranked score 215), mindfulness (198), and social connection (157). Within the meaning in life pillar, preferences in order of priority were: gratitude for life lived (268), life priorities (249), sources of meaning (235), and goals (188). Within the mindfulness pillar, preferences in order of priority were: emotional stability (272), focusing awareness on the present moment (261), acknowledging and accepting thoughts and feelings (240), and self-compassion (187). Within the social connection pillar, preferences in order of priority were: increasing opportunities for social connections (266), enhancing social support (245), improving social skills (240), and addressing worries about social situations (169).

Conclusions: By combining logistical and content preferences from our population sample with evidence-based practices from the literature, we have developed a psychoeducational course to promote mental health in older adults, centered around three pillars: meaning in life, mindfulness, and social connection. A curriculum syllabus complete with course description, learning Objectives, weekly topics/timelines, materials needed, notes, and handouts will be included with the final manuscript. The handouts can also be selected and distributed outside of a course context, such as outpatient clinics or inpatients settings, and curriculum elements can be incorporated into group or individual therapy.

Studies have widely documented that women's descriptive representation in parliaments enhances their substantive representation. We probe this relationship under varying levels of women's collective and individual marginality based on an original dataset documenting the parliamentary behaviour of Israeli legislators over eleven parliamentary terms (1977–2015). Using several measures of individual-level marginality we show that marginalized female legislators are more prone to engage in gender-related parliamentary activity than their less marginal counterparts, albeit only under a certain threshold of women's marginality as a group. The article elucidates the dynamic nature of the relationship between descriptive and substantive representation of disadvantaged groups by demonstrating that it is contingent on their collective standing in parliament and on the marginality of individual legislators as manifested in their strategic choices.

Irredentist disputes have produced distinct political ethnoterritories under the de jure sovereignty of recognised parent states, but the de facto political authority of external national homelands. This study problematises the relationship between national homeland and claimed ethnoterritory as a nested game in which, in addition to bargaining with each other, they face internal competition, outbidding, and changing costs of conflict, ultimately reducing commitment to external-facing bargains. This study contends that homelands pursuing irredentist conflict can reduce uncertainty and increase commitment from ethnoterritories by building hegemonic cross-border clientelist pyramids that link ethnoterritorial publics’ and elites’ political survival and livelihoods to supporting homelands’ preferences. Further, these structures marginalise alternative elites who may seek to contravene preferences by escalating conflict and increasing costs on homelands or bargaining across ethnic cleavages. Case studies of protracted conflicts in Cyprus, Kosovo, and Croatia support this argument and further find that public-sector distribution linked to the homeland is most effective in reducing competition and uncertainty, thereby increasing long-term commitment to preferences.

While previous studies have examined the factors contributing to the appointment of women in government cabinets, few have investigated the role of political leaders in promoting women's cabinet representation. Drawing on political socialization theory, we argue that political leaders from economically disadvantaged backgrounds are more inclined to appoint female members to ministerial positions than their wealthier counterparts. This propensity stems from leaders’ personal experiences of economic hardship, which foster their interest in improving political equality among social groups and reducing gender disparities by appointing more female ministers. Analyzing an original dataset encompassing leaders’ family backgrounds across 155 countries between 1966 and 2015, we find that leaders who have experienced economic hardship significantly increase the proportion of female ministers in executive cabinets. This finding holds across various model specifications and effectively addresses endogeneity concerns. Our research highlights the crucial role of political leaders in shaping gender politics based on their economic backgrounds.

Background: Most individuals with dementia in the UK die in care homes. 70% of these are residential, relying on external healthcare professionals to manage the complex needs. eHealth can help facilitate the delivery of holistic care in care homes, yet adoption has traditionally been faced with resistance. Innovative approaches employing Methods from implementation science are required to promote the uptake of eHealth in care homes.

Aim: To evaluate the feasibility of a theoretically-informed co-designed implementation plan for an eHealth intervention to support holistic assessment and decision making for people with dementia in care homes and their family carers, and to identify opportunities to strengthen it.

Methods: An embedded mixed-Methods study conducted in two residential care homes. Qualitative data comprised non-participant observations of the intervention in use, focus groups and semi-structured interviews with care home staff. Data was analysed using a codebook thematic analysis underpinned by the Normalistion Process Theory. Quantitative data included app usage data and two implementation measures, analysed using descriptive statistics. Patient and public involvement informed development and conduct of the study.

Results: 20 care home staff across two care homes used the intervention with 26 residents. Whilst there was some evidence of adoption, reach within the care home and feasibility of its implementation, usage data indicated that the intervention was largely not utilised as intended. Whilst there was sufficient coherence around the intervention, staff faced barriers related to collective action including workload and incompatibility with practice. Reflexive monitoring was therefore low as individuals could not appraise its impact, which compromised staff cognitive participation. Revisions to the plan related to strategies to provide further staff support, including encouraging family involvement and a more tailored approach to training.

Conclusions: Evaluating feasibility of the implementation plan of the intervention was a vital step in its development. Rapid evaluation and iterative response to barriers to use informed learning and allowed for real- time adjustments to implementation strategies, and a set of updated recommendations for use. Further collaboration on the revised strategies with people living with dementia and their family carers is required.