Objectives: Experienced quality of care of older people using long term care is not sufficiently reflected in quantitative quality measures, like surveys or indicators. Therefore, care organizations increasingly use narrative approaches to collect and analyze experiences of clients, relatives, and professionals with quality of care. These Methods enable care organizations to share experiences, identify dilemmas in care provision and provide rich information for quality improvement. However, information about such Methods is scattered. The aim of this scoping review is to explore which types of narrative approaches are used for quality improvement in the long- term care setting for older people. The review identifies, among other things, types of narrative approaches, their goal and challenges.

Methods: A literature search (in Embase, Medline ALL, Web of Science Core Collection, CINAHL, PsycINFO, Sociological Abstracts – proquest, Social Services Abstracts, International Bibliography of the Social Sciences, Google Scholar) was performed from inception up to 28th of April 2022. Thirty-nine articles were included.

Results: Almost all included studies were from Western countries, in particular the Netherlands and Canada, and much focused on intramural care. Different types of narrative approaches were identified, such as a participatory or co-design, photovoice or interview approach. The goal of the approaches was directed at the client, care relationship, organization, or a combination of those levels. The agenda for quality improvement was usually informed by insights revealed during the execution of the narrative approach and researchers were often leading this process. Most approaches are used in practice only once at one or more locations. Findings and suggestions for further research will be discussed, for example about including people with cognitive impairments or relatives.

Conclusions: This scoping review revealed a variety of approaches that attempt to collect narrative information from older people, relatives, and professionals to improve quality of long- term care. Development opportunities for narrative approaches are structural embedding of narrative approaches in practice, including people with (severe) cognitive problems, and effect studies about achieved improvements.

Background and Aim: Puerto Rico is experiencing a rapidly aging society. In old age, it is common to experience one or more chronic diseases that require special attention. If not properly addressed, these health conditions can reduce functionality in daily activities. Some risk factors that can affect health and functionality include sedentary lifestyle, social isolation, and unhealthy lifestyles. To reduce these risk factors, it is necessary to implement health promotion measures aimed at improving the well-being of older adults. Brain Dance has a positive impact on the health of older adults. Its benefits include increasing circulation, reorganizing the neurological system, reducing stress, maintaining joint flexibility, and being aware of the communication between body and mind. The aim was to promote the health of older adults through the 8 Movement Patterns of Brain Dance at CAMPEA, Santa Monica, Bayamón, during the months of March to May 2023.

Methods: A collaboration agreement was established between the Geriatric Research and Education Center and CAMPEA to train older adults and service providers on the benefits of Brain Dance, and educational materials were provided to complement the activities.

Results: The program was implemented as designed. A total of 12 older adults, 60+ practiced Brain Dance and 6 direct services providers were trained on the benefits of Brain Dance in older adults. An infographic with the Eight Movements Patterns was designed and distributed to older adults and services providers.

Conclusions: Older adults reported that engaging in Brain Dance helped them to increase their confidence, bring back memories from the past, strengthen their group interactions, gain new knowledge, develop new skills, self- discover, pay greater attention to the connection between their mind and body, and achieve a state of joy.

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.

Background and Aims: The growth of the elderly population poses challenges and opportunities in society. As we age, normal changes occur that can affect functionality and independence. Aging is associated with brain changes that result in cognitive decline. The most common cause of cognitive decline among the elderly is Alzheimer’s disease (AD). It is characterized by a progressive spectrum of memory problems that affect the functional capacity of the elderly and their ability to perform activities of daily living, increasing the level of dependence and the social, emotional, and economic burden on caregivers. Alzheimer’s disease is the 6th leading cause of death in the United States and the 4th leading cause of death in Puerto Rico. These challenges can only be addressed through clinical research for managing conditions, non-pharmacological treatments and therapies, and educational initiatives covering basic aspects of geriatrics aimed at healthcare professionals, direct service providers, and caregivers. These efforts will provide effective management alternatives when intervening with the elderly population and the public. The aims are: to discuss the educational initiative with Dominican caregivers, to review advances in Alzheimer’s disease research, to present the translation and cultural validation of Cognitive Stimulation Therapy as a non-pharmacological intervention for patients in the early stages of MCI and Alzheimer’s, and to raise awareness about the importance of physical literacy through the eight (8) Movement Patterns of Brain Dance for older adults.

We study the enumerativity of Gromov–Witten invariants where the domain curve is fixed in moduli and required to pass through the maximum possible number of points. We say a Fano manifold satisfies asymptotic enumerativity if such invariants are enumerative whenever the degree of the curve is sufficiently large. Lian and Pandharipande speculate that every Fano manifold satisfies asymptotic enumerativity. We give the first counterexamples, as well as some new examples where asymptotic enumerativity holds. The negative examples include special hypersurfaces of low Fano index and certain projective bundles, and the new positive examples include many Fano threefolds and all smooth hypersurfaces of degree $d \leq (n+3)/3$ in ${\mathbb P}^n$.

Summary: Lamotrigine is an antiepileptic and mood stabilizing drug. Among its adverse effects, the induction of mania has been described. We present the case of a 59-year-old man diagnosed with epilepsy since youth, with perictal psychotic symptoms effectively treated with haloperidol. The patient was treated with lamotrigine for over five years and presented symptoms of mania after two years of receiving it at moderate doses and being free of seizures. The symptoms improved with the lamotrigine switch. Previous cases of lamotrigine-induced manic symptoms have been predominantly observed in individuals with mood disorders, with only a few reported in children undergoing treatment for epilepsy. Further studies are necessary to elucidate the potential risk factors and the neurobiological mechanisms.

Objectives: UK policy priority is to support people with dementia (PLwD) to live at home for longer. Initial clinical assessment involves evaluating and managing risk to enable PLwD to live safely and well at home. Risk assessment scales are needed to identify, manage and reduce risk within contemporary dementia practice. The “Islington Dementia Navigator Risk Assessment Tool” (IDNRAT) is used by specialist and non-specialist staff to stratify the level of risk for PLwD and inform a risk management plan and the frequency of follow-up. We assessed whether IDNRAT enables risk detection and whether the risk intervention derived from it is implemented and improves the safety of people living at home with dementia.

Methods: A mixed Methods study to evaluate IDNRAT’s validity, and the feasibility and acceptability of the resulting risk management plan. We investigated the use of the IDNRAT to: (i) detect risk (concurrent validity) and measure the reliability of the tool; (ii) contribute to risk reduction (primary outcome was numbers of decisions implemented); (iii) explore patients’ and carers’ experience of risk stratification.

Results: We found risk stratification scores (n = 119) derived from IDNRAT and compared with gold standard clinical risk assessments showed concordance between clinicians’ ratings. Joint Dementia navigator and researcher interviews (n = 19) showed consistency between the different assessor scores demonstrating IDNRAT has good reliability. Care-plan data showed most participants (n = 275) scored in the low-risk band of IDNRAT (78.9%) at baseline assessment and risk severity ratings (red/amber/green) reduced over the 6–12-month time period. PLwD (n = 19) and family carers (n = 17) had differing perceptions about risk and the PLwD’s susceptibility to risk. Overall, participants found the risk assessment acceptable, were able to identify risks and felt included in decision-making processes.

Conclusions: We found that the IDNRAT used by non-specialist practitioners (dementia navigators) does enable people with dementia to live safely at home in terms of risk- identification, implemented risk enablement decisions and acceptability. IDNRAT is a valid risk assessment tool, which offers a tailored approach to the management of risk, and over 80% of care-plan decisions were implemented. This is consistent with best practice and the tool has potential for wider use.

Introduction: Throughout the course of the dementia, patients generally need a guardian to protect their rights due to the severity of their mental disabilities. The laws and procedures for guardianship for people with disabilities have been updated in several countries based on the UN Convention on the Rights of Persons with Disabilities promulgated in 2006.

Objectives: To compare the law and procedures for guardianship for people with mental disabilities of twelve countries from six continents.

Methods: Narrative review searching for civil codes/guardianship procedures, date of promulgation, scope of the guardian authority, preferred guardian, duration of the guardianship.

Results: Most countries predominantly promulgated their laws after the year 2000, being half of them updated after 2006. Most countries have two types of guardianship scopes: one concerning financial affairs and the other concerning personal affairs (such as welfare and medical care). Generally, guardianship concerning financial matters is the first to be established. In addition, most countries maintain the ward’s right to vote. In five out of twelve countries, there is an order of preference for choosing the guardian, being the spouses and adult children the preferred guardians. All these countries have the possibility of temporary guardianship. Three countries have a maximum period for guardianship with the possibility of renewal, while all others have indefinite time for guardianship duration. Only France explicitly grants the right to the ward to make medical decisions within guardianship procedures. Brazil’s Civil Code restricts guardianship to financial matters, whereas the Civil Procedure Code requires judges to define the scope of guardianship’s authority for each of the activities of the civil life. Since both codes hold equal authority, judges typically determine the extent of guardianship on a case- by-case basis.

Conclusions: Half of the nations have updated their laws after the promulgation of the UN Convention on the Rights of Persons with Disabilities.

Dementia is expected to increase worldwide and further Discussion concerning the rights of people with dementia is still needed. Although there is no ideal legal framework, the comparison of procedures from different countries may lead to valuable insights for further Discussions andassessments.

Decapod crustaceans, commonly utilised for pure or applied scientific research and commercial food production, have generally remained outside ethical debate. However, in the last decade many parts of the world have seen an increase in public interest in the welfare of decapod crustaceans and statutory legal protection has been introduced in several countries. Although still limited to a small number of countries and remaining relatively unharmonised, relevant legislation could be increasingly broadened to include decapods in further jurisdictions. Much existing legislation, originally intended for protecting terrestrial vertebrates during scientific study, might be unsuitable for aquatic invertebrates such as decapods. Indeed, precedence with many fish species and cephalopods suggests detail is lacking with respect to fundamental guidance. Therefore, similar inclusion of decapods into such legislation could make welfare or scientific goals more challenging to achieve unless relevant guidance is available, particularly to animal care practitioners. This horizon paper aims to summarise existing decapod legislation, and the considerations required should decapods be included in current conceptual frameworks and scientific legislation.

Summary: Apathy is one of the most common neuropsychiatric symptoms in dementia, mainly in Alzheimer’s disease and lobar frontal degeneration. Although diagnostic criteria guidelines have been developed to facilitate diagnosis and multiple drugs have been evaluated for treatment, apathy remains a very important challenge in clinical practice. The Objectives of the symposium is that specialists from Favaloro Foundation University Hospital Memory clinic in Buenos Aires provide an update on the evidence available for both the apathy diagnosis and treatment (pharmacological and non-pharmacological) patients with dementia, as well as showing that will come in the near future. The specialists will base the dissertation both on the available evidence and on their robust clinical experience in the dementia field. The presentation will focus on the available evidence diagnosis, differential diagnosis, and the best therapeutic tools available, pharmacological and non-pharmacological. Learning and knowing about apathy is essential for correct management.

Up today, apathy diagnosis is based on clinical signs and symptoms. General diagnostic criteria and specific criteria for some diseases have been developed. Memory clinic specialist will show the available tools and evidence for apathy diagnosis, the best way to differentiate from other similar disease/symptoms and will provide their robust clinical experience in this field.

Treatment of apathy is still a challenge in clinical practice. Several pharmacological treatments did not show clear symptoms improvement so non pharmacological treatment has become a fundamental tool for the patients- A specialized neurophysiologist will provide the actual techniques utilized in daily practice to treat apathy in dementia patients.

Pharmacological treatment for apathy is still a challenge. Multiple drugs have been tested in clinical trials but without significant symptoms improvement. Memory clinic specialist will show available evidence for pharmacological treatment for apathy and will provide their experience in clinical practice for subject management.

Considering that available pharmacological treatment for apathy did not show strong symptoms improvement, there is an unmet need to find a treatment for apathy- Specialist will present available information for ongoing research for apathy.

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.

Objectives: The aim of this study was to evaluate the association between self-reported sleep quality, use of sleep medications and cognitive impairment among a representative sample of the Brazilian elderly population.

Methods: We conducted a secondary analysis using the baseline data of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a representative sample of non-institutionalized older adults, aged 50 years or over, living across the five Brazilian regions. We divided our sample into groups according to self-rated sleep quality and the use of sleep medication, and descriptively reported sociodemographic and general health characteristics with their respective associations to each group. Subsequently, we analyzed the associations between these sleep measures and cognitive performance using linear regression.

Results: Data from 8,592 respondents were included, of which poor sleep perception was reported by 17.8% of participants, 16.2% were users of sleeping pills and 12.9% met criteria for cognitive impairment. Female sex, not having a partner, current smoking, having less education and more comorbidities were associated with poor sleep perception prevalence. Regarding the use of sleep aid, female sex, older age, not having a partner, having less education, more comorbidities and a problematic drinking behavior were associated to a current use. Any use of sleep medication (–0.06 (95% CI; –0.10 to –0.02)) and poor sleep perception (–0.06 (95% CI, –0.09 to –0.02)) were both associated with worse cognitive performance after adjustments in the multivariate analysis. Sensitivity analysis revealed that, when compared to individuals who reported “very good” sleep quality, the group who reported “poor” sleep quality was associated with worse cognitive scores (p = 0.015) When compared to not using sleeping medication, the group that used medication 3 or more times a week was associated with worse cognitive measures (p < 0.001).

Conclusions: We describe an association of sleep aid use and poor sleep perception with worse cognitive performance. We also report different frequencies of sleep quality perception and sleep aid use in accordance with a set of characteristics of this sample that can be considered potential risk factors for the development of sleep disorders and that can impact older adults’ quality of life.

Key words: Cognition, older adults, sleep quality, sleeping pills.

Introduction and Objectives: Vision plays an important role in theories of cognitive development and language acquisition. Studies on acquired blindness have shown a negative impact on the outcome of semantic and phonological fluency tasks in those who suffer from it. The Objectives of our work was to evaluate the potential effect of visual deficit on the lexical richness (quantity of different words or lexical units) of the work of the Argentine writer Jorge Luis Borges (JLB).

Material and Methods: Verses and prose texts by JLB (complete works of stories and poetry) were analyzed. The total number of words used was counted, and within them, the number of unique words (numbered words without counting their repetitions) was quantified using the Unique Word calculator tool from Planet Calc®. The results obtained after the period in which his blindness prevented him from reading texts were compared with the data obtained from his previous literary production. Statistical results were obtained using SPSS software. Means, standard deviations, and the result of a t-test were calculated.

Results: Data from 3 books of stories and 3 poetry books written between the years 1923 and 1949 (a period in which he still retained his reading ability) were collected, as well as data from 3 books of stories and 10 poetry books from his post-blindness period (starting from 1955). A total of 93446 and 59749 total words were obtained from the pre and post-blindness periods, respectively, with a total of 39887 and 24610 unique words from the mentioned periods. A percentage of unique words over total words was calculated for both periods, and a T-test for related measures was conducted. Although a lower percentage was observed in both the narratives between the pre-blindness stage (M = 45.09%; SD = 6.8%) and post-blindness stage (M = 40.92%; SD = 4.7%), as well as in the poems pre-blindness stage (40.92% SD 4%) and post-blindness stage (32.57% SD 4.5%), this difference was not statisticallysignificant(narrativesp = 0.155;poems p = 0.106).

Conclusions: The analysis of the comparison between pre-and post-blindness stages of lexical richness in JLB’s writing does not align with the fluency deficit reported in the literature. The continuity of his active intellectual life may have influenced his lexical performance through compensatory mechanisms.

The stability of liquid-film flows is essential in many industrial applications. In the dip-coating process, a liquid film forms over a substrate extracted at a constant speed from a bath. We studied the linear stability of this film considering different thicknesses $\hat {h}$ for four liquids, spanning an extensive range of Kapitza numbers ($Ka$). By solving the Orr–Sommerfeld eigenvalue problem with the Chebyshev–Tau spectral method, we calculated the threshold between growing and decaying perturbations, investigated the instability mechanism, and computed the absolute/convective threshold. The instability mechanism was studied by analysing the perturbations’ vorticity distribution and the kinetic energy balance. It was found that liquids with low $Ka$ (e.g. corn oil, $Ka = 4$) are stable for a smaller range of wavenumbers compared with liquid with high $Ka$ (e.g. liquid zinc, $Ka = 11\,525$). Surface tension has a stabilising and a destabilising effect. For long waves, it curves the vorticity lines near the substrate, reducing the flow under the crests. For short waves, it fosters vorticity production at the interface and creates a region of intense vorticity near the substrate. In addition, we discovered that the surface tension contributes to both the production and dissipation of perturbation's energy depending on the $Ka$ number. Regarding the absolute/convective threshold, we identified a window in the parameter space where unstable waves propagate throughout the entire domain (indicating absolute instability). Perturbations affecting Derjaguin's solution ($\hat {h}=1$) for $Ka<17$ and the Landau–Levich–Derjaguin solution ($\hat {h}=0.945 Re^{1/9}Ka^{-1/6}$), are advected by the flow (indicating convective instability).

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.

Background: The COVID-19 pandemic resulted in reduced patient access and deferral of medical services. Long wait times for patients to access specialized medical care became a challenge to health care systems. Baycrest is an academic health sciences centre in Toronto, Canada, that specializes in post-acute and ambulatory care for older adults. As a result of deferred care, wait times for the mental health services increased significantly. This compelled the ambulatory mental health program to apply quality improvement Methods to identify and prioritize care for the most unwell people on the waitlist, while avoiding duplication of referrals between hospitals. This study aimed to assess the utility and feasibility of this new process.

Methods: The quality process involved a Rapid Design Event approach, where the mental health programs created inclusion and exclusion eligibility criteria and established a priority system to assign patients to one of three categories based on need: high priority, routine, and decline. Identification of high priority referrals was meant to allow the most unwell patients to be seen sooner. The central navigation process was refined through quality improvement huddles and standard feedback mechanisms. After three weeks of trialing the process, a sustainability plan to move to operations was applied, and results were continuously monitored through reports and improvement board huddles.

Results: In the first 3 months of implementation, the percentage of patients receiving meaningful clinical contact within 14 days of referral increased from 3.8% to 82.3%, with contact by a clinician within an average of 4 days. Across the ambulatory mental health programs, wait times for psychogeriatric assessment for high priority patients improved from 141 days to 31.8days. Factors leading to the improvement will bediscussed.

Conclusions: The central navigation and extended triage processes were found to be feasible and of great utility. The high priority patients who needed to be assessed sooner were identified through an extended triage process. Meaningful clinical contact was made within days and wait times reduced for those most in need. This demonstrated how a quality improvement process can lead to significant improvements in health care delivery.

Globally, there is an observed increase in the elderly population. In Puerto Rico, 30% of the population is over 60 years old, positioning it as the sixth country worldwide with the highest aging population. This presentation discusses the demographic profile, ageism, stigma, the ethics of care, spirituality, and specialized therapeutic interventions.

Ageism is characterized by a series of stereotypes, prejudices, and discrimination, primarily rooted in social constructs. It occurs across organizations, political structures, and individual and social attitudes. This social phenomenon is a predisposing factor for social stigma, defined by sociologist Ervin Goffman (1963) as a discreditable mark borne by those who possess it.

Grandparents who raise their grandchildren face diverse psychosocial effects stemming from interactions with professionals, the State, and society in their role as caregivers, impacting their physical and mental health. Through qualitative Methods, reflections are proposed on these elderly individuals who are socially expected

to be cared for in this stage of life yet find themselves becoming caregivers for others. The effects of stigma and self-stigma on their daily and family lives are examined.

The ethics of care and spirituality are crucial factors contributing to a fuller and more resilient life for the elderly. Emphasizing the need to recognize and value caregiving relationships, not only as individual actions but as social practices that sustain common well-being, is essential.

Both the ethical principles of care and spirituality can be vital sources of comfort and strength, creating an environment of love that benefits the entire family.

This presentation not only provides a comprehensive view of the current situation of the elderly in Puerto Rico but also proposes practical and effective solutions to improve their quality of life and well-being. Attention to this social sector requires effective therapeutic interventions based on evidence, which positively impact the care and treatment of the elderly, providing crucial support for their well-being and stable mentalhealth.

With a focus on continuous improvement, this study seeks to foster a greater understanding and concrete actions that benefit this vulnerable population, ensuring comprehensive and dignified care during their years of greatest need.

Introducing the Profile of the Elderly in Puerto Rico and Social Stigmatization Speaker: Dra. Florencia Velázquez-Morales

Keywords: older adults, biopsychosocial, stigma, ageism, social construct, quality of life, elderly, spirituality, Puerto Rico

Summary: In the current world context, there is an increase in the population of older adults and a decrease in generational turnover. In the local context of Puerto Rico, this phenomenon is not an isolated fact of reality and is reflected in the growing number of older adults. According to the latest statistics, 30% of the current population is over 60 years old, making the island the sixth most aging country in the world. This poses a series of challenges that deserve special attention from the various fields of human behavior. For this reason, this paper focuses on addressing the various critical aspects related to the elderly, addressing the demographic profile and ageism as a predisposing factor of stigma.

To make an x-ray of this demographic group is much more than a statistical look, it deserves to be deepened in the biopsychosocial and spiritual aspects that allow a better understanding and attention to their needs. Ageism is a behavior characterized by a series of stereotypes, prejudices and discrimination against older adults, whose origin lies mainly in social and cultural constructs towards the population under Discussion. Its manifestation occurs at diverse levels and takes different forms, transversal in organizations and political structures, as well as in attitudes and beliefs towards older people. The presence of ageism in our environment requires greater and more specific attention, from a multidisciplinary and multisectoral approach. (Martínez, et. al., 2022).

This social phenomenon acts as a predisposing factor to social stigma, defined by the sociologist Ervin Goffman (1963) as a discrediting mark on those who bear it, which excludes them from the rest of society. He divides stigma into three categories: bodily abominations, character flaws, and tribal associations, which have a series of consequences such as social isolation, lack of access, and psychological effects, among others. Stigma can function as a barrier to accessing mental health services and negatively influence factors such as treatment adherence, symptom severity, or suicide risk. (Aguilar, 2023) It is important to address the stigma and ageism that make them invisible and underestimate their abilities to improve their quality of life.

The Role of Grandparents Speaker: Dr. José Luis Sierra

Keywords: grandparent caregivers, family dynamics, health, education, Puerto Rico, stigma, qualitative research.

Summary: Custodial grandparent families, where grandparents are the primary caregivers for their grandchildren, are often excluded from the traditionally constructed and socially privileged family model. These families face significant challenges related to health, self-care, and childcare due to difficulties in accessing and being recognized for social services. Redefining family meanings is crucial, as is listening to their perspectives on life. Statistical variations in the number of custodial grandparent families suggest that they are facing increasing challenges or that economic conditions in Puerto Rico prevent them from assuming caregiving roles as they would like.

The literature indicates that health and education are the most critical areas where these families face difficulties, impacting the family unit. Grandparents raising their grandchildren experience various psychosocial effects due to interactions with professionals, the state, and society in their caregiving role, affecting their physical and mental health. Through in-depth interviews and qualitative Methods, this presentation will reflect on these older adults who, instead of being cared for in this stage of life, become caregivers. The effects of stigma and self- stigma on their daily and family life will be explored. Reflections will be presented from a critical theoretical perspective, highlighting, and problematizing the situation.

Recommendations for policies and practices that improve support for these families in Puerto Rico will also be discussed. Emphasis will be placed on the need for public policies that include financial subsidies, tax exemptions, access to mental health and wellness services, training programs, and awareness campaigns to recognize and support the role of grandparent caregivers.

In consistent, the presentation will address how a better understanding and attention to the needs of grandparents can significantly improve their quality of life and well-being, thus benefiting the family as a whole and society in general.

The Ethics of Care and Spirituality in Elderly Care Presenter: Dra. Marieli Rivera Ortiz

Keywords: ethics of care, spirituality, elderly caregivers, Puerto Rico, interdependence, resilience.

The ethics of care is a normative approach emphasizing caregiving relationships and their underlying motivations. It recognizes the importance of interpersonal relationships and human interdependence, highlighting the shared responsibility in caring for others. The ethics of care can be defined as a practice and value that responds to human needs, building trust and connections between people (Held, 2006). In the context of grandparents caring for their grandchildren, this perspective becomes particularly significant, especially in Puerto Rico, where many grandparents find themselves in such roles.

It is crucial to recognize and value caregiving relationships not only as individual actions but also as social practices that sustain community well-being. Grandparent caregivers, through their ability to provide emotional stability and support, promote the moral and social development of children in an environment of trust and reciprocity. However, this responsibility brings significant challenges, such as feelings of loss, resentment, guilt, and considerable financial and emotional tensions.

In Puerto Rico, data from the Puerto Rico Community Survey (2014 –2018) by the U.S. Census Bureau indicate that approximately 89,369 grandparents live with their grandchildren. Of this group, around 41.4%, equivalent to 36,961 grandparents, bear the primary responsibility for their grandchildren’s care.

Given the significant number of grandparents who assume primary caregiving responsibilities in Puerto Rico, it is essential to consider the ethics of care and the importance of spirituality as factors contributing to a more fulfilling and resilient life for the elderly. Integrating spiritual care into their support provides an additional source of resilience and solace, enhancing their ability to create a stable and loving environment for the children under their care. In this scenario, grandparent caregivers not only improve their own well-being but also leave a lasting legacy of emotional strength and peace for future generations.

This presentation aims to explore how the ethics of care and spirituality can enhance the well- being and resilience of elderly caregivers in Puerto Rico. By acknowledging the shared responsibility and interdependence in caregiving, we can better support those who play such a vital role in their families andcommunities.

Therapeutic Interventions with the Elderly Presenter: Lic. Yanina Gisela Góngora

Keywords: caregiver grandparents, resilience, strengths model, therapeutic intervention, Puerto Rico, mental health.

The role of grandparents as primary caregivers for their grandchildren in Puerto Rico presents significant emotional and practical challenges, especially in later stages of life. Addressing these challenges not only meets daily practical needs but also promotes emotional well-being, essential for fostering lasting resilience.

This presentation aims to explore and evaluate the effectiveness of therapeutic interventions based on the strengths model to enhance the resilience and emotional well-being of caregiver grandparents in Puerto Rico. Assuming parental roles at an advanced age can profoundly impact the mental health and well-being of grandparents, exacerbating stress and anxiety. The lack of support from public policies aggravates these challenges, making it urgent to increase institutional and community recognition and support. In this context, the strengths model, which focuses on identifying and enhancing individuals’ internal capacities and resources, has proven effective in improving resilience and emotional well-being. A study by Fox et al. (2022) demonstrated that a strengths-based educational intervention significantly improved caregiver grandparents’ self-efficacy, with sustained effects over time. This approach acknowledges that everyone possesses knowledge, talents, skills, and resources to build a life according to their own terms and goals (Saleebey, 2006).

This research will review previous studies, academic articles, and institutional reports on the effectiveness of strengths-based interventions for caregiver grandparents. Academic databases and recognized sources will be utilized to compile and analyze relevant information. Moreover, this therapeutic approach not only offers individual solutions but also promotes the creation of support networks within the community and family, essential for alleviating caregiving burdens. This approach effectively addresses the complexities of intergenerational caregiving, proposing a support model that can be replicated and adapted in different contexts and communities.

Strengths-based interventions showed sustained improvements in caregiver grandparents’ self- efficacy, indicating their feasibility and effectiveness. Finally, recommended public policies include financial subsidies, tax exemptions, access to mental health and wellness services, training programs, and awareness campaigns to recognize and support caregiver grandparents. In consistent, a holistic approach encompassing therapeutic interventions, the strengths model, and community and institutional support is crucial for improving elderly caregivers’ well-being and mental health in Puerto Rico.

Our world is rapidly aging, with medical and public health advancements extending lifespans without necessarily enhancing the quality of those additional years. Individuals in their later years aspire to preserve dignity, maintain autonomy and independence, foster social inclusion, uphold justice and equality, be respected for their identity, and pursue good health, security, purpose and engagement throughout their lives. Unfortunately, ageism is pervasive and has a significant negative impact on the lives of older individuals. Ageism is the root source of severe violations of the human rights of older persons, incontrovertibly uncovered by the COVID-19 pandemic. Ageism not only damages global health and harms the world’s economy, but also poses a major barrier for older persons everywhere, especially in preventing them from receiving the human rights-based care and support they deserve. This approach to health specifically aims at realizing the right to health and other health-related human rights. These rights translate as social determinants of health and can be integrated into clinical practice. Their implementation is mainly dependent of political will and fair distribution of money, power and resources. Planning health care and support for older persons should be guided by human rights standards and principles with final goal of the empowerment of rights-holders to effectively claim their health rights.

Setting the scene: International Human Rights, Mental Health and Older persons

We all are, in principle, covered by the international human rights system. However, the current international human rights framework does neither include explicit guarantee against ageism, nor explicit obligation on States to take active measures to eliminate ageism and its discriminatory consequences. Older persons are very rarely mentioned in human rights treaties. All rights are equally important as set out in the International Bill of Human Rights (Universal Declaration of Human Rights; the International Covenant for Civil and Political Rights; and the International Covenant for Economic, Social, and Cultural Rights) and all international human rights treaties. Everyone, whoever and wherever they are, has an inherent right to the highest attainable standard of health, including the right to available, accessible, acceptable and affordable good quality care; and the right to liberty, independence and inclusion in the community. Unfortunately, older people with mental health conditions or cognitive decline experience a wide range of human rights violations. Coercive practices, social exclusion and discrimination are still too prevalent compounded by the lack of basic rights such as food and adequate housing. This presentation will discuss how the human rights legal framework can be applied to mental health care and support while advocating for better protection of the human rights of older persons through a dedicated UN Convention.

Objectives: The relationship between cognitive decline and life satisfaction in older adults remains unclear. This study aimed to examine whether older adults with normal cognition at baseline, who developed cognitive decline (i.e., mild cognitive impairment or dementia) over a five-year period, experience lower life satisfaction compared to those who remained cognitively intact.

Methods: The present longitudinal study was conducted in the Arakawa Ward, Tokyo, Japan. Among the initial 1,099 community-dwelling older adults who were between 65 to 84 years old in 2016, we analyzed data from 628 participants who were cognitively intact at baseline and remained in the study at follow-up (2022–2023) with complete data. The effect of developing cognitive decline on life satisfaction, measured by the Satisfaction with Life Scale (SWLS), was examined using a linear mixed model. In addition to developing cognitive decline, fixed effects included time, sex, age, education, depression (indicated by the Geriatric Depression Scale scores above 5), living status (living alone), and frequency of social interactions. The intercept and participants were treated as random effects.

Results: At follow-up, 87 participants were diagnosed with mild cognitive impairment and 7 with dementia. Overall, the mean SWLS score experienced a slight but statistically significant decrease over the five-year period (18.14 ± 5.27 at baseline and 17.75 ± 5.27 at follow-up, p = 0.02 as determined by a paired t-test). The linear mixed model analysis revealed that developing cognitive decline was not significantly associated with life satisfaction (p = 0.93). Notably, living alone and being in a depressive state were significantly associated with higher SWLS scores (p = 0.003 and p < 0.001, respectively).

Conclusions: Life satisfaction did not significantly decline in older adults who developed cognitive decline compared to those who remained cognitively intact. The unexpected findings that individuals living alone and those experiencing depressive states reported higher life satisfaction may indicate potential adaptive mechanisms, whereby these individuals might have developed strategies to find joy in everyday life. Further research is warranted to replicate these results and to explore the underlying factors or potential resilience mechanisms contributing to these findings.