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- 05 October 2020, p. i
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101 - THE APPLICATION OF MASS OBSERVATION DATA IN THE UNDERSTANDING OF AGEING, DEMENTIA AND END OF LIFE CARE
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- 04 November 2020, pp. 1-2
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Personal Narratives of Ageing
Personal Narratives of Ageing: This paper presents personal narratives reflecting on the ageing process, and growing older in the UK.
This presentation reflects on self-written narratives from 170 respondents to a mass observation directive, focusing on the experiences of growing older. Narrative methods are theoretically and methodologically diverse, and are helpful in social research to understand events or happenings in human lives. This data presents accounts from a heterogeneous sample in the form of self-penned responses. These experience-centred narratives bring stories of personal understanding into being by means of the first-person description of past, present, future or imaginary experiences of later life. This presentation will focus on the findings with reference to mental and physical and impacts, both real and anticipated to the ageing experience. We will also explore themes arising from the data including gender differences, age-cohort effects and stigma.
The data should be utilised to inform Health and Social Care education and practice, particularly in co-producing appropriate person-centred services with older people.
The Health Impact of Financial Fraud: ‘Scams’The Health Impact of financial fraud: This presentation will offer new and alternative insights into fraud and the health effects on older people, using data from the mass observation directive. The term utilised for such crimes in the UK is ‘Scam’.
The paper reports data captured from a Mass Observation Project “Directive” focusing on ‘scams’ (see the UK definition of ‘scam’ below) and the impact on individuals. One hundred and forty-four ‘Observers’ responded to the ‘Directive’. Narratives indicate that victimisation to a scam may have negative impacts on individuals’ mental wellbeing, self-esteem, and relationships with others. Furthermore, data analysis identified that fear of victimisation can also affect individuals, resulting in worry, anxiety, and maladaptive coping strategies.
Offering further understanding of the health impacts of ‘scams’ highlights the necessity to legitimise the issue as a public health concern.
A scam is interpreted to be: a misleading or deceptive business practice where you receive an unsolicited or uninvited contact (for example by email, letter, phone or ad) and false promises are made to con you out of money (Office of Fair Trading 2006).
Perceptions of DementiaPerceptions of Dementia: This paper (Exploring public perceptions and understanding of dementia: Analysing narratives from the Mass Observation Project, (Olsen et al 2019) presents a perspective on the public knowledge and understanding about dementia not previously considered, where respondents have written openly about their own experiences, and reflected on their perception of the wider public’s knowledge and understanding about dementia.
This paper considers narratives of 143 respondents (“Observers”) to a Mass Observation Project Directive exploring individuals’ perceptions of dementia. Perceptions of dementia held by “Observers” with experience of dementia and those without differed sharply. “Observers” with experience of dementia offered insight into living with, and caring for, a person with dementia; including the impact this had on their lives and personal relationships. Whereas, “Observers” with no direct experience of dementia focused more on common disease symptoms, such as memory loss and reflected idealised views of care. “Observers” often feared being diagnosed with dementia themselves. This suggests education to facilitate care planning and ameliorate fears held by the public is required.
Previously, perceptions of dementia have been captured utilising traditional research methods and samples drawn mainly from professionals. This new approach identifies public understanding of dementia, highlighting areas concern, and supplements the existing UK
Olsen, V., Taylor, L., Whitely, K., Ellerton, A., Kingston, P. & Bailey, J. Exploring public perceptions and understanding of dementia: Analysing narratives from the Mass Observation Project. Dementia: The International Journal of Social Research and Practice.https://doi.org/10.1177/1471301219861468.
End of life careThis paper considers narratives from two Mass Observation Directives exploring individuals’ perceptions of dementia (n=143) and personal narratives of ageing (n=170). ‘End of Life Care’ has, in a UK context, focused on care and support for individuals in the last months or years of their life. Care planning and management of this stage in the life course usually incorporates symptom management and emotional support for the individual, the family and carers. Whilst patient choice, involvement and co-production of the care plan is widely advocated to promote a dignified death, responses to the mass observation directives also reflect the need to revisit the options for individuals with a diagnosis of dementia and other life limiting illness. There was, in particular, a renewed call to return to the ‘euthanasia’ debate and to encourage discussion and end of life decisions to be undertaken earlier in the life course, prior to any diagnosis of a life limiting illness. As people’s attitudes and behaviours towards end of life care planning change, it is imperative to ascertain current perspectives to inform and guide future direction of social policy and services.
102 - Dementia and primary care – lessons from Europe: Symposium
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- 04 November 2020, p. 3
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Primary care doctors /General Practitioners are sometimes criticised for failing to recognise dementia in its early stages. Old age psychiatrists, neurologists or geriatricians take on the tasks of recognition, diagnosis (subtyping) and post-diagnostic support, and some Primary care doctors /General Practitioners welcome this division of labour as a way of avoiding the demanding tasks of dementia recognition and response. However, the rising prevalence of dementia syndromes in an ageing population is undermining the ability of secondary care specialists to fulfil their tasks of timely recognition, diagnosis and support. Primary care doctors /General Practitioners will be encouraged to take over some secondary care tasks. This will pose problems for Primary care doctors /General Practitioners, who may not have been trained to work with people with dementia, and who may not be able to incorporate such work into their practice even when trained. This symposium will explore the current and future challenges Primary care doctors /General Practitioners face in recognising and responding to dementia, and outline some lessons from four European countries (Ireland, Spain, Portugal and England). Themes to be presented include:
Barriers to the recognition of dementia,
The dementia-specific educational needs of Primary care doctors/General Practitioners,
Interprofessional education of community-based primary care teams,
Case management of people with dementia in primary care,
IT solutions to problems of support for people with dementia.
Effective dementia-care interventions in primary care post-diagnostic care pathways,
Systemically-inspired brief interventions in primary care.
Chair: Emeritus Professor Steve Iliffe, Centre for Ageing Population Studies, University College London [England]; co-chair: Professor Manuel Gonçalves-Pereira, Professor of Behavioural Medicine and Psychiatry, Nova Medical School, Universidade Nova de Lisboa [Portugal]
Speakers:
Dr Tony Foley, Lecturer Department of General Practice, University College Cork [Ireland]
Professor Manuel A. Franco, Head of Psychiatry and Mental Health Department. University Rio Hortega Hospital (Valladolid) [Spain]
Dr Conceição Balsinha, General Practitioner & Assistant professor/PhD student, Nova Medical School, Universidade Nova de Lisboa & Professor Manuel Gonçalves-Pereira, Nova Medical School, Universidade Nova de Lisboa [Portugal]
Emeritus Professor Steve Iliffe, Centre for Ageing Population studies, University College London [England]
103 - Risk and prevention of dementia: from observation to implementation
- Sebastian Köhler, Kay Deckers, Edo Richard, Rejko Krüger
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- 04 November 2020, pp. 3-4
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General introduction
Dementia is a global health problem with increasing numbers of people with dementia, especially in low and middle-income countries. Over the past decade, research and policy have been gradually expanding their view on lowering the burden of dementia by exploring the possibilities for dementia risk reduction strategies targeting modifiable risk factors. In this symposium, four speakers will present on new insights in dementia prevention from epidemiological research, randomized controlled trials and innovative implementation projects in primary and secondary care.
Social and cognitive activity as resilience factors for dementiaSebastian Köhler1 (presenting author), Dorina Cadar2, Daisy Fancourt2, Kay Deckers1, Andrew Steptoe2
1 Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
2 Department of Behavioural Science and Health, University College London, London, UK
104 - Awareness of Dementia and Coping to Preserve Quality of Life: A Five-Year Longitudinal Narrative Study
- K. Thorsen, M. C. N. Dourado, A. Johannessen
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- 04 November 2020, p. 8
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Background:
Awareness of dementia is examined in different scientific fields as significant for assessment of diagnosis, and for treatment and adaptation to the disease. There are very few longitudinal studies of individual experiences of awareness among people with dementia, related to quality of life.
Aim:To examine how younger people (< 65 years) with dementia (YOD) express awareness of the dementia and how, over time, they seem to handle awareness as a strategy to preserve quality of life.
Method:A longitudinal qualitative study with individuals with YOD was performed with interviews every six months over five years for a maximum of ten interviews. The interviews were analysed by modified grounded theory.
Findings:Awareness is a complex, multidimensional concept. Awareness of dementia is predisposed by personality, life history and established coping styles. The main coping styles – live in the moment, ignore the dementia, and make the best of it – seem to be rather consistent throughout the progression of the disease. Transitions in life situation, such as moving to a nursing home, may change the individual’s awareness of dementia.
Conclusion:Unawareness of dementia may have an important adaptive function to preserve quality of life. To increase awareness must be approached with reflexivity and the utmost sensitivity.
105 - Behavioral and Psychological Symptoms of Dementia: Novel modes of Treatment and Care Delivery
- Melanie T. Gentry, Janette Leal, Joshua Baruth, Jaclyn Lindsey
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- 04 November 2020, p. 11
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As the World Population continues to expand, the number of individuals affected by Alzheimer’s Disease and other Dementias is also rapidly increasing. The number of individuals living with dementia is expected to increase to 131.5 million by 2050. (Prince et al., 2015) Behavioral and Psychological Symptoms of Dementia (BPSD) are highly prevalent, affecting up to 80% of individuals with dementia. (Garre-Olmo, Lopez-Pousa et al. 2010) BPSD has significant negative consequences for morbidity, mortality, and quality of life in those with dementia. Unfortunately, available treatments for BPSD are often limited or inconsistent in their efficacy and prone to severe adverse drug effects such as increased mortality.(Schneider, Dagerman et al. 2006) It is increasingly clear that current approaches are inadequate and novel treatments for BPSD need to be explored and researched. This symposium will draw on the available research literature as well as clinical experiences and case examples to provide up to date information on some of the newest treatment options available for BPSD. Dr. Melanie Gentry will discuss the use of telemedicine and other forms of technology to improve diagnosis and treatment of individuals with BPSD. Dr. Baruth will discuss the rapidly growing interest in the use of medical marijuana and cannabinoids in the management of BPSD. Dr. Lindsey will review the evidence for neuromodulation techniques including electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS). Dr. Leal will review environmental and behaviorally based interventions. Garre-Olmo, J., S. Lopez-Pousa, J. Vilalta-Franch, M. de Gracia Blanco and A. B. Vilarrasa (2010). “Grouping and trajectories of the neuropsychiatric symptoms in patients with Alzheimer's disease, part I: symptom clusters.” J Alzheimers Dis 22(4): 1157-1167.
106 - Environmental Influences on the Cognitive and Psychological Well Being of Older Adults with Dementia
- William E. Reichman, L. Bradford Perkins, Hilde Verbeek
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- 04 November 2020, pp. 15-16
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This symposium will review the latest data on the influence of environmental design and its attributes on the cognitive and psychological wellbeing of older adults living with dementia. The presenters will cover the myriad ways in which the physical environment of care can adapt to the changing demands of older adults with sensory, motor and cognitive deficits and foster optimal functioning and quality of life. The role of emerging technologies will also be reviewed as they complement the contribution of the design of the physical environment to the wellbeing of older adults with cognitive impairment. Information will be offered through a review of the existing research literature as well as case studies that illustrate the impact of environmental modification on fostering wellbeing and minimizing the emergence of the behavioral and psychological symptoms of dementia. The presenters will represent and integrate sensibilities that have emerged from the fields of architecture, cognitive neuroscience and psychology.
How the Principles of the Culture Change Movement Inform Environmental Design and the Application of Technology in the Care of Older Adults Living with DementiaWilliam E. Reichman
The culture change movement informs a number of principles that have been applied to more contemporary design concepts for the congregate care of older adults living with dementia. This talk will review the core tenets of the Culture Change Movement as exemplified by the Greenhouse, Dementia Village and other innovative models of congregate long-term care. Specific reference will be made to how these tenets have been operationalized around the world into the design of programming and the creation of residential care environments that foster a better quality of life for older adults and an enhanced work environment for care providers. This talk will also include the emerging role of technologies that complement innovative design of the environment and which foster optimized social and recreational functioning of older adults living with dementia.
A Better Life Through a Better Nursing Home DesignL. Bradford Perkins
Over the last 20 years there has been extensive experimentation related to the role of the environment in the housing, care and treatment of persons with Alzheimer’s and other age related dementias. Prior to that time the typical housing and care environment was a locked unit in a skilled nursing or other restrictive senior living facility. In 1991 the Presbyterian Association on Aging in Western Pennsylvania opened Woodside Place on its Oakmont campus. This small 36 bed facility was designed to incorporate the latest research and care experience with persons suffering from these issues. This one small project, as well as the long post occupancy research led by Carnegie Mellon University, clearly demonstrated that individuals with Alzheimer’s and related forms of dementia could lead a healthier, happier, higher quality of life in a more residential, less restrictive environment. Not everything in this pioneering project worked, and five generations of living and care models have followed that have refined the ideas first demonstrated by Woodside Place. Bradford Perkins, whose firm designed Woodside Place and over 100 other related projects, will discuss what was learned from Woodside Place as well as the five generations of projects (and post occupancy research) that followed.
Innovative dementia care environments as alternatives for traditional nursing homes: evidence and experiences from the NetherlandsHilde Verbeek
Key goals of the dementia care environment focus on increasing autonomy, supporting independence and trying to enable one’s own lifestyle for as long as possible. To meet these goals, innovative, small-scale and homelike care environments have been developed that have radically changed the physical, social and organizational aspects of long-term care in the Netherlands. This presentation discusses various Dutch models that have implemented small-scale and homelike care environments, including green care farms, dementia village and citizen initiatives. The models reflect a common care concept, focusing on residents’ remaining strengths, providing opportunity for choice and aiming to sustain a sense of self and control. A small number of residents (usually 6 to 8) live together in a homelike environment and nursing staff are part of the household. Residents are encouraged to participate in daily household activities, emphasizing normalization of daily life with person-centred care. The physical environment resembles an archetypal home. This talk presents the scientific evidence on the impact and effects of these small-scale, homelike models on residents, their family caregivers and staff. Furthermore, the presentation will highlight working approaches and how these initiatives have positively influenced routine care across the long-term care spectrum.
107 - New trends in aging and dementia in Latin America and the Caribbean Region
- Daisy Acosta, Jorge J Llibre Guerra, Ivonne Z. Jiménez Velázquez, Juan de Jesús Llibre Rodriguez
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- 04 November 2020, p. 17
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Alzheimer’s disease (AD) and dementia has emerged as a significant societal issue and a global priority. The prevalence of dementia is rising more rapidly in low and middle income countries (LMIC) than in high income countries. Yet, knowledge of dementia risk factors is dominated by research from high income countries (HIC), which cannot be readily translated to LMIC. Latin American countries (LAC) have unique challenges related to dementia, including rapid aging population, high admixture degree and risk factors profile, which influence the prevalence and presentation of dementia. Several epidemiological studies during the past decade have shown a rapid increase of dementia in LAC, but the impact of genetic, protective and risk factors remain poorly understood. This research session will feature a series of short and engaging talks about new trends of dementia in the region and will answer key questions regarding dementia determinants and consequences in Hispanic populations. Participants will be first introduced to the aging process in LAC, prevalence and incidence of dementia within the region. The second presentation will report on genetics of Alzheimer disease in Hispanic populations. The third presenter will discuss the complexities of dementia multimorbidity and the impact of neuropsychiatric symptoms. The fourth presenter will discuss about Nationals and Regional Strategies to address dementia and reflects on recommendations and future directions for the region. All presentations will be based on findings from multiple research projects across the region. Furthermore, presenters will extended comparison to Non-Hispanics whites and Hispanics populations living in US, which allows cross countries/society comparisons. Overall, new information about dementia will be shared with the audience. Attendees will be able to identify the unique genetic and social determinants that drive AD in LAC. Recommendations will be given for preventive strategies tailored to LMIC. The findings to be shared will be essential for building evidence-based interventions that achieve the goals of the National Plan to Address Alzheimer’s Disease.
108 - THE ROLE OF ASSISTIVE TECHNOLOGIES IN PROMOTING SOCIAL HEALTH AND WELL-BEING
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- 04 November 2020, p. 18
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Lead: Dr. F.J.M. Meiland, Amsterdam UMC, location VUmc, department of Elderly Care Medicine.
A growing number of assistive technologies are being developed and evaluated in the field of dementia. With these technologies some psychosocial interventions may be delivered with more fun and/ or efficiency, which is considered important in this field with a growing number of needs and a declining number of people that can support in these needs. Technological support systems have evolved from simple, single tools to complex and integrated systems. In an INTERDEM state of the art position paper, we have reviewed issues regarding development, usability, (cost)effectiveness, deployment and ethics of assistive technologies for community dwelling people with dementia (Meiland et al., 2017). Some of these issues will be followed up in this symposium, where different types of technologies and different research methodologies in the field of dementia are presented. Scoping review, feasibility trials and randomized controlled trials are used to study various Assistive&Assisted Living services and computer-tablet interventions.
109 - Novel Treatments for Resistant Depression: Comparison of Older and Younger Patients
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- 04 November 2020, p. 21
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Treatment resistant depression (TRD) is defined as the failure to respond to two adequate antidepressant trials. TRD patients have high levels of psychosocial distress, poor levels of functioning and are at increased risk for suicide. Novel treatment approaches are being developed to address TRD involving both pharmacological and neuromodulation interventions. In this symposium, leaders in the field will outline three strategies for treating depression which has not responded to conventional therapy and contrast the efficacy of these strategies in younger vs. older patients. William McDonald MD (JB Fuqua Professor of Late -Life Depression, Emory University, Atlanta, GA) will provide a brief overview of TRD and moderate the discussion. George Petrides MD (Director of Clinical Trials Operation and Division of ECT, Zucker Hillside Hospital, New York, NY) will discuss recent data from the National Institute of Mental Health sponsored Consortium on ECT Research (CORE) outlining the response of older patients to ultrabrief right unilateral ECT in TRD. He will contrast the response to ECT in older vs, younger patients from the CORE database accumulated over the last 15 years. Collin Reiff MD (Addiction Psychiatrist, New York University Langone Health Center, NY, NY) will discuss his recent review in the American Journal of Psychiatry on Psychedelic and Psychedelic Assisted Psychotherapy and the implications on the treatment of medication resistant depression, including late life mood disorders. The FDA’s breakthrough designation of MDMA for the treatment of PTSD and psilocybin for the treatment of depression reflects the drugs’ potential to treat resistant psychiatric disorders. Psychedelic assisted therapy may play a unique role in late life mood disorders. Finally, Patricio Riva Posse MD (Director of the TRD and Ketamine Clinic, Emory University, Atlanta, GA) will discuss ketamine treatment in resistant depression including a comparison of response rates and safety data on ketamine treatment in older vs. younger patients. He has recently published the largest compilation of safety data for ketamine infusions and he will review a new tool to monitor safety in clinical practice. Dr. Riva Posse is medical director of the Emory TRD program and has enrolled over 1000 patients (100 in his IV ketamine clinic and about half over the age of 60 years) and followed patients through several novel treatments including transcranial magnetic stimulation, ketamine infusion therapy and ECT to start to look at differential response rates.
110 - Investigations of Risk, Resilience and Novel Therapeutics of Late Life Neuropsychiatric Disease
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- 04 November 2020, p. 22
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Converging data from multiple domains of preclinical and human studies has underscored the importance of focusing on genetic, synaptic and neural circuity as critical neurobiological mechanisms of late life neuropsychiatric disease. These complementary research approaches have been applied to identify novel molecular mechanisms that may represent early intervention targets, as well as promising new treatments. The symposium will include four speakers who span the range of studies in animal models, post-mortem brain tissue, molecular imaging and clinical trials combined with biomarkers. Dr Etienne Sibille will present his research on the procognitive, neurotrophic and neurogenic effects of novel compounds augmenting dendritic inhibition and restoring neuronal connectivity, which is affected in aging and in neurodegenerative disorders, such as Alzheimer’s disease. Dr. Robert Sweet will present new GWAS and human postmortem findings regarding risk/resilience to psychosis in Alzheimer's Disease, with an emphasis on synaptic mechanisms of resilience. Dr Helen Lavretsky will present a study of the neuroimaging, genetic and epigenetic effects of memantine and escitalopram treatment in late life depression. The strategy of incorporating biological measures into a clinical trial is an important opportunity to understanding the neurobiological mechanisms. Dr Gwenn Smith will present multi-modality molecular imaging data to understand the synaptic changes associated with Alzheimer’s Disease pathology in late life depression and mild cognitive impairment. Consideration of interdisciplinary research approaches and applications to different neuropsychiatric conditions may have particular relevance to understanding the neurobiological mechanisms underlying neuropsychiatric symptoms as risk factors or complications of neurodegenerative disease.
Molecular imaging methods to visualize the neuropathology of Alzheimer’s disease (AD) in vivo provide an unprecedented opportunity to understand the neuropsychiatric (NPS) and cognitive symptoms observed in early stage AD by testing hypotheses informed by human neuropathology and animal models. A fuller understanding of the neurobiology of early AD and its clinical progression is essential to identify individuals at risk and to identify targets for prevention and treatment. Numerous neuroimaging studies have shown that beta-amyloid and tau is necessary but not sufficient to explain cognitive decline and that models to explain cognitive decline must also include measures associated with synaptic dysfunction (eg cerebral glucose metabolism or brain volumes). Human data and animal models support the further investigation of serotonin (5-HT) degeneration. Relative to other molecular targets, there is stronger evidence for 5-HT loss in both cognitive deficits and neuropsychiatric symptoms (NPS) in Alzheimer’s Disease. 5-HT compounds are the only agents with preclinical evidence of multiple therapeutic mechanisms relevant to prevention and symptomatic treatment: blockade of amyloid precursor protein processing or neuroprotection, synaptic plasticity and improvement in both cognitive deficits and NPS. Multi-radiotracer PET studies of beta-amyloid (Aβ), tau and 5-HT have been performed longitudinally in amnestic, multi -domain, MCI (aMCI-MD) and cognitively normal elderly. Cortical and limbic 5-HT degeneration was a more powerful predictor of longitudinal memory decline than Aβ or Tau. Elucidating the role of 5-HT, in relation to Tau and Aβ in cognitive decline in aMCI-MD will have fundamental implications for the design of prevention and intervention studies targeting 5-HT.
111 - Surface neuromodulation (TMS and tDCS) for therapy of cognitive and psychiatric disorders
- Howard Chertkow
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- 04 November 2020, p. 25
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The field of neuromodulation has progressed significantly over the past two decades. It is evident that application of electrical (via tDCS, transcranial direct current stimulation) or magnetic (via rTMS, repetitive transcranial magnetic stimulation) brain stimulation over the skull surface can effect change in brain function, which appears sufficiently robust to have a therapeutic effect. Sometimes the neuromodulation is best coupled with other forms of training or rehabilitation for best efficacy. What are the most promising approaches? What conditions appear to benefit? What are the situations/diseases/ disease states where neuromodulation is sufficiently well-proven now (or may be so in the future) that clinicians should start to consider its use in their psychogeriatric practice? We will review studies showing that tDCS can have a therapeutic effect in dementia, stroke, depression, and a range of other psychiatric conditions. Recent work is showing that with tDCS one can achieve improvement in picture naming, executive function, and memory in Alzheimer Disease and Frontotemporal dementia (Howard Chertkow presentation, Baycrest Health Sciences, Toronto). In stroke rehabilitation, rTMS treatment has been shown to aid in motor and language recovery (Alex Thiel, McGill University). There is now sufficient evidence that tDCS and Magnetic Seizure therapy are beneficial in depression, that these can now become part of the therapeutic armamentarium in selected cases (Jeff Daskalakis, University of Toronto). A range of other neuropsychiatric conditions can also be considered for neuromodulation therapy with rTMS (Daniel Blumberger, University of Toronto, CAMH).By attending this symposium, a physician or health care professional will become familiar with the latest research into neuromodulation and its role in current therapy of neurological and psychiatric diseases.
112 - Teaching and Training Old Age Psychiatry around the world
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- 04 November 2020, p. 26
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Summary:
In response to the global challenges of population aging in the World, it is crucial to improve research, education and clinical training in old age in order to meet the growing demands placed on psychogeriatric care services.
An overview is provided on the status of old age psychology and psychiatry, and other health professionals, as part of the multidisciplinary care delivery system for the elderly in the World. Available educational offerings and clinical training in geriatric mental health and geriatrics at both undergraduate and postgraduate level are described.
Important issues raised include the need for more educational and clinical training programs for specialists, a broader commitment to aging research and the need to increase interest in working with older adults among students across disciplines at the medical, psychological and education faculties and hospitals.
This educational initiative must focus not only on the transmission of knowledge on aging-related topics, but also on the training of specific skills and competencies.
An effective intervention in psychogeriatrics should involve a strategy with the participation of a multidimensional network that includes the commitment of researchers, educators, clinicians, health policy-makers and older adults.
Several recommendations to improve educational strategies concerning late life mental health care are presented to promote discussion, and develop new educational strategies.
Presenters:Horácio Firmino – Advances at educational at the curriculum of the new Psychiatrists and other mental health professionals at Portugal
Carlos A. de Mendonça Lima- The WPA survey on Teaching and Training in Old Age Psychiatry: 2001-2018
Manuel Sanchez Perez – Mental Health Educational Reality at Spain
Manuel Teixeira Verissimo – Geriatrics New or Old discipline- educational perspectives of Europe and the reality of Portugal
201 - Behavioral and Psychological Symptoms of Dementia: a symposium of the IPA BPSD Shared Interest Forum
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- 04 November 2020, pp. 27-28
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Section A. Psychotropic drug use (20 minutes)
1) Sytse Zuidema: The RID (Reduction of inappropriate psychotropic drugs in dementia) study Nursing home residents with dementia and neuropsychiatric symptoms are prescribed psychotropic drugs too often and also sometimes inappropriate. Multidisciplinary interventions can help to facilitate better care by using psychosocial interventions and help to decrease inappropriate psychotropic drug use. We supported implementation of such interventions through participatory action research, to facilitate nursing homes to design, and implement their own local interventions. The results of the RCT (including a process evaluation) will be presented.
2) Tzung-Jeng Hwang: dextromethorphan for treating agitation
Agitation is highly prevalent in patients with dementia and associated with significant impairment of quality of life, early institutionalization, and higher mortality. Although no pharmacotherapy has been approved by the US FDA for dementia patients with agitation, off-label use of antipsychotic agents is common. But antipsychotic agents are clearly associated with increased adverse effects, including stroke and death. Dextromethorphan (DXM) is a low-affinity uncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist, a high-affinity sigma-1 receptor agonist, a serotonin and norepinephrine reuptake inhibitor, and a nicotinicα3β4 receptor antagonist. The combination of DXM and low dose quinidine (Q) has been approved for the treatment of pseudobulbar affect in 2010. A recent study found that DXM/Q may be effective for the management of agitation in patients with Alzheimer disease (AD). In this talk, a pilot study on using DXM alone to treat agitation in dementia will be reported. Overall, the use of DXM 60-240 mg/day resulted in a high proportion of improvement (CGI-agitation: 69% much improved, 25% minimally improved). No severe adverse events were found. The results support DXM may be efficacious and safe.
3) Marie Andree Bruneau: OPUS-AP
OPUS-AP aims at improving resident care through increased staff’s knowledge and competency, resident-centered approaches, nonpharmacologic interventions, and antipsychotic deprescribing in inappropriate indications. OPUS-AP is implemented through integrated knowledge translation and mobilization activities. Antipsychotic, benzodiazepine, antidepressant prescriptions and BPSD were evaluated every 3 months for 9 months. Phase 2 of OPUS-AP was conducted in 129 LTC centres in Quebec, Canada, from April to December 2019. At baseline (April 2019), 10,601 residents were admitted on OPUS-AP participating wards from which 74% had a diagnosis of major neurocognitive disorder (MNCD) and 47% an antipsychotic prescription. The follow-up cohort included 4,087 residents with both MNCD and antipsychotic prescription. Among the 1381 residents in whom antipsychotic deprescribing was attempted between baseline and 9 months and still included at 9 months, successful deprescribing was achieved in 79,2% (cessation 44,8% or dose decrease 34,5%)). No increase in benzodiazepine or antidepressant prescriptions nor worsening of BPSD were observed.
Section B. Updates on BPSD (20 minutes)1) Kathrin Schmuedderich: Severe agitation and quality of life
A secondary data analysis was performed on the relationships between the severity of agitation (NPI-Q) and the single dimensions of quality of life (QUALIDEM) in people with dementia living in German nursing homes. In order to determine the differences between people with severe agitation and the group of people with mild or no agitation, a matching method and regression analyses were used. The findings show that severe agitation is related to lower quality of life in five out of six dimensions of quality of life.
2) Wai-chi Chan: BPSD as a predictor of cognitive decline
Description will follow
3) Huali Wang: Challenging behavior in China
Description will follow
Section C. Measurement of BPSD (25 minutes)1) Wendy Moyle: Measurement of agitation
This presentation demonstrates how the use of video observation/coding, standardised measures of agitation (CMAI-SF), and physiological measures (actigraphy) produced different outcome results related to agitated behaviours following the introduction of a social robot. When measuring agitation, we need to consider using different types of measures to ensure data reliability and validity and longitudinal research methods to identify efficacy of psychosocial interventions and effective measurement of agitation when using social robots.
2) Discussion on measurement of agitation, discussing and making plans for datasharing based on a template for datastructures
Section D. ECT (15 minutes)1) Rob Kok: short intro on ECT in BPSD
The majority of patients with dementia develop agitation or aggression in the course of their disease. In some severe cases, pharmacological and other interventions are not effective in improving these symptoms. A recent systematic review suggested that electroconvulsive therapy (ECT) could be an effective treatment for severe and treatment-refractory agitation and aggression in dementia, with few adverse consequences. We need to have controlled studies, address the stigma of ECT and develop professional guidelines for the application of ECT for agitation and aggression in dementia, particularly because most patients are not able to provide informed consent.
2) Discussion and making plan for international survey on application of ECT in BPSD
202 - PSYCHOSOCIAL INTERVENTIONS FOR PEOPLE WITH DEMENTIA AS STRATEGIES TO MANAGE BEHAVIOURAL AND PSYCHOLOGICAL SYMPTOMS [supported by European Association of Geriatric Psychiatry – EAGP]
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- 04 November 2020, pp. 29-31
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Symposium Chairs
Lia Fernandes (Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Portugal) lfernandes@med.up.pt
Sujoy Mukherjee (Faculty of Old Age Psychiatry, The Royal College of Psychiatrists, United Kingdom) Sujoy.Mukherjee@westlondon.nhs.uk
Introduction Lia Fernandes Symposium Overview Presentation 1 Sujoy Mukherjee The treatment of Behavioural and Psychological Symptoms of Dementia: where do we stand? Presentation 2 Ana Rita Ferreira Assessing unmet needs in nursing homes: a promising way to prevent neuropsychiatric symptoms Presentation 3 Slavisa Lamounier The Arts as a medium for improving social inclusion in dementia Presentation 4 Lídia Sousa Music-based interventions in the acute setting for patients with dementia
203 - FAMILY QUALITY OF LIFE IN NEURODEGENERATIVE DISEASES: EXPLORING NEEDS AND SUPPORTS IN THE CROSS-BORDER AREA SPAIN-PORTUGAL
- Eva González Ortega
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- 04 November 2020, pp. 32-33
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Neurodegenerative diseases often have an impact on both patients and their family caregivers. Given that families are an important support resource for people with neurodegenerative diseases, it is important to ensure their own quality of life. This symposium aim to present the NEUROQUALYFAM project funded by Cross Border Cooperation Programme Spain–Portugal 2014–2020 (POCTEP). The main objective of this project is to improve the quality of life of family caregivers who care people with neurodegenerative disease at home through the assessment of their needs and support resources, and the subsequent design and optimization of high-quality resources and services that are family-centered.
204 - Social Health and Dementia
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- 04 November 2020, pp. 34-35
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Mapping the complexity of factors influencing cognitive functioning in dementia with a special focus on social health
Karin Wolf-Ostermann, Prof. Dr., wolf-ostermann@uni-bremen.de, Health Sciences Bremen, University of Bremen, Germany.
Henrik Wiegelmann, M.A., Health Sciences Bremen, University of Bremen, Germany, hwiegelmann@uni-bremen.de
Imke Seifert, M.A, Health Sciences Bremen, University of Bremen, Germany, imke.seifert@uni-bremen.de
Dorota Szczesniak, PhD, Department of Psychiatry, Wroclaw Medical University, Poland, dorota.szczesniak@umed.wroc.pl
Marta Lenart, Department of Psychiatry, Wroclaw Medical University, Poland, marta.lenart@umed.wroc.pl
Mateusz Luc, Department of Psychiatry, Wroclaw Medical University, Poland, mateusz.luc@student.umed.wroc.pl
Marcin Pawlowski, Department of Psychiatry, Wroclaw Medical University, Poland, marcin.pawlowski@student.umed.wroc.pl
Etienne Rouwette, Prof. Dr., Radboud University, Nijmegen, The Netherlands, e.rouwette@fm.ru.nl
Ansgar Gerhardus, Prof. Dr., Health Sciences Bremen, University of Bremen, Germany, ansgar.gerhardus@uni-bremen.de
Joanna Rymaszewska, Prof. Dr., Department of Psychiatry, Wroclaw Medical University, Poland, joanna.rymaszewska@umed.wroc.pl and on behalf of the SHARED Consortium
Introduction:Over the past years the scientific discourse on health moved beyond unidimensional approaches, focusing on a more complex bio-psycho-social understanding. Regarding dementia and cognitive health, several studies have shown that various multidimensional factors (risk/protective) and their interactions, as well as existing individual and social resources, contribute to the heterogeneity observed for onset and further course of dementia. This presentation will a) give a systematic overview of causal factors in relation to the onset and progression of cognitive functioning and dementia b) show results of a first generic system dynamics model as Causal Loop Diagram (CLD) visualizing how different factors of the system are interrelated.
Methods:A mixed methods approach was used. First, we conducted a systematic literature review on factors influencing cognitive health with an emphasis on social factors. Second, the Group Model Building (GMB) approach was used to further elaborate the knowledge base from the literature review and to start building a Causal Loop Diagram as a first comprehensive system dynamics working model. In a final third phase we integrated both strands, agreed on the knowledge base by stepwise discursive consensus and created the CLD.
Results:The CLD model includes 73 unique factors directly or indirectly influencing cognitive functioning. Those factors show the basic causal structure of the interplay of variables present in the development and trajectory of dementia. These factors could be grouped into six thematic/disciplinary clusters, such as personal factors, socioeconomic factors, lifestyle factors, neuro -bio-medical factors, environmental factors and social health factors. The model indicates a significant role of social health indicators for cognitive health in dementia.
Conclusion:The generic CLD model reflects the knowledge of a multidisciplinary group of researchers, merged with results from a systematic literature overview and supplemented by discussion and iterative feedback processes. The mixed methods approach as well as the integration of system thinking methods turned out to be a reasonable approach to develop and graphically represent the complex structure of factors influencing cognitive functioning in dementia. This model facilitates the development of novel hypotheses about causal relationships between social health and dementia.
205 - Building and Using an Apps Library for People Living with Dementia and their Carers
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- 04 November 2020, pp. 39-41
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Maurice Mulvenna, School of Computing, Ulster University for Soo Hun, Digital Health & Care Northern Ireland, Health and Social Care Board
Presentation 1: Apps Library as a digital resource for people living with dementia and carers; Soo Hun, Programme Manager, Digital Health & Care Northern Ireland, Health and Social Care Board
Presentation 2: Development of a CLEAR Dementia Care © App; Frances Duffy, Consultant Lead Clinical Psychologist for Older People, Northern Health and Social Care Trust
Presentation 3: Technology Facilitated Reminiscence in Dementia. Assumpta Ryan, Professor of Ageing and Health, School of Nursing, Ulster University
Presentation 4: Understanding behaviour of people living with dementia using apps; Maurice Mulvenna, Professor of Computer Science, Raymond, Bond, Courtney Potts, School of Computing, Ulster University.
Summary of Symposium
The symposium describes the context and rationale behind the Health and Social Care Board Northern Ireland taking the strategic initiative to develop digital resources to support an ‘app’ library. The initiative, part of the Dementia eHealth and Data Analytics Pathfinder Programme is developing a digital framework to enable the social prescribing of apps, initially in support of those with dementia and their carers. In this symposium, apps that have been developed are described, including the CLEAR Dementia Care © App, developed to help carers understand behaviour from the perspective of the person with dementia, and the InspireD app for individual specific reminiscence, for people living with dementia and their family carers. The final talk describes the new opportunities for researchers to employ anonymous digital data in their research studies to understand the behaviour of people living with dementia and their carers in using such digital apps.
Presentation 1:
Apps Library as a digital resource for people living with dementia and carers
Soo Hun, Programme Manager, Digital Health & Care Northern Ireland, Health and Social Care Board
People living with dementia and their carers need support to enable them to manage their condition and to live independently for as long as possible. Digital technology such as smartphones are owned by 79% of adults. There are over 300,000 health apps and 4m apps are downloaded daily. A new digital service offering support for people living with dementia and their carers has been launched by the Health and Social Care Board Northern Ireland. The initiative, part of the Dementia eHealth and Data Analytics Pathfinder Programme, uses data and technology to inform better services, support people with dementia and help plan for the future. The aim of the apps4dementia library, https://apps4dementia.orcha.co.uk, is to provide a place for users to find safe, trusted mobile Apps to provide information and guidance on the condition, support self-care of symptoms and enable people affected by dementia and their carers; to carry on with their day-to-day activities for as long as possible. A series of engagement workshops conducted with people affected by dementia and carers provided input and feedback on the design, content and usability of the library; suitability and types of Apps for inclusion, as well as training materials to be delivered to healthcare professionals. Developed in conjunction with App evaluator, Organisation for the Review of Care and Health Apps (ORCHA), the library offers a range of applications which have been independently checked and reviewed for data privacy, clinical assurance and user experience. 10 best rated Apps are available on the library that provide guidance and information, to help with sleep, communication, keeping minds active, reminders as well as apps that support carers to care for their loved ones. The library will help to identify gaps in digital tools and enable commissioning of necessary Apps, of which 2 new apps – InspireD and CLEAR app will be included in the library in March 2020.
Presentation 2:
Development of a CLEAR Dementia Care & App
Frances Duffy, Consultant Lead Clinical Psychologist for Older People, Northern Health and Social Care Trust
People living with dementia can present with behaviours that carers find difficult to understand. These behaviours are often a sign of distress the person experiences as they try to understand what is happening around them or when they are trying to meet their needs and are unable to tell others what they want. Failure to understand these behaviours can lead to increased distress for the person and their carers. It can also lead to unnecessary breakdown in placement or avoidable admission to hospital. CLEAR Dementia Care © was developed to help carers to understand behaviour from the perspective of the person with dementia. This helps carers to offer appropriate support which reduces distress and improves quality of life. The model has successfully implemented across a range of organisations.
A workshop attended by health care professionals, voluntary and community sector and people with dementia and their carers elicited positive feedback about the utility of a CLEAR Dementia Care App. Throughout development there has been Personal and Public Involvement (PPI) about the design and layout of the App from a range of potential service users. The outcome is an App that can easily be used by any person who has contact with a person with dementia, including family carers and paid staff. The app provides concise and accessible information to help understand behaviour and suggest ways which could reduce the distress associated with the behaviour. It provides useful information that is always easily available. This can enable early intervention to prevent escalation of behaviour, reduce distress to the person with dementia and also reducing carer stress and burnout. An additional function gives carers the option to chart behaviour in an easy and accessible way. This will provide further understanding about patterns in behaviour and help to identify potential causes.
Presentation 3:
Technology Facilitated Reminiscence in Dementia
Assumpta Ryan, Professor of Ageing and Health, School of Nursing, Ulster University
Reminiscence has been widely used as a therapeutic approach for people living with dementia and recent studies have focused on the use of technology to support the reminiscence experience. The aim of this study was to investigate the outcomes of a home based, individual specific reminiscence intervention facilitated through the use of an iPad app for people living with dementia and their family carers. The study used a quasi-experimental design, incorporating quantitative and qualitative components in three phases. Phase 1: A User Development Group comprising a paired sample of 6 people living with dementia and their family carers worked with the research team to refine and test the technology. Phase 2: The refined application was implemented with a paired sample of 30 people living with mild to moderate dementia and their family carers. All participants were provided with reminiscence and IT training and used the system for 12 weeks at home. Outcome measures, collected at three time points, examined the impact of reminiscence on mutuality, wellbeing, quality of life and quality of the relationship between participants living with dementia and their family carers. Phase 3: Individual interviews were conducted with a sample of participants (n=32) to explore their experience of the intervention. User interactions revealed that people living with dementia used the app independently and more frequently than their carers. There were statistically significant increases in mutuality, quality of caregiving relationships and emotional well-being from baseline to endpoint for people living with dementia. For carers, there were no significant changes in mutuality, quality of caregiving relationship and emotional wellbeing scores from baseline to endpoint. Participating dyads perceived the intervention as a positive experience which focused on gains rather than losses in the context of memory retention and learning new skills.
Presentation 4:
Understanding behaviour of people living with dementia using apps
Maurice Mulvenna, Professor of Computer Science, Raymond Bond, Courtney Potts, School of Computing, Ulster University.
Behavioural data analytics and event log analysis can be useful to gain insight into how users interact with technologies. Electronic event logging data were obtained for people living with dementia and family carers. Event logging is when each anonymised user interaction with an app is automatically logged and stored in a database. This study adopted the health interaction log data analysis pipeline, which involved data cleaning and preparation, as well as the use of exploratory data analysis and K-means clustering, to uncover behavioural patterns of usage by users of the InspireD reminiscence app, to address the question: What is the temporal behaviour of users interacting with the app? The results build on the findings of a feasibility study which found that that people living with dementia preferred to interact with photos and reminisce with personalized media. Reminiscing peaked on Thursdays and Fridays but dipped at the weekends. There was a correlation between the number of days the people living with dementia and carer interacted with the app. However, people living with dementia had many more interactions than carers. People living with dementia interacted with the app akin to one reminiscence session per week. K-means clustering uncovered four user archetypes, described as: a person living with dementia who demonstrates independent and consistent use of the app; a person living with dementia who is reliant on his/her carers for support with the app and exhibits unpredictable usage patterns; a person living with dementia who is highly reliant on his/her carers for engagement with the app; and very infrequent users.
206 - Suicide and euthanasia in young onset dementia
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- 04 November 2020, p. 42
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Background
Dementia affects people that have not reached the age of 65 years. Persons diagnosed with dementia before this age, are often referred to as people with “young onset dementia". They are normally diagnosed in a later stage of the disorder compared to their older peers. This, probably due to a larger variety of brain disorders causing dementia among young persons compared to what is the case among elderly. People with young onset dementia experience a great transformation of existential life. Studies have shown that they are more aware of the disease and depressed than people with late onset dementia. The awareness of disease increases the risk of suicide ideation in this population. Health personnel should therefore be more trained to detect and diagnose young persons with dementia at an earlier stage, to meet their needs. Providing tailored services to them and their families may contribute to prevent suicide and adequately address thoughts about ending life.
Content of the SessionWe will organize four lectures with speakers from Brazil, Norway, the Netherlands and Portugal. The first lecture will contain results focusing on awareness of the disease and suicide ideation and the different awareness between persons with young onset of dementia and late onset dementia. The second and third lecture will report results from two qualitative studies, in which young persons with dementia have been interviewed express ideas about suicide and end of life. The last one will build on a case report to discuss the role of family interventions in the clinical context of YOD, including scenarios involving including scenarios involving suicidality and challenges related with the legalization of euthanasia.
Scientific PurposeTo contribute to the development of knowledge and understanding of the situation of young persons with dementia and their life situation based on three scientific studies and a clinically based discussion of the topic.
207 - Cognitive deficits in specific settings: challenges for the assessment and disease management
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- 04 November 2020, pp. 45-47
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General synopsis of the Symposium: Cognitive impairment is an important geriatric syndrome. As the global population ages exponentially, the prevalence of cognitive impairment and dementia is increasing, and mental status assessment is key in the evaluation of older adults. However, there are several pitfalls during cognitive testing and special clinical situations that demands a more in-depth knowledge and attention from the examiner. The overall objective of this symposium is to show strategies and particularities of cognitive assessment in different settings (in the clinic, inside the hospital) and clinical scenarios (early onset impairment, mental illness comorbidity).