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- 01 November 2021, p. i
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Live Symposia
100 - Artificial Intelligence in Geriatric Mental Health: Recent Advances in Clinical Research
- Ellen Lee, Helmet Karim, Ipsit Vahia, Andrea Iaboni
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- 01 November 2021, p. 1
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With the rise of wearable sensors, advancement in comprehensible artificial intelligence (AI) algorithms, and growing acceptance of AI in medicine, AI has great potential to more reliably diagnose, prognose, and treat mental illnesses. The rapidly rising number of older adults worldwide presents a unique challenge for clinicians due to increased mental health needs in the setting of a dwindling clinical workforce. AI has enabled researchers to better understand mental illnesses by taking advantage of ‘big data.’
This symposium will present an overview of novel research leveraging AI (machine learning, natural language processing) to better track, understand, and support mental health and cognitive functioning in older adults.
Helmet Karim, PhD will present on prediction of treatment response in late-life major depressive disorder and the implications of those models.
Ellen Lee, MD will present on using natural language processing to understand psychosocial functioning in older adults.
Ipsit Vahia, MD will present on radio-based sensors to phenotype changes in behavior patterns that may correlate with a range of geropsychiatric symptoms.
Andrea Iaboni, MD DPhil FRCPC will present on multimodal wearable and vision-based sensors for the detection and categorization of behavioural symptoms of dementia.
The symposium includes three physician-scientists (Iaboni, Lee, Vahia), two women (Iaboni, Lee), and two early career faculty (Lee, Karim – co-chairs). The symposium represents four different institutions across the country (McLean/Harvard, Toronto Rehabilitation Institute/University of Toronto, UC San Diego, University of Pittsburgh) and four very different approaches using AI technology to improve understanding and outcomes in the field of geriatric mental health.
The symposium seeks to address the underutilization of AI in psychiatric research, especially in the field of aging research. The increased individual-level heterogeneity associated with aging; complex trajectories of decline in cognitive, mental, and physical health; and lack and slow adoption of older adult-centered technologies present great challenges to advancing the field. However, advances in the field of explainable AI and transdisciplinary development of AI approaches can address the unique challenges of aging research.
101 - Alzheimer Disease and Dementia: diagnostic challenges and future directions in Hispanic populations
- Jorge J Llibre Guerra, Daisy Acosta, Ivonne Z. Jiménez Velázquez, Ana Rodriguez-Salgado, Geeske Peeters, Juan de Jesús Llibre Rodriguez
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- 01 November 2021, p. 2
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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. A growing body of evidence shows that prevention through risk factor management is the key to reducing the burden of dementia in the society, especially in LMIC. However, a one-size-fits all approach to health promotion is neither efficient nor effective. 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. During this session, we will present findings and tools that will help tailor and personalize risk factor management in Hispanics populations. Participants will be first introduced to genetics of Alzheimer disease in Hispanic populations relative to non-Hispanics and the influence of gene by environment interactions. The second presentation will report on the epidemiology and risk factors of AD using cross countries/society comparisons (Non-Hispanics whites vs Hispanics living in US vs Hispanics living in Latin America.) The third presenter will discuss the development of a tool that visualizes how each risk factor contributes to the risk of dementia and how one may lower their risk by addressing the risk factors. The tool can be used in primary care settings in Cuba, Dominican Republic and Puerto Rico. Finally, the fourth presenter uses state-of-the-art digital assessment tools (brain health assessment), for low-cost monitoring of cognitive functioning, MCI and dementia. Such instruments are important for future evaluation of the impact of preventive strategies. At the end of the presentations, 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 tailored to reducing the burden of dementia in the Hispanic populations.
Session Chair:
Juan Llibre Rodriguez
Alzheimer Disease and genetics in Hispanic Populations
Jorge J Llibre-Guerra
Alzheimer disease epidemiology and risk factors in Caribbean and non-Caribbean Hispanics populations.
Ivonne Z. Jiménez Velázquez
Development of a tool to motivate for healthy behaviors to prevent dementia in the Caribbean.
Daisy Acosta
A brief digital cognitive assessment for detection of cognitive impairment in Hispanics populations.
Ana Rodriguez-Salgado
102 - IPA Guidelines on Dementia and Agitation: From Provisional to Final
- Jeffrey Cummings, Mary Sano, Jacobo Mintzer, Paul Rosenberg, Michael Splaine
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- 01 November 2021, p. 3
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Agitation is common across neuropsychiatric disorders and contributes to disability, institutionalization, and diminished quality of life for patients and their caregivers. In 2015 IPA convened a transparent process to build a consensus definition of agitation and agreement on what elements should be included in the syndrome that resulted in publication of provisional guidelines. (Cummings et al, 2015) In the 2020-2021 year, the two co-chairs of this symposium have led a new workgroup to make the provisional consensus definition of agitation in patients with cognitive disorders that can be applied in epidemiologic, non-interventional clinical, pharmacologic, non-pharmacologic interventional, and neurobiological studies and guide treatment final.
Co-Chairs will discuss methods used in updating and findings and compare changes made to the provisional guidelines. Dr. Sano will present new findings on the biological basis of agitation in dementia and Dr. Mintzer will present on application of guidelines in the special circumstances of persons in palliative and hospice care. Dr. Rosenberg will discuss the special circumstance of agitation care in hospital emergency departments. Mr. Splaine will present findings about the utilization of the 2015 guidelines in the peer reviewed literature, professional and government dementia care guidance, and clinical trials.
Cummings, J., Mintzer, J., Brodaty, H., Sano, M., Banerjee, S., Devanand, D., … Zhong, K. (2015). Agitation in cognitive disorders: International Psychogeriatric Association provisional consensus clinical and research definition. International Psychogeriatrics, 27(1), 7-17. doi:10.1017/S1041610214001963
103 - A global perspective on dignity-based psychogeriatric care: An urgent call for a Convention on rights for older people
- Debanjan Banerjee, Kiran Rabheru, Carlos Augusto de Mendonça Lima, Gabriel Ivbijaro
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- 01 November 2021, pp. 3-4
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The world is ageing fast with a renewed emphasis on comprehensive healthcare for older people. This has created a paradigm shift towards rights and social justice-based approach to augment the medical model of mental healthcare. Dignity is one such construct embedded into the human-rights approach. It comprises of self-respect and worthiness of an individual as well as social acceptance of his/her identity. Dignity is a multi-faceted concept and consists of privacy, independence, inclusion, autonomy, etc. It includes community participation, functional abilities, rights to sexuality and oral healthcare, outcomes which are often neglected in conventional psychogeriatric care. Ageism and fear of ageing can exacerbate social stereotypes thereby compromising dignity in older people and risk of elder abuse.
Geriatric psychiatry is uniquely positioned to equip mental healthcare with a ‘dignity-based’ approach promoting social connectedness and health equality. This further needs integration into all levels of public health for better access and holistic psychosocial management.
With this background and on the backdrop on the unique psychosocial challenges posed by the COVID- 19 pandemic, this symposium glances at various dimensions of dignity-based psychogeriatric care:
– Practical approach towards dignity promotion in healthcare using an attributional model
– Perspectives, healthcare challenges and research from LMIC like Brazil and India related to dignity among older people and its impact on ageism and human rights
– Rights-based geriatric mental healthcare in the developed nations
– Finally, an urgent call for Convention on human rights of older persons for promoting dignity in healthcare and combatting ageism
Live Free/Oral Communications
200 - Neuropsychiatric symptoms influence performance of activities of daily living in symptomatic Alzheimer’s Disease
- Nikos Giannakis, Maria Skondra, Suzanna Aligianni, Eliza Georgiou, Savvina Prapiadou, Iliana Lentzari, Antonios Politis, Nikos Laskaris, Panagiotis Alexopoulos
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- 01 November 2021, pp. 5-6
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Background:
The triad of symptom groups of Alzheimer’s disease (AD) encompasses cognitive impairment (e.g. impaired memory or orientation), neuropsychiatric symptoms like apathy, depressive mood, delusions, hallucinations or anxiety, and functional impairment exclusively in complex activities of daily living (cADL, e.g. preparing meals, managing finances) in minor neurocognitive disorder due to AD and both in complex and basic ADL (bADL, e.g. dressing, toileting) in major neurocognitive disorder due to AD. These functional impairments are widely thought to be exclusively attributable to the cognitive deficits of the disease. Of note, mounting evidence indicates that neuropsychiatric symptoms are very common in AD and pose a heavy burden to both patients and their caregivers.
Research objective:To unravel potential associations between neuropsychiatric symptoms and cADL and bADL in individuals with neurocognitive disorder due to AD by means of machine learning (ML).
Methods:The study included 189 cognitively intact older individuals (CI) and 130 with either minor or major neurocognitive disorder due to AD. Neuropsychiatric symptoms were captured with the Neuropsychiatric Inventory (NPI), covering delusions, hallucinations, aggression, depression, anxiety, apathy, elation, disinhibition, irritability, motor disturbance, nighttime behavioural disturbances and appetite disturbances; cognitive function was assessed with the Cognitive Telephone Screening Instrument (COGTEL); The Bristol ADL scale, an informant-rated measure, was employed for tapping performance of ADL. A variety of ML-models was constructed and trained/tested using a 5-fold cross validation, with SMOTE employed as a remedy for class imbalances. In all cases the features had been selected beforehand based on LASSO technique. The dependent variable was either cADL or bADL (after their discretization based on kMeans quantization). Additionally, the modelling of the diagnosis was also attempted within our ML framework.
Results:Gradient Boosting models performed superiorly. cADL and bADL levels are predicted based on both deficits in cognitive domains and NPI variables with an accuracy of 82.3% and 84.8% respectively.
In addition, diagnosis can be predicted, with an accuracy of 83.5%, based on a model in which NPI and Bristol ADL variables were significant predictors.
Conclusions:cADL- and bADL performance in patients with AD is influenced by both cognitive deficits and neuropsychiatric symptoms.
201 - Care Home Residents as Artists: Digital Connections in the age of Disconnect.
- Nicola Abraham, Rachel Hudspith
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- 01 November 2021, pp. 6-7
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Throughout the current global pandemic, many people have had to adapt to new ways of interacting through virtual platforms. For those with access to new technologies this transition has been straightforward, but not easy and for those without it, life has become socially isolating, frightening, and lonely. The impact of COVID-19 on the mental health of older adults is a serious concern, particularly for those living in care homes who have been forgotten or neglected by exclusionary government policy. Amnesty International’s 2020 report As if Expendable: The UK Government’s Failure to Protect Older People in Care Homes During the COVID-19 Pandemic provides analysis of the neglect to care and sufficiently support older adults living with dementia in supported living. The results of this inaction to provide care has led to many avoidable deaths, and caused fear and heartache for those who have lost family, friends and colleagues. It is at this moment, during the third UK lockdown that we would like to share a narrative of hope about the actions that we have taken within care home contexts to provide relief, reconnect residents safely with their neighbours, and found creative ways to inclusively provide care, support and celebrations of the identities of people in these contexts who have become statistics in news reports.
Between January and March 2021, undergraduate and postgraduate Applied Theatre students from The Royal Central School of Speech and Drama in partnership with Imperial College Healthcare NHS Trust collaborated with residents from One Housing Association to create and develop bespoke films, poems, songs and virtual reality 360 videos from the safety of their homes to bring to life their stories, hopes and inner artists. In this presentation, we will explore the impact of these projects on the participants’ wellbeing and examine the importance of providing older adults opportunities to be creative. We will additionally offer insights into the relationships that were made and developed during the projects, including family connections, intergenerational connections and playful relationships that emerged between the residents themselves and their Carers.
202 - Music Therapy Intervention to Reduce Caregiver Distress at End of Life: A Feasibility Study
- Kevin Whitford, Angela Ulrich, Travis Dockter, Brianna E. Larsen, Christina Wood, Monica Walton, Christina M. Phelps, Martha J. Siska, Amy Stelpflug, Maureen Bigelow, Maria I. Lapid
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- 01 November 2021, p. 7
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Context
Music therapy is frequently provided to patients at the end of life, and studies have shown a benefit in relief of symptoms and a positive impact on quality of life (QoL), but little is known regarding the effect of music therapy (MT) on caregivers. Caregivers are at risk for anxiety, emotional distress and experience anticipatory grief as the patient nears death. Caregivers are present with patients and may also benefit from MT.
ObjectiveTo assess the impact of MT on caregivers for hospice patients and determine the feasibility of research in this population.
MethodsTwenty caregivers of patients hospitalized for general inpatient hospice care were enrolled. MT was provided by a board-certified music therapist, and sessions included pre-MT assessment, 20-45 minutes of MT, and post-MT assessment. Caregiver stress was measured with the Pearlin Role Overload Measure (ROM), QoL was measured with the Linear Analogue Self-Assessment (LASA), and depression and anxiety were measured with the Patient Health Questionnaire for Depression and Anxiety (PHQ-4). These three measures were taken pre-MT, post-MT and 6 months post-MT. Caregivers were also asked to complete a Music Therapy Program Survey post-MT.
ResultsThe MT intervention was completed for 15/20 caregivers (75%). Of those who did not complete MT, 2 withdrew prior, 1 was not available, 1 patient passed during the MT session, and 1 patient died prior to MT. 14 caregivers completed pre-MT and post-MT assessments, and 9 caregivers completed assessments at all 3 timepoints. The MT Program Survey (post-MT assessment, n=14) showed 100% of caregivers were very satisfied with MT and would recommend to others, 78% found MT effective for stress relief, 69% for relaxation, 71% for spiritual support, 86% for emotional support, and 71% for feeling of wellness.
ConclusionResearch on MT is feasible for acute hospice care caregivers with a majority of caregivers consenting to research and about half completing surveys pre-MT, post-MT, and 6-months post-MT (9/20). Future larger studies should be conducted to better assess the impact of MT on caregivers.
203 - Decisional capacity and advance care planning in older people who are incarcerated
- Dionne Hart
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- 01 November 2021, p. 8
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There is a growing number of older people incarcerated across the United States. With a population of greater than 300 million, the US has 5% of the world’s population, yet incarcerates 25% of the world’s prisoners. From 2000 to 2005, the percentage of prisoners in federal and state correctional institutions who were 55 and older increased by 33%. According to the American Civil Liberties Union older prison population has climbed 1300% since the 1980s, with 125,000 inmates aged 55 or older incarcerated.
Correctional facilities are the largest mental health institutions with 1 out of 5 individuals with serious mental health or substance use disorders. These facilities lack the capacity to provide long-term care for those with severe physical or mental health disorders even in the most ideal circumstances.
Individuals within the criminal justice system have a higher burden of chronic physical and health disorders and have a lower life expectancy.
Health care decision making is one area where patients in custody have autonomy in discussing advance directives, substitute decision makers and medical decision making. However, prisoners are at risk of suboptimal care, unmet palliative and end of life care needs, and lacking or inappropriate surrogates. Without documentation of advance directives or surrogates there are bureaucratic, practical, and legal barriers particularly for those without family or friends. In addition, some individuals involved in the correctional system’s only surviving family members may also be their victims, thus have a conflict of interest.
This presentation will explore capacity and substitute decision making for individuals involved in the criminal justice system who have severe mental and physical health disorders. A case description will be used to illustrate a decision-making tree for patients who are incarcerated. As the world population continues to age, the number of older people who are incarcerated and unable to make healthcare decisions will continue to increase. In this special population, correctional system clinicians and providers need to be familiar with strategies to address the need for advance care planning before older people lose decisional capacity.
204 - Psychological distress and support needs of community residing older adults in urban India – An exploratory study
- Jayashree Dasgupta, Meenakshi Chopra
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- 01 November 2021, pp. 8-9
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Background:
COVID pandemic in India, lockdowns and an unprepared health system has affected wellbeing of older adults. Low public awareness about mental health issues and stigma also contribute to low help seeking. Exploring impact of COVID on mental health of older adults and understanding support needs is essential.
Research Objective:To examine mental wellbeing and coping strategies used by urban community residing older adults during the pandemic in India.
Method:As part of an ongoing community engagement initiative with older adults and their families, an online survey was conducted during the first wave of the pandemic in April/May 2020. Sociodemographic details and information on coping strategies were gathered. The five-item General Health Questionnaire (GHQ) was used to screen for psychological distress and data were analyzed using descriptive statistics. Respondents were contacted again in May 2021 during the second COVID wave for a telephonic interview to understand current levels of distress and coping strategies. Consent was taken for audio recording and interviews were conducted using a semi-structured interview guide. Interviews were transcribed and analyzed using thematic analysis.
Preliminary results of the ongoing study:Respondents (N=54) aged between 40-86 years (Mn = 60; SD = 18.9). Majority were male (61%), retired or homemakers (57%) and widowed/unmarried (52%). Of the sample 70% had one or more pre-existing medical conditions. A score of ≥ 2 on GHQ in 66% respondents indicates psychological distress. Stressors included health and well-being of family (62%), difficulty managing household work (42%) and increase in family conflicts (17%). Although 72% discussed their worries with family/friends, only 25% considered speaking with a mental health professional indicating low help seeking. Of respondents contacted again, 40% citied ill health or being busy as reasons for refusal to participate. Of those who agreed, 33% reported psychological distress. In-depth interviews, showed use of online mental wellness sessions and yoga/meditation to be beneficial coping strategies. Need for more online support groups was also highlighted.
Conclusion:Psychological distress is present amongst community residing older adults in urban India. A change in attitude towards tele mental health must be leveraged to provide support for adults experiencing psychological distress.
205 - Holocaust survivors residence in Israel and nursing homes around the world during COVID-19 pandemic
- Assaf Shelef
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- 01 November 2021, pp. 9-10
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Significant risk factors for Covid-19 infection include old age ,somatic illnesses as well as psychiatric and neurological illnesses such as dementia and schizophrenia .
This lecture reviews the specific case of measures and considerations that were used to protect elderly holocaust survivors with severe mental illness or dementia, in Israel. We had to protect our residents from the virus, yet preserve certain autonomy.
In addition this lecture reviews global aspects of nursing homes struggle during the pandemic as reflected in various periods (at beginning in march 2020, during various waves and after vaccinations). During the pandemic 100 holocaust survivors were monitored and protected in their long term residence at Lev-Hasharon mental health center, Israel with variety of measures such as recurrent PCR tests to inpatients and staff, isolation during fever and after emergency department visits etc. The features of caregivers visits changed in time. The safety measures that were taken in our nursing home and around the world is reviewed as well as the demand for preserving the autonomy and rights of the tenants.
At the beginning families could not visit at all and virtual contacts were maintained in patients that could communicate. After the first wave a "drive in" method was carried out, families communicated with their relatives from a car.
During the second wave of the virus in Israel (September 2020), an outbreak spread in our residence. 14 patients tested positive for COVID19, all suffering from dementia or schizophrenia. They were immediately placed in quarantine in Corona departments in other geriatric and general hospitals. All patients came back after recovering, small part of them regressed.
As the pandemic continued we allowed visits with social distance and masks that were monitored by the staff. After vaccinations we allowed families to be with the elderly patients in the open yard without staff inspection. Four patients were infected during the third wave, although they were immunized.
We had to consider every step of the way protection versus some autonomy to our patients and families and weigh creative ways to do this.
207 - The impact of changes in activities offered on care professional burden during the COVID-19 visitor ban in long-term care facilities
- Henriëtte G. Van Der Roest, Marieke Kroezen, Egbert Hartstra, Claudia Van Der Velden, Marleen Prins
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- 01 November 2021, pp. 10-11
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Background
Residents of long term care facilities (LTCFs) and their professional caregivers have been hit hard by the coronavirus. During the COVID-19 outbreak, many countries imposed national visitor-bans for LTCFs. In the Netherlands, the ban was in place from 20 March 2020 onwards and ended (partly) on 15 June 2020. The usual meaningful and pleasant day structure that is created through organized (group) activities, was heavily impacted by the visitor ban. It remains unclear which particular types of activities were stopped, whether ‘alternative’ activities were introduced that may acquire a structural character in the future, and how this affected care workers.
MethodsWe conducted online questionnaire research among LTCF residents, family members and care professionals at two time points; six weeks after the visitor-ban was implemented (T1) and one week after the ban was (partly) lifted (T2). The three groups received questionnaires on the consequences of the COVID-19 outbreak and the restrictive measures in place. Respondents were recruited independently for each measurement. This study only uses care professionals’ data. The influence of the up- and downscaling of activities on care professionals’ burden and ability to provide care was investigated using multivariate multiple linear regression.
Results811 professionals completed the questionnaire during T1 and 324 care workers during T2. A decrease in regular group activities during the visitor-ban was reported. Especially exercise activities, creative activities and music activities were undertaken less frequently. Also domestic activities, such as eating together and watching television, took place less frequently as compared to before the visitor-ban.
Activities that could be easily done on the unit, with sufficient social distance, were undertaken more frequently, such as music activities, conversations and playing games in the living room. The impact of the up- and downscaling of activities on care professional burden, and the perceived ability to provide adequate care, will be presented.
ConclusionsActivities are an important means for residents of long term care facilities for obtaining pleasure and giving a meaningful structure to the day. Future lessons can be learned from the adjustments that had to be made in the range of activities offered during the visitor-ban.
208 - Person-centred infection prevention and control during a pandemic: The Dementia Isolation Toolkit
- Andrea Iaboni, Hannah Quirt, Steven Stewart, Alisa Grigorovich, Claudia Barned, Kevin Rodrigues, Pia Kontos, Charlene Chu, Arlene Astell, Katia Engell, Colleen Maxwell, Julia Kirkham, Kathleen Bingham, Alastair Flint
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- 01 November 2021, p. 11
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Objectives:
People working in long-term care homes (LTCH) face ethical dilemmas about how to minimize the risk of spread of COVID-19, while also minimizing psychological hardship and other harms of infection control measures on residents. The Dementia Isolation Toolkit (www.dementiaisolationtoolkit.com; DIT) was developed to address the gap in ethical guidance for LTCH on how to safely and effectively isolate people with dementia while supporting the personhood and well-being of residents. In this presentation, we will present the DIT and report on the results of a survey of LTCH staff in Ontario, Canada on their experiences isolating residents in LTCH and the use of the DIT in supporting person-centred isolation care.
Methods:A link to an online survey was distributed to LTCH staff through provincial organizations and agencies as well as through social media and the DIT website. Inclusion criteria were LTCH staff working on-site at a LTCH since March 1, 2020, who had direct or indirect experience with the isolation/quarantine of LTCH residents. Results were summarized descriptively.
Results:A broad sample of LTCH staff (n=207) participated in the survey, most of whom had experienced an outbreak in their LTCH. Dementia (96%) was the most important barrier to implementation of infection control measures in LTCH, followed by staff distress about the effects of isolation on residents (61%). Important facilitators for isolation included delivery of 1:1 activities in the resident’s room (81%) and designating essential caregivers to provide support (67%), while inadequate staffing levels were reported as a barrier (55%). 65% of respondents indicated some familiarity with the DIT, and of those who had used the toolkit, 62% found it helpful in supporting isolation care, particularly in developing care plans and making and communicating decisions. Of those who had used the DIT, 48% found it fairly or very helpful at reducing their level of distress.
Conclusions:Isolation as an infection control and prevention (ICP) measure in LTCH environments can be harmful to residents and create moral distress in staff. ICP guidance and support of LTCH needs to address how to minimize these harms by providing dementia-specific guidance such as in the DIT.
209 - The Impact of Function Focused Care in Assisted Living Communities in the United States during the COVID-19 Pandemic
- Elizabeth Galik, Barbara Resnick, Rachel McPherson, Erin Vigne
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- 01 November 2021, p. 12
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The purpose of this study was to test the preliminary effectiveness and feasibility of implementation of a function focused care intervention, referred to as Function Focused Care for Assisted Living Using the Evidence Integration Triangle in Assisted Living Communities with Residents with Dementia, and consider the impact of COVID-19 restrictions on incidences of COVID-19 and worsening of behavioral symptoms. The intervention was designed to facilitate a philosophy of care in which staff are educated and helped to actively engage residents in functional and physical activity during all care interactions. This was a single group pre-post intervention study including 51 assisted living communities in a single state in the United States. The communities ranged in size from 8 to 50 beds with the mean number of beds being 13.25 (SD=7.69). The majority (99%) were for profit. There was significant improvement in the support of the environments (p=.01) and policies (p=.04) for physical activity. There was no significant change in falls, emergency room transfers, hospitalizations or nursing community transfers over time. Overall there were only 7 (18%) communities that had COVID-19 positive patients with the numbers ranging from 1-16 residents and percentage ranging from 0-31% and a mean percentage of 17%. The majority did not require that the residents quarantine in their rooms (87%) although they did restrict visitation with the exception of 3 (8%) communities that let families visit after training and with exposure and symptom risk assessments completed at each visit. Communities in which residents were quarantined in their rooms had a 40% greater likelihood of having COVID-19 positive residents than communities that did not quarantine residents. None of the restrictions imposed were associated with worsening of behavioral symptoms. The findings are descriptive and pilot in nature but can be used to guide future research around prevention and management of infections in assisted living.
210 - Are visits allowed? The impact of the COVID-19 pandemic on care home visitation and care delivery in the UK
- Clarissa Giebel, Kerry Hanna, Jacqueline Cannon, Hilary Tetlow, Paul Marlow, Justine Shenton, Stephen Mason, Manoj Rajagopal, Mark Gabbay
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- 01 November 2021, pp. 12-13
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Background:
COVID-19 has caused the sudden closure of care homes to the outside world, to stem the virus from infecting some of the most vulnerable groups of people – older adults residing in care homes. With very little knowledge to date, we aimed to explore the impact of COVID-19 on care provision and visits in care homes from staff and family members’ perspectives.
Methods:Care home staff and family carers of people living with dementia (PLWD) across the UK were recruited via convenience sampling and participated via telephone or Zoom. Participants took part in a semi-structured remote interview. Baseline data were collected between October and November 2020, and follow-up interviews were collected throughout March 2021. Anonymised transcripts were analysed separately by two research team members using thematic analysis, with codes discussed and themes generated jointly, supported by research team input.
Results:42 participants (26 family carers and 16 care home staff) took part in the baseline interviews, and 20 purposefully sampled participants (11 family carers and 9 care home staff) were followed up. Prior to vaccination roll out in the UK, at baseline, family carers expressed concern about a lack of clear guidance throughout the pandemic, with care homes delivering care differently and disparities noted in the levels and types of visiting allowed for family members. Lack of communication between care homes and family members, but also government and care homes, led to family carers feeling excluded and concerned about the well-being of their relative. Data on follow-up interviews are still being analysed.
Conclusions:This is the first empirical evidence to show how the pandemic has caused severe difficulties in providing adequate care for care home residents, with not only residents, but also care home staff and family carers being negatively affected. Follow-up data will shed light onto the impact of vaccination and eased visitation rights put in place since March 2021 on care delivery and connections between family carers and residents.
211 - Changes to post-diagnostic dementia support in England and Wales during the COVID-19 pandemic
- Alison Wheatley, Marie Poole, Louise Robinson
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- 01 November 2021, p. 13
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Background:
The COVID-19 pandemic precipitated widespread change across health and social care in England and Wales. A series of lockdowns and UK Government guidance designed to reduce the spread of COVID-19 which emphasised social distancing and increased use of personal protective equipment led to changes such as increased use of remote consultation technologies and the closure of services deemed non-essential. This included many services for people with dementia and their families, such as day centres and dementia cafes.
Objective:To explore the changes made to services during the pandemic and the impact of these changes on the delivery of good post-diagnostic dementia support.
Method:Professionals who had previously been recruited to the ongoing PriDem qualitative study were approached for follow up interview. Eighteen interviews with a total of 21 professionals working in health, social care and the third sector were conducted using telephone or video conferencing.
Interviews were audio recorded, transcribed and checked prior to thematic analysis.
Results:Key themes emerging from preliminary analysis of the data include: uncertainty about the future and the need to adapt quickly to shifting guidance; changing job roles and ways of working; the emotional and physical impact of the pandemic on staff working with people with dementia and their families; and the impact of changes made (e.g. increased PPE, remote working) on the ability to deliver post-diagnostic support. However, there were also some unintended positive outcomes of the changes. These included the ability to include family members living at a distance in remote consultations, allowing for more robust history-taking, as well as the uptake of technology to facilitate cross-sector and multidisciplinary working between professionals.
Conclusion:Delivering post-diagnostic dementia support during COVID-19 was challenging and forced dementia services to make adaptations. Participants expected that some of these changes would be incorporated into post-pandemic work, for example increased use of technology for multidisciplinary team meetings or blended approaches to patient-facing services involving both virtual and face to face work as appropriate. However, most participants agreed that it was not appropriate nor desirable to provide fully remote post-diagnostic support on a full time basis.
212 - Involvement, Worries and Loneliness of Family Caregivers of People with Dementia during the COVID-19 Visitor-ban in Long-term Care Facilities
- Marleen Prins, Bernadette Willemse, Claudia van der Velden, Anne Margriet Pot, Henriëtte van der Roest
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- Published online by Cambridge University Press:
- 01 November 2021, p. 14
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Background
To prevent COVID-19 from spreading in long-term care facilities (LTCFs), the Dutch government took national restrictive measures, including a visitor-ban in LTCFs between mid-March and May 2020.
Physical visits were replaced by alternatives as telephone or video calls. This study examines the relationship between the involvement of family caregivers (informal caregivers, ICs) of people with dementia (PwD) living in LTCFs and IC mental health during the visitor-ban. Furthermore, we examine whether this relationship is moderated by the frequency of contact with PwD during the visitor-ban and resilience of ICs.
MethodsA cross-sectional study was carried out, 375 Dutch long-term care organizations were invited by email to participate. LTCFs sent eligible ICs a link to an anonymous online survey. Family involvement was assessed by the visiting frequency and doing social (e.g. drinking coffee), or social and task-related (e.g. laundry) activities during visits before the visitor-ban.
Results958 ICs of PwD participated. Contact frequency increased for 17% ICs and decreased for 25% compared to visiting frequency. 43% of ICs did only social activities and 57% social and task-related activities. ICs who visited their relatives at least once a week before the visitor-ban were more worried during the visitor-ban than those with less regular visits (main effect). Contact frequency during the visitor-ban was a moderating factor, ICs who visited the PwD daily before, but had at least weekly contact during the visitor-ban, worried less. No main effects for activity type were found on loneliness , however resilience was a moderating factor. Resilient ICs who did more diverse activities (task and social related) before the visitor-ban, experienced less loneliness during the visitor ban.
ConclusionsThe results implicate that to reduce worries amongst ICs, LTCFs should facilitate in continuing contact with PwD during a visitor-ban, specifically in highly involved ICs. Also, non-resilient ICs that generally only do social activities are more prone to loneliness. It is advisable for healthcare and welfare professionals to reach out to this group, to help them with overcoming their loneliness.
213 - ECT-AD: Ethics and informed consent issues
- Louis Nykamp, Brent P. Forester, Adriana P. Hermida, Martina Mueller, Georgios Petrides, Hannah Heintz, Maria I. Lapid
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- Published online by Cambridge University Press:
- 01 November 2021, pp. 14-15
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Agitation is experienced by over 90% of individuals with Alzheimer’s disease (AD) which increases morbidity and mortality and contribute to caregiver burden. There are no FDA-approved treatments for severe agitation in people with advanced dementia. Behavioral interventions are first-line management strategies but are not effective in the most severely agitated patients. Off-label use of psychotropic medications have limited efficacy and risk for adverse effects. New management strategies for severe agitation in AD refractory to psychopharmacologic and behavioral interventions are timely and warranted. Preliminary studies provide evidence for the safety and efficacy of acute electroconvulsive therapy (ECT) in reducing agitation in this population.
The ECT-AD study is a multi-site NIH-funded randomized single-blind randomized controlled trial to investigate the safety and efficacy of ECT in severe and treatment refractory agitation and aggression in AD. In a vulnerable population with advanced dementia and lack of capacity to provide informed consent, there are ethical and consent issues that need to be considered. In this presentation, we will describe the human research subject aspects of working with this population, the process of informed consent and variation of state laws, and efforts to ensure participant safety and minimize undue influence or coercion.
214 - End-of-life decision-making capacity in older people with serious mental illness
- Carla Kotzé, Louw Roos, René Ehlers
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- Published online by Cambridge University Press:
- 01 November 2021, pp. 15-16
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Objectives:
The study’s main aim was to assess the end-of-life decision-making capacity and health-related values of older people with serious mental illness.
Design, Setting, and Participants:This was a cross-sectional, observational study, done at Weskoppies Psychiatric Hospital, Gauteng Province, South Africa that included 100 adults older than 60 years of age and diagnosed with serious mental illness.
Measurements:Socio-demographic, diagnostic, and treatment data were collected before administration of the Mini- Cog and a semi-structured clinical assessment of end-of-life decision-making capacity. Finally, the standardized interview, Assessment of Capacity to Consent to Treatment, was administered. This standardised instrument uses a hypothetical vignette to assess decision-making capacity and explores healthcare-related values.
Results:According to the semi-structured decision-making capacity assessment, 65% of participants had decision-making capacity for end-of-life decisions. The Assessment of Capacity to Consent to Treatment scores were significant (p<0.001) when compared to decision-making capacity. Significant correlations with impaired decision-making capacity included: lower scores on the Mini-Cog (p<0.001); a duration of serious mental illness of 30-39 years (p=0025); having a diagnosis of schizophrenia spectrum disorders (p=0.0007); and being admitted involuntarily (p<0.0001).
Conclusions:Two thirds of older people with serious mental illness had decision-making capacity and were able to engage in end-of-life care discussions. Healthcare providers have a duty to initiate advance care discussions, optimize decision-making capacity, and protect autonomous decision-making. Chronological age or diagnostic categories should never be used as reasons for discrimination, and older people with serious mental illness should receive end-of-life care in keeping with their preferences and values.
215 - ECN Awards: Anticholinergic Burden: A Study in a Psychiatry of Later Life Cohort
- Liam C. Kennedy, Chinyere Nwogbunyama
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- Published online by Cambridge University Press:
- 01 November 2021, pp. 16-17
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Background
Medications with anticholinergic activity are widely prescribed for a variety of medical, surgical, and psychiatric illnesses. There is strong evidence that the cumulative anticholinergic properties of such medications (i.e., the anticholinergic burden) contributes to significant longer-term adverse effects, including dementia, impaired mobility, and increased mortality. Despite this, the anticholinergic burden is often not given due consideration when cliniciansprescribe or review medications in routine clinical practice. This is of particularrelevance in services working with elderly patient populations, who are both more likely to experience polypharmacy and more vulnerable to medication adverse effects. Greater awareness of the risks of anticholinergic prescribing may lead to improvements in longer-term cognitive and physical functioning,and subsequently decreased disease burden on individuals and society as a whole.
Objectives/AimsTo identify and quantify anticholinergic burden among all patients currentlyattending a rural Psychiatry of Later Life service.
MethodsThis was a cross-sectional observational study. Chart reviews were carried out on all patients open to the service at the time of the study in November 2020. Each patient’s medication regime was analysed to calculate its overall score onthe Anticholinergic Effect on Cognition Scale (AEC), using an online tool developed by South London and Maudsley NHS Foundation Trust. Other variables such as each patient’s age, sex, and cognitive status (categorized as no cognitive impairment; mild cognitive impairment (MCI); or dementia) were also documented. Data was anonymised on collection. AEC scores of 2 or morewere deemed to be at threshold for ‘review and withdraw or switch’ of medications.
ResultsA total of 80 patients were included in the study (48 female; mean age 77 [SD = 6.5] years). 45% of patients had a documented diagnosis of dementia, 11%had a documented diagnosis of MCI and 44% had no documented cognitive impairment. Overall, the majority of patients (53.75%) were found to have an AEC score of 2 or greater (AEC range 0-6, mean 2.5 [SD = 1.5]). Of patients with a diagnosis of dementia, 58% were found to have an AEC of 2 or greater.
ConclusionsThe possible detrimental effects of prescribed medication on cognition and physical health are likely under-recognised in routine clinical practice. Greaterawareness of the anticholinergic properties of a wide variety of commonly prescribed medication may lead to more selective and informed prescribing.
Abstract has been accepted for a poster presentation at the British Association for Psychopharmacology Summer Meeting (July 2021), and at the European College of Neuropsychopharmacology Annual Congress (October 2021).