The aim of this study was to examine the potential contribution of Death Cafés to the creation of a society that is inclusive of death, which is necessary for ACP, through an analysis of the motivations and orientations of Death Cafés hosts to run Death Cafés.

Interviews were conducted with 16 host of Death Cafés. Interview transcripts were segmented, coded and categorized, focusing on motivations and orientations for running Death Cafés.

Motivation for running Death Cafés were categorized into four categories: “The bereavement experience of the host”, “The identity crisis of the host”, “Dissatisfaction with a society in which death is taboo”, and “Unlocking new possibilities for Buddhist temples”

The orientation of Death Cafés was categorized into two categories. Namely, “Personal growth” and “Community development”.

Attitudes towards the attendees with grief were categorized in two categories. “Not mentioned” and ” Welcome participation/refer to more appropriate projects “.

The characteristics of the host and venue were categorized as “Buddhist monk and/or Buddhist temple” and “Other”.

The relationship between these four factors was examined. When the host's bereavement experience was the motivation for starting the Death Cafés, they tended to regard death as an overwhelming experience and to run an individually oriented Death Cafés with the intention of personal growth. When the motivation for starting the Death Cafés was dissatisfaction with a society that considered death a taboo subject, attitudes towards death tended to be neutral and the café tended to be socially oriented with the intention of community development. Where the motivation for starting the Death Cafés was to expand the possibilities of the Buddhist temple, which was one of the subcategories of “Community development”, attitudes towards death were neutral and café tended to be both individual and socially oriented.

Death Cafés held in Buddhist temples may have the potential to contribute to the creation of a death-inclusive society in Japan and could be an ACP implementation strategy.

Since its first implementation in 1998, significant evidence has been presented of the positive impact of the TimeSlips creative expression method for people with dementia in long-term care (LTC) settings. Our research with people with dementia in Colombia extends this evidence in important new directions: it is the longest TimeSlips study to date (at 32 consecutive weeks); it is the first to evaluate the feasibility of the online delivery of the method (in response to the strict COVID-19 quarantine in Colombia); it is the first study to investigate the impact of the TimeSlips method on the personhood, quality of life and psychological well- being of Spanish-speaking participants in non-LTC settings in the Global South.

Trained facilitators provided weekly, one-hour TimeSlips group storytelling sessions via Zoom over 32 consecutive weeks to eight participants with dementia. Semi- structured interviews of participants and care partners were conducted within one week of the final intervention. Thematic analysis evaluated the resultant qualitative data.

Our online implementation of the TimeSlips creative expression method reinforced key facets of participants’ personhood (self-expression and self-perception, which led in turn to increased care partner appreciation), had a positive impact on key domains of quality of life (mood, energy levels and cognitive function) and stimulated a key aspect of psychological well-being (the formation and maintenance of social ties).

Our study demonstrated that the online delivery of the TimeSlips method to participants who remain in their own homes is both feasible and effective. With more than 2.5 million people with dementia in Latin America (most of whom remain at home post-diagnosis) and a predicted 180% increase in prevalence to 2050 (compared with a 70% increase in Europe), our pioneering study offers important precedents for future, related research, in which a direct comparison between the benefits of online versus face-to-face delivery of the method would be important next step.

Due to longevity, universal health coverage, declining population, and a stable society, it is estimated that the number of people with dementia will reach 10 million by the mid-21st century, accounting for 10% of the total population in Japan. To move toward a dementia-friendly community, it is essential to develop innovative and effective dementia care. However, human and economic resources are limited. Therefore, we focused on traditional Buddhist denominations that have organizations, educational systems, human resources, networks, and care venues. The fundamental question of this study is: Japanese Buddhism has created basis for mindfulness-based cognitive therapy, but is it also innovative in the care of older people?

We looked for papers that 1) were written in a medical rather than a religious context, 2) were written in English, and 3) dealt with the care of the older people in Japan.

1) Institutional care workers’ need for Buddhist priests for helping anxiety of older residents was reported. 2) Effectiveness of community cafés for the family caregivers of people with dementia in the Buddhist temples were reported. 3) Potentials of monthly visit to bereaved families, Buddhist priests’ tradition, as the outreach of grief care was suggested. 4) Care workers’ own ideas about death after working in the landscape of dying and death was reported by the interview which used Buddhist priests as the interviewers.

Participation of Buddhist priests as 1) spiritual cares for the residents in the institutions, 2) carers for the family carers in the community, 3) carers of the bereaved families in the outreach activity, and 4) carers for the care workers, were reported. However, robust evidence was not enough. From the standpoint of Japanese clinicians, there are too few papers compared to the actual contributions. More studies should be done which might also work as external monitoring. Traditional Buddhism in Japan has a closed membership system which is based on the family gravesite system and is generally not enthusiastic about propagation, which would also be compatible with a secular care system.

Reliable and consistent social support are associated with the mental health and well-being of persons with severe mental illness, including bipolar disorder (BD). Yet the COVID-19 pandemic and associated social distancing measures (e.g., shelter-in-place) reduced access to regular social contacts, while social media use increased concomitantly.

For this study, we had two goals. First we report descriptive information regarding social media use (SMU) by persons with BD during COVID-19 (all platforms). Specific to Facebook, we next developed and tested a hypothesized model in order to identify direct and indirect associations between BD symptoms, social support, loneliness, life satisfaction, and social media use. Responses were collected during the global spread of the Delta variant and prior/concurrent with the Omicron variant, 20 months after the World Health Organization declared COVID-19 a global pandemic.

Over eight weeks, participants were recruited using social media advertising micro- targeted to adults with BD. On average, participants were 53.96 years of age (SD = 13.22, range 20-77 years), they had completed 15.40 years of education (SD = 4.28) and were diagnosed with BD 19.60 years ago (SD = 10.31). Path analysis was performed to develop and test our hypothesized model.

Almost all participants (93%) reported having both Facebook and LinkedIn accounts; 91.1% reported regular use of either or both. During the pandemic, most (60.8%) reported accessing social media several times a day; 36% reported using social media more often since the emergence of COVID-19. Specific to Facebook, the model we hypothesized differed somewhat from what emerged. The resulting model suggests that symptoms of depression predict loneliness and inversely, social support and life satisfaction. Social support predicts social Facebook use whereas passive Facebook use predicts life satisfaction. Symptoms of depression emerged as indirect predictors of SMU via social support.

Our findings suggest that the operational definition of passive-active SMU requires further analysis and refinement. In contrast to theory, passive Facebook use appears positively correlated with well-being among certain populations. Longitudinal data collection over multiple points is required to identify associations between BD symptoms, social media use and well-being over time.

The COVID-19 pandemic has been a mass bereavement event disrupting social functioning of individuals in the general population, restricted and changed end-of-life, mourning and grief processes. In these circumstances grief may become pathologic and complicated grief (CG) may rise. The vulnerability of elders to CG in times of loss and bereavement in the COVID-19 context has been hardly studied. The current study aimed to examine grief processes, complicated grief and their relationship with protective and vulnerability factors among adults and elders (45 years old and above) who experienced loss at the time of the COVID-19 pandemic. Methods: A total of 113 adults aged 45 and above were included in the analytic convenience sample. Quantitative data was collected by self-reported questionnaires of CG, resilience, well-being, state anxiety and negative engagement with hostile world scenarios (HWS). Additionally, qualitative data on grief experiences was collected in semi-structured interviews of 9 participants.

Factor analysis results supported prior identified factors of CG among the aged. Multivariate analysis and stepwise regression identified factors associated with CG: female gender, state anxiety and negative engagement with HWS were identified as vulnerability factors whereas resilience emerged as a protective factor. Thematic analysis identified two main themes among participants: (1) COVID-19 as an emotional accelerator and (2) Support from social resources in COVID-19 times.

Findings add to our understanding of complicated grief among adults and elders in epidemic times. A unique and novel finding is the relationship found between negative engagement with HWS and complicated grief. This highlights the importance of examining how individuals facing adversities in general and loss in particular, perceive their ability to cope with life hardships. Furthermore, further research for establishing diagnostic criteria of CG for the aged is recommended.

The increasing availability of data offers new possibilities for supporting quality of care in long-term care (LTC) for older adults, also for dementia care units in nursing homes. Examples are quantitative data in electronic health records (i.e. medication), data collected by technological devices such as sensors and wearables (i.e. data related to psychical and mental health including for example heart rate and sleeping patterns), but also qualitative data stored in texts (e.g. transcribed conversations about perceived quality of life). LTC organisations currently lack tools to interpret and integrate the data in the shared decision-making (SDM) process. This project investigates the necessities for data-informed SDM.

The study was conducted in co-design with the knowledge group ‘Data Science’ residing in the Living Lab in Ageing and Long-Term Care, Maastricht. A focus group-setting, in which a diverse set of stakeholders, including data/ICT-specialists, care managers and client representatives, took place to discuss bottlenecks, possibilities and solutions related to data-informed SDM.

In total, representatives (n=18) from 7 care organisations participated in three separated focus groups. This resulted in several themes that were deemed necessary for data-informed SDM: 1) an organisational vision on data and data-informed SDM, 2) investment in data-driven care SDM, 3) the instalment of multidisciplinary teams, including clients, informal and formal caregivers, 4) a planned implementation process is needed, and 5) the use of living lab constructions.

A well-thought-out, integral learning process, including a vision statement on data and the installation of multidisciplinary teams working on data-problems, is deemed necessary in order for LTC organisations to accomplish data-informed SDM. A concrete step-by-step plan, which can provide LTC organizations with tools to embed data in the current SDM process, is suggested to help organisations in their quest to data-informed personal care.

This study aims to analyze the effect of reminiscence therapy using immersive virtual reality technology, in comparison with conventional reminiscence therapy, on anxiety and depressive symptoms of people with dementia.

This pilot study followed a randomized controlled trial design. A convenience sample of 16 people with dementia was randomly divided in experimental and control groups. Due to health-related factors, 2 participants abandoned the study before completing the intervention. Intervention consisted of 8 biweekly individual reminiscence sessions conducted by trained researchers, in which participants in the experimental group viewed 360o videos of locations with personal relevance considering their life narratives, using virtual reality headsets to promote an immersive experience. Intervention in the control group was similar, except the videos were displayed in a computer monitor. The assessment was carried out before and after the intervention, using the Geriatric Depression Scale (15 items) and the Generalized Anxiety Disorder scale (7 items).

Intervention and control groups were compared regarding sociodemographic variables and level of dementia progression at baseline. No statistically significant differences were found. Regarding the comparison of anxiety and depressive symptoms pre- and post-intervention, a slight decrease was observed in both groups, although statistical significance was not reached (p>0.05).

The results of the present study do not illustrate an added value regarding the use of immersive stimuli with virtual reality technology, in reminiscence therapy programs with people with dementia. Further research is warranted to better ascertain the cost effectiveness of using these technologies in the non-pharmacological treatment of people with dementia.

Ageism, defined as stereotyping, prejudice, or discrimination against older people, is an emerging public health concern [1]. Ageist attitudes and behaviors in health care are found to negatively affect the physical and mental well-being of older individuals [2]. This study is the first to investigate ageism and its determinants in Lebanese healthcare settings.

We diffused an online survey including the Fraboni Scale for Ageism (FSA) [3] and other variables to nurses, physicians, nursing, and medical students at an urban university hospital in Lebanon. We obtained online consent from participants prior to filling the survey. The study was approved by the Institutional Review Board of St. Georges Hospital University Medical Center (IRB-REC/O/066-21/3321).

We recruited 233 participants (47.2% medical students, 21.5% nurses, 20.6% physicians and 10.7% nursing students). Mean age was 29.2 (Standard Deviation—SD = 12) years. Almost two-thirds were female. Half the sample came from rural areas. Almost 60% currently live or have lived with an adult aged≥ 60 years. The FSA total score ranged between 33 and 87 (mean 58.9; SD 10.2). The mean/SD scores were 22.6 (4.5), 17.2 (3.2) and 19.1 (4.3) for the antilocution, discrimination and avoidance subscales of the FSA respectively. There was a positive correlation between age and FSA total score (p=0.041), in addition to discrimination and avoidance subscores (p=0.0001). Originating from rural areas was associated with significantly lower discrimination scores. Living or having lived with an older individual was associated with significantly lower overall ageism and discrimination scores. In addition, students (nursing and medical) were found to have lower ageist perceptions and attitudes compared to healthcare professionals (nurses and physicians). Table 1 shows the results of bivariate analyses performed. Regression analyses showed that only living or having lived with an older person remained significantly associated with lower ageism scores (p=0.036) after accounting for other covariables.

Lower ageism was found among students compared to practicing nurses and physicians. Having lived with an older person was a protective factor against ageism. Specific anti-ageism interventions may need to be implemented to mitigate its impact in healthcare among students and practitioners.

Table 1

Bivariate analyses of FSA total score and subscores on covariates of interest

The Time for Dementia (TFD) is an educational programme for healthcare students to learn from ‘experts by experience’ through longitudinal contact with a family affected by dementia. Since 2014, over 1,900 families have taken part. In December 2021, as a result of a student complaint about racism, expectations of inclusivity, diversity and inclusion (EDI) were examined and an anti-discriminatory practice plan for TFD was developed.

One of the proposed outputs of this plan was the creation of a communique to outline the expectations on EDI for circulation to participant families and students in TFD. Several considerations were acknowledged to be important: i) Generational differences and expectations about anti-discrimination; specifically, the use of language; ii) The complexity of addressing this issue with people with dementia; who may have difficulties with recall or disinhibition due to their condition; iv) The need to enhance understanding of different perspectives and needs between families and students.

The iterative development (January-September 2022) of the final communique included;

1. 1. The formation of a working group including student inclusivity representatives and TfD families to develop the communique.

2. 2. A draft set of ‘inclusivity principles’ was created and feedback was sort from a sample of TFD participants independent of the working group (n=15).

3. 3. As a result of feedback, these principles were amended by the working group.

4. 4. The circulation of these inclusivity principles to the families taking part in TFD from July 2022.

5. 5. A qualitative research study was conducted on the reception of these principles (n=14).

This poster will present the communique that was developed, the results of the thematic analysis on its reception, and key reflections on its development.

Universities have a responsibility to prevent and effectively deal with discrimination on placements and this includes educational programs with ‘experts by experience’. Educational programs with people with dementia and their carers, who are volunteers, not patients, need special consideration. While this marks the start of TFD engagement with EDI issues, we hope by sharing our experiences will offer inspiration and confidence to other educators in psychogeriatrics to engage with these issues.

At the end of this workshop, participants will be able to:

1. - Integrate a human rights and dignity-based strategies into daily clinical care for older persons with mental health conditions

2. - Identify the effects of intersections of ageism, ableism, mentalism and elder abuse on the care provided to older persons with mental health conditions

3. - Describe and support the need for an international (UN) Convention on the rights of older persons to improve the care of older persons with mental health conditions

Our world faces rapid population aging. Based on the WHO estimates, nearly 20% of older persons will have mental health conditions such as dementia, depression, anxiety and substance use, often complicated by physical and psychosocial comorbidities. Various mental health inequalities exist in this vulnerable population negatively influencing their healthcare and social status. This includes the ‘triple jeopardy’ of ageism, ableism and mentalism. The ongoing COVID-19 crisis has only widened the marginalization of older persons and especially those with mental health conditions.

Even though there has been a paradigm-shift in neurobiological understanding of psychogeriatrics, dignity-based mental healthcare is still silent in research as well as practice. This workshop brings in recommendations to include the principles of rights, dignity, equality, equity and respect in clinical care for older persons living with mental health conditions, including dementia. These suggestions are based on literature review, position statements of global organizations working in this area, the Decade enablers of the UN Decade of Healthy Aging (2021-2030) and also clinical experience of the authors. Special focus will be on end-of-life care, advance directives and those in institutionalized settings.

The workshop will involve a strategic and interactive discussion based on real-life case vignettes. Feedback will be sought on the perceived status of dignity and human rights in current clinical practice. Focus will be on ensuring dignity and promoting human rights in routine clinical care and patient-physician communication, age-friendly healthcare settings for older persons and the role of dignity therapy. The need for an International Convention for the rights of older persons will also be highlighted with evidence.

Elder abuse and inadequate end-of-life care as two of the many common manifestations of the implicit bias and core root cause of the phenomenon of the “ageism spectrum”. Ensuring dignity and human rights in older persons can combat ageism and prevent elder abuse. Adequate sensitivity and training of professionals in this area will set the future pathway for dignified mental health interventions in the older persons with mental health conditions that are devoid of age-based discrimination and prejudice.

The objective of this study is to describe the prevalence of benzodiazepine in a sample of patients (≥65 years) attended by liaison psychiatry units (LPU) in Spain and its possible relation to falls.

This is an observational., cross-sectional, multicenter study. We obtained data from a sample of 165 patients (≥65 years) admitted to 7 general hospitals in Spain referred from different departments to each liaison psychiatry unit. Data was collected for a month and a half period. Psychiatric evaluations were performed while the patients were on wards.

We obtained a sample of 165 patients (78 women, 88 men) with a mean age of 76,03 years old (42.10% <75 years, 57,83% ≥ 75 years). Most of them were married and they lived accompanied (67,27%). Only 5,45% lived in a nursing home. 65,45% of patients had prescribed at least one psychotropic drug before LPU intervention; mainly (50,9%) benzodiazepines (60%women/40%men). 70,9% of these group of patients had more than one psychotropic drug prescribed before LPU. After LPU intervention in 39,39% at least one drug was withdrawn (in 50,81 % of cases benzodiazepines). Falls in the past 6 months were reported in 24.8% of total patients. Patients under benzodiazepine treatment had fallen in 29% of cases. After LPU intervention benzodiazepines were withdrawn in 56,25% % of them.

Benzodiazepines are widely used in our sample and frequently is associated with polypharmacy. LPU intervention might be a useful tool to reduce the use of them, specially for those who reported falls.

Longitudinal studies might be carried out to study these factors and their possible relationship with falls, given that Benzodiazepines are consistently associated with a higher risk of falls. It is unclear whether specific subgroups such as short-acting benzodiazepines and selective serotonin reuptake inhibitors are safer in terms of fall risk. Ppropriate prescription of medications such as BZDs is an important public health issue.

Anticipatory grief is frequently experienced by family caregivers of persons with dementia. It is defined as the feelings of pain and loss that appear in the caregiver prior to the death of the person cared for, and it is linked to negative consequences for the physical and psychological caregiver’s health. However, more research is needed about this construct. The purpose of this work was to explore the differences regarding gender and kinship in anticipatory grief in caregivers and to explore its associations with distress experienced by the caregivers.

The sample consisted of 70 caregivers. The anticipatory grief was measured with the Caregiver Grief Scale (CGS; Meichsner et al., 2016). Also, frequency of problematic behaviours in the person with dementia and caregiver reactions to them (RMPBC; Teri et al., 1992), depressive symptomatology (CES-D; Radloff, 1977), guilt (CGQ; Losada et al., 2010), anxiety (Tension Sub-scale of POMS’s Questionnaire; Fernández et al., 2000), emotional ambivalence (CAS; Losada et al., 2017) and the experiential avoidance in caregiving (EACQ; Losada et al., 2014) were measured.

Independent-samples T-tests were conducted to study if there were differences in anticipatory grief according to the gender of the caregiver and the kinship with the person with dementia. Secondly, Pearson correlations were conducted to study the associations between anticipatory grief and emotional distress variables.

The results showed no significative differences according to the gender of the caregiver in anticipatory grief. However, a longer caregiver ́s age and being a spouse caregiver was related to a greater anticipatory grief. Regarding the person cared for, behavioral problems and caregivers ́ reaction to them were associated with anticipatory grief. With regard to caregiver ́s emotional distress, significant and positive correlations were also obtained between anticipatory grief and its subscales with depressive symptomatology, guilt, anxiety, emotional ambivalence and experiential avoidance in caregiving.

The results suggest that anticipatory grief may have a relevant role in the well-being of dementia family caregivers. Therefore, it is necessary to consider this process in the assessment and intervention in this context with caregivers.

Reviews show that music interventions may be effective in reducing depressive symptoms among nursing home residents. Since interventions use various ways to include music, results on the effectiveness on depressive symptoms are often inconsistent. A previous review found that receptive music interventions (e.g., music listening) are more effective than active music interventions to reduce depressive symptoms among nursing home residents. Other research suggest that active music interventions (e.g., playing instruments, dancing) are more effective. Moreover, therapists seem to prefer using active music interventions. Because of its low costs, the previously found effectiveness and low side effects, it is important to gain more insight into components specific to the intervention that may contribute to its effectiveness in reducing depressive symptoms. This insight may help to fine-tune interventions and develop treatment protocols.

A Bayesian Network Meta-analysis was conducted to calculate the relative effectiveness of interventions including music. In addition, different network-meta-regression analyses were conducted to explorer components that may contribute to the effectiveness of the included studies.

Our search strategy resulted in N=22 eligible Randomized Controlled Trials (RCT), that included music in the reported interventions. Compared to Care as Usual, a multidisciplinary approach including music was the most effective (MD=-0.92, 95% CrI -2.8 to 0.97), followed by music interventions focused on sensory stimulation (MD=-0.43, 95% CrI -1.1 to 0.19), music interventions with reminiscence (MD=-0.38, 95% CrI -1.2 to 0.45) and cognitive interventions with music (MD=-0.31, 95% CrI -2.0 to 1.40). Level of depression (ƅ=-0.88, CrI 95% [-1.81 to 0.06]), and being physical dependent (ƅ=-0.29, CrI 95% [-1.20 to 0.61]), moderated the effectiveness of interventions, although this was not significant. We did not found any difference between active and receptive music interventions.

In the constructed network, interventions that included music, were not more effective in reducing depressive symptoms among nursing home residents when compared to the care as usual group. However, some subgroups seem to benefit more from music than others. To gain more insight in the effectiveness of music in reducing depressive symptoms, more research is needed, targeting those specific target groups.

A significant number of patients with COVID-19 experience prolonged symptoms well known as Long-COVID that can occurred between 3 to 24 weeks after acute phase. Most frequent symptoms expressed are fatigue, and cognitive dysfunction, but few studies have investigated the effect in outpatients ‘elderly population. A recent Study followed hospitalized seniors for COVID-19; 22% complain “Brain Fog” one year later correlated with cognitive impairment. It is a challenge to recognized symptoms as “Brain Fog” or fatigue in a frail population affected by dementia (pwd) that yet experience cognitive impairment and disability.

This observational study wants to evaluate the effect of COVID on clinical, cognitive, functional and frailty indices before infection and after in a sample of older pwd matching with control group in outpatients setting.

We collected 67 pwd and COVID infection between March 2020 and 2022 followed by Memory Clinic with pre and post geriatric assessment compared with 41 older people with dementia in control group without COVID-19. The geriatric assessment describes comorbility (CIRS), cognitive performance (MMSE), functional assessment (IADL. ADL), psychological and behavioral symptoms (NPI) and frailty evaluation (CFS) at baseline T0 (within 6 moths before COVID infections), at T1 (4-6 moths after ) and T2 (12 months after). Death is recorder for both groups

Both groups are similar for demographic and clinical characteristics at the baseline. We calculated Delta value T0-T1 and T1-T2 for clinical variables and compared case and control group. As compared to control group, COVID group showed significantly worsening in comorbility in T1 and in disability (ADL) in T1 and T2, meanwhile challenging behavior improve during the time. Both in T1 and T2 COVID group develops in worst frailty compared to control group. None difference in mortality between groups. A possible information bias is that it is not possible to exclude presence of asymptomatic covid case in control group.

COVID infection in older pwd seems to chance and speed up the natural frailty curve in people with dementia. Is it an effect of a hidden Long COVID? The study open new hypothesis in neurodegenerative implication of prolonged neuroinflammation caused by COVID brain infection.

Outcomes and care experiences for people with dementia are worse than for those without the condition and the workforce is in crisis. High quality care requires adequate training that includes an understanding of those living with the condition.

Time for Dementia is an educational programme in which healthcare students visit a person with dementia and their family carer over a two-year period (Banerjee et al., 2017). People with dementia and their carers are our ‘experts’ and teach students about life with dementia, healthcare experiences and what helps them to live well with dementia. The aim of the programme is to improve student attitudes, knowledge, and empathy towards dementia.

Since 2014, 6500 healthcare students, including medical, nursing and allied health professions, have undertaken the programme in the UK at 7 different universities. Research indicates that there are higher levels of knowledge and positive attitudes in students undertaking the programme, compared to those who did not. This symposium will present several sub-studies outlining what has been learned so far from the mixed methods evaluation of Time for Dementia. The symposium will include 3 speakers on 3 key themes:

1. 1. The development and delivery of Time for Dementia programme and educational outcomes for students.

2. 2. The factors influencing career preferences for working with people with dementia.

3. 3. The development of empathy towards people with dementia in undergraduate healthcare students

Key take-aways

• How to deliver a lived experience programme at scale.

• The value of a lived experience education programme.

• How undergraduate education can shape empathy and career preferences.