The 8-Item Informant Interview to Differentiate Aging and Dementia (AD8) was developed as a screening tool for dementia with a cutoff of 2 suggested by the initial study. However, various studies found different cutoff values, and many found a cutoff of 2 might result in a high false positive rate. Furthermore, a higher false positive rate in Taiwan was repeatedly shown when AD8 was self-administered in local government screening programs. This study aimed to test the performance of AD8, define its best cutoff value, review factors that may affect its performance, and reconsider its proper role in clinical practice.

We recruited 118 participant-informant dyads from a university teaching hospital. For each informant, the AD8 was administered first and then the Clinical Dementia Rating to minimize contamination effect. For each participant, two geriatric psychiatrists considered history, physical and mental status examination, laboratory testing, neuropsychological testing, and neuroimaging results to make the final consensus diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The receiver operator characteristic curve was used to assess the diagnostic performance of AD8.

There were 59 subjects with normal cognition, 28 with mild neurocognitive disorder, and 31 with major neurocognitive disorder or dementia. To discriminate between dementia and non- dementia, a cutoff of 2 resulted in a sensitivity of 0.903, specificity of 0.598, and area under the curve (AUC) of 0.751. Moving the cutoff to 3 and 4 led to better specificity (0.7126, 0.8621) and greater AUC (0.776, 0.818), albeit some loss in sensitivity (0.8387, 0.7742). The best cutoff score was 4 based on the Youden index. Without considering the mild cognitive impairment group, the optimal cutoff remained at 4, with equal sensitivity and even higher specificity.

Our findings suggest the AD8 may perform better and have a lower false positive rate with a cutoff value higher than 2. A literature review found its performance could be affected by disease prevalence across various healthcare settings, education level, regions, respondents’ personality and understanding of questions, conduct of test, flow of test administration, etc. We will discuss the details and best screening strategies at the IPA Congress.

Dementia care is a critical area of need in the community and institutional settings, with estimated one-third of seniors younger than 80 years of age with dementia living in institutional settings and this proportion increases to 42% for those 80 years and older in Canada. It is of critical importance to promote excellence and best practices in dementia care by preparing for well-trained dementia workforce through capacity building.

This project developed a dementia care micro-credential education to enable competency development of new graduates and upskilling of workers through simulation-based learning. This micro-credential program leveraged interdisciplinary partnership, to develop nine core modules related to best practices in dementia care, facilitated with a Gamified Educational Network (GEN). GEN is an evidence-based learning management platform that provides learners with a simulated and immersive experience to engage them in a virtual learning environment that allows for rich experiential interaction with other users and its content.

Face and content validity was established by an inter-professional committee including geriatric psychiatry, nursing, social work, occupational therapy, behavioral therapy, knowledge mobilization and simulation education experts. Next phase will begin to establish construct validity. It is expected that GEN will have a positive impact on increasing learner’s motivation and engagement in the educational tasks, as well as improving learner’s competencies and outcomes through its multi-modal approaches, including gamification (usage of game-based elements in a non-game context to engage learners and promote learning), active observational practice, independent hands-on practice, case-based discussion, peer-to-peer assessment, expert facilitated feedback, skills debriefing and reflective practice.

This micro-credential program will provide an enhanced dementia care curriculum for building capacity of existing workers, and those entering into the workforce to promote a dementia-friendly environment for older adults.

Measuring and monitoring stress has potential benefits for the care and self-management of stressors for people with dementia. Early identification of stressors may help to cope with challenging behaviours (CB), occurring in up to 80% of nursing home residents with dementia. The identification of stressors causing CB is difficult (as often residents cannot themselves indicate what is experienced as stressful or relaxing), hampering the psychosocial approach. Several studies have found that skin conductance and heart activity can be used as a proxy for stress. Measuring these physiological parameters using wearable sensors, might be helpful to identify (de)stressors and consequently, a psychosocial treatment approach. Therefore, wearables are promising as a supportive technology in the care of people with dementia and CB. However, stakeholders (i.e., (in)formal caregivers of people with dementia) indicate that current available (wearable) systems to measure stress are not fit for purpose within the everyday care of people with dementia. In addition, due to legislation, not all systems are allowed. The purpose of the current research is to develop a system prototype together with different stakeholders.

A prototype of a system measuring stress suitable in the care for people with dementia will be developed during different iterations between September 2022-July 2024. A community of stakeholders will be built, in which the needs, requirements and evaluations of people with dementia, (in)formal caregivers, legal- and IT-experts, will be collected through literature studies, focus groups, interviews and co-design sessions. The system will be developed and adjusted appropriately, taking social, technical and legal requirements into account.

Preliminary results will be presented regarding identified requirements for initial system prototypes as well as lessons learned from first iterations with conceptual and working prototypes. Implications for the care and self-management of people with dementia will be discussed.

The WHO Global Action Plan against Dementia calls for “at least 75% of member states providing carer support and training by 2025”. In response to the global target, WHO has developed iSupport aiming to provide support for caregivers of people living with dementia. The generic WHO iSupport has been translated and adapted in 39 countries and 37 languages so far. The adapted versions of WHO iSupport are now being implemented worldwide, usually as an online program for caregivers. The feasibility, accessibility, effectiveness and sustainability of the iSupport program in different cultural context is now being explored extensively. This symposium aims to share the up-to-date research findings and lessons learned on the adaptation and implementation process and users’ perspectives from diverse cultural background. It will include seven presentation and be divided into sessions: 3 presentations on Session I and 4 presentations on Session II.

Session I: The first presentation will be dedicated to overviewing the development and the progress of adaptation and implementation of WHO iSupport. The second presentation will focus on the adaptation of iSupport in Uganda. The presentation will inform the utility of iSupport in Sub-Sahara Africa. Based on individual semi-structural interview data from Tunisia, the third presentation will highlight that caregivers’ experience and needs are valuable for cultural adaptation of iSupport.

Session II: The first presentation will demonstrate how facilitator-enabled iSupport intervention would change the interaction and engagement in learning among Chinese caregivers living in Australia and Greater China. The second presentation will focus on adapting iSupport in Switzerland using a community-based participatory approach. The third presentation will show the potential benefit of raising awareness of the Russian society about dementia after the implementation of iSupport through digital technologies. The fourth presentation will report on the co-design of an adapted version of iSupport for young caregivers.

The symposium is expected to inform further development, improvement and implementation of WHO iSupport for diverse cultural background. This will be not only valuable information for participants who are interested in iSupport but also for those (interested in) investigating interventions developed in another cultural setting.

Caregivers of persons with Alzheimer’s disease or related dementia (ADRD) are essential for a better quality of life of those they care for. Their role can have a severe impact on their own physical and mental health, as well as on their social and financial situation, according to the current literature. For this reason, WHO has provided the iSupport tool to provide support to caregivers of people with ADRD. Its adaptation and implementation in Tunisia is challenged by the lack of Tunisian data concerning the experience and needs of this population.

To explore, in cooperation with the WHO, the experience of caregivers of persons with ADRD in Tunisia, and their potential training and support needs.

A qualitative cross-sectional study using individual semi-directive interviews was conducted with caregivers of persons with ADRD in Tunisia. Interviews were recorded and transcribed. A thematic analysis of the interviews was performed by two researchers.

Fifteen caregivers (11 women and 4 men) were interviewed on-site, or by telephone. Concerning their overall experience of caregiving, several main themes have emerged: The disruption of the relationship with the close relative (including the role switching, or the impossible mourning), the disruption of the relationship with oneself (including the forgetting of oneself, or the revision of priorities) and the disruption of the relationship with the others and the world (including the isolation and the withdrawal into the dyad caregiver - close relative with an ADRD, the lack of time, or the life as an unending daily struggle). When it comes to training and support needs, content and format preferences were identified.

This work helped us to adapt iSupport to the specific needs of caregivers in Tunisia. Data concerning their overall experience should provide an opportunity for a better adaptation of the social and policy context.

Some studies have shown that older people experience less experiential avoidance and more gratitude when they were compared with younger people (López, 2020). These variables might be important to improve the mental health of older people, especially in crisis situations.

Investigate the relationship between experiential avoidance (EA), gratitude and distress in old people post crisis COVID-19.

A cross-sectional study was carried out. Data from 361 people older than 60 years. The mean age was 68,44 (SD= 5.31), 62.9% were woman. The sample included in the cross-sectional analysis consisted of who provided data on the Acceptance and Action Questionnaire - II (AAQ–II; Bond et al., 2011), Gratitude subscale of the Values in Action Inventory of Strengths-Short Form (Littman-Ovadia, 2015) and Hospital Anxiety and Depression Scale (Zigmond & Snaith, 1983). Pearson´s correlations were used to explore the relationships among study variables including EA, gratitude, and emotional distress. Lineal regression analyses were used to investigate the incremental explained variance in emotional distress according to the main hypotheses. Standardized regression coefficients β were used to determine the relative contribution of these variables.

EA and gratitude were negatively correlated (r=-.27; p= <.000). Gratitude and emotional distress were negatively correlated (r=-.30; p= <.000). EA and emotional distress were positive correlated (r=.61; p= <.000). Regression analyses indicated that AAQ-II and gratitude were significant predictors of emotional distress among old people. AAQ-II and gratitude were added. AAQ-II and gratitude were significant predictor of emotional distress R2adj=62.7 % explain the model.

EA and gratitude are powerful factors to predict emotional distress in a crisis among older people. EA is an important construct in the understanding of emotional distress. This is an initial step to deep in the process of internal experiences and promoting gratitude can be very beneficial to generate programs to promote mental health in old people.

There is great concern about the care of the older adults in institutions, especially in recent years. One of the reasons is the cases of elder abuse, not only highlighted by academic and scientific sources, but also by the media. Humanization, respect, empowerment and non-infantilization are key elements to promote good treatment in nursing homes (López et al., 2021).

The aim of this study was to evaluate the care in nursing homes using the Professional good care scale in nursing homes (Pérez-Rojo et al., 2021).

The sample for this study consisted of 269 employees working in different older adults nursing homes in Spain (182 nursing aides and 87 other nursing home professionals: nurses, occupational therapists, psychologists, physiotherapists, social workers, sociocultural animators, speech therapists). The employees' evaluations of themselves (their own performance) and their own evaluation of their coworkers in the nursing home (the overall good care in the nursing home) in these two groups of professionals (nursing aides and nursing home staff that care residents) were assessed and compared. T-test were used for data analyses.

The results showed no significant differences between the two groups of professionals when they considered their own performance.

However, statistically significant differences were found when they considered the overall performance in their residency in humanization (p<.001), non-infantilization (p<.001) and in the overall score of the good care scale (p<.001). Good care in nursing homes was significantly perceived as less frequent among nursing aides.

It is important for the evaluation of good care of older adults by the staff to assess both their perception of themselves and their assessment of their coworkers. Good care is the result of a complex construct in which a wide range of factors converge. Therefore, it is essential to contemplate the most accurate assessment of it. To evaluate and promote good care, it seems appropriate to assess the overall performance of all the employees of the nursing home and not only the assessment that each one makes of the treatment he/she gives to the older adults with whom he/she works.

Previous research has suggested that negative self-perceptions of aging and lower sense of control were significantly associated with worse physical and mental health, including physical limitations and feelings of guilt for perceiving oneself as a burden. However, no study has analyzed the associations of these variables when jointly considered and assessed the potential differences in the associations between people aged 40 to 59 years and people aged 60 years and older. The objective of this study was to assess the potential differences in the associations mentioned above between people aged 40 to 59 years and people aged 60 years and older.

Participants were 377 people over 40 years (206 aged 40 to 59 years and 171 participants aged 60 years and older) who answered an online survey. The association between negative self-perceptions of aging, perceived control, physical limitations, and guilt for perceiving oneself as a burden was tested through path-analyses, with differences between age groups tested through multigroup analysis.

Significant differences between age groups were obtained. The results suggest that the influence of negative self-perceptions of aging on guilt for perceiving oneself as a burden is indirect through lower sense of control in participants aged 40 to 59 years; in participants aged 60 and over, negative self-perceptions of aging had a direct and indirect effect on guilt through greater physical limitations.

Negative self-perceptions of aging seem to be a relevant variable to understand feelings of guilt for perceiving oneself as a burden in both middle-aged adults and older adults. However, this study documents potential differences in the correlates of guilt for perceiving oneself as a burden between participants aged 40 to 59 years and individuals aged 60 years and older. Specifically, the results suggest that the associations between negative self-perceptions of aging and guilt for perceiving oneself as a burden are modulated by lower sense of control in middle-aged and by greater physical limitations in older adults. These results support the relevance of social and cognitive processes related with aging for understanding feelings of guilt for perceiving oneself as a burden.

Quality of life is an essential outcome parameter in geriatric research; however, research to date offers mixed evidence about the factors associated with health-related quality of life (HRQOL) among people with dementia (PWDs). We aimed to identify factors relating to HRQOL among PWDs living in long-term care (LTC) facilities.

A total of 299 from 1,607 registered long-term care facilities were randomly selected in every administrative region of Taiwan. A cross-sectional two-phase survey, which included the demographic data, comorbidities, EuroQol-5 dimensions-5 levels (EQ-5D-5L), mini-mental state examination (MMSE) score, clinical dementia rating scores (CDR), behavioral and psychological symptoms of dementia, and activities of daily living (ADL) of PWDs, was then conducted from 2019 to 2020.

A total of 1,313 PWDs who self-completed EQ-5D-5L were enrolled in this analysis with a mean age of 76.43 ± 12.7 years. The mean utility and visual analogue scale (VAS) scores of EQ-5D-5L were 0.10 (standard deviation, SD = 0.48) and 66.57 (SD = 20.67), respectively. Multivariate linear regression analysis showed that higher scores in ADL, instrumental ADL, and lower CDR sum scores were associated with higher EQ-5D-5L utility scores. Higher ADL scores and higher MMSE scores were associated with higher scores in an EQ-5D-5L-VAS. More depressive symptoms were related to both lower utility score and lower EQ-5D-5L-VAS score.

Findings highlight the importance to recognize and to treat depression to maintain HRQOL of PWDs in LTC facilities. Longitudinal studies are needed to better understand the long-term changes in HRQOL of PWDs.

People with dementia and informal caregivers utilize a variety of coping strategies to deal with the consequences of a dementia diagnosis. In the beginning they often rely on informal support, but research shows that they could benefit from formal support. The societal and cultural context may also influence how people deal with dementia. Yet, most research that takes place across countries or cultures provides little detail about cross-country differences or similarities. The purpose of this qualitative study is firstly to describe experiences of receiving a diagnosis and experiences, barriers and facilitators towards post-diagnostic support and secondly, and to examine differences and similarities between countries

A cross-country qualitative study with people with dementia recently diagnosed and their informal caregivers was carried out in Australia, Canada, the Netherlands and Poland between March 2020 and September 2020. A wide range of recruitment strategies and methods was adopted to aid recruitment and participation during the covid pandemic. Participants could participate in (online) Individual and dyadic interviews as well as online focus groups. To examine experiences after diagnosis and support, methods utilized ‘projective techniques’ whereby participants could project their experiences onto two fictional characters (a person with dementia, and her informal caregiver). A multi-step iterative inductive qualitative content analysis was carried out.

23 people with dementia and 53 informal caregivers participated. The following themes were identified; ‘getting a diagnosis, ‘coming to terms with dementia’, ‘support from friends and family’, ‘formal support’, ‘adapting to the role of informal caregiver’ and ‘living well with dementia’. ‘Formal support’ and ‘support from friends and family’ could serve as a barrier, facilitator or both in relation to ‘coming to terms with dementia’ and ‘adapting to the role of informal caregiver’. Coming to terms was a necessity for living well with dementia. ‘Adapting to the role of informal caregiver’ was an ongoing adaption process that was part of ‘coming to terms with dementia’ and extended into ‘living well with dementia’. Similarities of the themes across countries were larger than the differences.

Support should enable the process of coming to terms with dementia in a culturally appropriate manner.

The narratives of care staff, residents and significant others (SOs) about their personal experiences with care offer insight into their perceived care quality. This information enables the co-creation and evaluation of good care. Therefore, we aimed to develop a method to systematically collect and reflect on micro-narratives, on multiple levels.

From January 2020 to April 2022, we conducted a participatory action study in two care home locations. By continuously following the cycle of action research, we collaboratively worked on the content development, organizational implementation, and technical realization of our method. We used a distributed ethnography software tool (SenseMaker®) as the starting point. Input from care staff, residents and SOs was obtained through participatory observations, interviews, focus groups, and informal conversations.

Together, we developed Experience Matters, a method for collecting, sharing and reflecting on micro-narratives about personal experiences with care. In Experience Matters, care staff, residents and SOs share their experiences as micro-narratives and add meaning to them by answering a number of quantitative questions. The answers to these questions are attached to the micro-narratives as metadata. Using this method, the micro-narratives and metadata can be used to co-create and evaluate care for individual residents (micro-level application) and care provided by a team (meso-level application), and to develop quality policy and accountability reports (macro-level application). Care staff indicated that using Experience Matters contributes to job satisfaction, team spirit and feelings of empowerment. Residents reported increased feelings of equality, and SOs felt more involved in the care process. Lastly, managers and directors indicated that the method leads to real-time insights into the quality of care.

Collaboratively developed with all stakeholders, Experience Matters enables collecting, sharing and reflecting on micro-narratives for the co-creation and evaluation of good care. To implement the method effectively, organizations may consider deploying Experience Matters as part of a larger transition towards being a learning organization.

This is a report of a workshop for local residents organized by university researchers in various fields with the aim to develop a dementia prevention method. The five academic fields involved in the project are Health & Sports, Psychology, Food Nutrition, Music, and Nursing.

Dementia Prevention Workshop took place once a week between October 2021 and July 2022 except for some intervals due to surges in Covid-19 infection cases. Dual task exercises were conducted at each session, followed by groupworks by researchers of Psychology, Nutrition, Music, and Nursing Science taking turns. Psychologists facilitated the understanding of assertion, nutritionists held lectures on food life designed for dementia prevention, musicians played instruments, and nurses intervened through the Group Reminiscence Method. The Nursing Science experts conducted evaluations at the beginning and the end of each session using SF-36 and CES-D and checked the participants’ mood before and after the reminiscence session with Japanese UWIST mood adjective checklist (JUMACL).

16 participants took the measurement after the workshop, and their average age (SD) was 72.9 (5.5). In the overall evaluation, the participants’ motor ability improved(p<.05), and they retained cognitive functions. In SF-36, no statistically significant differences were observed before and after the classroom. Compared to the data from 2017, the scores in the social aspect were lower. In CES-D, the scores significantly worsened after the workshop, with some participants’ scores exceeding 16 points, which is the depression cutoff point. In JUMACL, the Tense Arousal (TA) related to the arousal state and the Energetic Arousal (EA), which is supposedly related to intellectual activities, both improved after the session.

In a single evaluation before and after a group reminiscence session, the state of relaxed concentration with a suggested connection with intellectual activities, but the overall evaluation result throughout the workshop project suggested the need to reinforce the approach to the mental aspect because of some participants observed with decreased scores in the mental aspects with depressive tendency. We will establish an intervention plan by also incorporating the impact of Covid-19-related depression.

Apathy is the most common neuropsychiatric symptom in Alzheimer’s disease (AD), however there are no approved treatments. In the recent Apathy in Dementia Methylphenidate Trial 2 (ADMET 2), methylphenidate treatment resulted in a significant reduction in apathy with a small to medium effect size. We assessed response in ADMET 2 to identify individuals likely to benefit from methylphenidate.

In ADMET 2, AD patients with clinically significant apathy were randomized to methylphenidate or placebo. Twenty-three potential predictors of treatment outcome chosen a priori for evaluation were divided into levels (e.g. anxiety present/absent). For each predictor, change in Neuropsychiatric Inventory apathy (NPI-A) due to methylphenidate for each level was estimated. Predictors with larger differences in effect (>= 2pt NPI-A) between levels were selected. Participants were then grouped into 10 subgroups by their index scores, constructed based on model-based prediction of response (NPI-A >=4).

In total 177 participants (66% male, mean (SD) age 75.7 (8.0), Mini-Mental State Examination 18.9 (4.8)) had 3 month follow-up data. Six potential predictors met criteria for multivariate modelling. The median Index score was -1.33 (range: -8.35 to 6.83). Methylphenidate was more efficacious in participants with no NPI anxiety (change in NPI-A - 2.21, Standard Error (SE):0.60, p=0.0004) or agitation (-2.63, SE: 0.68, p=0.0002), and who were on cholinesterase inhibitors (ChEI) (-2.44, SE:0.62, p=0.0001), between 52-72 years of age (- 2.93, SE:1.05, p=0.007), had normal diastolic blood pressure (-2.43, SE: 1.03, p=0.02), and more functional impairment (-2.56, SE: 1.16, p=0.03) as measured by the Alzheimer’s Disease Cooperative Study Activities of Daily Living scale. After 3 months of methylphenidate, 79% of participants with a higher index score (>median) responded (>= 4pt NPI-A) and 49% of those with a lower index score responded.

Individuals who were less anxious or agitated, younger, on a ChEI, had normal diastolic blood pressure, and with more impaired function were more likely to benefit from methylphenidate when compared to placebo. Consistent with its potential activating effects, methylphenidate may be particularly beneficial for apathetic AD participants with lower baseline anxiety and agitation.

Caregiving of a relative with dementia is considered a chronic stressful situation that generates physical and psychological strain and that may have negative effects on caregivers’ health. Many caregivers make the decision to enter their relatives in a nursing-home, however, there are few studies that analyze psychosocial (e.g., guilt) and biomarkers of cardiovascular risk (C-reactive protein, CRP) variables that are related to this decision during the caregiving process stress. The aim of this study was to analyze caregivers’ differences between caregivers who finish the role of caring of their relatives with dementia and those who continue their caregiving role throughout the process of caring in a 3-year period.

The sample consisted of 294 family caregivers of people with dementia and was divided in two groups; a) caregivers who institutionalized their relatives during a 3-year period (12.7%); and caregivers who maintained their role as caregivers (87.3%).

Preliminary results show that caregivers who institutionalized their relatives with dementia in some time point of the caregiving process presented at baseline more frequency of behavioral problems (t = -2.95; p < .01), more feelings of guilt (t = -3.52; p < .01) and compassion (t = -3.79; p < .01), reported less frequency of dysfunctional thoughts about caregiving (t = 1.99; p < .05) and presented higher levels of CRP (t = 2.72; p < .01), compared to caregivers who maintained their role as caregivers. In addition, caregivers who institutionalized their relative were younger (t= 2.13; p < .05) and reported more weekly hours (t= -3.46; p < .01) and more days (t= -3.01; p < .01) of home help compared to those caregivers who maintained their role. No significant effects were found for caregivers’ gender (p = .38), daily hours caring (t= 1.54; p = .13) nor time caring (t=-1.1; p = .27).

The results of this study present several clinical implications. Knowing variables that are related to the decision of institutionalization could prevent it as well as it can be useful to accompany caregivers by providing support throughout the entire process.

The 8-item Informant Interview to Differentiate Aging and Dementia (AD8) was developed as a screening tool for dementia with a cutoff of 2 suggested by the initial study. However, various studies found different cutoff values, and many suggested a cutoff of 2 might result in a high false positive rate. A higher false positive rate in Taiwan was repeatedly shown when AD8 was self-administered in local government screening programs. We have developed a modified version of AD8 (m-AD8) with the purpose of enhancing its specificity. This study aimed to compare the performance of AD8 and m-AD8.

The m-AD8 consists of all items adapted from the original AD8. Modifications included: (1) limiting the evaluated period to the past year instead of the past several years, (2) reselecting examples to reflect the socio-cultural context in Taiwan, and (3) rearranging the order of questions according to their complexity. We recruited 118 participant-informant dyads from a university teaching hospital. For each informant, the AD8 was administered first and then the Clinical Dementia Rating (CDR) to minimize contamination effect. The m-AD8 was administered 7 days later. Two geriatric psychiatrists made the final consensus DSM-5 diagnosis for each subject after considering all clinical information, including history, Mini-Mental State Examination (MMSE), CDR, and, if available, other past neuropsychological tests and neuroimaging.

There were 59 subjects with normal cognition, 28 with mild neurocognitive disorder, and 31 with dementia (major neurocognitive disorder). When comparing dementia vs. non-dementia, the optimal cutoff value was 4 for both versions according to the Youden index. The AUC, sensitivity, and specificity were 0.893, 0.774, 0.862 for AD8, and 0.883, 0.741, 0.954 for m-AD8, respectively. The m-AD8 showed improved specificity, which was also true when the cutoff value was set as 2 or 3.

The optimal cutoff value for both versions was 4. The modification may change the performance of AD8 with improved specificity. These findings suggest that, depending on different situations, AD8 with a cutoff value higher than 2 may perform better in dementia screening.

Treatment-resistant depression (TRD) is not uncommon in older people. Brain stimulation, such as 4-6 weeks of repetitive transcranial magnetic stimulation (rTMS) or theta burst stimulation (TBS) targeting the left dorsolateral prefrontal cortex, has been evidenced as an essential intervention for adult TRD and also documented in the current international treatment guideline. In 2018, Taiwan Food and Drug Administration cleared the rTMS as a treatment option for TRD and now rTMS is still a treatment at their own expense in Taiwan. Additionally, prolonged intermittent TBS (piTBS) protocol has been proven its similar antidepressant efficacy as standard 4-6 weeks rTMS/iTBS in adult TRD, but in a shorter treatment course of 2 weeks. For older adults with depression, 4-6 weeks of treatment course may burden their caregiver due to their limited ambulation and transportation ability. However, hitherto there was no study to investigate the antidepressant efficacy of left-sided prefrontal piTBS in treating older TRD.

A chart review was performed at a single Taiwan hospital from 2018 to 2020. 17-items Hamilton Depression Rating Scale (HDRS-17) was measured before and after the piTBS intervention. Maudsley Staging Method was used for the depression treatment refractoriness.

We identified 23 old adults with TRD (mean [SD] age, 66.0[5.2]; 78% female) who underwent 10-20 sessions of daily piTBS (1800 pulses/session; 10sessions, n=18, 15sessions,n=4, 20session,n=1). On continuous outcomes, mean(SD) HDRS-17 total scores improved from 20.5(6.62) to 11.8(7.7) after receiving piTBS intervention. The mean percent improvement of HDRS-17 was 46.0%±29.4%. Dichotomous outcomes showed response rate of 43.5% and remission rate of 34.8%. No seizures or other serious adverse events were noted, and no premature discontinuation was noted.

This study is the largest study demonstrating the piTBS protocol provides a comparable reduction in depression symptoms in older adults with TRD, similar to the effectiveness in adult TRD and the efficacy of standard sequential bilateral rTMS/iTBS in older TRD in the FOUR-D trial. Regarding desirable efficiency and effectiveness, piTBS may be an optimal form of rTMS in treating older adults with TRD. Further large comparative effectiveness trials with standard iTBS or high-frequency rTMS in this population are warranted.

Repetitive transcranial magnetic stimulation (rTMS) is an effective, safe, and well-tolerated option for treatment-resistant depression (TRD). The minimal medical and cognitive side effects are advantages of rTMS for all patients. However, the majority of rTMS studies in older adults are notable for underdosing rTMS relative to the corresponding FDA-protocol, as noted by recent international meta-analyses. This study utilizes the standardized rTMS FDA protocol and compares the response rates between older adult and non-older adult patients in a TRD clinic in Atlanta, Georgia with depressive symptoms as the primary outcome and anxiety symptoms as the secondary outcome.

This retrospective chart review of patients who received rTMS between March 2017 to June 2022 used descriptive statistics to compare treatment parameters and dropout rates between older adult and non-older adult patients. A 2 x 3 repeated-measures analysis of variance (ANOVA) analyzed changes in self-reported depression and anxiety symptom severity throughout treatment course (baseline, treatment midpoint, and final treatment) between the two groups.

Eighty-nine patients were included for analysis: Group 1: >55 years old (n= 42; M= 66.48, sd= 6.16; 71% female), and Group 2: <55 years old (n = 47; M= 37.40, sd= 9.13; 60% female). All patients received at least 3000 pulses per session, with 85.71% of patients completing the FDA protocol in Group 1 and 85.11% of patients completing in Group 2. A >50% improvement in depression scores at the end of treatment were seen in 38.1% of patients in Group 1 and 31.9% of patients in Group 2. Both groups demonstrated significant within-group reductions of depression throughout treatment (ps < .001). A smaller subset of patients completed an anxiety questionnaire. Forty percent in Group 1 (n=24) and 33.3% in Group 2 (n=25) showed a >50% improvement in anxiety scores by end of treatment. Both groups demonstrated significant within-group reductions of anxiety throughout treatment (ps < .001). The between groups’ difference for change in depression and anxiety scores was not statistically significant.

With FDA protocol dosing, older and non-older patients have consistent response and tolerability. While overall response rates were slightly lower than reported standardized clinical trials, our real-world sample highlights the effectiveness of rTMS for patients, including adults over 55, treated in an unselected, naturalistic outpatient sample.

Due to a lack of validated assessment instruments, this study aimed to pilot test the newly developed Health and Social Care Professionals’ Knowledge & Attitudes Towards Later Life Sexuality (HSCP-KALLS) instrument. The HSCP-KALLS instrument is designed to assess health and social care professionals’ knowledge (46 items) and attitudes (40 items) towards later life sexuality including components related to dementia, sex worker services and Lesbian, Gay, Bisexual, Transgender, Intersex or Queer/Questioning (LGBTIQ+).

A group of health and social care professionals (n = 22) and Healthcare-related educator (n = 2) were invited to complete the HSCP-KALLS instrument. Feedback on items phrasing and the experience of completing the instrument was sought.

Written feedback regarding either phrase of items or use of the instrument was not specifically addressed by participants. A high level of internal consistency was revealed for both the knowledge and attitude items (α = 0.84 & 0.88, respectively). A decent level of knowledge (M=39.75, SD=4.90) and positive attitudes (M=161.04, SD=13.50) towards later life sexuality were demonstrated by participants. Participants had greater knowledge on items related to ageing, intimacy, and sexuality (95%), with a lower level of knowledge on items related to sexuality diversity (e.g., LGBTIQ+). Providing more trainings about later life sexuality was frequently addressed in the knowledge written feedback. Participants generally demonstrated positive attitudes towards later life sexuality. However, a high proportion of ambivalent responses were noted on some attitude items (e.g., A9 & A18) that participants indicated in written feedback that their responses would depend on circumstances.

Preliminary reliability and feasibility of using the HSCP-KALLS instrument has been encouraging, with further testing in large samples now, required to robustly establish psychometric properties. Supporting later life sexuality is essential and the use of HSCP-KALLS instrument can inform and identify professional development needs of health and social care professionals to improve care provision for older people by supporting their expression of sexuality in healthcare settings.