People with dementia commonly have impaired social functioning and may not recognise this. This lack of insight may result in worse outcomes for the person and their family carers. We aimed to characterise insight into social functioning in dementia, and describe its association with dementia severity.

Observational cross-sectional study of people aged >65 years with clinically diagnosed dementia and their family informants recruited from three sites in Germany, Japan and the United Kingdom. We used the Social Functioning in Dementia scale (SF-DEM), which assesses three domains: “spending time with other people” (domain 1), “communicating with other people” (domain 2), and “sensitivity to other people” (domain 3). We calculated lack of insight into social functioning as the discrepancy between the ratings of the participants with dementia and their informant. We described this discrepancy and the proportion of people with dementia whose rating was overestimated, congruent or underestimated compared to their family informant. We calculated the association between SF-DEM discrepancy score and total mini-mental status examination (MMSE) score and recall and attention/concentration subdomains.

In 108 participants with dementia (50.9% women), mean age = 78.9 (standard deviation, SD 6.5) years, and mean MMSE score = 22.7 (SD 3.7). Ratings of patients and informants for domain 1 did not differ, but patient-rating was higher than carer-rating for domain 2 (patient-rated score 11.2 (2.5), carer-rated score 10.1 (3.4); p = 0.003) and domain 3 (patient-rated score 9.7 (2.4), carer-rated score 8.1 (2.8); p < 0.001). Sixty (55.6%) people with dementia overestimated their overall social functioning, 30 (27.8%) underestimated, and 18 (16.7%) gave ratings congruent with their family informant. Performance on the MMSE, and its sub-domains was not associated with SF-DEM discrepancy score.

We found that insight varies according to subdomains of social functioning, with people with dementia rating their communication and sensitivity differently, and usually higher than their carers. Researchers and clinicians should consider insight into social functioning in dementia as a multidimensional, rather than a unified, concept. Clinicians should help family members understand and adapt by explaining their relative with dementia’s lack of insight about aspects of their social functioning.

Older adults are vulnerable to postoperative delirium after surgery and anesthesia, which may affect their cognitive function and increase depressive symptoms. Anesthesia nurses are dominant in the number of anesthesia medical teams. This study aimed to examine the differences between anesthesia nurses' self- perceived roles and competencies and their recognition of the roles and competencies of anesthesia specialty nurses.

A cross-sectional study was conducted. A structured questionnaire based on a guideline of the International Council of Nurses was designed.

The participated anesthesia nurses’ (N=200) scale scores and mean scores for each question on the self-perceived role and competency scales were lower than the scores on their recognition of the roles and competencies of anesthesia specialty nurse scales. Regarding the self-perceived roles, the scholar domain received the lowest score (Mean= 2.99, SD= 1.00), while the self-perceived competencies, the management domain received the lowest score (Mean = 3.81, SD = 0.67). Similarly, the scholar domain received the lowest score (mean = 3.34, SD = 1.068) in recognition of the roles of an anesthetic specialist nurse, while the management domain received the lowest score (mean = 4.18, SD = 0.58) in the recognition of the competencies of an anesthesia specialist nurse. Anesthesia nurses' self-perceived roles were affected by their nursing ladder and the hospital level at which anesthesia nurses work. Their self-perceived competencies were affected by their nursing ladder and salary. In addition, their recognition of the roles as anesthesia specialist nurses was affected by the hospital level at which anesthesia nurses work. The nursing ladder affected their recognition of the competencies of an anesthesia specialist nurse.

This study has demonstrated that anesthesia nurses must improve their self-perceptions of their roles and competencies to satisfy the expectations of their roles and competencies as anesthesia specialty nurses. The findings of this study could be used to develop future anesthesia nurse education and training programs to provide better care to elderly patients.

As the world’s population ages, the number of people with dementia is expected to increase. In addition to progressive cognitive and functional deterioration, dementia comprises neuropsychiatric symptoms (NPS). NPS present significant management challenges based on their high frequency and disruptive nature. Against the prevailing guidelines, their treatment is often over-reliant on psychotropic drugs and other restrictive care approaches, frequently without a thorough assessment of underlying and potentially modifiable causes, such as over- and under-stimulating environments, untreated medical illnesses, drug interactions, or unidentified unmet needs. Consistent with the latter, the unmet needs model proposes that these neuropsychiatric phenomena are needs-driven and constitute indicators of identifiable unmet physical, psychological, emotional, or social needs. Despite this backdrop, few studies have investigated this association using standardized and replicable measures. In this context, the present study aims to put the unmet needs model into a practical context in order to disentangle the contribution of the unmet needs, assessed with the Camberwell Assessment of Need for the Elderly (CANE), to the presence of NPS.

A cross-sectional study was conducted. Participants were assessed with validated, accessible, and replicable measures, including the CANE interview and the Neuropsychiatric Inventory (NPI). Other variables collected included residents’ demographic characteristics, cognitive and functional impairment, and daily medication. Multivariate models were used to explore potential risk factors for NPS.

Residents from four nursing homes entered the study. Results found that those with unmet needs assessed using CANE and those taking hypnotic/sedative medications had a higher risk of presenting at least one NPS, even after adjusting for other demographic and clinical-functional covariates.

Built on the main finding that unmet needs assessed with CANE can independently contribute to explaining the presence of NPS, a working model is proposed to find solutions for these symptoms based on uncovering unmet needs. The CANE, as a practical, low-cost, yet clinically relevant assessment of met and unmet needs may be used to signal need areas that can be useful for formulation and intervention purposes and may offer the first step towards individually-tailored non- pharmacological interventions for NPS.

To explore the benefits and barriers of using an interactive robotic seal (PARO, Figure 1) based on the experiences of nursing home residents living with dementia and chronic pain, their family members, and formal caregivers.

Semi-structured interviews were conducted alongside a feasibility randomized controlled trial at one nursing home in Brisbane, Australia between July 2021 and January 2022 (Trial registration: ACTRN 12621000837820). Residents with dementia and chronic pain interacted with PARO individually for 15 min once or twice daily, five days per week for three consecutive weeks. After which, individual interviews were conducted with residents who were capable of communicating (n=13), family members (n=3), registered nurses (n=4), care assistants (n=11), a physical therapist (n=1), a diversional therapist (n=1) and the facility manager (n=1) who experienced or observed the residents’ interactions with PARO. The interviews were audio-recorded, transcribed, and analyzed using thematic analysis.

Almost all participants reported that interacting with PARO benefited residents with dementia and their caregivers. These benefits included (1) reducing pain by providing distraction and stimulation; (2) reducing behavioral and psychological symptoms of dementia; (3) promoting positive emotions by recalling memories; and (4) reducing anxiety and care burden for family and formal caregivers. Neutral attitudes toward PARO were reported by three residents with mild cognitive impairment as they reported it did not make any difference. Barriers to using PARO included limited staff training and the implementation of person‐ centered care due to limited resources.

Overall, multiple stakeholders were positive about using PARO to reduce pain and behavioral symptoms of nursing home residents living with dementia and chronic pain. PARO may also reduce the care burden of family and formal caregivers. PARO might be incorporated into daily practice to support nursing home residents living with dementia. Improving staff training and understanding individual preferences of residents may enhance the implementation of PARO in this population.

Figure 1

A resident living with dementia and her family after interacting with PARO (Distribution of this photo has been approved by the resident and her family)

Being diagnosed with dementia can be a hectic and critical period. While severe dementia may act as a shield when it comes to suicidal risk, mild and early dementia stages may still preserve cognitive functions to elaborate a suicidal plan. Having insight may lead to feelings of despair and sadness that patients find unbearable to deal with. The aim of this article is to review the current literature regarding suicidal risk after a dementia diagnosis.

Review of the most recent literature regarding the risk of suicide among patients with a recent dementia diagnosis. The research was carried out through the PubMed and UptoDate databases, using the terms “dementia”, “diagnosis” and “suicidal risk”.

Previous research showed inconclusive findings, with some authors suggesting a higher risk of an early suicide attempt in patients recently diagnosed with dementia, and others suggesting otherwise. Nowadays, the literature mainly reports that older adults with recent dementia diagnoses are at increased risk of endeavoring suicide. There is an important requirement to offer appropriate support to patients and their families, at the time, or as soon as possible, when a dementia diagnosis is made, to diminish the risk of suicide attempts in these patients.

Patients with recent diagnosis of dementia, or diagnosed at an earlier age, seem to have higher suicidal risk. The period immediately after diagnosis is when individuals need greater support, so these results demand for better assistance for those experiencing such intellectual decline.

Most people living with dementia do so at home, comprising approximately 30 million people globally. Despite extensive research on psychotropic medication use in long-term care settings, there has been little comparative research looking at psychotropic use in people living with dementia at home.

The study aim was to systematically review the literature to identify factors associated with psychotropic medication use in people living with dementia at home.

The PROSPERO-registered review was conducted using PRISMA guidelines. A comprehensive search of four databases (2010 to 2020) was undertaken for the systematic review to identify empirical studies. A combination of MESH search terms for dementia, community-dwelling, and psychotropic medications were used. Suitable data were subject to meta-analysis using Comprehensive Meta-Analysis to calculate raw data to event rates and pooled, adjusted event rates for different modifier sub-analyses. Thematic analysis was utilised to synthesise emergent factors and a meta-analysis undertaken on suitable data.

The search identified 619 articles of which 39 met inclusion/exclusion criteria. Use of psychotropics ranged from 18.7% for anxiolytic/hypnotics, to 26.9% for antipsychotics and 33.1% for antidepressants. Thematic analysis suggested that psychotropic prescribing was associated with a range of patient and environmental factors, including, but not limited to: (i) age (<75yr; >90yr); (ii) gender (being male); (iii) more advanced functional decline; and (iv) living alone. There was a conspicuous absence of data pertaining to carer and prescriber factors. Significant associations were identified in the meta-analysis between psychotropic use and respite in full-time care or hospitalisation as well as co-morbid psychiatric illness.

The reasons for psychotropic prescribing in this population remain poorly understood. Significant associations and knowledge gaps identified here generate opportunities for further research and development of targeted interventions to improve care and meeting the needs of this population group. This includes cautionary trigger questions for prescribers including: What am I treating? Who am I treating? How will I measure response? How can I ensure that psychotropics initiated in respite/hospital are used short-term only?

We aimed to study the relationship between glutathione (GSH), a key molecule of the anti-oxidant defense system in the blood, and glutathione reductase (GR), which reduces oxidized GSSG to GSH and maintains redox balance, with the prevalence of Alzheimer’s dementia and cognitive decline.

20 with normal cognition and 20 with Alzheimer's dementia who completed the 3rd f/u clinical evaluation over 6 years were selected by matching age and gender. Plasma glutathione (GSH) and glutathione reductase (GR) concentrations were independent variables. Clinical diagnosis and neurocognitive test scores were used as dependent variables indicating cognitive status.

The higher the GR, the greater the possibility of normal cognition rather than Alzheimer's dementia. Also, the higher the GR, the higher the neurocognitive score. However, this association was not significant in GSH in any way. After 6 years, the conversion rate from normal cognition to cognitive impairment was significantly higher in the lower 50th percentile of the GR group than in the upper 50th percentile.

According to the result of this study, the higher the GR, the lower the prevalence of Alzheimer's dementia and incidence of cognitive impairment, and the higher the cognitive outcome. Therefore, GR can be regarded as a protective biomarker for Alzheimer’s dementia and cognitive decline.

There is an urgent need for clinical blood biomarkers which can rule in/out neurological disorders early in those with psychiatric symptoms, personality or behavioural changes and/or functional decline together with cognitive symptoms. The neuronal axonal protein neurofilament light (NfL) is released from damaged neuronal axons and can be measured in in blood and cerebrospinal fluid (CSF). We have undertaken a series of studies aimed at examining the clinical utility of blood and CSF NfL in assisting with the distinction between psychiatric and neurodegenerative / neurological disorders.

Since 2016 we have measured blood and CSF NfL levels across multiple psychiatric and neurological populations recruited through Neuropsychiatry, Royal Melbourne Hospital and our collaborators (national and international). We have described our findings in a series of published studies. Data from our ongoing work, in larger cohorts and diagnostic groups, will be presented. The diagnostic groups include people with psychiatric disorders (schizophrenia, bipolar disorder, depression, functional neurological disorders), neurodegenerative disorders (Alzheimer’s disease, frontotemporal dementia, Huntington’s disease, Niemann-Pick Type C) and neurological disorders (e.g., epilepsy).

Our initial pilot study (n=129) found that CSF NfL was a promising biomarker in differentiating psychiatric from neurological disorders. In our larger follow up larger study (n=498) which included more diagnostic groups CSF NfL levels exhibited high accuracy (91%), sensitivity (92%), and specificity (87%) in differentiating psychiatric from neurological disorders, and distinguished behavioural variant frontotemporal dementia from frontal lobe syndrome phenocopies/mimics, with high accuracy. We have found that NfL is not elevated in people with treatment resistant schizophrenia compared to controls and is elevated in people with Niemann-Pick Type C compared to people with psychiatric disorders and controls. Further (unpublished) data has shown that these findings are replicated with plasma NfL levels across 400 further psychiatric, neurological and control participants.

NfL is a highly promising biomarker which differentiates psychiatric from neurological disorders with high sensitivity and specificity. The translation of NfL levels into standard clinical practice could substantially improve the clinical diagnostic process in people with complex neuropsychiatric and cognitive disorders.

Ageing and dementia affect many aspects of life, including intimate relationships, sex and sexual expression. Older people, including those living with dementia, can have sexual relationships and form new ones. Their sexual and physical health, quality of life, and psychological well-being can be improved by respecting their intimacy and sexuality expression preferences. However, due to ageism and stigma, healthcare professionals often ignore the sexual feelings and needs of those with dementia living in long-term care. Discussions with stakeholders and literature show limited attention paid to understanding the sexual preferences of people living with dementia in health and social care. In 2020, the Intimacy and Sexuality Expression Preference (ISEP) tool was developed for use in long-term care to gather information on intimate and sexual expression preferences of older people, including those living with dementia, to assist in care provision. The ISEP tool was trialled in a Queensland, Australia, nursing home with 14 older residents. This presentation will share insight into the use of the ISEP tool and how it informs the development of ‘ISEP: A Practical User Guide’. This guide provides information on how to (a) use the ISEP tool for assessment; (b) interpret and integrate findings into care (i.e., identify a potential course of action); and (c) evaluate outcomes. Illustrative examples will be included. It will inform how preferences for the expression of sexuality can be practically addressed to improve care practices and care outcomes (i.e., satisfaction and quality of life) for people with dementia.

Treatment of idiopathic normal-pressure hydrocephalus (iNPH) requires collaboration between dementia specialists and neurosurgeons. The role of dementia specialists is to differentiate patients with iNPH from patients with other dementia diseases and to determine if other dementia diseases are comorbid with iNPH. We conducted a nationwide hospital-based questionnaire survey on iNPH in medical centers for dementia (MCDs).

We developed a questionnaire to assess how physicians in MCDs evaluate and treat patients with cognitive impairment due to suspected iNPH and the difficulties these physicians experience in the evaluation and treatment of patients. The questionnaire was sent to all 456 MCDs in Japan.

Questionnaires from 279 MCDs were returned to us (response rate: 61.2%). Patients underwent cognitive tests, evaluation of the triad symptoms of iNPH, and morphological neuroimaging examinations in 96.8, 77.8, and 98.2% of the MCDs, respectively. Patients with suspected iNPH were referred to other hospitals (e.g., hospitals with neurosurgery departments) from 78.9% of MCDs, and cerebrospinal fluid (CSF) tap test was performed in 44 MCDs (15.8%). iNPH guidelines (iNPHGLs) and disproportionately enlarged subarachnoid space hydrocephalus (DESH), a specific morphological finding, were used and known in 39.4% and 38% of MCDs, respectively. Logistic regression analysis with “Refer the patient to other hospitals (e.g., hospitals with neurosurgery departments) when iNPH is suspected.” as the response variable and (a) using the iNPHGLs, (b) knowledge of DESH, (c) confidence regarding DESH, (d) difficulty with performing brain magnetic resonance imaging, (e) knowledge of the methods of CSF tap test, (f) absence of physician who can perform lumbar puncture, and (g) experience of being told by neurosurgeons that referred patients are not indicated for shunt surgery as explanatory variables revealed that the last two factors were significant predictors of patient referral from MCDs to other hospitals.

Sufficient differential or comorbid diagnosis using CSF tap test was performed in a few MCDs. Medical care for patients with iNPH in MCDs may be improved by having dementia specialists perform CSF tap tests and share the eligibility criteria for shunt surgery with neurosurgeons.

Falls is the leading cause of injury, and injury-related cognitive decline and death for older adults. Weight loss and malnutrition contribute to the risk of falls through increased frailty, visual and cognitive impairment, and predicts both the severity and recovery time of falls. Psychological and social factors such as isolation, loneliness, cognitive impairment, anxiety and depression are significantly associated with falls and weight loss for older adults. Reminiscence therapy is a psychological intervention that can improve anxiety, mood disorders, cognition and isolation; however, it is not yet known the impact that reminiscence therapy has on the incidence of falls and weight loss. This abstract will present the existing research on reminiscence therapy for the prevention of falls and weight loss, describe a group reminiscence therapy protocol to target these risk factors, and outline preliminary findings from a small pilot trial group therapy program conducted in February, 2023.

Data on pre and post incidence of falls and weight loss collected from eHealth records for: 1) 3 months prior to the group, and 2) the 9-week duration of the group will be discussed. Group participants will complete a pre and post Depression Anxiety Stress Scale (DASS21) and provide feedback on the therapy protocol.

This presentation will discuss the suitability of a group reminiscence therapy protocol to reduce psychological and social risk factors associated with falls and weight loss for older adults in residential aged care.

The group population of older adults has suffered the highest number of deaths and impact on health associated with the COVID-19 pandemic. Many older adults can perceive this pandemic as a traumatic experience. However, many older adults may have also experienced positive changes, defined as post-traumatic growth (PTG). Several factors may enhance or hinder this possibility of development.

This study aimed to analyze if the effects of COVID-19 affection (direct and indirect), anxiety and depression on PTG would be mediated by the protective variables life purpose and resilience.

359 older adults over 60 years old completed a web-based survey during the COVID-19 pandemic including sociodemographic data, direct/indirect affectation by COVID-19, anxiety, depression, resilience, life purpose and PTG.

63.2% of the participants were women and 58.2% were married. 89.1% had been infected by COVID-19, 1.7% had been hospitalized, 15.6% had lost a loved one and 17.2% have had a relative hospitalized because of COVID-19. Women (M = 56.77; SD = 18.00) showed higher levels of PTG than men (M = 52.41; SD = 17.84) (t = -2.19; p < .05). Differences in the outcome variables based on direct or indirect COVID-19 affection were not found. The path analysis showed that the effect of COVID-19 symptoms on PTG was mainly mediated by life purpose, and anxiety to a lesser extent. We also confirmed two indirect effects: (1) the negative effect of depression on PTG through resilience and life purpose assessed simultaneously; (2) the positive effect of resilience on PTG through life purpose. Results showed an excellent model fit to this model (χ² = 3.759; χ²/gl = 5; p = .585; GFI = .997; CFI = .999; RMSEA = .001).

The identification of protective and vulnerability variables is essential to protect older adults from mental disorders. This study highlights the need for developing interventions that aim to increase PTG by promoting life purpose and resilience.

The recognition of dementia as a multifactorial disorder encourages the exploration of potentially modifiable risk factors. Social health might play a role in cognitive decline and dementia. The Social Health And REserve in the Dementia patient journey (SHARED) project aims to unravel the interplay between social health and biological and psychological factors on the trajectory from cognitive healthy. A multi-method approach is used, including the development of a conceptual framework for social health and its application in epidemiological and qualitative studies. Epidemiological studies in the SHARED project reveal potentially modifiable social health characteristics or markers associated with cognitive decline, dementia and mortality. This may shape new avenues for future interventions to prevent or delay cognitive decline and dementia and to enhance living well with dementia.

Several guidelines propose the use of cognitive stimulation (CS) in people with dementia. Multi-component CS interventions seem most effective in improving cognitive function, quality of life, and behavioral and psychological symptoms of dementia. For successful implementation, it is important to analyze CS interventions in detail in order to identify frequently used and potentially effective components. The aim of this systematic review is to identify, describe and summarise multicomponent CS interventions conducted in nursing homes aiming to improve cognitive function, quality of life, mood, and behavior of people with dementia in nursing homes.

This review is based on established methodological frameworks for systematic evidence syntheses. We conducted a database search in February 2021, using PubMed, CENTRAL, PsycINFO, ALOIS and CINAHL. Two independent reviewers assessed all search results for eligible studies and assessed studies’ methodological quality using the Cochrane Risk of Bias tool for RCTs and the Joanna Briggs Institute checklist for quasi-experimental studies. Evaluation and intervention development studies of any design examining multicomponent interventions CS were included. Components of included intervention programs were analyzed using the TIDieR and CReDECI 2 criteria following a narrative analysis.

We identified 19,992 references and included 45 publications. We observed large heterogeneity regarding intervention components, delivery, materials, mode of delivery, intervention provider, and intervention duration. Intervention components included for example reminiscence therapy, activities of daily living, cognitive exercises or reality orientation. Risk of bias was generally low. Reporting of complex interventions was frequently insufficient. No study reported patient and public involvement (PPI) at any stage of the research process.

This systematic review is the first to describe complex CS interventions conducted in nursing homes in detail. Results indicate the need for more detailed intervention description for future studies based on TIDieR and CReDECI2 guidelines to allow reliable replication of these interventions. Despite enormous research activities, many questions regarding the implementation and efficacy are still unanswered as process evaluations are lacking. In addition, reproducibility of interventions is hardly possible due to limited reporting. Future studies should use established frameworks for the development, evaluation and implementation of complex interventions and apply PPI concepts.