Cognitive impairment is a growing problem with increasing burden in ageing global population. Older adults with major depressive disorder (MDD) have higher risk of dementia during ageing. Neurofilament light chain (NfL) has been proven as a potential biomarker related to dementia. The present study aims to assess the cognitive deficits in older adults with MDD and investigate their association with peripheral blood levels of NfL.

We enrolled 39 individuals with MDD and 15 individuals with mild neurocognitive disorder or major neurocognitive disorder, Alzheimer’s type. Both groups were over age 65 and with restricted Mini-Mental State Examination (MMSE) score. Demographic data, clinical variables, and plasma NfL levels were obtained. We used cluster analysis according to their cognitive profile and estimated the correlation between plasma NfL levels and cognitive impairment in each domain.

In the MDD group, participants have higher rate of family psychiatry history and higher rate of current alcohol use habit compared with patients with neurocognitive disorders. In the neurocognitive disorders group, participants showed significantly lower score in total MMSE and higher plasma NfL levels. Part of the MDD patients presented cognitive deficits similar to that of neurocognitive disorders (cluster A). In cluster A, the total MMSE score (r=-0.58277, p=0.0287) and the comprehension domain (r=-0.71717, p=0.0039) were negatively correlated to NfL levels after adjusting for age, while the associations had not been observed in the other cluster.

We noted the negative correlation between NfL levels and cognitive performance in MDD patients whose cognitive manifestation were more similar to that of degenerative neurocognitive disorders. NfL might be a potential marker to predict patients with MDD to develop cognitive decline especially in domains typically found in Alzheimer’s disease. Further longitudinal studies are required to validate our findings for clinical implications.

Despite the high prevalence of anxiety and depression, many family carers of people living with dementia are not able to access timely psychological support due to various barriers such as lack of respite care and a shortage of skilled therapists. Online treatments have the potential to improve access, and also scalability, reducing inequalities in access to care. This uncontrolled feasibility study aimed to evaluate whether it is feasible to deliver internet- delivered guided self-help Acceptance and Commitment Therapy (iACT4CARERS) within primary and secondary care services in the UK, and whether the intervention is acceptable to family carers of people living with dementia.

Family carers of people living with dementia presenting with mild to moderate anxiety or depression were recruited through healthcare services and public advertisements. Participants were offered eight, guided, self-help online ACT sessions adapted for the needs of family carers. Participants were also allocated a therapist who responded to questions to support their completion of each weekly session. Participants completed questionnaires assessing anxiety, depression and other outcomes before and after the intervention. They were also invited to attend an individual semi-structured interview to provide feedback on iACT4CARERSE at the end of the study.

Seventy-nine participants attended the screening session over six months, and 33 eligible participants (age range 47-85) received iACT4CARERS. Further, 70% of participants completed seven or all eight sessions, and 27% of participants were lost to follow-up, but none of the reasons for early withdrawal was related to the intervention. There was preliminary evidence of improvements in anxiety, depression and psychological flexibility, particularly in anxiety, which demonstrated an average reduction of 26% on the GAD7 anxiety scale. The results of qualitative interviews suggested that iACT4CARERS is acceptable to family carers. Positive carer experiences were particularly facilitated by the relatedness of the contents, increased feelings of connectedness and the user-friendliness of the online platform.

The feasibility study provided evidence for the feasibility and acceptability of iACT4CARERS. This feasibility study led to an ongoing full-scale randomised controlled trial testing the clinical and cost effectiveness of iACT4CARERS. Recent developments of the iACT4CARERS project will be discussed.

An intersubjective understanding of mutual roles and responsibilities in the care process is needed to effectively co-create good care for residents of the care home.

This study offers insight into the perspectives of professionals, informal caregivers, and residents on their own role and responsibilities and that of others, and examines how this affects their co-creative relationships.

We conducted semi-structured interviews with professionals (n=9), informal caregivers (n=10), and residents (n=10) from two psychogeriatric wards. An inductive thematic analysis was then performed, using Margaret Urban Walker’s expressive- collaborative model of morality (1998) as a sensitizing concept.

Professionals and informal caregivers both view themselves as the main responsible for the resident’s wellbeing. Whereas professionals see themselves as experts on care for residents with psychogeriatric issues, informal caregivers see themselves as experts on the resident as a person. From these roles, both profess to know what is best for the resident. Further, professionals see themselves as someone naturally deserving trust due to their expertise, whereas they are seen by informal caregivers as someone who needs to win their trust. Informal caregivers see themselves as a warrantor for the residents wellbeing, whereas they are seen by professionals as someone who needs to relinquish control over care, so they can return to being the resident’s loved one. Although both professionals and informal caregivers ascribe a central role to the resident in the care process, their behaviors unintentionally urge residents towards a more passive role. Residents who are not generally compliant to the norms of the care home appear to view themselves as rebels. These (and more) differences in perceived roles and responsibilities lead to tensions in the co-creative relationships between professionals, informal caregivers, and residents.

Professionals, informal caregivers, and residents have differing perspectives on mutual roles and responsibilities in the care process, which hampers their co-creation of good care. This study implies that interventions aimed at improving the co-creation of good care may be focused on those involved first becoming acquainted with each other’s perceived roles and responsibilities.

Residential care facilities (RCFs) provide 24/7 care to older adults with cognitive and/or physical disabilities. RCFs aim to provide person-centred care (PCC) to enhance the quality of life (QoL) of residents. Residents are dependent on their environment to fulfil their needs and wishes, such as drinking alcohol or smoking tobacco. Although alcohol and tobacco use can be experienced as a part of QoL in the final phase of life and the motivation to quit these substances is low, it can cause severe health problems in older adults. In RCFs this may cause a dilemma between the QoL of individual residents and the health and safety problems of all residents. This study aims to explore multiple perspectives on alcohol and tobacco use within the RCF.

A qualitative research design was chosen, and semi-structured interviews were conducted. A various sample was purposively selected in two organizations on two types of units (psychogeriatric units and units providing care for residents with mainly physical disabilities): residents who use alcohol and/or tobacco and those who do not. Subsequently, four of these 16 residents were invited to participate in an in-depth case study. To explore the dynamics of the social environment, both formal and informal caregivers were invited to participate.

Residents are satisfied with their current use and value their autonomy regarding alcohol and tobacco use. Residents acknowledge that their use could cause a nuisance to others. Multiple caregivers are involved in their use and residents experience dependency on these caregivers to smoke tobacco or drink alcohol. There was limited interaction between the residents and their (in)formal caregivers and amongst the caregivers on this topic. Moreover, caregivers tended to act from their own perspectives, based on their professional expertise, knowledge, and attitudes towards residents’ alcohol and tobacco use.

A dilemma arises between protecting residents from the adverse (health) outcomes of alcohol and tobacco use and sustaining their QoL by optimizing their autonomy. Future research could assess how to integrate providing PCC to residents by offering choices and autonomy, while considering the addictive component of these substances, health, and safety risks for all.

Ageism is defined by the World Health Organization as stereotypes, prejudice, and discrimination towards others or oneself based on age. Ageism is thought to pose a risk to the physical and mental health of older adults, but little is known about how to measure it in LPUs. We propose that a form of ageism can be detected by comparing the referrals made by liaison psychiatry services among patients over age 65 at discharge with functional status and medical comorbidity. Our hypothesis is that the worse the functional index and medical comorbidity, the fewer referrals to psychiatric services and the more referrals to primary care physicians.

This is an observational, cross-sectional, multicenter study. We obtained data from a sample of 165 patients (≥65 years) admitted to seven general hospitals in Spain referred from different departments to each LPU. Data was collected over a period of one and a half months. Psychiatric evaluations were performed while the patients were in the wards. Sociodemographic, clinical, and care variables were collected. Functional status was measured with the Barthel and Lawton index and comorbidity with the Charlson index.

We obtained a sample of 165 patients with a mean age of 76,03 years old. The mean Barthel index was 87,18 previous admission and 61,15 at the time of our first visit. The mean Lawton index was 5,266667 and the Charlson index was 6,03. The different options for referral were primary care physician, psychiatric facilities, nursing homes, substance use centers, or exitus. Statistical analysis was performed using the nonparametric Kruskal-Wallis test to determine if there were significant differences (p < 0,05) between the indices and referrals. Contrary to our hypothesis, statistical significance was observed only for the Lawton index, but with more referrals to psychiatric facilities among patients with the worst functional scores. No other statistical significance was observed.

Functional status and medical comorbidity did not play a role in the referral of inpatients managed by LPUs. Further studies are needed to clarify whether there is any form of ageism in the referral of elderly inpatients attended by Psychiatric Liaison Units.

Research in informal dementia caregiving has focused on the negative outcomes it implies as a chronic stress situation, even though positive feelings derived from the caregiving experience are also reported. This co-occurrence of positive and negative experiences is a form of emotional complexity that has barely been explored in caregivers although it could be relevant for understanding caregivers' vulnerability to distress. To explore this emotional complexity, profiles of caregivers according to their levels of positive and negative affect were created and compared with regard to their reported anxiety, ambivalence feelings, experiential avoidance, quality of the actual relationship, thoughts of institutionalizing the person with dementia (PWD), and social support.

363 primary family caregivers were distributed in groups based on their reported depressive feelings and positive emotions related to caregiving and the PWD. Four groups were identified: (1) flat (low negative affect, low positive affect), (2) negative (high negative affect, low positive affect), (3) positive (low negative affect, high positive affect), (4) mixed (high negative affect, high positive affect). ANOVAS were performed to explore differences between groups.

Caregivers in the positive and mixed profiles reported better actual relationships with the PWD and higher experiential avoidance. Caregivers with both negative and mixed profile showed higher anxiety than the other profiles, and the negative profile also reported higher thoughts about institutionalizing the care-recipient and more ambivalence. Caregivers in the positive group reported the highest social support.

The obtained findings converge in the idea that caregivers ́ positive emotions towards the PWD are closely related to the quality of the relationship, and may be involved in a delayed decision to institutionalize her/him. The presence of negative affect (depressive feelings) is associated with anxiety symptoms, even when positive emotions are reported, supporting the high prevalence of anxiety-depressive comorbidity in this population. Finally, the negative profile (low positive and high negative affect) is the one that reports more ambivalence. Taken together, these findings suggest that caregiving for PWD should be considered an emotionally complex situation with positive affect derived from the caregiving being key in understanding caregivers’ well-being and distress.

The assessment of MBI involves two important issues: 1) to know the underlying structure of the Mild Behavioral Impairment Checklist (MBI-C) a questionnaire designed to evaluates Neuropsychiatric Symptoms (NPS) in pre-dementia states; and 2) to consider self and proxy (i.e., study partner) symptom ratings that may not capture comparable samples. Our objective is to give some answer to these questions: first, to analyze the underlying structure of the MBI-C at baseline and follow-up using Multidimensional Scaling (MDS) and two, to determine how self and proxy ratings and the choice of rating type impact in the results of the MBI-C.

To analyze MBI-C structure, 200 Subjective Cognitive Decline and Mild Cognitive Impairment patients from the CompAS longitudinal study completed baseline and follow-up assessments. Two-step bidimensional weighted dichotomous MDS were performed. All items were included in the first step. Items closely associated with each dimension (1 SD above or below the mean) were selected in a second step to obtain the final models solution.

We will also present a review of the literature on the importance of self and proxy MBI-C ratings. We will also present new empirical evidence based on data from over 10,000 cognitively normal.

Results from baseline and follow-up showed two dimensions: Dimension I (right-left) differentiate high and low emotional activation and Dimension II (top-down) high and low behavioral activation. The combination of both generates 4 quadrants: resistance, restlessness, flattening and desolation. The final models were built considering the most relevant items, with little differences between baseline and follow-up. The good fit of the models, type of two-dimensional solution and group weights were similar in baseline and follow-up.

Regarding our second objective, the results suggest that self and proxy ratings may not capture comparable samples and that the choice of rating type can indeed impact the conclusions drawn from analysis.

The 4 quadrants identified could be the most useful NPS to determine risk factors for predementia patients. Also, the findings suggest that the way of applying the MBI-C has relevant implications.

-Patients with a memory deficit, as well as patients with small deficits in various cognitive areas, with the requirement that there is no functional impairment in their domestic or work life, do not meet the criteria to be diagnosed with dementia, but they do meet the criteria for a diagnosis of mild cognitive impairment (MCI), which constitutes a transitional state between normal aging and mild dementia.

-Every year, 15% of patients with MCI with involvement only in the memory section, go on to be diagnosed with dementia.

In recent years, the use of a food for special medical purposes (FSMP), Souvenaid®, has been introduced into clinical practice, which, due to the composition of its active ingredient, Fortasyn connect (omega-3 fatty acids, uridine, choline, vitamins C, E, B6 and B12, selenium and folic acid) helps to:

• • Promote the development of neuronal synapses, demonstrating that it maintains the integrity of white and gray matter.

• • Reduce loss of functional connectivity.

• • Increase hippocampal cholinergic synapses and cholinergic neurotransmission.

• • Improve cognitive performance dependent on the hippocampus

A survey has been developed to explore the impact of a nutritional intervention, through the use of an FSMP in the areas related to cognition, functionality, and behavior, in a geriatric cohort with MCI older than 80 years. (Connect - Survey in the environment of mild cognitive impairment).

Survey: Each Geriatrics and Neurology professional had to select 5 cases that met the following characteristics: Presence of MCI, Age ≥ 80 years, and Receiving Souvenaid.

The professional sent CRO Alpha Bioresearch the list of caregivers with their contact details. The CRO contacted the subjects by telephone 3, 6, and 12 months after starting Souvenaid to carry out the survey.

The survey collects the perception of the patient and caregiver's cognition, functionality, and behavior, through a Likert scale with 5 possible response alternatives. The questionnaire is divided into two different parts:

1. – Data about the treatment (questions 1 to 5)

2. – Questions about the patient's health (questions 1 to 12);

The last one is divided into three parts: data on cognition 3 questions (questions 1 to 3), data on functional abilities with 5 questions (questions 4 to 8), and data on behavior 4 questions (questions 9 to 12).

Regarding the treatment at 12 months, there is a tolerance that reaches 76%, and 88% do not present problems with the administration of what is prescribed. The most common time of day for administration is breakfast and snacks. The most used flavor was vanilla and cappuccino. The most common way to acquire it was the direct route.

Regarding cognitive functions, the ability to remember is improved by 20%, orientation by 12%, and recognition by 8%, maintaining stability without changes by around 60-70%. Functional capacities improved between 8 and 16%, presenting no changes between 68-80%. Regarding the behavior, the improvement is between 12 to 28% in the evaluated items, presenting no changes between 60-84%.

There is stabilization at 3, 6, and 12 months both in cognition, functionality, and behavior. The positive impression of the perceived improvement in memory (around 20%) and apathy (exceeding 20% and reaching 28% per year) are striking.

With population ageing, an emergent issue in workforce planning is how to ensure that future healthcare professionals are both competent and willing to work with older adults with complex needs. This includes dementia care; which is widely recognised as a policy and practice priority. Yet research suggests that working with older people is unattractive to undergraduate healthcare students. However, how students view a career working with people with dementia is not well understood, in either related specialities (such as geriatrics or old age mental health) or as a general clinical interest.

This sequential mixed methods study aimed to identify the factors that contribute to preferences for working with people with dementia. A summary of three papers will be presented:

1. 1) Preferences of nursing and medical students for working with older adults and people with dementia: a systematic review.

2. 2) Preferences of newly qualified healthcare professionals for working with people with dementia: a qualitative study (n=27).

3. 3) Student nurses' career preferences for working with people with dementia: A longitudinal cohort study (n=840).

The findings from these studies have contributed to the development of a conceptual framework for understanding career preferences for working with people with dementia in students and newly qualified nurses. key factors related to dementia preferences include:

• Student characteristics (e.g. gender, attitudes and knowledge) and whether students perceive their attributes are aligned with dementia care;

• Impact of experiences including dementia educational programmes;

• Importance of making a difference to patients’ lives;

• Perception of working with people with dementia as a ‘different type of care’;

• Perceptions of people with dementia including care challenges;

• Career characteristics.

The findings will be discussed in relation to implications for education and policy for how preferences for working with people with dementia may be developed in line with workforce needs.

Major neurocognitive disorder (or simply Dementia) is one of the main causes of disability and burden disease to caregivers and the health system, and a frequent cause of mortality worldwide. Alzheimer`s disease (AD) is the most common type (60-70%).

AD is a progressive neurodegenerative disorder characterized by amyloid-β (Aβ) deposition, causing neuronal and synaptic loss with subsequent cognitive disfunction.

There is cumulating evidence that sleep disturbances are associated with several pathological conditions, and AD is one of these. The prevalence and severity of sleep disorders is significant in AD patients, with sleep disturbances often precede its clinical diagnosis in many years. Some studies focus on possible mechanisms by which (abnormal) sleep participate in AD pathogenesis, and concluded individuals with sleep disturbances are at higher risk of developing dementia.

To highlight the current evidence on whether sleep disorders could precipitate or accelerate the clinical course of AD.

Non-systematic review about sleep abnormalities and AD pathogenesis.

Several authors described a two-way relationship between sleep and amyloid pathology - sleep deprivation would lead to increased production and decreased clearance of Aβ; once Aβ is accumulated it results in more disrupted sleep, with an increase of Aβ production during wakefulness and a decrease of its clearance during sleep.

Recent data showed that sleep continuity and architecture (decreased total sleep time, slow-wave sleep, and REM sleep) are disturbed in AD patients.

Otherwise, sleep deprivation may be associated with decreased glymphatic system clearance, leading to accumulation of neurotoxic proteins, particularly Aβ (and tau). It`s also associated with proinflammatory states due to accumulation of reactive oxygen species, nucleotides and proteins during wakefulness, which leads to immune response that causes neuronal dysfunction and cellular death. Insomnia and sleep deprivation were also associated with activation of complement pathway and immunoglobulins secretion. Many studies suggest chronic sleep disruption changes blood–brain barrier structure and function leading to Aβ accumulation.

There is emerging evidence that points sleep disturbances as both a potential marker for AD pathology and risk predictor of developing the disease. Future investigations should evaluate the relationship between specific sleep disorders and AD physiopathology.

There is increasing focus on effective preventative interventions applicable at the population scale such as through technology and web-based approaches. We aimed to reduce cognitive decline with ageing using an online package of interventions delivered intensively for 12 months followed by monthly boosters for 24 months.

Invitations were sent to people aged 55-77 years from the 45 and Up study, a population-based cohort study of one in ten people aged 45 years and older in New South Wales, Australia (n=267,000). Participants were required to be eligible for at least two of four modules addressing physical inactivity and associated health risks (Physical Activity), adherence to a Mediterranean-type diet and health risks associated with poor nutrition (Nutrition), cognitive activity (Brain Training) and mental well-being (Peace of Mind). Participants received modules based on their risks, with 1:1 randomized allocation to active personalised coaching modules (intervention) or static information-based modules (control). The primary outcome was change in an online combined multi-domain cognitive score measured using COGSTATE and Cambridge Brain Sciences tests using intention to treat analysis. Secondary outcomes included specific cognitive domain and ANU-ADRI risk scores.

From 96,418 invitations, 14,064 (14%) consented; 11,026 (11%) were eligible; and 6,104 (6%) completed all 10 baseline assessments. Over three years there was a significantly greater improvement in the global composite cognition z-score in the intervention group, ES = 0.106 (p<0.001). Significant benefits were also found in complex attention, executive function and learning and memory (all p<0.001), as well as on a validated dementia risk instrument (p=0.007).

An online platform that tailored physical activity, nutrition, brain training, depression and anxiety interventions to an individual’s risk factor profile over three years significantly delayed cognitive decline in older adults. This platform is scalable and if rolled out at a population level may help reduce the prevalence of dementia globally.

The relationship between objective cognitive performance and physical frailty has been explored in the recent literature and cognitive frailty has emerged as a strong field of study in psychogerontology. However, less is known about the relationship between subjective cognitive status and physical frailty. The aim of this communication is to present the relationships found between subjective cognitive decline and physical frailty in the third wave of the Compostela Aging Study, the first in which frailty status has been studied.

Cognitive and neuropsychological, functional, and affective assessment was conducted with persons over 50 years of age with subjective memory complaints in the health area of Santiago de Compostela. 149 participants who completed the third wave of the study and who did not present dementia or other serious pathologies were selected. Mild Cognitive Impairment (MCI) was diagnosed according to the current criteria in a special meeting of the research team. In the participants without MCI, the intensity and severity of their complaints were assessed according to the Subjective Cognitive Decline (SCD) criteria. Physical frailty was assessed following the frailty phenotype as described by Fried et al.

Only 4 participants (2.7%) presented physical frailty (3, 4 or 5 criteria in the frailty phenotype). Of those presenting physical pre-frailty (1 or 2 criteria), 36 were MCI (23.8%), 33 SCD (21.9%) and 36 controls. Finally, 40 participants (26.5%) presented no frailty criteria (8 with MCI, 13 with SCD and 19 controls). Participants with SCD and pre-frailty were of intermediate age and they had more years of education than the group with MCI and pre-frailty, although these differences were not significant. They have significantly more symptoms of depression (GDS) and worse mental health status (GHQ-12) than participants without frailty and pre-frailty controls, and more symptoms of anxiety (GAD-7) than participants without frailty.

The relationship between subjective memory complaints and frailty could help to establish groups at special risk of cognitive impairment in phases prior to objective cognitive decline, being these groups particularly optimal targets for preventive intervention. However, a detailed characterization of these subgroups is still required.

Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a 20-week group treatment program for patients with borderline personality disorders (BPD). STEPPS is an evidence-based treatment to reduce BPD symptoms. However, the mean age of patients studied thus far is 33 years. Studies evaluating STEPPS in older adults are lacking. Aim of this study was to investigate the feasibility of STEPPS in older adults with BPD symptoms.

A naturalistic, pre- vs post-treatment pilot study design. Twenty-four patients (mean age 64 years) completed the Dutch version of the STEPPS program. Primary outcome was BPD symptoms and secondary outcome was psychological distress and maladaptive personality functioning.

The STEPPS pilot in older adults demonstrated a significant decrease in BPD symptoms (Cohen’s d = 1.6), improved self-control of emotions and impulses (r = 0.58), and improved identity integration (Cohen’s d = 0.5). No significant differences were found for psychological distress.

STEPPS is feasible for older adults with BPD symptoms. The treatment program led to a decreased in BPD symptoms and improvement of emotion regulation skills in older adults.

To further improve the feasibility of STEPSS in older adults a Delphi study was performed with seven experts in the field. The results of this Delphi study will additionally be discussed in this presentation. Most important recommendations were the addition of age-specific topics to the STEPPS program, e.g., changing social roles, life review, and/or physical limitations.

Informal caregivers of people with dementia are at high risk of developing mental and physical distress because of the intensity of the care provided. iSupport is an evidence-based online program developed by the World Health Organization (WHO) to provide education and support to informal everyday care. The study aims to describe the process and results of iSupport cultural adaptation in Switzerland.

We used a mixed-methods design, with a community based participatory research approach. The adaptation of iSupport followed WHO adaptation guidelines and developed into five steps: content translation, linguistic and cultural revision by the members of the Community Advisory Board, validation with health professions faculty, validation with formal and informal caregivers, and fidelity check appraisal by members of the WHO.

Findings from each phase showed and consolidated the adjustments needed for a culturally adapted Swiss version of iSupport. We collected feedback and implemented changes related to the following areas: language register and expressions (e.g., from lesson to chapter; from suffering from dementia to affected by dementia); graphics and illustrations (e.g. from generalized objects’ illustrations to featured humans’ illustrations); exercises and case studies (e.g., from general, non-familiar scenarios to local and verisimilar examples); and extra features to add to the online version (e.g., short tailoring assessment questionnaire, interactive forum section, glossary). Additionally, based on the suggestions from the interviews with health professions faculty, we also created a training of trainers (ToT) version of iSupport for health care professionals.

Our results show that adopting a community based participatory approach and collecting lived experiences from the final users and stakeholders is essential to meet local needs and to inform the further development, testing and implementation of an online evidence-based intervention to a specific cultural context.

Internationally there is a growing interest in evaluating experienced quality of care to better tailor care to resident’s needs. Narratives are a promising method to achieve this, because they capture experiences, identify conflicting values, and provide rich data that can be used to learn from and improve quality of care with. In the Netherlands, narratives are becoming a more substantial element within the quality improvement cycle of nursing homes. In this symposium, four Dutch research groups will present studies on how different narratives can be used and implemented in nursing homes to achieve and maintain high quality of care for residents.

The first speaker will present how micro-narratives from care staff, residents and significant others enable the evaluation of long-term care. The second speaker will present how stakeholders improve care by reflecting together on rich narrative portraits of residents’ experiences. The third speaker will present the results of a study investigating how the narrative quality evaluation method ‘Connecting Conversations’ can be implemented in nursing home organizations. And, the last speaker will present findings on how the Dutch healthcare inspectorate is currently overseeing the quality of person-centred care in long-term care facilities and discuss the potential of a more reflexive approach using narrative methods.

In pediatric multisystem inflammatory syndrome and isolated viral myocarditis/myopericarditis, autonomic nervous system function can be evaluated by a non-invasive method called heart rate variability. This study aims to evaluate heart rate variability in these two groups by comparing them with each other. This is the first study assessing these values in these two groups of patients.

Patients who are diagnosed with multisystem inflammatory syndrome in children and isolated viral myocarditis/myopericarditis at a university hospital from September 2021 to February 2023 are screened by electrocardiography, echocardiography, and 24-hour Holter monitoring. A healthy control group, compatible in age and gender with the patient groups, was selected from healthy subjects that applied to the hospital for palpitation, murmur, and/or chest pain. Heart rate variability parameters and related laboratory markers were analyzed and compared among the three groups.

There were 30 patients with multisystem inflammatory syndrome in children, 43 patients with isolated viral myocarditis/myopericarditis, and 109 participants in the healthy control group. Statistically significant differences were found in most of the heart rate variability parameters: standard deviation of normal to normal intervals (SDNN), the mean of the 5- minute RR interval standard deviations (SDNNİ), the standard deviation of 5-minute R wave to R wave(RR) interval means (SDANN), the root mean square of successive RR interval differences (RMSSD), and the percentage of the beats with a consecutive RR interval difference of more than 50 ms (pNN50%), very low frequency, high frequency, low frequency, triangular index, and low frequency/high-frequency ratio. Multisystem inflammatory syndrome in children patients had impaired and declined heart rate variability values compared to the other two groups. In patients with myocarditis/myopericarditis, we couldn’t find a significant difference in these parameters with the control group.

Heart rate variability can be used as an important non-invasive autonomic function parameter in determining prognosis and treatment plans, especially in patients diagnosed with multisystem inflammatory syndrome in children. This impairment of autonomic activity could be more prominent in patients with decreased left ventricular systolic functions.