Pub Date : 2024-02-02DOI: 10.1017/s1041610223004301
Sivakumar Palanimuthu Thangaraju
Aim:To describe the experience, challenges and solutions in implementing an outreach initiative to promote healthy ageingBackground:Prevalence of mental health conditions in older adults is increasing rapidly in developing countries like India due to population ageing. UN Decade of Healthy Ageing (2021-2030) has been launched with focus on combatting ageism, promoting age friendly environment, integrated care and providing access to good quality long term care. Implementing interventions to promote healthy ageing in the Indian context has significant challenges in the background of limited availability dedicated elderly friendly health and social care systems.Methods:Description of the outreach initiatives launched by the Geriatric Psychiatry Unit, Department of Psychiatry, National Institute of Mental Health and Neurosciences a tertiary care academic unit for old age psychiatry in India.Results:A systematic and comprehensive outreach initiative for healthy ageing has been implemented over 2 years. The main objectives for the initiative includes promoting awareness about ageing and mental health, promoting age friendly environment, training of caregivers, volunteers and other stakeholders, psychosocial intervention in old age homes, promoting integrative medicine for healthy ageing and providing geriatric tele-psychiatry services. The important strengths of this initiative has been collaboration with non-governmental organizations, promoting active participation from older adults and volunteers, mobilizing resources through corporate social responsibility funding and effective use of technology.Conclusion:The experience of implementing this outreach initiative has contributed to important learnings for the team. The proposed solutions to address the challenges in sustaining this initiative and scaling up to reach a larger population will be discussed.
{"title":"P181: Outreach initiative to promote healthy ageing: Experiences from a Geriatric Psychiatry Unit in India","authors":"Sivakumar Palanimuthu Thangaraju","doi":"10.1017/s1041610223004301","DOIUrl":"https://doi.org/10.1017/s1041610223004301","url":null,"abstract":"Aim:To describe the experience, challenges and solutions in implementing an outreach initiative to promote healthy ageingBackground:Prevalence of mental health conditions in older adults is increasing rapidly in developing countries like India due to population ageing. UN Decade of Healthy Ageing (2021-2030) has been launched with focus on combatting ageism, promoting age friendly environment, integrated care and providing access to good quality long term care. Implementing interventions to promote healthy ageing in the Indian context has significant challenges in the background of limited availability dedicated elderly friendly health and social care systems.Methods:Description of the outreach initiatives launched by the Geriatric Psychiatry Unit, Department of Psychiatry, National Institute of Mental Health and Neurosciences a tertiary care academic unit for old age psychiatry in India.Results:A systematic and comprehensive outreach initiative for healthy ageing has been implemented over 2 years. The main objectives for the initiative includes promoting awareness about ageing and mental health, promoting age friendly environment, training of caregivers, volunteers and other stakeholders, psychosocial intervention in old age homes, promoting integrative medicine for healthy ageing and providing geriatric tele-psychiatry services. The important strengths of this initiative has been collaboration with non-governmental organizations, promoting active participation from older adults and volunteers, mobilizing resources through corporate social responsibility funding and effective use of technology.Conclusion:The experience of implementing this outreach initiative has contributed to important learnings for the team. The proposed solutions to address the challenges in sustaining this initiative and scaling up to reach a larger population will be discussed.","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":"112 1","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139661891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-02DOI: 10.1017/s1041610223003903
Ana Sofia Pozo Vico, Debora Moral Cuesta, Maria Belen Gonzalez Glaria, Francesca Soler Parets, Beatriz Echarte Archanco, Karmele Garaioa Aranburu, Angela Zulema Hernandez Amador, Marina Sanchez Latorre, Chenhui Chen, Rodrigo Molero De Avila Garcia, Marta Lorente Escudero
Introduction:Psychobehavioral symptoms are one of the main causes of institutionalization. After the first months of institutionalization, it could be a good opportunity to consider deprescribing psychotropics, at the same time person-centered non-pharmacological measures should be implemented. Also, if dementia stage is moderate or advanced, acetylcholinesterase- olyph-inhibitor (AchEI) should be deprescribed.Objectives:To evaluate the difference between the number of psychotropic drugs in institutionalized patients and those who are at home.Materials and Methods:We selected all the patients admitted in the Acute Geriatric Unit of “Hospital Universitario de Navarra” during May and June of two consecutive years (2021 and 2022). We collected demographic, administrative, functional and pathological variables, as well as delirium predisposing factors, drugs on admission and discharge and Drug-Burden-Index (DBI). A descriptive study was carried out and our hypothesis was analyzed.Results:658 patients were recluted with a medium age of 87.8, 55.6% were females, 44.5% had dementia and 22% were Institutionalized. The mean hospital stay was 5.8 days and 11.7% died. Functionally, the mean Barthel was 56.5 and Lawton 1.49. Regarding comorbidities: arterial hypertension (81%), Osteoarthritis (55%), heart failure (51%), dislipemia (47%), chronic kidney disease (42%), auricular fibrillation (39%), osteoporosis (33%) and diabetes (31%). Regarding geriatric syndromes: polypharmacy (87,5%), sleep disturbances (48%), hearing loss (43%), chronic pain (41,5%), visual loss and constipation (38%) and depression (33%). The main delirium predisposing factors were: age more than 80 (93.5%), olypharmacy, neurological disease (47%), altered senses, chronic pain and depression. Comparing psychotropic use between institutionalized and non institutionalized: psychotropics (78%vs69%), night psichotropics (72%vs63%), neuroleptics (37%vs18,5%), AchEI (13%vs6,5%), antiepileptics (21%14%). All of them p<0.05. However, there were no statistically significant differences in the use of benzodiazepines, antidepressant or antiparkinsonian.Conclusion:Nowadays, institutionalized patients have more phsychotropic drugs than non-institutionalized ones, especially neuroleptics. Moreover, they are more frequent in patients with severe dementia. Maybe, the explanation is DEPRESCRIPTION AVOIDANCE due to an acute fear of a behavioral decompensation. We recommend educating in non-pharmacological measures and insisting on an adequacy of pharmacological prescriptions periodically.
{"title":"P7: Institutionalization and Psychotropics","authors":"Ana Sofia Pozo Vico, Debora Moral Cuesta, Maria Belen Gonzalez Glaria, Francesca Soler Parets, Beatriz Echarte Archanco, Karmele Garaioa Aranburu, Angela Zulema Hernandez Amador, Marina Sanchez Latorre, Chenhui Chen, Rodrigo Molero De Avila Garcia, Marta Lorente Escudero","doi":"10.1017/s1041610223003903","DOIUrl":"https://doi.org/10.1017/s1041610223003903","url":null,"abstract":"Introduction:Psychobehavioral symptoms are one of the main causes of institutionalization. After the first months of institutionalization, it could be a good opportunity to consider deprescribing psychotropics, at the same time person-centered non-pharmacological measures should be implemented. Also, if dementia stage is moderate or advanced, acetylcholinesterase- olyph-inhibitor (AchEI) should be deprescribed.Objectives:To evaluate the difference between the number of psychotropic drugs in institutionalized patients and those who are at home.Materials and Methods:We selected all the patients admitted in the Acute Geriatric Unit of “Hospital Universitario de Navarra” during May and June of two consecutive years (2021 and 2022). We collected demographic, administrative, functional and pathological variables, as well as delirium predisposing factors, drugs on admission and discharge and Drug-Burden-Index (DBI). A descriptive study was carried out and our hypothesis was analyzed.Results:658 patients were recluted with a medium age of 87.8, 55.6% were females, 44.5% had dementia and 22% were Institutionalized. The mean hospital stay was 5.8 days and 11.7% died. Functionally, the mean Barthel was 56.5 and Lawton 1.49. Regarding comorbidities: arterial hypertension (81%), Osteoarthritis (55%), heart failure (51%), dislipemia (47%), chronic kidney disease (42%), auricular fibrillation (39%), osteoporosis (33%) and diabetes (31%). Regarding geriatric syndromes: polypharmacy (87,5%), sleep disturbances (48%), hearing loss (43%), chronic pain (41,5%), visual loss and constipation (38%) and depression (33%). The main delirium predisposing factors were: age more than 80 (93.5%), olypharmacy, neurological disease (47%), altered senses, chronic pain and depression. Comparing psychotropic use between institutionalized and non institutionalized: psychotropics (78%vs69%), night psichotropics (72%vs63%), neuroleptics (37%vs18,5%), AchEI (13%vs6,5%), antiepileptics (21%14%). All of them p<0.05. However, there were no statistically significant differences in the use of benzodiazepines, antidepressant or antiparkinsonian.Conclusion:Nowadays, institutionalized patients have more phsychotropic drugs than non-institutionalized ones, especially neuroleptics. Moreover, they are more frequent in patients with severe dementia. Maybe, the explanation is DEPRESCRIPTION AVOIDANCE due to an acute fear of a behavioral decompensation. We recommend educating in non-pharmacological measures and insisting on an adequacy of pharmacological prescriptions periodically.","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":"21 1","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139661865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-02DOI: 10.1017/s1041610223004283
CT Tang, SM Tan
Objective:The most recent treatment guidelines on delayed sleep phase disorder recommend the use of melatonin. However, these guidelines are in need of an update. Numerous systematic reviews and meta-analyses have since been conducted. This research aims to summarize all systematic reviews and meta-analyses investigating the efficacy of melatonin in delayed sleep phase disorder.Methods:We performed a literature search using Pubmed, Embase, Cochrane Database of Systematic Reviews and Google. Characteristics and findings of all eligible systematic reviews and meta-analyses were summarised.Results:Five reviews, which included trials up to 2014, were obtained. The timing of melatonin administration and outcomes of interest varied considerably amongst the trials. All of the reviews found improvement in sleep-onset latency, while two reviews noted advancement in melatonin onset time.Conclusions:There is a need for more updated evidence exploring the use of melatonin in delayed sleep phase disorder. Future studies should also specify if they are evaluating the hypnotic and/or chronobiotic effects of melatonin and consider these in their design.
目标：关于睡眠时相延迟症的最新治疗指南建议使用褪黑素。然而，这些指南需要更新。自此以后，进行了大量的系统综述和荟萃分析。本研究旨在总结所有研究褪黑素对延迟睡眠障碍疗效的系统综述和荟萃分析。方法：我们使用 Pubmed、Embase、Cochrane 系统综述数据库和 Google 进行了文献检索。结果：共获得5篇综述，其中包括截至2014年的试验。不同试验的褪黑素给药时间和相关结果差异很大。所有综述均发现睡眠起始潜伏期有所改善，而两篇综述指出褪黑激素起始时间有所提前。结论：需要更多最新证据来探讨褪黑激素在延迟睡眠期障碍中的应用。未来的研究还应明确说明他们是否在评估褪黑素的催眠和/或慢性生物效应，并在设计中考虑这些因素。
{"title":"P176: Efficacy of Melatonin in Delayed Sleep Phase Disorder: An Umbrella Review","authors":"CT Tang, SM Tan","doi":"10.1017/s1041610223004283","DOIUrl":"https://doi.org/10.1017/s1041610223004283","url":null,"abstract":"Objective:The most recent treatment guidelines on delayed sleep phase disorder recommend the use of melatonin. However, these guidelines are in need of an update. Numerous systematic reviews and meta-analyses have since been conducted. This research aims to summarize all systematic reviews and meta-analyses investigating the efficacy of melatonin in delayed sleep phase disorder.Methods:We performed a literature search using Pubmed, Embase, Cochrane Database of Systematic Reviews and Google. Characteristics and findings of all eligible systematic reviews and meta-analyses were summarised.Results:Five reviews, which included trials up to 2014, were obtained. The timing of melatonin administration and outcomes of interest varied considerably amongst the trials. All of the reviews found improvement in sleep-onset latency, while two reviews noted advancement in melatonin onset time.Conclusions:There is a need for more updated evidence exploring the use of melatonin in delayed sleep phase disorder. Future studies should also specify if they are evaluating the hypnotic and/or chronobiotic effects of melatonin and consider these in their design.","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":"83 1","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139661866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-02DOI: 10.1017/s1041610223002223
Yvonne Feeney
Background:Globally, dementia prevalence is rising. In the UK, over a million people are expected to be impacted by dementia by 2050. One in four hospital beds are occupied by a person with dementia, and it is inevitable that healthcare professionals will work with people with dementia during their career and across a variety of settings. To deliver effective person-centered care, healthcare professionals need to have the capacity and skills to practice with empathy. Greater empathy can lead to better patient relationships, reduced burnout, and enhanced recognition of personhood. However, people with dementia frequently report episodes of care that lack empathetic approaches. To improve the quality of care, high quality dementia education needs to be provided at undergraduate level. To inform the design and delivery of suitable educational resources, this study aimed to understand the major factors that impact the development of empathy towards people with dementia during undergraduate education.Methods:A constructivist, longitudinal grounded theory study (Charmaz, 2014) was conducted. Data were collected in 2019 using semi-structured interviews with undergraduate nursing, physiotherapy, and medical students (n=30). A second interview was completed with students (n=26) eighteen months later. Emergent findings were informed by simultaneous data collection and analysis using constant comparison techniques, and the use of theoretical memo writing.Results:Preliminary findings suggested that the development of empathy towards people with dementia was impacted by social and emotional exposure during undergraduate years. Data centered on four sub-categories. While there were barriers connecting and understanding people with dementia, students experienced conflicting expectations about empathy more widely. Positive and negative cultural experiences during placement led to emotional changes and a shift in ideals.Conclusion:Environments that promote empathetic practice during clinical placement could impact the development of empathy in undergraduate healthcare education more widely. This study highlights a need for educational design that focuses on both the patient and the environment.
{"title":"“I think the rose-tinted glasses do just sort of slowly come off”: a grounded theory study on the development of empathy towards people with dementia in healthcare student education.","authors":"Yvonne Feeney","doi":"10.1017/s1041610223002223","DOIUrl":"https://doi.org/10.1017/s1041610223002223","url":null,"abstract":"Background:Globally, dementia prevalence is rising. In the UK, over a million people are expected to be impacted by dementia by 2050. One in four hospital beds are occupied by a person with dementia, and it is inevitable that healthcare professionals will work with people with dementia during their career and across a variety of settings. To deliver effective person-centered care, healthcare professionals need to have the capacity and skills to practice with empathy. Greater empathy can lead to better patient relationships, reduced burnout, and enhanced recognition of personhood. However, people with dementia frequently report episodes of care that lack empathetic approaches. To improve the quality of care, high quality dementia education needs to be provided at undergraduate level. To inform the design and delivery of suitable educational resources, this study aimed to understand the major factors that impact the development of empathy towards people with dementia during undergraduate education.Methods:A constructivist, longitudinal grounded theory study (Charmaz, 2014) was conducted. Data were collected in 2019 using semi-structured interviews with undergraduate nursing, physiotherapy, and medical students (n=30). A second interview was completed with students (n=26) eighteen months later. Emergent findings were informed by simultaneous data collection and analysis using constant comparison techniques, and the use of theoretical memo writing.Results:Preliminary findings suggested that the development of empathy towards people with dementia was impacted by social and emotional exposure during undergraduate years. Data centered on four sub-categories. While there were barriers connecting and understanding people with dementia, students experienced conflicting expectations about empathy more widely. Positive and negative cultural experiences during placement led to emotional changes and a shift in ideals.Conclusion:Environments that promote empathetic practice during clinical placement could impact the development of empathy in undergraduate healthcare education more widely. This study highlights a need for educational design that focuses on both the patient and the environment.","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":"305 1","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139661868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-02DOI: 10.1017/s1041610223003320
Tiur Sihombing
Background:The number of elderly populations continues to increase as the advancement in healthcare grows, which is shown by the increase of life expectancy, the declining mortality rates, and the surge of people with dementia (PwD). This mental health issue is barely identifiable by health workers and the elderly themselves especially during COVID-19 pandemic. Therefore, it is important to evaluate and identify the unmet needs of people with dementia, especially mild to moderate dementia.Objective:To describe the unmet needs of people with mild to moderate dementia during COVID- 19 pandemic in 2021 in East Jakarta, Indonesia.Methods:This study is using the CDR (Clinical Dementia Rating Scale) to assess severity level of Dementia, then using the CANE (Camberwell Assessment of Need for the Elderly) instrument to assess the unmet needs of people with mild to moderate dementia.Results:96 participants were assessed suffer from mild dementia (75%) and moderate dementia (25%). This study procured five substantial unmet needs proportion, which are friendship (26.0%), psychological distress (20.8%), close relationships (19.8%), memory dysfunction (16.7%), and daily activities (10.4%). During interviews in conducting unmet needs assessments, people with mild to moderate dementia and accompanying families expressed their desire for an activity that would be useful to overcome their unmet needs.Conclusion:The COVID-19 pandemic for the people with mild to moderate dementia has an impact on friendships, psychological distress, memory dysfunction and daily activities so they need meaningful activities to overcome them.
{"title":"P192: The Unmet Needs of People with Mild to Moderate Dementia During COVID-19 Pandemic in East Jakarta","authors":"Tiur Sihombing","doi":"10.1017/s1041610223003320","DOIUrl":"https://doi.org/10.1017/s1041610223003320","url":null,"abstract":"Background:The number of elderly populations continues to increase as the advancement in healthcare grows, which is shown by the increase of life expectancy, the declining mortality rates, and the surge of people with dementia (PwD). This mental health issue is barely identifiable by health workers and the elderly themselves especially during COVID-19 pandemic. Therefore, it is important to evaluate and identify the unmet needs of people with dementia, especially mild to moderate dementia.Objective:To describe the unmet needs of people with mild to moderate dementia during COVID- 19 pandemic in 2021 in East Jakarta, Indonesia.Methods:This study is using the CDR (Clinical Dementia Rating Scale) to assess severity level of Dementia, then using the CANE (Camberwell Assessment of Need for the Elderly) instrument to assess the unmet needs of people with mild to moderate dementia.Results:96 participants were assessed suffer from mild dementia (75%) and moderate dementia (25%). This study procured five substantial unmet needs proportion, which are friendship (26.0%), psychological distress (20.8%), close relationships (19.8%), memory dysfunction (16.7%), and daily activities (10.4%). During interviews in conducting unmet needs assessments, people with mild to moderate dementia and accompanying families expressed their desire for an activity that would be useful to overcome their unmet needs.Conclusion:The COVID-19 pandemic for the people with mild to moderate dementia has an impact on friendships, psychological distress, memory dysfunction and daily activities so they need meaningful activities to overcome them.","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":"29 1","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139661872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-02DOI: 10.1017/s1041610223001254
Annaliese Blair, Catherine Bateman, Katrina Anderson
Objectives:evaluate the clinical outcomes for acute hospital patients with dementia, delirium or at risk for delirium supported by the person-centred volunteer program in australian rural hospitals.Design:a non-randomised, mixed methods, controlled trial.Participants:older adults admitted to 7 rural acute hospitals. Intervention (n=270) patients were >65 years with a diagnosis of dementia and/or delirium or had risk factors for delirium and received volunteer services. Family carers (n=83) of intervention patients were interviewed. Staff survey and focus groups. Control (n=188) patients were randomly drawn from patients admitted to the same hospital 12 months prior to the volunteer program who would have met program eligibility criteria.Intervention:trained volunteers provided 1:1 person centred care with a focus on nutrition and hydration support, hearing and visual aids, activities, and orientation.Measures:medical record audits provided data on volunteer visits, diagnoses, length of stay (los), behavioural incidents, readmission, specialling, mortality, admission to residential care, falls, pressure ulcers and medication use.Results:across all sites there was a significant reduction in rates of 1:1 specialling (p=.011) and 28 day readmission (p=.006) for patients receiving the volunteer intervention. Los was significantly shorter for the control group (p=.001). All other patient outcomes were equivalent for the intervention and control group (p>.05). Volunteers integrated themselves into the care team providing person-centred care, increased safety and quality of care and were an “extra pair of hands”, reducing care burden for staff and importantly for families: “for me, knowing someone was there … i can't even tell you what a benefit that was”. 98% of staff rated the program as supportive of them in their careEnablers were clear processes for screening, training and supporting volunteers. Key challenges included initial role delineation, staff/volunteer trust and sustainability.Conclusion:appropriately trained and supported volunteers are cost effective and can improve the safety and quality of care for hospitalised patients with cognitive impairment in rural hospitals.
{"title":"FC27: Golden Angels: The impact of volunteer support for patients with dementia and delirium in Australian rural hospitals","authors":"Annaliese Blair, Catherine Bateman, Katrina Anderson","doi":"10.1017/s1041610223001254","DOIUrl":"https://doi.org/10.1017/s1041610223001254","url":null,"abstract":"Objectives:evaluate the clinical outcomes for acute hospital patients with dementia, delirium or at risk for delirium supported by the person-centred volunteer program in australian rural hospitals.Design:a non-randomised, mixed methods, controlled trial.Participants:older adults admitted to 7 rural acute hospitals. Intervention (n=270) patients were >65 years with a diagnosis of dementia and/or delirium or had risk factors for delirium and received volunteer services. Family carers (n=83) of intervention patients were interviewed. Staff survey and focus groups. Control (n=188) patients were randomly drawn from patients admitted to the same hospital 12 months prior to the volunteer program who would have met program eligibility criteria.Intervention:trained volunteers provided 1:1 person centred care with a focus on nutrition and hydration support, hearing and visual aids, activities, and orientation.Measures:medical record audits provided data on volunteer visits, diagnoses, length of stay (los), behavioural incidents, readmission, specialling, mortality, admission to residential care, falls, pressure ulcers and medication use.Results:across all sites there was a significant reduction in rates of 1:1 specialling (p=.011) and 28 day readmission (p=.006) for patients receiving the volunteer intervention. Los was significantly shorter for the control group (p=.001). All other patient outcomes were equivalent for the intervention and control group (p>.05). Volunteers integrated themselves into the care team providing person-centred care, increased safety and quality of care and were an “extra pair of hands”, reducing care burden for staff and importantly for families: “for me, knowing someone was there … i can't even tell you what a benefit that was”. 98% of staff rated the program as supportive of them in their careEnablers were clear processes for screening, training and supporting volunteers. Key challenges included initial role delineation, staff/volunteer trust and sustainability.Conclusion:appropriately trained and supported volunteers are cost effective and can improve the safety and quality of care for hospitalised patients with cognitive impairment in rural hospitals.<jats:fig position=\"float\"><jats:graphic xmlns:xlink=\"http://www.w3.org/1999/xlink\" mime-subtype=\"png\" mimetype=\"image\" position=\"float\" xlink:href=\"S1041610223001254_ufig1.png\" /></jats:fig>","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":"298 1 1","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139666793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-02DOI: 10.1017/s1041610223004234
Annette O.A. Plouvier, Julia Revet, Raymond T.C.M. Koopmans, Maria I. Lapid, Rob M. Kok, Debby L. Gerritsen
Objective:Neuropsychiatric symptoms (NPS) are common in people with dementia and have a negative effect. Commonly used pharmacological and psychosocial interventions are not always effective and NPS can become refractory. Electroconvulsive therapy (ECT) may be effective for (severe) agitation and aggression and is well tolerated. Nevertheless, its application seems limited in the Netherlands. We explored the application of and attitudes of physicians towards ECT for (severe) NPS in older people with dementia in the Netherlands.Methods:A survey study among geriatricians, elderly care physicians and old-age psychiatrists in the Netherlands in July 2020. An online invitation was included in the digital newsletter of the professional society or directly sent to the professional network of one of the authors (in case of old-age psychiatrists). The questionnaire included 20 closed- and open ended questions on demographic characteristics, experiences with (consideration of) referral for/application of ECT and attitudes towards ECT.Results:Sixty-one respondents completed the survey, eight had ever considered ECT. Two of these eight referred patient(s) for depressive behavior, sometimes combined with agitation. Lack of experience, ECT not being included in guidelines for this indication, unfamiliarity with possible (side) effects and risks, ethical and practical issues were the main reasons of the respondents for not considering ECT. Most respondents were open to referring patients with dementia for ECT to treat (severe) NPS, specifically in case of refractory symptoms.Conclusion:Respondents are not negative about ECT, yet rarely consider it due to lack of awareness and knowledge and the ethical and practical issues related to its application. Although the response to our survey was low and the number of respondents is limited, we do feel that ECT may be an alternative for palliative sedation, which is used incidentally in cases of refractory NPS in the Netherlands. Further exploring the support base and possibilities for application of ECT-treatment for refractory NPS might therefore be worthwhile.
{"title":"P160: Electroconvulsive therapy for neuropsychiatric symptoms in dementia: survey among Dutch physicians","authors":"Annette O.A. Plouvier, Julia Revet, Raymond T.C.M. Koopmans, Maria I. Lapid, Rob M. Kok, Debby L. Gerritsen","doi":"10.1017/s1041610223004234","DOIUrl":"https://doi.org/10.1017/s1041610223004234","url":null,"abstract":"Objective:Neuropsychiatric symptoms (NPS) are common in people with dementia and have a negative effect. Commonly used pharmacological and psychosocial interventions are not always effective and NPS can become refractory. Electroconvulsive therapy (ECT) may be effective for (severe) agitation and aggression and is well tolerated. Nevertheless, its application seems limited in the Netherlands. We explored the application of and attitudes of physicians towards ECT for (severe) NPS in older people with dementia in the Netherlands.Methods:A survey study among geriatricians, elderly care physicians and old-age psychiatrists in the Netherlands in July 2020. An online invitation was included in the digital newsletter of the professional society or directly sent to the professional network of one of the authors (in case of old-age psychiatrists). The questionnaire included 20 closed- and open ended questions on demographic characteristics, experiences with (consideration of) referral for/application of ECT and attitudes towards ECT.Results:Sixty-one respondents completed the survey, eight had ever considered ECT. Two of these eight referred patient(s) for depressive behavior, sometimes combined with agitation. Lack of experience, ECT not being included in guidelines for this indication, unfamiliarity with possible (side) effects and risks, ethical and practical issues were the main reasons of the respondents for not considering ECT. Most respondents were open to referring patients with dementia for ECT to treat (severe) NPS, specifically in case of refractory symptoms.Conclusion:Respondents are not negative about ECT, yet rarely consider it due to lack of awareness and knowledge and the ethical and practical issues related to its application. Although the response to our survey was low and the number of respondents is limited, we do feel that ECT may be an alternative for palliative sedation, which is used incidentally in cases of refractory NPS in the Netherlands. Further exploring the support base and possibilities for application of ECT-treatment for refractory NPS might therefore be worthwhile.","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":"1 1","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139667030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-02DOI: 10.1017/s1041610223001473
Carlos Augusto de Mendonca Lima, Debanjan Banerjee, Liat Ayalon, Kiran Rabheru
In 2020 there were 727 million persons aged 65 years or over in the world and this number is expected to reach over 1.5 billion in 2050. Of these, 20% suffer of a mental health condition and 60% live in low- and middle-income countries where barriers (stigma, poor access to social and health care systems) present issues even during stable times. A humanitarian crisis is defined as a singular event or a series of events that are threatening in terms of health, safety or wellbeing of a community or group of individuals, and require action that is usually urgent and often non-routine. Examples of such crisis are wars, natural disasters, epidemics and forced immigration. There is an urgent need of an international commitment to planning for humanitarian emergencies that include individual and community psychosocial support for older adults with mental health conditions. The current lack of inclusion for these older adults in humanitarian response is dramatic and constitute a clear violation of their Human Rights. Governments and humanitarian actors need to do more during crisis to ensure that individual's specific needs are addressed. A humanitarian response includes the collective actions of actors responding to the global needs. Each state has the responsibility first to take care of the victims of these emergencies occurring on its territory. Humanitarian actors must provide assistance in accordance with the principles of humanity, neutrality and impartiality. Promoting and ensuring compliance with these principles are essential elements of effective humanitarian coordination, in respect of the Human Rights principles, in particular when vulnerable people such older adults with mental health conditions are involved. The symposium intends to describe the consequences on older adults’ mental health during humanitarian emergencies and discuss potential solutions to improve the humanitarian response for all in need.
{"title":"Workshop 2: Humanitarian Crisis and Old Age Mental Health","authors":"Carlos Augusto de Mendonca Lima, Debanjan Banerjee, Liat Ayalon, Kiran Rabheru","doi":"10.1017/s1041610223001473","DOIUrl":"https://doi.org/10.1017/s1041610223001473","url":null,"abstract":"In 2020 there were 727 million persons aged 65 years or over in the world and this number is expected to reach over 1.5 billion in 2050. Of these, 20% suffer of a mental health condition and 60% live in low- and middle-income countries where barriers (stigma, poor access to social and health care systems) present issues even during stable times. A humanitarian crisis is defined as a singular event or a series of events that are threatening in terms of health, safety or wellbeing of a community or group of individuals, and require action that is usually urgent and often non-routine. Examples of such crisis are wars, natural disasters, epidemics and forced immigration. There is an urgent need of an international commitment to planning for humanitarian emergencies that include individual and community psychosocial support for older adults with mental health conditions. The current lack of inclusion for these older adults in humanitarian response is dramatic and constitute a clear violation of their Human Rights. Governments and humanitarian actors need to do more during crisis to ensure that individual's specific needs are addressed. A humanitarian response includes the collective actions of actors responding to the global needs. Each state has the responsibility first to take care of the victims of these emergencies occurring on its territory. Humanitarian actors must provide assistance in accordance with the principles of humanity, neutrality and impartiality. Promoting and ensuring compliance with these principles are essential elements of effective humanitarian coordination, in respect of the Human Rights principles, in particular when vulnerable people such older adults with mental health conditions are involved. The symposium intends to describe the consequences on older adults’ mental health during humanitarian emergencies and discuss potential solutions to improve the humanitarian response for all in need.","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":"66 1","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139661867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mild Behavioral Impairment (MBI) refers to a late-onset neurobehavioral syndrome in which neuropsychiatric symptoms (NPS) represent early markers of dementia. Though being a promising diagnostic category for neurobiological research, in daily clinical practice, the boundaries and relationships between MBI and late-life psychiatric disorders are yet to be established. Particularly, no studies have been conducted so far on the prognostic implications of an MBI diagnosis in the psychogeriatric context.For these reasons, since June 2020, we are conducting a prospective longitudinal study on MBI in psychogeriatric patients. On June 2022, 144 elderly patients (≥50 years) referred to the outpatient clinic of the 2nd Psychiatric Unit of the University of Pisa had been recruited. Patients had been diagnosed with a primary psychiatric disorder (N=73, 50.6%), MBI (N=40, 27.8%) or dementia (N=31, 21.5%). Patients with MBI showed a significantly higher age at onset of psychiatric disorders and depressive episodes than patients diagnosed with primary psychiatric disorders. MCI and vascular leukoencephalopathy were also more common in patients with MBI. Moreover, compared to primary psychiatric disorders, MBI was associated with a significantly higher psychopathology severity, especially in the apathy and negative symptoms domain.Preliminary longitudinal analyses were also performed on a subsample of 83 patients followed-up for at least 3 months (on average for one year): at baseline 44 patients had been diagnosed with primary mood disorders including 23 patients in remission and 21 patients with current mood episodes; 22 patients had MBI and 17 were diagnosed with dementia. While at follow-up patients with mood episodes showed a significant decrease in psychopathology severity and increase in global functioning, those with MBI had no significant improvements.In conclusion, MBI is a common condition in psychogeriatric settings and shows distinctive clinical features that may help differential diagnosis. Moreover, the presence of MBI in patients with late-life psychiatric disorders may affect both clinical and functional outcomes. The recognition of patients with MBI symptoms, including apathy, might be useful for the early detection of individuals with poor prognosis.
{"title":"Mild Behavioral impairment (MBI) and late-life psychiatric disorders: Differential clinical features and outcomes.","authors":"Camilla Elefante, Giulio Emilio Brancati, Filippo Baldacci, Lorenzo Lattanzi, Roberto Ceravolo, Giulio Perugi","doi":"10.1017/s1041610223001898","DOIUrl":"https://doi.org/10.1017/s1041610223001898","url":null,"abstract":"Mild Behavioral Impairment (MBI) refers to a late-onset neurobehavioral syndrome in which neuropsychiatric symptoms (NPS) represent early markers of dementia. Though being a promising diagnostic category for neurobiological research, in daily clinical practice, the boundaries and relationships between MBI and late-life psychiatric disorders are yet to be established. Particularly, no studies have been conducted so far on the prognostic implications of an MBI diagnosis in the psychogeriatric context.For these reasons, since June 2020, we are conducting a prospective longitudinal study on MBI in psychogeriatric patients. On June 2022, 144 elderly patients (≥50 years) referred to the outpatient clinic of the 2nd Psychiatric Unit of the University of Pisa had been recruited. Patients had been diagnosed with a primary psychiatric disorder (N=73, 50.6%), MBI (N=40, 27.8%) or dementia (N=31, 21.5%). Patients with MBI showed a significantly higher age at onset of psychiatric disorders and depressive episodes than patients diagnosed with primary psychiatric disorders. MCI and vascular leukoencephalopathy were also more common in patients with MBI. Moreover, compared to primary psychiatric disorders, MBI was associated with a significantly higher psychopathology severity, especially in the apathy and negative symptoms domain.Preliminary longitudinal analyses were also performed on a subsample of 83 patients followed-up for at least 3 months (on average for one year): at baseline 44 patients had been diagnosed with primary mood disorders including 23 patients in remission and 21 patients with current mood episodes; 22 patients had MBI and 17 were diagnosed with dementia. While at follow-up patients with mood episodes showed a significant decrease in psychopathology severity and increase in global functioning, those with MBI had no significant improvements.In conclusion, MBI is a common condition in psychogeriatric settings and shows distinctive clinical features that may help differential diagnosis. Moreover, the presence of MBI in patients with late-life psychiatric disorders may affect both clinical and functional outcomes. The recognition of patients with MBI symptoms, including apathy, might be useful for the early detection of individuals with poor prognosis.","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":"12 1","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139661874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-02DOI: 10.1017/s1041610223002752
Sajeeka Jeyakumar, George T. Grossberg
Introduction:Average life expectancy in Nepal has been increasing annually (1991: 54 y/o, current: 72 y/o). The growth rate of the elderly population is faster than that of the total population in Nepal.Objective:With only one Geriatric Psychiatrist in Nepal, Dr. Nidesh Sapkota, who received fellowship training at Saint Louis University (SLU), there is a need to develop a Geriatric Mental Health Program, similar to the model created in India by Dr. George Grossberg. Working with the Patan Academy of Health Sciences School of Medicine (PAHSSM) in Nepal, the objective is to develop added mental health resources for the aging population by teaching and integrating evaluative materials from our Geriatric Psychiatry clinic at SLU.Methods:We received funding from Graduate Medical Education to spend 1-month at the PAHSSM with Dr. Sapkota in May 2023. The goal is to learn about Psychogeriatric issues in Nepal by observing faculty and trainees working with geriatric patients and assessing the country's unmet needs for this population. The framework of the pre-existing program will be updated with current science in Psychogeriatrics with the support of the Nepalese government and WHO. The methodology includes training healthcare providers to use screening tools, developing educational programs, and mental health and aging conferences with educators, researchers, and physicians from around the world, as well as establishing an exchange program for residents in Nepal and SLU for Geriatric Psychiatry training.Results:Results of this pilot grant will be shared at future IPA meetings.Conclusion:This experience will lead to opportunities to assess mental health disorders influenced by cultural and social differences. This can give us a better understanding of the lack of mental health needs and how we can close the gap, primarily for low-middle income aging populations across the globe. Increased understanding of cultural differences impacting mental illness amongst other ethnic communities specifically how various forms of dementia are experienced, viewed and treated can lead to more appropriate interventions. This project will help initiate a Global Geriatric Mental Health program at SLU that can draw attention to the disparities of the burden of mental illness across the globe by providing access to care within/between countries.
导言：尼泊尔人的平均预期寿命每年都在增长（1991 年为 54 岁，目前为 72 岁）。目标：尼泊尔只有尼德什-萨普科塔（Nidesh Sapkota）医生一名老年精神科医生，他曾在圣路易斯大学（SLU）接受过研究培训，因此有必要制定一项老年精神健康计划，类似于乔治-格罗斯伯格医生在印度创立的模式。我们与尼泊尔帕坦健康科学医学院（Patan Academy of Health Sciences School of Medicine，PAHSSM）合作，目的是通过教学和整合圣路易斯大学老年精神病学诊所的评估材料，为老龄人口开发更多的心理健康资源。我们的目标是通过观察教职员工和受训人员与老年病人的合作，了解尼泊尔的老年精神病学问题，并评估该国对这一人群尚未满足的需求。在尼泊尔政府和世界卫生组织的支持下，原有计划的框架将根据当前的老年精神病学科学进行更新。方法包括培训医疗服务提供者使用筛查工具，制定教育计划，与来自世界各地的教育工作者、研究人员和医生举行心理健康和老龄化会议，以及为尼泊尔和 SLU 的老年精神病学培训住院医师建立交流计划。这可以让我们更好地了解精神健康需求的缺乏，以及我们如何缩小差距，主要是针对全球中低收入的老龄人口。加深了解文化差异对其他种族社区精神疾病的影响，特别是如何体验、看待和治疗各种形式的痴呆症，有助于采取更适当的干预措施。该项目将有助于在 SLU 启动全球老年心理健康计划，通过提供国家内部/国家之间的医疗服务，引起人们对全球精神疾病负担差异的关注。
{"title":"P169: IMPROVING THE MENTAL HEALTH CARE NEEDS OF OLDER ADULTS IN NEPAL.","authors":"Sajeeka Jeyakumar, George T. Grossberg","doi":"10.1017/s1041610223002752","DOIUrl":"https://doi.org/10.1017/s1041610223002752","url":null,"abstract":"Introduction:Average life expectancy in Nepal has been increasing annually (1991: 54 y/o, current: 72 y/o). The growth rate of the elderly population is faster than that of the total population in Nepal.Objective:With only one Geriatric Psychiatrist in Nepal, Dr. Nidesh Sapkota, who received fellowship training at Saint Louis University (SLU), there is a need to develop a Geriatric Mental Health Program, similar to the model created in India by Dr. George Grossberg. Working with the Patan Academy of Health Sciences School of Medicine (PAHSSM) in Nepal, the objective is to develop added mental health resources for the aging population by teaching and integrating evaluative materials from our Geriatric Psychiatry clinic at SLU.Methods:We received funding from Graduate Medical Education to spend 1-month at the PAHSSM with Dr. Sapkota in May 2023. The goal is to learn about Psychogeriatric issues in Nepal by observing faculty and trainees working with geriatric patients and assessing the country's unmet needs for this population. The framework of the pre-existing program will be updated with current science in Psychogeriatrics with the support of the Nepalese government and WHO. The methodology includes training healthcare providers to use screening tools, developing educational programs, and mental health and aging conferences with educators, researchers, and physicians from around the world, as well as establishing an exchange program for residents in Nepal and SLU for Geriatric Psychiatry training.Results:Results of this pilot grant will be shared at future IPA meetings.Conclusion:This experience will lead to opportunities to assess mental health disorders influenced by cultural and social differences. This can give us a better understanding of the lack of mental health needs and how we can close the gap, primarily for low-middle income aging populations across the globe. Increased understanding of cultural differences impacting mental illness amongst other ethnic communities specifically how various forms of dementia are experienced, viewed and treated can lead to more appropriate interventions. This project will help initiate a Global Geriatric Mental Health program at SLU that can draw attention to the disparities of the burden of mental illness across the globe by providing access to care within/between countries.","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":"179 1","pages":""},"PeriodicalIF":7.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139661883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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