Approximately 30% of patients with Alzheimer’s disease experience hallucinations and/or delusions related to Alzheimer’s disease psychosis (ADP). Patients are often managed with off-label antipsychotics, which are associated with considerable safety concerns. ACP-204 is a 5-HT2A selective inverse agonist and antagonist (and, less so, 5-HT2C). It was developed with an improved pharmacological profile compared with first-in-class pimavanserin. Here we describe the study design for 3 independent phase 2 and 3 studies of ACP-204.
Methods
The master protocol ACP-204-006 (NCT06159673) includes 3 similar, independent, operationally seamless, double-blind, placebo-controlled, multicenter studies investigating the efficacy and safety of ACP-204 in ADP. Eligibility criteria include individuals 55-95 years of age with Alzheimer’s disease and psychosis. Part 1 (phase 2) will evaluate efficacy and dose response of ACP-204 60 mg and 30 mg vs placebo in participants with ADP. Part 2A and Part 2B (phase 3) will either confirm both doses, or pursue only a single dose from Part 1. Participants in each of the 3 independent studies will be randomized 1:1:1 to receive ACP-204 60 mg, 30 mg, or 0 mg (placebo) for 6 weeks in a double-blind treatment period. Part 1 will enroll ∼318 total participants (∼106 per arm), and Parts 2A and 2B separately will each enroll ∼378 total participants (∼126 per arm), providing ≥80% (Part 1) or ≥85% (Part 2A and 2B) power to detect a significant effect of ACP-204 over placebo at alpha level 0.05 using a two-sided test. Participants who complete Part 1, 2A, or 2B may be eligible to roll over into the long-term open-label extension (OLE) study, ACP-204-008 (NCT06194799). Each of the 3 studies will include a ≤42-day screening period, 6-week double-blind treatment period, 30-day safety follow-up period for participants not rolling over into OLE, and a mortality follow-up for participants with early study termination (Figure 1). The primary, secondary, and select other endpoints are shown in Figure 1.
Results
This ongoing study has an estimated completion date of February 2028.
Conclusions
ACP-204-006 will be the first clinical study to evaluate the efficacy and safety of ACP-204 in patients with ADP, a population with considerable unmet needs.
{"title":"15. DESIGN OF THE PHASE 2/3, DOUBLE-BLIND, PLACEBO-CONTROLLED, MULTICENTER STUDIES INVESTIGATING THE EFFICACY AND SAFETY OF ACP-204, A NOVEL 5-HT2A INVERSE AGONIST, IN ALZHEIMER’S DISEASE PSYCHOSIS","authors":"Samantha Friend , Bryan Dirks , Becky Howell , Xiaoshu Feng , Peter Zhang , Sanjeev Pathak","doi":"10.1016/j.jagp.2025.04.018","DOIUrl":"10.1016/j.jagp.2025.04.018","url":null,"abstract":"<div><h3>Introduction</h3><div>Approximately 30% of patients with Alzheimer’s disease experience hallucinations and/or delusions related to Alzheimer’s disease psychosis (ADP). Patients are often managed with off-label antipsychotics, which are associated with considerable safety concerns. ACP-204 is a 5-HT2A selective inverse agonist and antagonist (and, less so, 5-HT2C). It was developed with an improved pharmacological profile compared with first-in-class pimavanserin. Here we describe the study design for 3 independent phase 2 and 3 studies of ACP-204.</div></div><div><h3>Methods</h3><div>The master protocol ACP-204-006 (NCT06159673) includes 3 similar, independent, operationally seamless, double-blind, placebo-controlled, multicenter studies investigating the efficacy and safety of ACP-204 in ADP. Eligibility criteria include individuals 55-95 years of age with Alzheimer’s disease and psychosis. Part 1 (phase 2) will evaluate efficacy and dose response of ACP-204 60 mg and 30 mg vs placebo in participants with ADP. Part 2A and Part 2B (phase 3) will either confirm both doses, or pursue only a single dose from Part 1. Participants in each of the 3 independent studies will be randomized 1:1:1 to receive ACP-204 60 mg, 30 mg, or 0 mg (placebo) for 6 weeks in a double-blind treatment period. Part 1 will enroll ∼318 total participants (∼106 per arm), and Parts 2A and 2B separately will each enroll ∼378 total participants (∼126 per arm), providing ≥80% (Part 1) or ≥85% (Part 2A and 2B) power to detect a significant effect of ACP-204 over placebo at alpha level 0.05 using a two-sided test. Participants who complete Part 1, 2A, or 2B may be eligible to roll over into the long-term open-label extension (OLE) study, ACP-204-008 (NCT06194799). Each of the 3 studies will include a ≤42-day screening period, 6-week double-blind treatment period, 30-day safety follow-up period for participants not rolling over into OLE, and a mortality follow-up for participants with early study termination (Figure 1). The primary, secondary, and select other endpoints are shown in Figure 1.</div></div><div><h3>Results</h3><div>This ongoing study has an estimated completion date of February 2028.</div></div><div><h3>Conclusions</h3><div>ACP-204-006 will be the first clinical study to evaluate the efficacy and safety of ACP-204 in patients with ADP, a population with considerable unmet needs.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S11-S12"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614462","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 : 2025-07-14DOI: 10.1016/j.jagp.2025.04.045
Justine Ku , Alexander Parker , Jacklyn Vargas , Emily Troyer , Jordan Kohn
<div><h3>Introduction</h3><div>As individuals age, leisure time often increases, leading to greater engagement in less physically demanding activities like various forms of media, including television, books, and computer use (Matthews et al., 2008). While media use has been a significant area of research among younger populations, it remains underexplored in studies involving older adults. In particular, the connections between media usage and mental health—specifically, depression— in this demographic are even less understood. For example, do individuals with depression tend to favor certain types of media over others? It is essential to examine actual data and patterns of media usage in older adults, especially given that depression significantly increases mortality rates in elderly populations aged 65 and older compared to non-depressed counterparts (Schulz et. al., 2000). Although pharmacological treatments for depression are available, older adults often face increased sensitivity to side effects, potential interactions with other medications, and issues related to drug metabolism. Polypharmacy and the cumulative effects of medication usage over decades also warrant caution amongst older populations. As such, examining how behavioral preferences and variations in media consumption impact mental health among aging populations is important for developing more holistic guidelines to inform health delivery and policy. This research therefore aims to improve the quality of life for old age individuals by investigating behavioral patterns and associations with depression, particularly by addressing gaps in understanding media preferences among older adults.</div></div><div><h3>Methods</h3><div>This analysis utilized 2020 Public Survey data and 2021 Consumption and Activities Mail Survey (CAMS) from the Health and Retirement Study (HRS), sponsored by the National Institute on Aging (NIA U01AG009740) and conducted by the Univ. of Michigan. Data missingness ranged 0-2.4% and were multiply imputed (m=20) under the missing at random mechanism using random forest classification and regression (analytical sample N=3,710, > 55 years old). Respondents were categorized as having significant depressive symptoms (N=532; 14.7%) based on previously-validated CESD-8 score ≥4 cutoff. Media activities (MAs) included TV/movies, newspapers/magazines, books, music, communication (telephone, letters, e-mail, facebook, skype), and computer use. Covariates included age, gender, race, ethnicity, marital status, employment status, educational attainment, and degree of functional impairment (e.g., ADLs, IADLs). Negative binomial (NB) and binary logistic regression models were used to determine relationships between MAs, CESD score and depression category. Descriptive statistics, univariate comparisons, and regression model estimates and confidence intervals were obtained by pooling results across imputed datasets according to Rubin’s rules.</div></div><div><h3>Results<
随着个人年龄的增长，休闲时间往往增加，导致更多地参与到对体力要求较低的活动中，如各种形式的媒体，包括电视、书籍和电脑使用（Matthews et al., 2008）。虽然媒体使用一直是年轻人研究的重要领域，但在涉及老年人的研究中仍未得到充分探讨。特别是，媒体使用与心理健康之间的联系——特别是抑郁症——在这一人群中，人们甚至不太了解。例如，抑郁症患者是否倾向于偏爱某些类型的媒体？检查老年人媒体使用的实际数据和模式是至关重要的，特别是考虑到与非抑郁症人群相比，65岁及以上老年人的抑郁症显著增加了死亡率（Schulz et. al., 2000）。虽然抑郁症的药物治疗是可行的，但老年人往往对副作用、与其他药物的潜在相互作用以及与药物代谢相关的问题更加敏感。在老年人群中，多种用药和数十年来药物使用的累积效应也值得谨慎。因此，研究媒体消费的行为偏好和变化如何影响老龄人口的心理健康，对于制定更全面的指导方针，为卫生服务和政策提供信息具有重要意义。因此，本研究旨在通过调查行为模式及其与抑郁症的关系，特别是通过解决老年人在理解媒体偏好方面的差距，提高老年人的生活质量。方法本分析利用了健康与退休研究（HRS）的2020年公众调查数据和2021年消费和活动邮件调查（CAMS），该研究由美国国家老龄化研究所（NIA U01AG009740）赞助，由密歇根大学进行。数据缺失范围为0-2.4%，在随机缺失机制下采用随机森林分类和回归(分析样本N=3,710, >；55岁)。受访者被归类为有显著抑郁症状(N=532；14.7%)，基于先前验证的CESD-8评分≥4分截止。媒体活动（MAs）包括电视/电影、报纸/杂志、书籍、音乐、通信（电话、信件、电子邮件、facebook、skype）和电脑使用。协变量包括年龄、性别、种族、民族、婚姻状况、就业状况、受教育程度和功能障碍程度（如ADLs、IADLs）。采用负二项（NB）和二元logistic回归模型确定MAs、CESD评分与抑郁类别的关系。描述性统计、单变量比较、回归模型估计和置信区间根据Rubin的规则通过汇集输入数据集的结果获得。结果有明显抑郁症状的被调查者比没有抑郁症状的人更年轻、功能受损更严重、受教育程度更低、女性、非白人、西班牙裔、未婚和失业的可能性更大。单因素分析显示，有抑郁症状者的报纸/杂志休闲阅读时间较少（2.72±4.3 vs 3.46±5.8小时/周）；Z=4.36, p <；0.005)和书籍(3.04±6.5 vs. 3.92±7.5小时/周；Z=3.90, p <；0.005)和更少的电脑使用时间（8.33±14.8 vs 10.5±14.7小时/周）；Z=6.37, p <；0.005)，但在电视、音乐和通讯方面没有差异。MAs呈弱相关（rho=0.00-0.28）。在NB回归中进行协变量调整（R2=17.6%）后，电视使用（但没有其他MA）与抑郁症状的小幅增加呈正相关，例如，电视使用增加10小时/周与CESD-8评分增加2.9%相关。逻辑回归未显示MA与存在显著抑郁症状之间存在任何协变量调整的关联。本研究揭示了一个显著的人口统计学发现：与2020年CDC数据显示的非西班牙裔白人成年人的抑郁症发病率较高相比，有明显抑郁症状的受访者更有可能是非西班牙裔的西班牙裔成年人。其他发现与现有文献一致，包括有明显抑郁症状的受访者更可能是女性、功能受损、受教育程度较低、未婚和失业。未来的研究应该探索这些差异的原因，以及它们是否反映了不同的样本人口、文化因素或差异地区。了解社会因素与心理健康结果之间的相互关系，可能有助于制定有效的、有针对性的心理健康护理战略。关于媒体使用及其与抑郁症的关系，非抑郁症的受访者报告说，他们更多地参与认知要求高的媒体活动，比如阅读杂志和书籍，并且花更多的时间使用电脑。
{"title":"43. BEYOND ENTERTAINMENT: MEDIA PATTERNS AND ASSOCIATIONS WITH DEPRESSION IN OLDER ADULTS","authors":"Justine Ku , Alexander Parker , Jacklyn Vargas , Emily Troyer , Jordan Kohn","doi":"10.1016/j.jagp.2025.04.045","DOIUrl":"10.1016/j.jagp.2025.04.045","url":null,"abstract":"<div><h3>Introduction</h3><div>As individuals age, leisure time often increases, leading to greater engagement in less physically demanding activities like various forms of media, including television, books, and computer use (Matthews et al., 2008). While media use has been a significant area of research among younger populations, it remains underexplored in studies involving older adults. In particular, the connections between media usage and mental health—specifically, depression— in this demographic are even less understood. For example, do individuals with depression tend to favor certain types of media over others? It is essential to examine actual data and patterns of media usage in older adults, especially given that depression significantly increases mortality rates in elderly populations aged 65 and older compared to non-depressed counterparts (Schulz et. al., 2000). Although pharmacological treatments for depression are available, older adults often face increased sensitivity to side effects, potential interactions with other medications, and issues related to drug metabolism. Polypharmacy and the cumulative effects of medication usage over decades also warrant caution amongst older populations. As such, examining how behavioral preferences and variations in media consumption impact mental health among aging populations is important for developing more holistic guidelines to inform health delivery and policy. This research therefore aims to improve the quality of life for old age individuals by investigating behavioral patterns and associations with depression, particularly by addressing gaps in understanding media preferences among older adults.</div></div><div><h3>Methods</h3><div>This analysis utilized 2020 Public Survey data and 2021 Consumption and Activities Mail Survey (CAMS) from the Health and Retirement Study (HRS), sponsored by the National Institute on Aging (NIA U01AG009740) and conducted by the Univ. of Michigan. Data missingness ranged 0-2.4% and were multiply imputed (m=20) under the missing at random mechanism using random forest classification and regression (analytical sample N=3,710, > 55 years old). Respondents were categorized as having significant depressive symptoms (N=532; 14.7%) based on previously-validated CESD-8 score ≥4 cutoff. Media activities (MAs) included TV/movies, newspapers/magazines, books, music, communication (telephone, letters, e-mail, facebook, skype), and computer use. Covariates included age, gender, race, ethnicity, marital status, employment status, educational attainment, and degree of functional impairment (e.g., ADLs, IADLs). Negative binomial (NB) and binary logistic regression models were used to determine relationships between MAs, CESD score and depression category. Descriptive statistics, univariate comparisons, and regression model estimates and confidence intervals were obtained by pooling results across imputed datasets according to Rubin’s rules.</div></div><div><h3>Results<","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S31-S32"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613994","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 : 2025-07-14DOI: 10.1016/j.jagp.2025.04.069
Rachel Sava , Julia Golden , Weronika Pasciak , Julia Kimball , Kozbi Bayne , Ipsit Vahia
Introduction
As the prevalence of dementia grows, the demand for caregivers concomitantly rises. In the U.S. alone, over 11 million people serve as unpaid dementia caregivers, and women represent a majority among them (Alzheimer’s Association, 2024) (Xiong, 2020). Research shows that female caregivers experience greater overall burden, impact on their lives, and depression as compared with their male counterparts (Pillemer, 2018). A recent surge in technologies that support dementia caregivers may offer tools to combat these ever-growing gender disparities. We review the breadth of tech-based approaches that can support caregiving in dementia and explore how they may alleviate caregiving burden for women.
Methods
Given the constantly evolving field of technology in dementia care, we employed an exploratory approach to capture a comprehensive range of emerging technologies. To capture the broadest range of technologies, we utilized a literature review, brainstorming sessions with an interdisciplinary team and experts in the field, and internet searching to identify relevant web-based resources. We then deconstructed the evidence to determine the types of technologies whose use is supported by evidence.
Results
We identified several categories of technologies that may help support female caregivers. They include: communication and tracking tools, transportation tools, interventions aimed at reducing caregiver loneliness, AI-driven monitoring systems, caregiver support platforms and task management apps, and interventions aimed at stress reduction for caregivers.
Conclusions
A growing arsenal of technologies exists to reduce caregiver burden and improve the quality of life for the patient-caregiver dyad. These technologies may be particularly important for female caregivers, who are disproportionately affected by the role. We advocate for investment in these technologies as a path to supporting women and reducing gender disparity in caregiving.
{"title":"67. AN INVESTMENT IN CAREGIVER TECHNOLOGIES IS AN INVESTMENT IN WOMEN’S HEALTH","authors":"Rachel Sava , Julia Golden , Weronika Pasciak , Julia Kimball , Kozbi Bayne , Ipsit Vahia","doi":"10.1016/j.jagp.2025.04.069","DOIUrl":"10.1016/j.jagp.2025.04.069","url":null,"abstract":"<div><h3>Introduction</h3><div>As the prevalence of dementia grows, the demand for caregivers concomitantly rises. In the U.S. alone, over 11 million people serve as unpaid dementia caregivers, and women represent a majority among them (Alzheimer’s Association, 2024) (Xiong, 2020). Research shows that female caregivers experience greater overall burden, impact on their lives, and depression as compared with their male counterparts (Pillemer, 2018). A recent surge in technologies that support dementia caregivers may offer tools to combat these ever-growing gender disparities. We review the breadth of tech-based approaches that can support caregiving in dementia and explore how they may alleviate caregiving burden for women.</div></div><div><h3>Methods</h3><div>Given the constantly evolving field of technology in dementia care, we employed an exploratory approach to capture a comprehensive range of emerging technologies. To capture the broadest range of technologies, we utilized a literature review, brainstorming sessions with an interdisciplinary team and experts in the field, and internet searching to identify relevant web-based resources. We then deconstructed the evidence to determine the types of technologies whose use is supported by evidence.</div></div><div><h3>Results</h3><div>We identified several categories of technologies that may help support female caregivers. They include: communication and tracking tools, transportation tools, interventions aimed at reducing caregiver loneliness, AI-driven monitoring systems, caregiver support platforms and task management apps, and interventions aimed at stress reduction for caregivers.</div></div><div><h3>Conclusions</h3><div>A growing arsenal of technologies exists to reduce caregiver burden and improve the quality of life for the patient-caregiver dyad. These technologies may be particularly important for female caregivers, who are disproportionately affected by the role. We advocate for investment in these technologies as a path to supporting women and reducing gender disparity in caregiving.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S49"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614136","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 : 2025-07-14DOI: 10.1016/j.jagp.2025.04.024
Jamie Scott , Bianca Barreto , Madeline Lane , Aninditha Vengassery , Bienvenida Austria , Heidi Kaminsky , Blaine Greenwald
<div><h3>Introduction</h3><div>The burgeoning elderly population in the US has catalyzed attention to both healthcare and manpower challenges. For example, since recent reports indicate that loneliness and social isolation in older individuals range from 18% - 33% and are associated with a wide range of adverse health outcomes (including chronic diseases, mental health disorders, cognitive decline and increased mortality), these undesirable and at times painful psychological states have emerged as important psychosocial targets. However, despite the demographic imperative of aging, several reports indicate that interest in geriatric care amongst medical students is generally low, but that exposure to and positive experiences with older adults during education can improve such interest. To address these issues, a unique intergenerational program was developed linking medical students to socially isolated patients being treated in an academic geriatric psychiatry clinic.</div></div><div><h3>Methods</h3><div>A six-month program called SHIELD (Students Helping Isolated Elders) was launched in the Geriatric Psychiatry Clinic of Zucker Hillside Hospital/Northwell Health in April 2024. Medical students in a Psychiatry Interest Group at Northwell’s affiliated medical college (Zucker School of Medicine at Hofstra/Northwell) were solicited to participate in a friendly visitor volunteer program to non-demented patients with depression and/or anxiety diagnoses occurring in the context of social isolation and loneliness. Twenty patients and twenty medical students (ranging from 1st to 3rd year) were recruited and individual patient-student pairs then linked for in-person interactions. In addition to typical conversational exchanges, students were directed to encourage patient reminiscence, play board games, accompany patients to medical appointments, and act as patient advocates. Frequency of visit guidelines were set between once/week to once/month at a minimum. Qualitative impressions of the program and their interactions with students were solicited from participating patients. At six months, a 5-point Likert-like scale (5 being highest [i.e. most interested] rating) was sent to the medical students surveying pre- and post-program potential interest in careers in Psychiatry, Geriatric Psychiatry and Geriatric Medicine.</div></div><div><h3>Results</h3><div>Three patients initially signed up for SHIELD but then changed their mind about participating; and another met with a student several times and then withdrew. Three students withdrew from the program citing time constraints and schedule conflicts. Qualitative feedback from patients were uniformly positive, with nearly all reporting that visits were happily anticipated and interactions rewarding. Fifteen of 17 students completed the survey. Pre-program, 33% of students were interested in pursuing a career in Psychiatry; 13% in Geriatric Psychiatry; and 20% in Geriatric Medicine. Post-program 73% of student
美国迅速增长的老年人口引发了人们对医疗保健和人力资源挑战的关注。例如，由于最近的报告表明，老年人的孤独和社会孤立程度在18%至33%之间，并与各种不良健康后果（包括慢性病、精神健康障碍、认知能力下降和死亡率上升）有关，因此，这些不受欢迎的、有时是痛苦的心理状态已成为重要的社会心理目标。然而，尽管人口老龄化势在必行，但一些报告表明，医学生对老年护理的兴趣普遍较低，但在教育期间接触老年人并与老年人积极接触可以提高这种兴趣。为了解决这些问题，一个独特的代际项目被开发出来，将医学院学生与在学术老年精神病学诊所接受治疗的社会孤立患者联系起来。方法于2024年4月在Zucker Hillside医院/Northwell Health老年精神病学诊所启动了为期6个月的SHIELD （Students help Isolated Elders）项目。诺斯韦尔附属医学院（霍夫斯特拉/诺斯韦尔的扎克医学院）的一个精神病学兴趣小组的医学生被邀请参加一个友好的访客志愿者计划，以帮助在社会孤立和孤独的背景下诊断为抑郁症和/或焦虑症的非痴呆患者。招募了20名患者和20名医学生（从一年级到三年级），然后将个体患者-学生对联系起来进行面对面的互动。除了典型的对话交流，学生们还被引导去鼓励病人回忆，玩棋盘游戏，陪病人去看医生，并充当病人的倡导者。访视频率指引设定在最少每周一次至每月一次之间。对项目的定性印象以及他们与学生的互动从参与的患者中征求。六个月后，一份李克特式5分量表（5分为最高[即最感兴趣]评分）被发给医学生，调查他们在项目前和项目后对精神病学、老年精神病学和老年医学职业的潜在兴趣。结果3名患者最初报名参加SHIELD，但后来改变了主意；还有一名学生与一名学生见了几次面，然后就退学了。三名学生以时间限制和日程冲突为由退出了该项目。来自患者的定性反馈一致是积极的，几乎所有人都报告说访问是愉快的，互动是有益的。17名学生中有15名完成了调查。项目前，33%的学生有兴趣从事精神病学工作；老年精神病学13%；老年医学占20%。项目结束后，73%的学生对精神病学职业感兴趣；老年精神病学47%；老年医学占47%。结论一项为期6个月的跨代项目在纽约大都市的城市/郊区社区得以成功实施，该项目的特点是对医学生和社会孤立和孤独的老年精神病学门诊患者进行每周一至每月的面对面访问。在这个项目之后，参与的医学生调查扩展了先前的报告，即直接和令人满意的接触非精神病老年人与对老年职业的兴趣显著增强有关。鉴于目前普通精神病学和内科住院医师的毕业生在老年精神病学和老年医学奖学金项目中各自的入学率低得惊人，目前的研究结果支持了在医学培训期间与老年患者早期积极互动的重要性，这可能会影响老年医学专家人力资源迫在眉睫的危机。
{"title":"22. IMPACT OF MEDICAL STUDENT INTERACTIONS WITH GERIATRIC PSYCHIATRY OUTPATIENTS","authors":"Jamie Scott , Bianca Barreto , Madeline Lane , Aninditha Vengassery , Bienvenida Austria , Heidi Kaminsky , Blaine Greenwald","doi":"10.1016/j.jagp.2025.04.024","DOIUrl":"10.1016/j.jagp.2025.04.024","url":null,"abstract":"<div><h3>Introduction</h3><div>The burgeoning elderly population in the US has catalyzed attention to both healthcare and manpower challenges. For example, since recent reports indicate that loneliness and social isolation in older individuals range from 18% - 33% and are associated with a wide range of adverse health outcomes (including chronic diseases, mental health disorders, cognitive decline and increased mortality), these undesirable and at times painful psychological states have emerged as important psychosocial targets. However, despite the demographic imperative of aging, several reports indicate that interest in geriatric care amongst medical students is generally low, but that exposure to and positive experiences with older adults during education can improve such interest. To address these issues, a unique intergenerational program was developed linking medical students to socially isolated patients being treated in an academic geriatric psychiatry clinic.</div></div><div><h3>Methods</h3><div>A six-month program called SHIELD (Students Helping Isolated Elders) was launched in the Geriatric Psychiatry Clinic of Zucker Hillside Hospital/Northwell Health in April 2024. Medical students in a Psychiatry Interest Group at Northwell’s affiliated medical college (Zucker School of Medicine at Hofstra/Northwell) were solicited to participate in a friendly visitor volunteer program to non-demented patients with depression and/or anxiety diagnoses occurring in the context of social isolation and loneliness. Twenty patients and twenty medical students (ranging from 1st to 3rd year) were recruited and individual patient-student pairs then linked for in-person interactions. In addition to typical conversational exchanges, students were directed to encourage patient reminiscence, play board games, accompany patients to medical appointments, and act as patient advocates. Frequency of visit guidelines were set between once/week to once/month at a minimum. Qualitative impressions of the program and their interactions with students were solicited from participating patients. At six months, a 5-point Likert-like scale (5 being highest [i.e. most interested] rating) was sent to the medical students surveying pre- and post-program potential interest in careers in Psychiatry, Geriatric Psychiatry and Geriatric Medicine.</div></div><div><h3>Results</h3><div>Three patients initially signed up for SHIELD but then changed their mind about participating; and another met with a student several times and then withdrew. Three students withdrew from the program citing time constraints and schedule conflicts. Qualitative feedback from patients were uniformly positive, with nearly all reporting that visits were happily anticipated and interactions rewarding. Fifteen of 17 students completed the survey. Pre-program, 33% of students were interested in pursuing a career in Psychiatry; 13% in Geriatric Psychiatry; and 20% in Geriatric Medicine. Post-program 73% of student","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S16-S17"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614139","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}
Virtual companionship services that utilize volunteers to engage with community-living persons with dementia (PWD) may be a cost-effective and sustainable way to improve behavioral outcomes, quality of life, and reduce caregiver (CG) strain. However, there is limited evidence about acceptability, feasibility, and perceived benefits of such programs. This study evaluates satisfaction with MEMORI Corps, a 12-week virtual companionship and activity program, among PWD and CGs who participated in a pilot randomized controlled trial.
Methods
Online program satisfaction surveys were completed by CGs of PWD who received the intervention. Descriptive analysis was used to summarize 3 major domains: acceptability and feasibility of program components, perceived program impact on the PWD, and perceived program impact on the CG.
Results
Nearly 90% of CGs reported excellent/good feasibility and acceptability for all 22 program aspects. GREATER THAN 50% of CGs agreed with 8/11 perceived benefits the PWD received from the program. The greatest perceived benefits were that the PWD enjoyed the volunteer’s companionship and the activity sessions. ≥70% of CGs disagreed that the program made things worse, was distressing/upsetting, or was boring for the PWD. GREATER THAN 50% of CGs agreed with 13/16 perceived benefits personally received from the program. The greatest perceived benefits personally received were the happiness it brought CGs to see the PWD engaging with the volunteer and the time it allowed CGs for themselves.
Conclusions
CGs reported high satisfaction with MEMORI Corps overall. They also identified areas with lower satisfaction, including program orientation and knowing program expectations, which provide opportunities for enhancement.
{"title":"29. THE MAKING ENGAGEMENT MEANINGFUL THROUGH ORGANIZED ROUTINE INTERACTION (MEMORI) CORPS PROGRAM: A DESCRIPTIVE ANALYSIS OF PARTICIPANT SATISFACTION","authors":"Macy Young , Cynthia Fields , Quincy Samus , Katherine Marx","doi":"10.1016/j.jagp.2025.04.031","DOIUrl":"10.1016/j.jagp.2025.04.031","url":null,"abstract":"<div><h3>Introduction</h3><div>Virtual companionship services that utilize volunteers to engage with community-living persons with dementia (PWD) may be a cost-effective and sustainable way to improve behavioral outcomes, quality of life, and reduce caregiver (CG) strain. However, there is limited evidence about acceptability, feasibility, and perceived benefits of such programs. This study evaluates satisfaction with MEMORI Corps, a 12-week virtual companionship and activity program, among PWD and CGs who participated in a pilot randomized controlled trial.</div></div><div><h3>Methods</h3><div>Online program satisfaction surveys were completed by CGs of PWD who received the intervention. Descriptive analysis was used to summarize 3 major domains: acceptability and feasibility of program components, perceived program impact on the PWD, and perceived program impact on the CG.</div></div><div><h3>Results</h3><div>Nearly 90% of CGs reported excellent/good feasibility and acceptability for all 22 program aspects. GREATER THAN 50% of CGs agreed with 8/11 perceived benefits the PWD received from the program. The greatest perceived benefits were that the PWD enjoyed the volunteer’s companionship and the activity sessions. ≥70% of CGs disagreed that the program made things worse, was distressing/upsetting, or was boring for the PWD. GREATER THAN 50% of CGs agreed with 13/16 perceived benefits personally received from the program. The greatest perceived benefits personally received were the happiness it brought CGs to see the PWD engaging with the volunteer and the time it allowed CGs for themselves.</div></div><div><h3>Conclusions</h3><div>CGs reported high satisfaction with MEMORI Corps overall. They also identified areas with lower satisfaction, including program orientation and knowing program expectations, which provide opportunities for enhancement.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S21"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614116","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 : 2025-07-14DOI: 10.1016/j.jagp.2025.04.067
Karen Richardson , Laura Marrone
Introduction
According to recent data, seven in ten older adults had used at least one prescription drug in the past thirty days and one in five older adults had used at least five prescription drugs. These numbers indicate that polypharmacy is already prevalent, and with the number of prescriptions written and filled increasing, the number of patients taking multiple medications will also likely increase. Taking multiple medications increases the risk of adverse interactions and side effects, especially in the geriatric population. This issue was highlighted by a case in which psychiatry was consulted. The patient was an 80 year old female with a history of major depressive disorder with psychotic features who was admitted to the medicine service due to behavioral concerns and severe sleep disturbance in the setting of polypharmacy and recent onset of urinary retention and constipation in the weeks following a psychiatric hospitalization but prior to outpatient psychiatry follow up. The patient was prescribed nine oral medications total, four of which were psychotropic medications. Over the admission, her medical issues were addressed and some of her medications were tapered with the goal of discontinuing. This case inspired the following literature review and summary examining polypharmacy in elderly patients with psychiatric conditions.
Methods
A chart review of the hospital electronic medical record was completed for this clinical case. A literature search was performed in PubMed including publications in the last 5 years using terms such as “geriatric,” “psychiatry,” and “polypharmacy” and then further reviewed for relevance to search terms and topic and excluded if non-contributory. Studies examining polypharmacy without prescriptions of psychotropics were excluded.
Results
Results are presented in a table format organized by topic outlining findings, current recommendations, areas for improvement, and possible solutions to help mitigate polypharmacy practices.
Conclusions
Polypharmacy in the elderly continues to be a significant issue, and implementation of evidence-based recommendations will help mitigate the negative impacts of unnecessary polypharmacy on health and wellness of geriatric psychiatry patient populations. Areas for future study and intervention are discussed.
{"title":"65. POLYPHARMACY AND BEHAVIOR CHANGE IN THE GERIATRIC PSYCHIATRY POPULATION: A CLINICAL CASE AND REVIEW","authors":"Karen Richardson , Laura Marrone","doi":"10.1016/j.jagp.2025.04.067","DOIUrl":"10.1016/j.jagp.2025.04.067","url":null,"abstract":"<div><h3>Introduction</h3><div>According to recent data, seven in ten older adults had used at least one prescription drug in the past thirty days and one in five older adults had used at least five prescription drugs. These numbers indicate that polypharmacy is already prevalent, and with the number of prescriptions written and filled increasing, the number of patients taking multiple medications will also likely increase. Taking multiple medications increases the risk of adverse interactions and side effects, especially in the geriatric population. This issue was highlighted by a case in which psychiatry was consulted. The patient was an 80 year old female with a history of major depressive disorder with psychotic features who was admitted to the medicine service due to behavioral concerns and severe sleep disturbance in the setting of polypharmacy and recent onset of urinary retention and constipation in the weeks following a psychiatric hospitalization but prior to outpatient psychiatry follow up. The patient was prescribed nine oral medications total, four of which were psychotropic medications. Over the admission, her medical issues were addressed and some of her medications were tapered with the goal of discontinuing. This case inspired the following literature review and summary examining polypharmacy in elderly patients with psychiatric conditions.</div></div><div><h3>Methods</h3><div>A chart review of the hospital electronic medical record was completed for this clinical case. A literature search was performed in PubMed including publications in the last 5 years using terms such as “geriatric,” “psychiatry,” and “polypharmacy” and then further reviewed for relevance to search terms and topic and excluded if non-contributory. Studies examining polypharmacy without prescriptions of psychotropics were excluded.</div></div><div><h3>Results</h3><div>Results are presented in a table format organized by topic outlining findings, current recommendations, areas for improvement, and possible solutions to help mitigate polypharmacy practices.</div></div><div><h3>Conclusions</h3><div>Polypharmacy in the elderly continues to be a significant issue, and implementation of evidence-based recommendations will help mitigate the negative impacts of unnecessary polypharmacy on health and wellness of geriatric psychiatry patient populations. Areas for future study and intervention are discussed.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S48"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614135","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 : 2025-07-14DOI: 10.1016/j.jagp.2025.04.008
Luis Navazo , Samera Taki , Ava Bamdad , Tim Ho , Kira Aldrich , Dawn Vanderhoef
<div><h3>Introduction</h3><div>Tardive dyskinesia (TD) is a persistent and often debilitating hyperkinetic movement disorder associated with prolonged exposure to dopamine receptor blocking agents (DRBAs). Uncontrolled movements due to TD can cause additional burdens to patients, including difficulty swallowing and performing activities of daily living. Even in the approximately 25% of patients with TD who are unaware of their uncontrolled movements, quality of life for the patient, caregiver, and family can be negatively affected. Valbenazine is a highly selective vesicular monoamine transporter 2 (VMAT2) inhibitor, approved as a once-daily medication for the treatment of TD and chorea associated with Huntington’s Disease. In placebo-controlled trials and long-term studies, valbenazine has been shown to be safe and uniquely effective in treating TD. Here, we report the case of a patient who had severe wounds due to undiagnosed TD and was eventually treated with valbenazine for TD.</div></div><div><h3>Methods</h3><div>N/A</div></div><div><h3>Results</h3><div>In May 2022, a 64-year-old female patient presented with severe wounds on her lumbar spine. At presentation, the patient was taking 200 mg quetiapine, lowered from 300 mg two months prior, for type 1 bipolar disorder and had a GREATER THAN 10-year history of DRBA use. Standard of care wound treatment was initiated by her primary care provider; however, the wounds were not healing with repeated re-openings. In October 2022, assessment by a geriatrician and certified wound care specialist determined that the wounds were caused by sheer force from uncontrolled dyskinesia while sitting or lying in bed. Based on clinician assessment and medical history, the patient was diagnosed with TD. She was also evaluated using the Abnormal Involuntary Movement Scale (AIMS), a clinician-rated scale used to measure the severity of dyskinesia across 7 body regions. AIMS item scores range from 0 (“none”) to 4 (“severe”), and the AIMS total score (sum of items 1-7) range from 0 to 28. The patient had an AIMS total score of 12, with particularly severe movements in both the trunk (item score = 4) and lower extremities (item score = 4). The patient was resistant to her TD diagnosis, expressing a lack of awareness of her movements. She was provided a trial of 40 mg valbenazine samples to treat her TD, but did not take this medication due to her hesitancy/aversion to acknowledge the TD diagnosis. In April 2023 (6 months after TD diagnosis), the patient finally initiated treatment with 40 mg valbenazine. After assessment at 2 weeks, the patient had improved but was still experiencing uncontrolled movements, particularly in the trunk and lower extremities; thus, her valbenazine dose was increased to 60 mg. After 23 weeks of consistent treatment with valbenazine, the patient’s AIMS total score decreased by5points (AIMS total score=7), and she reported improvements in her daily functioning. The patient saw significant im
{"title":"5. VALBENAZINE TREATMENT FOR TARDIVE DYSKINESIA IN A 64-YEAR-OLD FEMALE PRESENTING WITH NONHEALING WOUNDS DUE TO TRUNCAL DYSKINESIA: A CASE REPORT","authors":"Luis Navazo , Samera Taki , Ava Bamdad , Tim Ho , Kira Aldrich , Dawn Vanderhoef","doi":"10.1016/j.jagp.2025.04.008","DOIUrl":"10.1016/j.jagp.2025.04.008","url":null,"abstract":"<div><h3>Introduction</h3><div>Tardive dyskinesia (TD) is a persistent and often debilitating hyperkinetic movement disorder associated with prolonged exposure to dopamine receptor blocking agents (DRBAs). Uncontrolled movements due to TD can cause additional burdens to patients, including difficulty swallowing and performing activities of daily living. Even in the approximately 25% of patients with TD who are unaware of their uncontrolled movements, quality of life for the patient, caregiver, and family can be negatively affected. Valbenazine is a highly selective vesicular monoamine transporter 2 (VMAT2) inhibitor, approved as a once-daily medication for the treatment of TD and chorea associated with Huntington’s Disease. In placebo-controlled trials and long-term studies, valbenazine has been shown to be safe and uniquely effective in treating TD. Here, we report the case of a patient who had severe wounds due to undiagnosed TD and was eventually treated with valbenazine for TD.</div></div><div><h3>Methods</h3><div>N/A</div></div><div><h3>Results</h3><div>In May 2022, a 64-year-old female patient presented with severe wounds on her lumbar spine. At presentation, the patient was taking 200 mg quetiapine, lowered from 300 mg two months prior, for type 1 bipolar disorder and had a GREATER THAN 10-year history of DRBA use. Standard of care wound treatment was initiated by her primary care provider; however, the wounds were not healing with repeated re-openings. In October 2022, assessment by a geriatrician and certified wound care specialist determined that the wounds were caused by sheer force from uncontrolled dyskinesia while sitting or lying in bed. Based on clinician assessment and medical history, the patient was diagnosed with TD. She was also evaluated using the Abnormal Involuntary Movement Scale (AIMS), a clinician-rated scale used to measure the severity of dyskinesia across 7 body regions. AIMS item scores range from 0 (“none”) to 4 (“severe”), and the AIMS total score (sum of items 1-7) range from 0 to 28. The patient had an AIMS total score of 12, with particularly severe movements in both the trunk (item score = 4) and lower extremities (item score = 4). The patient was resistant to her TD diagnosis, expressing a lack of awareness of her movements. She was provided a trial of 40 mg valbenazine samples to treat her TD, but did not take this medication due to her hesitancy/aversion to acknowledge the TD diagnosis. In April 2023 (6 months after TD diagnosis), the patient finally initiated treatment with 40 mg valbenazine. After assessment at 2 weeks, the patient had improved but was still experiencing uncontrolled movements, particularly in the trunk and lower extremities; thus, her valbenazine dose was increased to 60 mg. After 23 weeks of consistent treatment with valbenazine, the patient’s AIMS total score decreased by5points (AIMS total score=7), and she reported improvements in her daily functioning. The patient saw significant im","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S4"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613894","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 : 2025-07-14DOI: 10.1016/j.jagp.2025.04.010
Sungsu Lee , Kirk Harris
<div><h3>Introduction</h3><div>Patients with severe mental illnesses have high health utilization rates yet also have poor medical outcomes. There is some evidence to suggest that medical emergencies occur while a patient is admitted to an inpatient psychiatric unit, in the context of already poor baseline health status. As we care for older patients with medical comorbidities, there is potential that medical complexity may limit admissions to inpatient psychiatric units, posing concerns of ageism. Here, we examine the number of cases requiring transfer to inpatient medical units and the characteristics of those patients.</div></div><div><h3>Methods</h3><div>This was a retrospective chart review of the medical record at Strong Memorial Hospital. We reviewed the psychiatric admissions that took place from 2015-2023 and found patients that were discharged to a medical unit. We found the number of psychiatric admissions over the 8-year period and calculated the rate of transfers to inpatient medical units. We calculated the odds ratio of medical transfers based on patient characteristics, including admission to a geriatric unit, gender, length of stay, smoking status, race, and whether they required the use of restraints.</div></div><div><h3>Results</h3><div>From 2015-2023, there were a total of 12,496 inpatient psychiatric admissions at our hospital. Out of these admissions, a total of 307 patients required a transfer to an inpatient medicine unit. There was a noticeable shift in medical transfers that occurred during COVID, as around 8% of all patients admitted to the geriatric psychiatry unit from 2020 to 2022 required a transfer to the medical unit. Age over 65 had an OR of requiring a medical transfer of 4.79 [95%CI 3.73 6.15], admission to the geriatric unit had an OR of 2.58 [95%CI 2.03 3.30]. Black patients less likely to require a medical transfer with an OR of 0.51 [95%CI 0.38 0.70]. There were no statistically significant differences in the ORs for gender, length of stay, whether the patient required restraints.</div></div><div><h3>Conclusions</h3><div>It is not surprising that the rate of medical transfers is higher from the geriatric psychiatric unit, given the increasing medical complexity with age. What is surprising is that black patients were half as likely to experience a medical transfer, though possible that there are confounders that we have not yet adjusted for, which is a limitation for this study at this phase and is the next area of work. The likelihood of medical transfers based on other characteristics, including lab results of psychiatrically admitted patients remains a work in progress. This work demonstrates that there are significant numbers of patients who are admitted psychiatrically who develop medical complications serious enough to warrant transfer to a medical unit. With a better characterization of these cases, these predictors could be utilized in triage when patients first present to the hospital to determine
{"title":"7. MEDICAL EMERGENCIES IN INPATIENT PSYCHIATRY: PREVALENCE OF MEDICAL TRANSFERS FROM INPATIENT PSYCHIATRIC UNITS AT AN ACADEMIC MEDICAL CENTER","authors":"Sungsu Lee , Kirk Harris","doi":"10.1016/j.jagp.2025.04.010","DOIUrl":"10.1016/j.jagp.2025.04.010","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients with severe mental illnesses have high health utilization rates yet also have poor medical outcomes. There is some evidence to suggest that medical emergencies occur while a patient is admitted to an inpatient psychiatric unit, in the context of already poor baseline health status. As we care for older patients with medical comorbidities, there is potential that medical complexity may limit admissions to inpatient psychiatric units, posing concerns of ageism. Here, we examine the number of cases requiring transfer to inpatient medical units and the characteristics of those patients.</div></div><div><h3>Methods</h3><div>This was a retrospective chart review of the medical record at Strong Memorial Hospital. We reviewed the psychiatric admissions that took place from 2015-2023 and found patients that were discharged to a medical unit. We found the number of psychiatric admissions over the 8-year period and calculated the rate of transfers to inpatient medical units. We calculated the odds ratio of medical transfers based on patient characteristics, including admission to a geriatric unit, gender, length of stay, smoking status, race, and whether they required the use of restraints.</div></div><div><h3>Results</h3><div>From 2015-2023, there were a total of 12,496 inpatient psychiatric admissions at our hospital. Out of these admissions, a total of 307 patients required a transfer to an inpatient medicine unit. There was a noticeable shift in medical transfers that occurred during COVID, as around 8% of all patients admitted to the geriatric psychiatry unit from 2020 to 2022 required a transfer to the medical unit. Age over 65 had an OR of requiring a medical transfer of 4.79 [95%CI 3.73 6.15], admission to the geriatric unit had an OR of 2.58 [95%CI 2.03 3.30]. Black patients less likely to require a medical transfer with an OR of 0.51 [95%CI 0.38 0.70]. There were no statistically significant differences in the ORs for gender, length of stay, whether the patient required restraints.</div></div><div><h3>Conclusions</h3><div>It is not surprising that the rate of medical transfers is higher from the geriatric psychiatric unit, given the increasing medical complexity with age. What is surprising is that black patients were half as likely to experience a medical transfer, though possible that there are confounders that we have not yet adjusted for, which is a limitation for this study at this phase and is the next area of work. The likelihood of medical transfers based on other characteristics, including lab results of psychiatrically admitted patients remains a work in progress. This work demonstrates that there are significant numbers of patients who are admitted psychiatrically who develop medical complications serious enough to warrant transfer to a medical unit. With a better characterization of these cases, these predictors could be utilized in triage when patients first present to the hospital to determine ","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S5-S6"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613897","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 : 2025-07-14DOI: 10.1016/j.jagp.2025.04.025
Praveen Paritosh , Ipsit Vahia
<div><h3>Introduction</h3><div>The value of measurement-based care (MBC) in psychiatry and primary care is well-established. Implementation of MBC frequently leverages digital approaches including apps or ecological momentary assessment. However, for older adults only have low digital literacy simplifying the process further may lead to more efficient collection of meaningful clinical data. Voice as a modality can offer several advantages over web or text interfaces for older adults: significantly improve accessibility, reduce cognitive load, and lower physical barriers. A completely hands-free, voice only interaction provides a high level of accessibility and independence for users. Thus, we tested the feasibility of connecting with an AI via a simple phone call, for mental health screening</div></div><div><h3>Methods</h3><div>This work represents the first application of the 3rd Ear voice interviewing platform for building conversational agents that dynamically adapt their questioning to each patient’s responses. By focusing on interviewing rather than offering clinical judgment or recommendations, the platform minimizes the risks of AI hallucinations and bias. The platform orchestrates adaptive, goal-directed dialogue that aligns with established screening tools while unveiling a more nuanced understanding of the patient’s story.</div><div>Stacy is a phone-based bot built on the third ear platform. The bot is designed to administer the PHQ 9 via interview/conversation. for this initial proof of concept, we implemented two screening calls, conducted by the investigators.</div><div>After the user calls the phone, a neural network model transcribes their speech into text. This text is then analyzed for evidence of the depressive system in question and then the derived evidence is passed to the conversational engine, which then guides an open-source large language model to produce a response. This is finally passed to a state-of-the art text-to-speech system which then produces a voice response back on the phone call.</div></div><div><h3>Results</h3><div>Our primary finding was that Stacy can successfully carry out the PHQ-9, ask for elaborations when needed to get more confidence, and fill out the paper form. A typical interview took 3-5 minutes, with an average latency of 1200 milli seconds, which is about 100 ms/question. The users reported minimal delay in voice response and smooth conversational flow. Notably, the users reported that when they interrupted the Stacy bot mid conversation, it was able to pivot comparably to a human.</div></div><div><h3>Conclusions</h3><div>Using phone based AI tools has the potential to simplify and improve the efficacy of measurement based care, particularly for older adults. Our proof of concept focused only on a single scale – the PHQ 9. However, this approach can be expanded to include multiple measures and has the potential to reduce cost while improving data collection by deploying a conversational/intervi
{"title":"23. COULD A PHONECALL TO AN AI SIMPLIFY MEASUREMENT-BASED CARE FOR OLDER ADULTS: PROOF OF CONCEPT","authors":"Praveen Paritosh , Ipsit Vahia","doi":"10.1016/j.jagp.2025.04.025","DOIUrl":"10.1016/j.jagp.2025.04.025","url":null,"abstract":"<div><h3>Introduction</h3><div>The value of measurement-based care (MBC) in psychiatry and primary care is well-established. Implementation of MBC frequently leverages digital approaches including apps or ecological momentary assessment. However, for older adults only have low digital literacy simplifying the process further may lead to more efficient collection of meaningful clinical data. Voice as a modality can offer several advantages over web or text interfaces for older adults: significantly improve accessibility, reduce cognitive load, and lower physical barriers. A completely hands-free, voice only interaction provides a high level of accessibility and independence for users. Thus, we tested the feasibility of connecting with an AI via a simple phone call, for mental health screening</div></div><div><h3>Methods</h3><div>This work represents the first application of the 3rd Ear voice interviewing platform for building conversational agents that dynamically adapt their questioning to each patient’s responses. By focusing on interviewing rather than offering clinical judgment or recommendations, the platform minimizes the risks of AI hallucinations and bias. The platform orchestrates adaptive, goal-directed dialogue that aligns with established screening tools while unveiling a more nuanced understanding of the patient’s story.</div><div>Stacy is a phone-based bot built on the third ear platform. The bot is designed to administer the PHQ 9 via interview/conversation. for this initial proof of concept, we implemented two screening calls, conducted by the investigators.</div><div>After the user calls the phone, a neural network model transcribes their speech into text. This text is then analyzed for evidence of the depressive system in question and then the derived evidence is passed to the conversational engine, which then guides an open-source large language model to produce a response. This is finally passed to a state-of-the art text-to-speech system which then produces a voice response back on the phone call.</div></div><div><h3>Results</h3><div>Our primary finding was that Stacy can successfully carry out the PHQ-9, ask for elaborations when needed to get more confidence, and fill out the paper form. A typical interview took 3-5 minutes, with an average latency of 1200 milli seconds, which is about 100 ms/question. The users reported minimal delay in voice response and smooth conversational flow. Notably, the users reported that when they interrupted the Stacy bot mid conversation, it was able to pivot comparably to a human.</div></div><div><h3>Conclusions</h3><div>Using phone based AI tools has the potential to simplify and improve the efficacy of measurement based care, particularly for older adults. Our proof of concept focused only on a single scale – the PHQ 9. However, this approach can be expanded to include multiple measures and has the potential to reduce cost while improving data collection by deploying a conversational/intervi","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S17"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613980","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 : 2025-07-14DOI: 10.1016/j.jagp.2025.04.029
Robert Kohn
<div><h3>Introduction</h3><div>Attention to the mental health of the elderly and protection of their human rights is receiving increased attention internationally. In addition, how to manage the increasing burden posed by Alzheimer’s disease and related disorders has become an international priority. The COVID-19 pandemic has brought into the forefront the need to also consider protection in humanitarian emergencies.</div></div><div><h3>Methods</h3><div>The current tools and mechanisms that protect the human rights of the elderly internationally are reviewed with a focus on mental health. The work of international commissions and reports with recommendations are examined. The state of human rights legislation in the Americas, Europe and Africa will be discussed. Examples of laws on human rights protection in specific countries such as India and China will be highlighted.</div></div><div><h3>Results</h3><div>On December 10, 1948 the General Assembly of the United Nations (UN) adopted resolution 217 A (III) The Universal Declaration of Human Rights. In the 1990’s the UN made a paradigm shift ethically and legally considering the elderly as bearers of rights rather than a vulnerable group requiring protection. The UN does not, however, have a specific treaty or convention regarding human rights of the elderly as part of its human rights system as is the case in relation to other specific groups. Office of the High Commissioner for Human Rights (OHCHR) has recognized this shortcoming, and its impact during the COVID-19 pandemic. In 1996 the Revised European Social Charter, Article 23, the Right of Elderly Persons to Social Protection to ensure the effective exercise of the right of elderly persons to social protection. The European Union has adopted the Charter of Fundamental Human Rights which includes respecting the rights of the elderly to lead a life of dignity and independence and to participate in social and cultural life. The African Charter on Human and Peoples' Rights has the distinction of being the only human rights treaty of its nature that embodies both civil and political as well as economic, social, and cultural rights in the same instrument. The aged and the disabled shall also have the right to special measures of protection in keeping with their physical or moral needs. Arguably, the Americas have gone further than any region in promoting the human rights of the elderly. On June 15, 2015 the OAS adopted the Inter-American Convention on Protecting the Human Rights of Older Persons. The most recent report on the progress of member states in its implementation was in 2022. How to manage the increasing burden of dementia has become a priority for many countries. Numerous countries have launched policies, plans, strategies or frameworks to improve the quality of life of those with dementia and their caregivers. The Alzheimer’s Disease International Kyoto Declaration, 2004 defined ten levels of action for countries to take.</div></div><di
{"title":"27. INTERNATIONAL HUMAN RIGHTS IN THE ELDERLY","authors":"Robert Kohn","doi":"10.1016/j.jagp.2025.04.029","DOIUrl":"10.1016/j.jagp.2025.04.029","url":null,"abstract":"<div><h3>Introduction</h3><div>Attention to the mental health of the elderly and protection of their human rights is receiving increased attention internationally. In addition, how to manage the increasing burden posed by Alzheimer’s disease and related disorders has become an international priority. The COVID-19 pandemic has brought into the forefront the need to also consider protection in humanitarian emergencies.</div></div><div><h3>Methods</h3><div>The current tools and mechanisms that protect the human rights of the elderly internationally are reviewed with a focus on mental health. The work of international commissions and reports with recommendations are examined. The state of human rights legislation in the Americas, Europe and Africa will be discussed. Examples of laws on human rights protection in specific countries such as India and China will be highlighted.</div></div><div><h3>Results</h3><div>On December 10, 1948 the General Assembly of the United Nations (UN) adopted resolution 217 A (III) The Universal Declaration of Human Rights. In the 1990’s the UN made a paradigm shift ethically and legally considering the elderly as bearers of rights rather than a vulnerable group requiring protection. The UN does not, however, have a specific treaty or convention regarding human rights of the elderly as part of its human rights system as is the case in relation to other specific groups. Office of the High Commissioner for Human Rights (OHCHR) has recognized this shortcoming, and its impact during the COVID-19 pandemic. In 1996 the Revised European Social Charter, Article 23, the Right of Elderly Persons to Social Protection to ensure the effective exercise of the right of elderly persons to social protection. The European Union has adopted the Charter of Fundamental Human Rights which includes respecting the rights of the elderly to lead a life of dignity and independence and to participate in social and cultural life. The African Charter on Human and Peoples' Rights has the distinction of being the only human rights treaty of its nature that embodies both civil and political as well as economic, social, and cultural rights in the same instrument. The aged and the disabled shall also have the right to special measures of protection in keeping with their physical or moral needs. Arguably, the Americas have gone further than any region in promoting the human rights of the elderly. On June 15, 2015 the OAS adopted the Inter-American Convention on Protecting the Human Rights of Older Persons. The most recent report on the progress of member states in its implementation was in 2022. How to manage the increasing burden of dementia has become a priority for many countries. Numerous countries have launched policies, plans, strategies or frameworks to improve the quality of life of those with dementia and their caregivers. The Alzheimer’s Disease International Kyoto Declaration, 2004 defined ten levels of action for countries to take.</div></div><di","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S19-S20"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613995","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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