Pub Date : 2025-07-26DOI: 10.1016/j.jagp.2025.07.008
Jonathan D. Winter M.D. , J. William Kerns M.D. , Danya M. Qato PharmD, M.P.H., Ph.D. , Linda Wastila B.S.Pharm, M.S.P.H., Ph.D. , Katherine M. Winter C.F.N.P. , Nicole Brandt PharmD, M.B.A. , Christopher Winter B.S.N. , Yu-Hua Fu M.S. , Eposi Elonge M.S. , Sarah R. Reves C-F.N.P., M.B.A. , C.J. Christian Bergman M.D., C.M.D. , Alex H. Krist M.D., M.P.H. , Rebecca S. Etz Ph.D.
Objectives
Valproate, an anti-seizure medication (ASM) approved for seizures, bipolar mania, and migraine prophylaxis, is increasingly used in nursing homes (NHs) for reasons unclear. Mandated NH reporting of ASMs began in October 2024, a requirement for other psychotropics since 2012. This study surveyed NH clinicians to explain why valproate is prescribed and why such prescribing is increasing.
Design
National cross-sectional survey. Developed by a multidisciplinary team using pilot data and existing literature, conducted anonymously via SurveyMonkey (November 2024–April 2025), and leveraging convenience sampling through crowdsourcing.
Setting
United States’ NHs.
Participants
A total of 159 NH clinician prescribers: 58% female, 73% white; 57% physicians, 43% advanced practice providers; 60% holding geriatric or psychiatric certifications.
Results
Ninety-seven percent of clinicians reported that off-label valproate use for psychiatric symptoms drove observed prevalence increases, while 74% affirmed such use individually. Few clinicians attributed gains to FDA-approved prescribing indications. Eighty-five percent identified efforts to reduce antipsychotics and benzodiazepines as key contributors to increases. Infrequent valproate dose reduction, staffing shortages, and limited access to nonpharmacologic interventions were also highlighted as causative factors. Generally, clinicians consider valproate low-to-moderate risk (93%) and effective for psychiatric symptoms in NHs (77%), though not superior to alternatives.
Conclusions
Clinicians report that perceived increases in NH valproate use are primarily off-label, and may reflect strategies to manage psychiatric symptoms while circumventing regulatory scrutiny emphasizing other psychotropic medications. They believe policies targeting high-risk psychotropic reduction while overlooking ASMs have driven unmonitored ASM increases with unclear safety and efficacy implications. Whether incorporating ASMs into reporting mandates existing for other psychotropics closes these regulatory gaps remains uncertain.
{"title":"A National Survey of Nursing Home Clinicians to Explain Increased Valproate Prescribing","authors":"Jonathan D. Winter M.D. , J. William Kerns M.D. , Danya M. Qato PharmD, M.P.H., Ph.D. , Linda Wastila B.S.Pharm, M.S.P.H., Ph.D. , Katherine M. Winter C.F.N.P. , Nicole Brandt PharmD, M.B.A. , Christopher Winter B.S.N. , Yu-Hua Fu M.S. , Eposi Elonge M.S. , Sarah R. Reves C-F.N.P., M.B.A. , C.J. Christian Bergman M.D., C.M.D. , Alex H. Krist M.D., M.P.H. , Rebecca S. Etz Ph.D.","doi":"10.1016/j.jagp.2025.07.008","DOIUrl":"10.1016/j.jagp.2025.07.008","url":null,"abstract":"<div><h3>Objectives</h3><div>Valproate, an anti-seizure medication (ASM) approved for seizures, bipolar mania, and migraine prophylaxis, is increasingly used in nursing homes (NHs) for reasons unclear. Mandated NH reporting of ASMs began in October 2024, a requirement for other psychotropics since 2012. This study surveyed NH clinicians to explain why valproate is prescribed and why such prescribing is increasing.</div></div><div><h3>Design</h3><div>National cross-sectional survey. Developed by a multidisciplinary team using pilot data and existing literature, conducted anonymously via SurveyMonkey (November 2024–April 2025), and leveraging convenience sampling through crowdsourcing.</div></div><div><h3>Setting</h3><div>United States’ NHs.</div></div><div><h3>Participants</h3><div>A total of 159 NH clinician prescribers: 58% female, 73% white; 57% physicians, 43% advanced practice providers; 60% holding geriatric or psychiatric certifications.</div></div><div><h3>Results</h3><div>Ninety-seven percent of clinicians reported that off-label valproate use for psychiatric symptoms drove observed prevalence increases, while 74% affirmed such use individually. Few clinicians attributed gains to FDA-approved prescribing indications. Eighty-five percent identified efforts to reduce antipsychotics and benzodiazepines as key contributors to increases. Infrequent valproate dose reduction, staffing shortages, and limited access to nonpharmacologic interventions were also highlighted as causative factors. Generally, clinicians consider valproate low-to-moderate risk (93%) and effective for psychiatric symptoms in NHs (77%), though not superior to alternatives.</div></div><div><h3>Conclusions</h3><div>Clinicians report that perceived increases in NH valproate use are primarily off-label, and may reflect strategies to manage psychiatric symptoms while circumventing regulatory scrutiny emphasizing other psychotropic medications. They believe policies targeting high-risk psychotropic reduction while overlooking ASMs have driven unmonitored ASM increases with unclear safety and efficacy implications. Whether incorporating ASMs into reporting mandates existing for other psychotropics closes these regulatory gaps remains uncertain.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 11","pages":"Pages 1197-1206"},"PeriodicalIF":3.8,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144926741","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 : 2025-07-25DOI: 10.1016/j.jagp.2025.07.004
David C. Steffens M.D., M.H.S.
{"title":"Connecting and Learning","authors":"David C. Steffens M.D., M.H.S.","doi":"10.1016/j.jagp.2025.07.004","DOIUrl":"10.1016/j.jagp.2025.07.004","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 11","pages":"Pages 1240-1246"},"PeriodicalIF":3.8,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857414","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 : 2025-07-23DOI: 10.1016/j.jagp.2025.07.003
Charlotte M. Gillespie MSc, Jesse M. Bering PhD
Psilocybin’s efficacy as a treatment for treatment-resistant depression (TRD) has led to a wave of new legislation permitting its usage in medical settings. Older adults are affected disproportionately by TRD and may be especially good candidates for this promising treatment. However, due to the drug’s past (and present) illicit status and exposure to historic antidrug messaging, older prospective patients may hold more stigmatized attitudes towards this treatment than those who are younger. Stigma and sensationalism pose special challenges for the dissemination of effective, accurate information about therapeutic psilocybin, with recent “hype” around the drug treatment possibly further alienating these individuals. Because current clinical communication strategies may be inadvertently reinforcing negative attitudes about psychedelics rather than reducing them, we offer some general communication guidelines for therapeutic psilocybin geared towards the older patient profile.
{"title":"Avoiding Stigma and Sensationalism in Therapeutic Psilocybin Communications: Considerations for Reaching Older Patients","authors":"Charlotte M. Gillespie MSc, Jesse M. Bering PhD","doi":"10.1016/j.jagp.2025.07.003","DOIUrl":"10.1016/j.jagp.2025.07.003","url":null,"abstract":"<div><div>Psilocybin’s efficacy as a treatment for treatment-resistant depression (TRD) has led to a wave of new legislation permitting its usage in medical settings. Older adults are affected disproportionately by TRD and may be especially good candidates for this promising treatment. However, due to the drug’s past (and present) illicit status and exposure to historic antidrug messaging, older prospective patients may hold more stigmatized attitudes towards this treatment than those who are younger. Stigma and sensationalism pose special challenges for the dissemination of effective, accurate information about therapeutic psilocybin, with recent “hype” around the drug treatment possibly further alienating these individuals. Because current clinical communication strategies may be inadvertently reinforcing negative attitudes about psychedelics rather than reducing them, we offer some general communication guidelines for therapeutic psilocybin geared towards the older patient profile.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 12","pages":"Pages 1251-1259"},"PeriodicalIF":3.8,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144885034","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 : 2025-07-16DOI: 10.1016/j.jagp.2025.07.001
Amber Gum Ph.D.
{"title":"Integrating a Behavioral Intervention Into Elder Abuse Services Shows Promise in Treating Depression and PTSD in Elder Abuse Survivors","authors":"Amber Gum Ph.D.","doi":"10.1016/j.jagp.2025.07.001","DOIUrl":"10.1016/j.jagp.2025.07.001","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 11","pages":"Pages 1131-1133"},"PeriodicalIF":3.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144791820","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.2025.04.038
Allison Gregg , Joseph Kim , Jack Kaufman , Jeremy Maciarz , Vincent Koppelmans , Scott Langenecker , Regan Patrick , Sara Weisenbach
<div><h3>Introduction</h3><div>Rumination, a predisposing and perpetuating feature of depression, has been linked to personality and cognitive variables. However, little is known about their comparative influence on rumination. This study examined personality and cognition as predictors of rumination in early-onset, later life depression (LLD), for those with and without a history of depression. Exploratory analysis investigated this relationship in the subset of patients in a current depressive episode (state depression).</div></div><div><h3>Methods</h3><div>Participants were 76 adults aged 55-79 divided into two groups: “ever depressed” (N=35) including those with current or remitted depression, and “never depressed” (N=41) including those with no history of depression. A subset of the “ever depressed” group in a current depressive episode (N=18) were considered in the exploratory state depression analysis. Personality predictors were the five domains assessed by the NEO Personality Inventory – Revised (NEO-PI-R), openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism. Cognitive predictors were selected based on theory and existing support in the literature for their association with rumination, and included measures of executive function (Trail Making Test B, D-KEFS Color-Word Interference Condition 3, Wisconsin Card Sorting Test Perseverative Responses), attention (WAIS-IV Digit Span Forward), and global cognitive ability (Mini Mental Status Exam).</div><div>The omnibus analysis was conducted using hierarchical linear regression modelling for predictors of rumination, with variable blocks composed of 1) demographic factors (age, sex, education), 2) depression history (ever/never depressed), 3) all cognitive and personality variables, and 4) interaction terms (depression history x variable) for WCST Perseverative Errors and NEO-PI Neuroticism, the only variables with significant interaction effects in Block 3. Exploratory analysis considered whether results were influenced by depression severity for those in a current depressive episode, with hierarchical regression variable blocks of 1) demographic factors (age, sex, education), 2) MADRS score, and 3) WCST Perseverative Responses and NEO-PI Neuroticism Factor Score, along with their interaction terms based on depression severity (MADRS total score x variable).</div></div><div><h3>Results</h3><div>Depression history was a significant predictor of rumination in the primary analysis and remained significant following inclusion of all cognitive and personality variables. Neuroticism (β=.39, p LESS THAN .001) and WCST Perseverative Responses (β=0.18, p LESS THAN .05) significantly predicted rumination, though their interaction terms with depression history were nonsignificant. After inclusion of the interaction terms, MMSE emerged as a significant predictor of rumination (β=.17, p LESS THAN .05), despite initial nonsignificance.</div><div>For the exploratory analys
反刍是抑郁症的一个易感和持久特征，与人格和认知变量有关。然而，人们对它们对反刍的相对影响知之甚少。这项研究考察了人格和认知作为早发性、晚期生活抑郁症（LLD）的预测因素，对于那些有或没有抑郁症史的人来说。探索性分析在当前抑郁发作（状态抑郁）的患者亚群中调查了这种关系。方法研究对象为76名年龄在55-79岁的成年人，分为两组：“曾经抑郁”组（N=35），包括当前抑郁或抑郁症缓解者，和“从未抑郁”组（N=41），包括无抑郁史者。探索性状态抑郁分析考虑了当前抑郁发作的“曾经抑郁”组的子集（N=18）。人格预测因子是通过NEO- pi - r （NEO- pi - r）评估的五个领域：开放性、严谨性、外向性、宜人性和神经质。认知预测因子是根据理论和现有文献的支持来选择的，包括执行功能（Trail Making Test B, D-KEFS Color-Word Interference Condition 3， Wisconsin Card Sorting Test持之以恒的反应）、注意力（WAIS-IV Digit Span Forward）和整体认知能力（Mini Mental Status Test）。采用层次线性回归模型对反刍预测因子进行综合分析，变量块由1)人口统计学因素（年龄、性别、教育程度），2)抑郁史（曾经/从未抑郁过），3)所有认知和人格变量，以及4)WCST持续性错误和NEO-PI神经质的交互项（抑郁史x变量）组成，这是第3块中唯一具有显著交互作用的变量。探索性分析考虑当前抑郁发作患者的结果是否受到抑郁严重程度的影响，采用分层回归变量区块：1)人口因素（年龄、性别、教育程度），2)MADRS评分，3)WCST持续性反应和NEO-PI神经质因子评分，以及基于抑郁严重程度（MADRS总分x变量）的相互作用项。结果在初步分析中，抑郁史是反刍的重要预测因子，并且在纳入所有认知和人格变量后仍然具有重要意义。神经质(β=。39, p < 0.001)和WCST持续性反应（β=0.18, p < 0.05）显著预测反刍，尽管它们与抑郁史的相互作用不显著。在纳入交互作用项后，MMSE成为反刍的显著预测因子（β=）。17, p < 0.05)，尽管最初不显著。在探索性分析中，MADRS评分显著预测状态性抑郁症患者的反刍行为，占协变量之外方差的55.7% （R2=）。69， F(1,13)=23.2, p < 0.001)。在纳入神经质因子评分、WCST持续性反应及其与MADRS评分的相互作用项后，没有一个预测变量与反刍水平显著相关。在考虑了各种社会人口变量后，抑郁史可以预测LLD的反刍行为，证实了先前的研究表明，特质性抑郁会增加老年人反刍行为的风险。神经质对反刍有显著的预测作用，表明个性可能增加抑郁症状的易感性，而与抑郁病史无关。在所考虑的认知领域中，只有认知灵活性（WCST持续性反应）与反刍有关。关于MMSE表现对反刍水平的贡献的模棱两可的发现可能表明LLD中人格和认知之间存在更复杂的潜在关系，尽管这种联系需要进一步研究。对状态抑郁组的探索性分析并没有复制那些在综合分析中显著的预测因子的显著性，这表明反刍的预测因子可能在状态和特质水平的抑郁中有所不同。总体而言，结果暗示人格因素，即神经质，比认知更能预测老年人的反刍，尽管这种关系可能在状态性和特质性抑郁中有所不同。
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Pub Date : 2025-07-14DOI: 10.1016/j.jagp.2025.04.041
Matthew Engel , Emmeline Ayers , Joe Verghese , Mirnova Ceïde
Introduction
Apathy is frequently seen in neuropsychiatric diseases, including Parkinson disease and Alzheimer dementia, and may also be an independent risk factor for the development of motoric-cognitive risk syndrome (MCR). Existing literature on apathy has focused on community-dwelling cohorts from highly developed nations, such that the generalizability of work identifying a link between apathy and motoric-cognitive outcomes has not been fully demonstrated.
Methods
N=742 older adults were recruited from urban and rural areas in Kozhikode district, Kerala, India to participate in this cross-sectional study to examine the relationship between apathy, MCR, cognitive impairment, and other demographic characteristics. Apathy was assessed using the Apathy Evaluation Scale, and depression was measured with the Geriatric Depression Scale. MCR was defined as cognitive complaints and slow gait, with gait speed assessed as 1 SD below age- and sex-adjusted norms. Statistical analyses, including bivariate and regression models, were conducted to evaluate associations between apathy, gait velocity, and MCR using SPSS software.
Results
Compared with subjects in the lowest apathy tertile, those in the highest tertile were older (69.9 vs 67.5 years, p LESS THAN 0.0001), less physically active (0.9 vs 1.5 active days per week, p LESS THAN 0.05), in worse subjective general health (p LESS THAN 0.05) and had slower gait (74.9 vs 81.4 cm/s, p LESS THAN 0.005). High-apathy subjects also had lower ACE scores (79.3 vs 84.3, p LESS THAN 0.0001) and higher GDS scores (9.6 vs 5.6, p LESS THAN 0.0001), but not higher levels of dysphoria (p=0.1519). Before adjustment, apathy was found to negatively correlate with gait velocity (β = -0.112, p≤0.005), and this relationship was principally moderated by ACE score. Although subjects with MCR had higher levels of apathy compared to those without MCR (34.6 vs 31.4, p LESS THAN 0.01), prevalent MCR and apathy tertile were not significantly associated in logistic regression models.
Conclusions
Among community-dwelling older adults in Kerala, apathy is inversely associated with gait velocity but not prevalent MCR, and the former relationship is moderated by degree of cognitive impairment, as determined by ACE score. These findings suggest that apathy may exist on a continuum with gait slowing, MCR, and clinically significant dementia, but future longitudinal studies will be needed to determine a temporal relationship.
冷漠常见于神经精神疾病，包括帕金森病和阿尔茨海默病，也可能是运动-认知危险综合征（MCR）发展的独立危险因素。关于冷漠的现有文献主要集中在来自高度发达国家的社区居住人群，因此，确定冷漠与运动认知结果之间联系的工作的普遍性尚未得到充分证明。方法从印度喀拉拉邦Kozhikode地区的城市和农村地区招募742名老年人参与这项横断面研究，研究冷漠、MCR、认知障碍和其他人口统计学特征之间的关系。冷漠用冷漠量表评估，抑郁用老年抑郁量表测量。MCR被定义为认知障碍和步态缓慢，步态速度评估为低于年龄和性别调整标准1 SD。采用SPSS软件进行统计分析，包括双变量和回归模型，以评估冷漠、步态速度和MCR之间的关系。结果与最低冷漠分位数的受试者相比，最高冷漠分位数的受试者年龄较大（69.9 vs 67.5岁，p < 0.0001），体力活动较少（每周活动天数为0.9 vs 1.5, p < 0.05），主观一般健康状况较差（p < 0.05），步态较慢（74.9 vs 81.4 cm/s, p < 0.005）。高冷漠受试者也有较低的ACE评分（79.3 vs 84.3, p < 0.0001）和较高的GDS评分（9.6 vs 5.6, p < 0.0001），但没有较高水平的烦躁不安（p=0.1519）。调整前，冷漠与步态速度呈负相关（β = -0.112,p≤0.005），这种关系主要由ACE评分调节。尽管患有MCR的受试者的冷漠水平高于无MCR的受试者（34.6比31.4,p < 0.01），但在logistic回归模型中，MCR的流行与冷漠能力没有显著相关。结论在喀拉拉邦社区居住的老年人中，冷漠与步态速度呈负相关，但与MCR不相关，前者与认知障碍程度的关系被ACE评分所调节。这些发现表明，冷漠可能与步态减慢、MCR和临床显著的痴呆存在连续关系，但未来的纵向研究将需要确定其时间关系。
{"title":"39. APATHY IS ASSOCIATED WITH GAIT VELOCITY IN A SOUTH INDIAN COMMUNITY DWELLING COHORT","authors":"Matthew Engel , Emmeline Ayers , Joe Verghese , Mirnova Ceïde","doi":"10.1016/j.jagp.2025.04.041","DOIUrl":"10.1016/j.jagp.2025.04.041","url":null,"abstract":"<div><h3>Introduction</h3><div>Apathy is frequently seen in neuropsychiatric diseases, including Parkinson disease and Alzheimer dementia, and may also be an independent risk factor for the development of motoric-cognitive risk syndrome (MCR). Existing literature on apathy has focused on community-dwelling cohorts from highly developed nations, such that the generalizability of work identifying a link between apathy and motoric-cognitive outcomes has not been fully demonstrated.</div></div><div><h3>Methods</h3><div>N=742 older adults were recruited from urban and rural areas in Kozhikode district, Kerala, India to participate in this cross-sectional study to examine the relationship between apathy, MCR, cognitive impairment, and other demographic characteristics. Apathy was assessed using the Apathy Evaluation Scale, and depression was measured with the Geriatric Depression Scale. MCR was defined as cognitive complaints and slow gait, with gait speed assessed as 1 SD below age- and sex-adjusted norms. Statistical analyses, including bivariate and regression models, were conducted to evaluate associations between apathy, gait velocity, and MCR using SPSS software.</div></div><div><h3>Results</h3><div>Compared with subjects in the lowest apathy tertile, those in the highest tertile were older (69.9 vs 67.5 years, p LESS THAN 0.0001), less physically active (0.9 vs 1.5 active days per week, p LESS THAN 0.05), in worse subjective general health (p LESS THAN 0.05) and had slower gait (74.9 vs 81.4 cm/s, p LESS THAN 0.005). High-apathy subjects also had lower ACE scores (79.3 vs 84.3, p LESS THAN 0.0001) and higher GDS scores (9.6 vs 5.6, p LESS THAN 0.0001), but not higher levels of dysphoria (p=0.1519). Before adjustment, apathy was found to negatively correlate with gait velocity (β = -0.112, p≤0.005), and this relationship was principally moderated by ACE score. Although subjects with MCR had higher levels of apathy compared to those without MCR (34.6 vs 31.4, p LESS THAN 0.01), prevalent MCR and apathy tertile were not significantly associated in logistic regression models.</div></div><div><h3>Conclusions</h3><div>Among community-dwelling older adults in Kerala, apathy is inversely associated with gait velocity but not prevalent MCR, and the former relationship is moderated by degree of cognitive impairment, as determined by ACE score. These findings suggest that apathy may exist on a continuum with gait slowing, MCR, and clinically significant dementia, but future longitudinal studies will be needed to determine a temporal relationship.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S28"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613909","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.2025.04.065
Ethan Lau
<div><h3>Introduction</h3><div>Medically complex older adults in geriatric psychiatry often find themselves requiring additional layers of social support to access optimal care, including transportation to various medical appointments, housing support, and coordination of care between multiple specialties. Of particular importance is the need for psychosocial support in the form of close family, friends, and peers, especially since these key pillars of support tend to diminish with age. Preserving the wellbeing of these caregivers and mitigation of caregiver burden are among some of the major priorities in supporting these patients throughout their psychiatric care [1]. The purpose of this poster is to promote best practices in caregiver support and to raise awareness regarding the need for more research in this area.</div></div><div><h3>Methods</h3><div>This case focuses on Mr. M, a 69 yo male with a psychiatric history of schizophrenia and major depressive disorder with multiple medical comorbidities including malignant tumor of bladder currently undergoing chemotherapy. Patient’s clinical documents in our electronic medical records system were reviewed. A literature survey was performed on the topics of caregiver burden and strategies to alleviate this burden. Mr. M has had multiple suicide attempts in the past and four recorded psychiatric hospitalizations and has baseline aggression and perseverative speech concerning for neurocognitive dysfunction. Mr. M receives multiple layers of support that assist him in continuing to receive both psychiatric and medical care, including subsidies for independent living, case management, and his sister, Ms. S, who acts as his primary caregiver and attends all appointments with him. Mr. M has had multiple risks of eviction in the context of psychiatric decompensation as a result of medication nonadherence. However, Ms. S, as his primary caregiver, has assisted Mr. M in not only adherence to medication but also by advocating for him at home and at medical appointments. While Ms. S has cited the emotional and psychological constraints of long-term caregiving, acknowledgement of caregiver burden and provision of psychosocial support has helped in reducing caregiver distress.</div></div><div><h3>Results</h3><div>The review of recent literature supports family caregiving as an important factor in promoting health in older adults while also providing best practice guidelines in how to mitigate caregiver burden and continue promoting patient health throughout the course of their psychiatric illness. These strategies are broadly categorized in three main groups: first, psychosocial interventions such as addressing information needs and providing communication and stress management skills; second, meditative interventions such as mindfulness-based cognitive therapy, acceptance and commitment therapy; third, physical activity interventions which promote psychological well-being [2]. Notably, evidence shows a reduct
{"title":"63. BEST PRACTICES IN FAMILY CAREGIVER SUPPORT OF THE MEDICALLY COMPLEX OLDER ADULT","authors":"Ethan Lau","doi":"10.1016/j.jagp.2025.04.065","DOIUrl":"10.1016/j.jagp.2025.04.065","url":null,"abstract":"<div><h3>Introduction</h3><div>Medically complex older adults in geriatric psychiatry often find themselves requiring additional layers of social support to access optimal care, including transportation to various medical appointments, housing support, and coordination of care between multiple specialties. Of particular importance is the need for psychosocial support in the form of close family, friends, and peers, especially since these key pillars of support tend to diminish with age. Preserving the wellbeing of these caregivers and mitigation of caregiver burden are among some of the major priorities in supporting these patients throughout their psychiatric care [1]. The purpose of this poster is to promote best practices in caregiver support and to raise awareness regarding the need for more research in this area.</div></div><div><h3>Methods</h3><div>This case focuses on Mr. M, a 69 yo male with a psychiatric history of schizophrenia and major depressive disorder with multiple medical comorbidities including malignant tumor of bladder currently undergoing chemotherapy. Patient’s clinical documents in our electronic medical records system were reviewed. A literature survey was performed on the topics of caregiver burden and strategies to alleviate this burden. Mr. M has had multiple suicide attempts in the past and four recorded psychiatric hospitalizations and has baseline aggression and perseverative speech concerning for neurocognitive dysfunction. Mr. M receives multiple layers of support that assist him in continuing to receive both psychiatric and medical care, including subsidies for independent living, case management, and his sister, Ms. S, who acts as his primary caregiver and attends all appointments with him. Mr. M has had multiple risks of eviction in the context of psychiatric decompensation as a result of medication nonadherence. However, Ms. S, as his primary caregiver, has assisted Mr. M in not only adherence to medication but also by advocating for him at home and at medical appointments. While Ms. S has cited the emotional and psychological constraints of long-term caregiving, acknowledgement of caregiver burden and provision of psychosocial support has helped in reducing caregiver distress.</div></div><div><h3>Results</h3><div>The review of recent literature supports family caregiving as an important factor in promoting health in older adults while also providing best practice guidelines in how to mitigate caregiver burden and continue promoting patient health throughout the course of their psychiatric illness. These strategies are broadly categorized in three main groups: first, psychosocial interventions such as addressing information needs and providing communication and stress management skills; second, meditative interventions such as mindfulness-based cognitive therapy, acceptance and commitment therapy; third, physical activity interventions which promote psychological well-being [2]. Notably, evidence shows a reduct","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S46-S47"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614133","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.2025.04.005
Shilpa Srinivasan , Brad Cole MBA FACMPE , James McMahon APRN , Takia Woods BA, CCHW , Amberly Osteen BS, CST , Alice Bruce MD , Leonardo Bonilha MD, PhD , Julius Fridriksson PhD
<div><h3>Introduction</h3><div>Approximately 6.9 million older Americans are living ith Alzheimer’s dementia (AD) and other dementias, ith prevalence increasing with age, affecting 5.0% of people ages 65-74 years, 13.2% of people ages 75-84 years, and 33.4% of people above age 85. While the diagnosis of Mild Cognitive Impairment (MCI) or dementia can facilitate access to treatment and interventions, delays in timely diagnosis, as well as coordination of care across caregivers and community resources serve as barriers, especially in primary care settings, where the majority of older adults receive their medical care. Such barriers include volume of primary care provider (PCP) visits with brief durations for each, lack of sufficient access to collateral informants, and variable confidence and expertise of PCPs to screen, diagnose and subsequently manage patients with cognitive disorders. With the advent of biomarkers for detection, disease-modifying therapies for the treatment of MCI and AD, and the growing focus on prevention and health promotion in midlife, responding to innovative approaches in diagnostics and therapeutics is a critical yet imminent challenge for PCPs and dementia specialists.</div><div>In response to these challenges and needs, the University of South Carolina (USC) Brain Health Network (BHN) was developed as a permanent, State-funded initiative with the main mission of ensuring statewide access to advanced, collaborative cognitive care, and to provide community support throughout South Carolina. Responding to needs assessment and focus groups of caregivers statewide, the BHN represents a collaborative, interdisciplinary partnership with health system providers (Primary Care, Geriatric Psychiatry, Neurology, etc.) to set up a seamless and integrated process to support front-line providers (PCPs) and aim to ensure persons with Alzheimer’s Disease and Related Dementias (ADRD) and their caregivers receive support and obtain a clear understanding of their health care system and care navigation in their community.</div><div>This poster describes the development and operational processes of the BHN, highlighting the interdisciplinary aspects of dementia care, as well as the interprofessional role of community health workers (CHW), through relationships with organizations and formal partnerships with the Alzheimer's Association and the Area Agency on Aging/Council of Government, including Area Agency on Aging departments statewide, to facilitate patient engagement and caregiver support state-wide to promote health and enhance care navigation across the continuum of dementia care.</div></div><div><h3>Methods</h3><div>The BHN partners with health systems to achieve 3 main goals: (1) provide greater access and coordinated care for patients and caregivers, (2) provide further support and education for individuals diagnosed (and their caregivers), and (3) provide access to innovations in treatment and diagnostics, especially in under-serve
{"title":"2. GOING FURTHER TOGETHER: INTERDISCIPLINARY, COLLABORATIVE UNIVERSITY OF SOUTH CAROLINA BRAIN HEALTH NETWORK TO EMPOWER PATIENT-CENTERED APPROACHES TO INNOVATIVE DEMENTIA CARE","authors":"Shilpa Srinivasan , Brad Cole MBA FACMPE , James McMahon APRN , Takia Woods BA, CCHW , Amberly Osteen BS, CST , Alice Bruce MD , Leonardo Bonilha MD, PhD , Julius Fridriksson PhD","doi":"10.1016/j.jagp.2025.04.005","DOIUrl":"10.1016/j.jagp.2025.04.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Approximately 6.9 million older Americans are living ith Alzheimer’s dementia (AD) and other dementias, ith prevalence increasing with age, affecting 5.0% of people ages 65-74 years, 13.2% of people ages 75-84 years, and 33.4% of people above age 85. While the diagnosis of Mild Cognitive Impairment (MCI) or dementia can facilitate access to treatment and interventions, delays in timely diagnosis, as well as coordination of care across caregivers and community resources serve as barriers, especially in primary care settings, where the majority of older adults receive their medical care. Such barriers include volume of primary care provider (PCP) visits with brief durations for each, lack of sufficient access to collateral informants, and variable confidence and expertise of PCPs to screen, diagnose and subsequently manage patients with cognitive disorders. With the advent of biomarkers for detection, disease-modifying therapies for the treatment of MCI and AD, and the growing focus on prevention and health promotion in midlife, responding to innovative approaches in diagnostics and therapeutics is a critical yet imminent challenge for PCPs and dementia specialists.</div><div>In response to these challenges and needs, the University of South Carolina (USC) Brain Health Network (BHN) was developed as a permanent, State-funded initiative with the main mission of ensuring statewide access to advanced, collaborative cognitive care, and to provide community support throughout South Carolina. Responding to needs assessment and focus groups of caregivers statewide, the BHN represents a collaborative, interdisciplinary partnership with health system providers (Primary Care, Geriatric Psychiatry, Neurology, etc.) to set up a seamless and integrated process to support front-line providers (PCPs) and aim to ensure persons with Alzheimer’s Disease and Related Dementias (ADRD) and their caregivers receive support and obtain a clear understanding of their health care system and care navigation in their community.</div><div>This poster describes the development and operational processes of the BHN, highlighting the interdisciplinary aspects of dementia care, as well as the interprofessional role of community health workers (CHW), through relationships with organizations and formal partnerships with the Alzheimer's Association and the Area Agency on Aging/Council of Government, including Area Agency on Aging departments statewide, to facilitate patient engagement and caregiver support state-wide to promote health and enhance care navigation across the continuum of dementia care.</div></div><div><h3>Methods</h3><div>The BHN partners with health systems to achieve 3 main goals: (1) provide greater access and coordinated care for patients and caregivers, (2) provide further support and education for individuals diagnosed (and their caregivers), and (3) provide access to innovations in treatment and diagnostics, especially in under-serve","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S1-S3"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614360","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.2025.04.020
Amy Grooms , Margaret May-Martin , Lou Ann Eads , George James , Laura Dunn
<div><h3>Introduction</h3><div>Among older adults with major depressive disorder who receive pharmacologic treatment, it has been estimated that at least one-third do not respond to at least two adequate trials of antidepressants—i.e., the definition of treatment-resistant depression currently used by the FDA when considering indications for new therapies. Although electroconvulsive therapy (ECT) is a highly effective intervention for severe depression or depression with psychotic features, its use in older adults can be limited due to concerns for adverse side effects, including anterograde and retrograde amnesia, and increased risks in individuals with cardiovascular or neurologic comorbidities.</div><div>Repetitive transcranial magnetic stimulation (rTMS), particularly in the form of intermittent theta-burst stimulation (iTBS), has emerged as a promising non-invasive alternative for treatment of depression. The novel Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) protocol, which recently received FDA clearance, consists of ten daily high-dose sessions of iTBS targeting the left dorsolateral prefrontal cortex (DLPFC), which enables treatment time to be condensed into five days, rather than the typical four to six week course of conventional rTMS. The protocol also utilizes functional connectivity (fcMRI)-guided, personalized, algorithmic targeting of the region of the left DLPFC that is identified as being the most anticorrelated with the subgenual anterior cingulate cortex.</div><div>In the initial clinical trials, the SAINT protocol demonstrated impressive results, with over 80% of patients achieving remission in the open-label trial, and 50-80% meeting remission criteria at some point during the four week follow-up period in the randomized sham-controlled trial. However, studies evaluating the efficacy of SAINT in the geriatric population remain absent. Furthermore, real-world patient populations need to be treated to better gauge the effectiveness of this treatment outside of clinical trials.</div></div><div><h3>Methods</h3><div>The University of Arkansas for Medical Sciences (UAMS), through its Interventional Psychiatry Program, was the first site in the United States to offer SAINT to patients in a clinical setting. We received patient referrals from all over the United States, as well as, locally, with the majority being self-referrals. After a comprehensive psychiatric evaluation, patients were offered SAINT TMS if they met criteria for treatment resistant MDD without psychotic features and had no contraindications for the MRI or procedure. A resting-state fMRI was obtained for each patient in the Brain Research Institute housed within the psychiatry department at UAMS. The fMRI data was then uploaded to Magnus Medical to develop a personalized treatment target within the left DLPFC for each patient.</div><div>Each patient received ten sessions a day for 5 consecutive days. Each session lasted 10min and there was a min
{"title":"17. SAINT FOR TREATMENT-RESISTANT DEPRESSION: REAL WORLD FINDINGS","authors":"Amy Grooms , Margaret May-Martin , Lou Ann Eads , George James , Laura Dunn","doi":"10.1016/j.jagp.2025.04.020","DOIUrl":"10.1016/j.jagp.2025.04.020","url":null,"abstract":"<div><h3>Introduction</h3><div>Among older adults with major depressive disorder who receive pharmacologic treatment, it has been estimated that at least one-third do not respond to at least two adequate trials of antidepressants—i.e., the definition of treatment-resistant depression currently used by the FDA when considering indications for new therapies. Although electroconvulsive therapy (ECT) is a highly effective intervention for severe depression or depression with psychotic features, its use in older adults can be limited due to concerns for adverse side effects, including anterograde and retrograde amnesia, and increased risks in individuals with cardiovascular or neurologic comorbidities.</div><div>Repetitive transcranial magnetic stimulation (rTMS), particularly in the form of intermittent theta-burst stimulation (iTBS), has emerged as a promising non-invasive alternative for treatment of depression. The novel Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) protocol, which recently received FDA clearance, consists of ten daily high-dose sessions of iTBS targeting the left dorsolateral prefrontal cortex (DLPFC), which enables treatment time to be condensed into five days, rather than the typical four to six week course of conventional rTMS. The protocol also utilizes functional connectivity (fcMRI)-guided, personalized, algorithmic targeting of the region of the left DLPFC that is identified as being the most anticorrelated with the subgenual anterior cingulate cortex.</div><div>In the initial clinical trials, the SAINT protocol demonstrated impressive results, with over 80% of patients achieving remission in the open-label trial, and 50-80% meeting remission criteria at some point during the four week follow-up period in the randomized sham-controlled trial. However, studies evaluating the efficacy of SAINT in the geriatric population remain absent. Furthermore, real-world patient populations need to be treated to better gauge the effectiveness of this treatment outside of clinical trials.</div></div><div><h3>Methods</h3><div>The University of Arkansas for Medical Sciences (UAMS), through its Interventional Psychiatry Program, was the first site in the United States to offer SAINT to patients in a clinical setting. We received patient referrals from all over the United States, as well as, locally, with the majority being self-referrals. After a comprehensive psychiatric evaluation, patients were offered SAINT TMS if they met criteria for treatment resistant MDD without psychotic features and had no contraindications for the MRI or procedure. A resting-state fMRI was obtained for each patient in the Brain Research Institute housed within the psychiatry department at UAMS. The fMRI data was then uploaded to Magnus Medical to develop a personalized treatment target within the left DLPFC for each patient.</div><div>Each patient received ten sessions a day for 5 consecutive days. Each session lasted 10min and there was a min","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S13-S14"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614464","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.2025.04.009
Jack Kaufman , Sara Weisnebach
<div><h3>Introduction</h3><div>The presence of childhood trauma in the geriatric population is as high, if not higher than those in middle age or young adulthood, where many estimates range from 15-45%. This is likely especially true among those with history of depression (LLD). Still, geriatricians, psychiatrists, and psychologists often remain focused on the acute aspects of worsening mood and possible depression tied to typical aging (e.g., functional limitations, declining physical health, and interpersonal losses, etc.) neglecting two important aspects of a person’s depressive past and current presentation: childhood trauma and baseline personality characteristics. We sought to investigate if, and to what extent, neuroticism – the personality variable most implicated in psychopathology – and childhood trauma relate to a person’s history of depression.</div></div><div><h3>Methods</h3><div>99 adults aged 55-79 (M age = 65, SD = 6.5) were administered the Structured Clinical Interview for DSM-5 (SCID-5) and categorized as 61 never-depressed (N-DEP) and 38 with at least one depressive episode (DEP) with a first onset before the age of 35 (including active and remitted). All participants were administered the NEO Personality Inventory (NEO-PI) and the Childhood Trauma Questionnaire (CTQ). There were two primary outcomes: to describe the prevalence and make-up of childhood trauma in a sample of older adults and to investigate its relationship with personality variables to an individual’s history of depression. Exploratory analyses were conducted to see if the type of childhood trauma uniquely predicted depressive episodes. Linear mixed models, including hierarchical regression were used to for this analysis and were adjusted for age, sex, and education.</div></div><div><h3>Results</h3><div>In our sample with a majority of never-depressed participants, 54% scored over 35, the typical threshold for clinical significance on the CTQ, with the sexual abuse subscale receiving the lowest amount of suprathreshold scores (22%) and emotional neglect being the highest amount (55%). Further, when comparing between N-DEP and DEP groups, we found nearly three and a half times as much emotional abuse and nearly three times as much physical abuse in the DEP group. Neuroticism facet scores (entered in the second block) were predictive of depression history (p LESS THAN .001), but childhood trauma scores (entered in the third block) were not. Finally, of the five subscales, only emotional abuse was a significant contributor to the model (block three, replacing overall CTQ scores; p = 01) when entered in their own model steps.</div></div><div><h3>Conclusions</h3><div>The majority of the sample reporting scores considered clinically meaningful confirmed our hypothesis that these experiences are likely more common than previously suspected. Further, our results highlight the importance of giving trait-based variables – principally, the facet of personality labeled neu
{"title":"6. LATENT ASPECTS OF LATE-LIFE DEPRESSION: EXPLORING THE ROLE OF CHILDHOOD TRAUMA AND PERSONALITY","authors":"Jack Kaufman , Sara Weisnebach","doi":"10.1016/j.jagp.2025.04.009","DOIUrl":"10.1016/j.jagp.2025.04.009","url":null,"abstract":"<div><h3>Introduction</h3><div>The presence of childhood trauma in the geriatric population is as high, if not higher than those in middle age or young adulthood, where many estimates range from 15-45%. This is likely especially true among those with history of depression (LLD). Still, geriatricians, psychiatrists, and psychologists often remain focused on the acute aspects of worsening mood and possible depression tied to typical aging (e.g., functional limitations, declining physical health, and interpersonal losses, etc.) neglecting two important aspects of a person’s depressive past and current presentation: childhood trauma and baseline personality characteristics. We sought to investigate if, and to what extent, neuroticism – the personality variable most implicated in psychopathology – and childhood trauma relate to a person’s history of depression.</div></div><div><h3>Methods</h3><div>99 adults aged 55-79 (M age = 65, SD = 6.5) were administered the Structured Clinical Interview for DSM-5 (SCID-5) and categorized as 61 never-depressed (N-DEP) and 38 with at least one depressive episode (DEP) with a first onset before the age of 35 (including active and remitted). All participants were administered the NEO Personality Inventory (NEO-PI) and the Childhood Trauma Questionnaire (CTQ). There were two primary outcomes: to describe the prevalence and make-up of childhood trauma in a sample of older adults and to investigate its relationship with personality variables to an individual’s history of depression. Exploratory analyses were conducted to see if the type of childhood trauma uniquely predicted depressive episodes. Linear mixed models, including hierarchical regression were used to for this analysis and were adjusted for age, sex, and education.</div></div><div><h3>Results</h3><div>In our sample with a majority of never-depressed participants, 54% scored over 35, the typical threshold for clinical significance on the CTQ, with the sexual abuse subscale receiving the lowest amount of suprathreshold scores (22%) and emotional neglect being the highest amount (55%). Further, when comparing between N-DEP and DEP groups, we found nearly three and a half times as much emotional abuse and nearly three times as much physical abuse in the DEP group. Neuroticism facet scores (entered in the second block) were predictive of depression history (p LESS THAN .001), but childhood trauma scores (entered in the third block) were not. Finally, of the five subscales, only emotional abuse was a significant contributor to the model (block three, replacing overall CTQ scores; p = 01) when entered in their own model steps.</div></div><div><h3>Conclusions</h3><div>The majority of the sample reporting scores considered clinically meaningful confirmed our hypothesis that these experiences are likely more common than previously suspected. Further, our results highlight the importance of giving trait-based variables – principally, the facet of personality labeled neu","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S5"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613896","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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