Pub Date : 2025-07-14DOI: 10.1016/j.jagp.2025.04.017
Ryan Pate , Christine Gould , Ira Yenko , Maryam Makowski , Oceanna Li , Vanessa Silva , Feng Vankee Lin , Dolores Gallagher-Thompson , Erin Cassidy-Eagle
<div><h3>Introduction</h3><div>The number of older adults seeking psychiatric care is increasing exponentially and the pressure is on to create interventions that can increase the access of support for older adults and reach as many patients as possible. Positive psychological interventions that focus on the psychological wellbeing of older adults present an opportunity to address a range of factors that can impact the lives of older adults. Group interventions foster social connections while reducing cost and limited access to clinicians; the overall aim of this project was to conduct a program evaluation of an innovative, rotating psychological wellness group for older adults. In keeping with this, a needs assessment of patient values and priorities, including the What Matters Most tool, in older adults was performed.</div></div><div><h3>Methods</h3><div>This program includes a psychological wellness group offering for older adults with 8 modules covering a collection of topics that support optimal psychological wellness and promote health and resilience (i.e. digital tools and mobile apps, value-based behavioral activation to improve your mood, eating for a healthy brain, caring for the caregiver, introduction to mindfulness, improving your sleep, physical activity and strategies for managing anxiety) that are held weekly, ranging in duration from 2-4 weeks, over a 7 month period. Participants were referred from outpatient psychiatry clinics, geriatric medicine providers in medical center, and local community organizations servicing older adults. To be included, patients had to be 65+ years old, English speaking, open to group treatment, and without a diagnosis of dementia. Once participants were triaged and selected, a questionnaire was sent that addressed multiple aspects of their past medical history as well as their personal values and goals of care, prompting patients to identify what matters most to them in the domains of functionality, enjoyment, and connectivity as well as an open text question allowing them to expand on which three goals matter the most above all.</div></div><div><h3>Results</h3><div>Older adults (N=19) were enrolled in the psychological wellness group, including 9 males and 10 females. Nine of the participants reported that they lived alone. Survey results indicated that older adults greatly prioritize maintaining cognitive status as their greatest health priority. The perceived importance of maintaining social connectivity via relationships with family and friends was rated equally if not higher than several aspects of physical functionality. The following representative direct patient quotes encapsulate this sentiment well with one subject’s list “1. Connecting deeply with people. 2. Having confidence I can handle whatever comes my way. 3. I’d like to remove the fear that currently has a grip on me so that I am comfortable getting out and about without anxiety.” “[Be] able to take care of myself, have a clear mind
{"title":"14. VALUES AND PRIORITIES OF OLDER ADULTS: CREATING COLLABORATIVE GOALS IN PSYCHIATRIC CARE","authors":"Ryan Pate , Christine Gould , Ira Yenko , Maryam Makowski , Oceanna Li , Vanessa Silva , Feng Vankee Lin , Dolores Gallagher-Thompson , Erin Cassidy-Eagle","doi":"10.1016/j.jagp.2025.04.017","DOIUrl":"10.1016/j.jagp.2025.04.017","url":null,"abstract":"<div><h3>Introduction</h3><div>The number of older adults seeking psychiatric care is increasing exponentially and the pressure is on to create interventions that can increase the access of support for older adults and reach as many patients as possible. Positive psychological interventions that focus on the psychological wellbeing of older adults present an opportunity to address a range of factors that can impact the lives of older adults. Group interventions foster social connections while reducing cost and limited access to clinicians; the overall aim of this project was to conduct a program evaluation of an innovative, rotating psychological wellness group for older adults. In keeping with this, a needs assessment of patient values and priorities, including the What Matters Most tool, in older adults was performed.</div></div><div><h3>Methods</h3><div>This program includes a psychological wellness group offering for older adults with 8 modules covering a collection of topics that support optimal psychological wellness and promote health and resilience (i.e. digital tools and mobile apps, value-based behavioral activation to improve your mood, eating for a healthy brain, caring for the caregiver, introduction to mindfulness, improving your sleep, physical activity and strategies for managing anxiety) that are held weekly, ranging in duration from 2-4 weeks, over a 7 month period. Participants were referred from outpatient psychiatry clinics, geriatric medicine providers in medical center, and local community organizations servicing older adults. To be included, patients had to be 65+ years old, English speaking, open to group treatment, and without a diagnosis of dementia. Once participants were triaged and selected, a questionnaire was sent that addressed multiple aspects of their past medical history as well as their personal values and goals of care, prompting patients to identify what matters most to them in the domains of functionality, enjoyment, and connectivity as well as an open text question allowing them to expand on which three goals matter the most above all.</div></div><div><h3>Results</h3><div>Older adults (N=19) were enrolled in the psychological wellness group, including 9 males and 10 females. Nine of the participants reported that they lived alone. Survey results indicated that older adults greatly prioritize maintaining cognitive status as their greatest health priority. The perceived importance of maintaining social connectivity via relationships with family and friends was rated equally if not higher than several aspects of physical functionality. The following representative direct patient quotes encapsulate this sentiment well with one subject’s list “1. Connecting deeply with people. 2. Having confidence I can handle whatever comes my way. 3. I’d like to remove the fear that currently has a grip on me so that I am comfortable getting out and about without anxiety.” “[Be] able to take care of myself, have a clear mind ","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S10-S11"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613904","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.2025.04.047
Sadeq Kawsar , Katharine Brewster , Mark Nathanson , Margaret Hamilton , Mahfuzur Rahman
Introduction
There is a national shortage of psychiatrists in the field of geriatric psychiatry, particularly in underserved areas. The main goals of the New York Statewide / Columbia University Geriatric Psychiatry Fellowship are to 1) develop geriatric psychiatrists who are national leaders; (2) disseminate expertise in geriatric psychiatry to underserved urban and rural areas; and (3) foster the development of a geriatric mental health workforce in NY State.
The program provides educational experiences in a variety of academic and federally designated medically underserved urban and rural settings, from its academic base at the Columbia University Irving Medical Center to hospital centers in underserved areas such as Greater Binghamton Health Center and Rockland Psychiatric Center. All fellows, in both the NYC and Binghamton tracks, rotate at a wide range of clinical sites in NYC, Upstate NY, and Rockland County and have been entitled to many resources. However, while the NYC track consistently fills its fellowship slots, our Upstate NY track is often underfilled. We hypothesize that the diversity of training opportunities in the program and availability of many academic and clinical resources are a main draw to the fellowship Columbia Geriatric Psychiatry Fellowship, but we do not know whether completion of the fellowship has helped contribute to a geriatric mental health workforce and developed leaders in the field of geriatric psychiatry in NY State. The survey also asks about graduates’ experiences in the fellowship and suggestions to improve recruitment into rural fellowship programs nationwide.
Methods
We have identified over 30 email addresses of graduates of the Columbia Geriatric Psychiatry Fellowship since 2001 and we aim to send out a 12-question confidential survey to the fellowship graduates asking about their experience in the fellowship, how it has influenced their career trajectory, as well as their current work settings and patient population.
Results
We have developed the 12-question survey, and we aim to send it out to fellowship graduates after receiving IRB approval. We will send the survey out in December 2024, collect all data by January 2025, and publish the results in March 2025 for the AAGP annual meeting.
Conclusions
We will hypothesize if the fellowship’s unique collaboration between an urban academic medical center and rural state-run hospitals, working with underserved population in NY State, utilization of resources and teach geriatric psychiatry to a wide range of learners has helped facilitate leadership opportunities in geriatric psychiatry in the United States.
{"title":"45. DEVELOPING NATIONAL LEADERS IN GERIATRIC PSYCHIATRY WORKFORCE; A SURVEY OF GERIATRIC PSYCHIATRY. FELLOWSHIP GRADUATES WHO WERE TRAINED IN UNDERSERVED AREAS OF NEW YORK STATE.","authors":"Sadeq Kawsar , Katharine Brewster , Mark Nathanson , Margaret Hamilton , Mahfuzur Rahman","doi":"10.1016/j.jagp.2025.04.047","DOIUrl":"10.1016/j.jagp.2025.04.047","url":null,"abstract":"<div><h3>Introduction</h3><div>There is a national shortage of psychiatrists in the field of geriatric psychiatry, particularly in underserved areas. The main goals of the New York Statewide / Columbia University Geriatric Psychiatry Fellowship are to 1) develop geriatric psychiatrists who are national leaders; (2) disseminate expertise in geriatric psychiatry to underserved urban and rural areas; and (3) foster the development of a geriatric mental health workforce in NY State.</div><div>The program provides educational experiences in a variety of academic and federally designated medically underserved urban and rural settings, from its academic base at the Columbia University Irving Medical Center to hospital centers in underserved areas such as Greater Binghamton Health Center and Rockland Psychiatric Center. All fellows, in both the NYC and Binghamton tracks, rotate at a wide range of clinical sites in NYC, Upstate NY, and Rockland County and have been entitled to many resources. However, while the NYC track consistently fills its fellowship slots, our Upstate NY track is often underfilled. We hypothesize that the diversity of training opportunities in the program and availability of many academic and clinical resources are a main draw to the fellowship Columbia Geriatric Psychiatry Fellowship, but we do not know whether completion of the fellowship has helped contribute to a geriatric mental health workforce and developed leaders in the field of geriatric psychiatry in NY State. The survey also asks about graduates’ experiences in the fellowship and suggestions to improve recruitment into rural fellowship programs nationwide.</div></div><div><h3>Methods</h3><div>We have identified over 30 email addresses of graduates of the Columbia Geriatric Psychiatry Fellowship since 2001 and we aim to send out a 12-question confidential survey to the fellowship graduates asking about their experience in the fellowship, how it has influenced their career trajectory, as well as their current work settings and patient population.</div></div><div><h3>Results</h3><div>We have developed the 12-question survey, and we aim to send it out to fellowship graduates after receiving IRB approval. We will send the survey out in December 2024, collect all data by January 2025, and publish the results in March 2025 for the AAGP annual meeting.</div></div><div><h3>Conclusions</h3><div>We will hypothesize if the fellowship’s unique collaboration between an urban academic medical center and rural state-run hospitals, working with underserved population in NY State, utilization of resources and teach geriatric psychiatry to a wide range of learners has helped facilitate leadership opportunities in geriatric psychiatry in the United States.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S33-S34"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613906","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.2025.04.030
Leslie Citrome , Sanjeda R. Chumki , Pedro Such , David Wang , Anton M. Palma , Zhen Zhang , Alireza Atri , Alireza Atri
<div><h3>Introduction</h3><div>Agitation is a prevalent, highly distressing and burdensome neuropsychiatric symptom of Alzheimer’s disease. In this vulnerable patient population, it is especially critical to maximize benefits, minimize risks, and understand expected treatment outcomes. This analysis delineates the clinical benefit and risk profile of brexpiprazole in patients with agitation associated with dementia due to Alzheimer’s disease, using number needed to treat (NNT), number needed to harm (NNH), and likelihood to be helped or harmed (LHH).</div></div><div><h3>Methods</h3><div>Data are pooled from two fixed-dose pivotal clinical trials of brexpiprazole in patients with agitation associated with dementia due to Alzheimer’s disease (NCT01862640 [Trial 283], NCT03548584 [Trial 213]), and analyzed for brexpiprazole 2 or 3 mg/day (FDA-approved recommended-to-maximum dose) versus placebo. In both trials, the Cohen-Mansfield Agitation Inventory (CMAI) was the primary efficacy measure. For this post hoc analysis, the main efficacy outcome was agitation response rate, defined as ≥20-point reduction in CMAI Total score from baseline to Week 12. Previous analyses indicate that a 20-point within-person CMAI reduction reflects a clinically meaningful benefit in this population. The main safety outcome was incidence of discontinuation due to treatment-emergent adverse events (TEAEs). Other efficacy and safety outcomes were also analyzed. For the identified outcomes, NNT, NNH and LHH were calculated. NNT and NNH indicate how many patients would need to be treated with brexpiprazole versus placebo in order for one additional patient to experience a benefit (NNT) or a harm (NNH). LHH is the ratio of NNH to NNT. Lower NNT values, and higher NNH and LHH values, are more supportive of brexpiprazole versus placebo.</div></div><div><h3>Results</h3><div>Response rates (≥20-point CMAI Total reduction) were 50.1% (182/363) for brexpiprazole, and 37.7% (93/247) for placebo, yielding a NNT of 9 (95% confidence internal [CI]: 5, 22). The incidence of discontinuation due to TEAEs was 4.9% (18/366) for brexpiprazole, and 4.8% (12/251) for placebo, yielding a NNH of 730 (95% CI: not significant). Together, these specific outcomes result in a LHH of 81.</div></div><div><h3>Conclusions</h3><div>Brexpiprazole is 81 times more likely to result in treatment response (as defined by a ≥20-point reduction in CMAI Total score) than discontinuation because of a TEAE. This analysis provides meaningful clinical interpretation of benefits and risks of brexpiprazole in patients with agitation associated with dementia due to Alzheimer’s disease. These data expand the evidence-base for brexpiprazole, and underscore the favorable efficacy and safety profile that supports the use of brexpiprazole in this patient population.</div><div>This abstract was submitted at the late-breaker deadline to allow sufficient time to discuss the methodology, and ultimately ensure that clinically relev
{"title":"28. BREXPIPRAZOLE FOR AGITATION ASSOCIATED WITH DEMENTIA DUE TO ALZHEIMER’S DISEASE: NUMBER NEEDED TO TREAT, NUMBER NEEDED TO HARM, AND LIKELIHOOD TO BE HELPED OR HARMED","authors":"Leslie Citrome , Sanjeda R. Chumki , Pedro Such , David Wang , Anton M. Palma , Zhen Zhang , Alireza Atri , Alireza Atri","doi":"10.1016/j.jagp.2025.04.030","DOIUrl":"10.1016/j.jagp.2025.04.030","url":null,"abstract":"<div><h3>Introduction</h3><div>Agitation is a prevalent, highly distressing and burdensome neuropsychiatric symptom of Alzheimer’s disease. In this vulnerable patient population, it is especially critical to maximize benefits, minimize risks, and understand expected treatment outcomes. This analysis delineates the clinical benefit and risk profile of brexpiprazole in patients with agitation associated with dementia due to Alzheimer’s disease, using number needed to treat (NNT), number needed to harm (NNH), and likelihood to be helped or harmed (LHH).</div></div><div><h3>Methods</h3><div>Data are pooled from two fixed-dose pivotal clinical trials of brexpiprazole in patients with agitation associated with dementia due to Alzheimer’s disease (NCT01862640 [Trial 283], NCT03548584 [Trial 213]), and analyzed for brexpiprazole 2 or 3 mg/day (FDA-approved recommended-to-maximum dose) versus placebo. In both trials, the Cohen-Mansfield Agitation Inventory (CMAI) was the primary efficacy measure. For this post hoc analysis, the main efficacy outcome was agitation response rate, defined as ≥20-point reduction in CMAI Total score from baseline to Week 12. Previous analyses indicate that a 20-point within-person CMAI reduction reflects a clinically meaningful benefit in this population. The main safety outcome was incidence of discontinuation due to treatment-emergent adverse events (TEAEs). Other efficacy and safety outcomes were also analyzed. For the identified outcomes, NNT, NNH and LHH were calculated. NNT and NNH indicate how many patients would need to be treated with brexpiprazole versus placebo in order for one additional patient to experience a benefit (NNT) or a harm (NNH). LHH is the ratio of NNH to NNT. Lower NNT values, and higher NNH and LHH values, are more supportive of brexpiprazole versus placebo.</div></div><div><h3>Results</h3><div>Response rates (≥20-point CMAI Total reduction) were 50.1% (182/363) for brexpiprazole, and 37.7% (93/247) for placebo, yielding a NNT of 9 (95% confidence internal [CI]: 5, 22). The incidence of discontinuation due to TEAEs was 4.9% (18/366) for brexpiprazole, and 4.8% (12/251) for placebo, yielding a NNH of 730 (95% CI: not significant). Together, these specific outcomes result in a LHH of 81.</div></div><div><h3>Conclusions</h3><div>Brexpiprazole is 81 times more likely to result in treatment response (as defined by a ≥20-point reduction in CMAI Total score) than discontinuation because of a TEAE. This analysis provides meaningful clinical interpretation of benefits and risks of brexpiprazole in patients with agitation associated with dementia due to Alzheimer’s disease. These data expand the evidence-base for brexpiprazole, and underscore the favorable efficacy and safety profile that supports the use of brexpiprazole in this patient population.</div><div>This abstract was submitted at the late-breaker deadline to allow sufficient time to discuss the methodology, and ultimately ensure that clinically relev","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S20"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613979","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.2025.04.039
Oluranti Omolara Babalola , Adebobola Imeh-Nathaniel (PhD) , Addison Niles (MD) , Richard L. Goodwin (PhD) , Laurie Theriot Roley (MD) , Ohmar Win (MD) , Thomas I. Nathaniel (PhD)
Introduction
Despite tauhe significant burden of Alzheimer's Dementia (AD) with Normal Pressure Hydrocephalus (NPH) and Mild Cognitive Impairment (MCI), placed on the aging population, their loved ones, and healthcare systems, these conditions remain under-researched. The overlap of NPH and MCI symptoms in persons with AD presents challenges for diagnosis, however, timely and effective management of these comorbidities can help prevent the progression to severe dementia. This study aims to examine the relationship between sociodemographic factors and psychotropic medication use in AD patients diagnosed with NPH and MCI, using the Social Determinants of Health (SDH) model.
Methods
The study analyzed 33,735 patients diagnosed with MCI (n=33,064) or NPH (n=671) between February 2016 and August 2021 at Prisma Health-Upstate South Carolina. Multivariable logistic regression identified key factors associated with NPH and MCI, including age, race, and medication use.
Results
NPH patients were older (69.38 ± 16.42 vs. 63.19 ± 21.78 years) and predominantly White (92.1% vs. 80.7%). Tobacco use (OR = 1.175, 95% CI, 1.004-1.375) and buspirone use (OR = 1.415, 95% CI, 1.116-1.794) were positively associated with NPH while being Black (OR = 0.388, 95% CI, 0.277-0.542) and risperidone use (OR = 0.217, 95% CI, 0.103-0.459) were associated with MCI. Sex-stratified analyses revealed that men with NPH were more likely to use SSRIs, while women were more likely to use memantine and buspirone.
Conclusions
The SDH framework highlighted disparities in diagnosis, revealing that White patients with AD are more likely to be diagnosed with NPH, potentially due to better access to healthcare. These findings emphasize the need for targeted interventions that address social factors, improve access to psychotropic medications, and reduce healthcare disparities to enhance outcomes for AD patients with NPH and MCI.
{"title":"37. EXAMINING PSYCHOTROPIC MEDICATION, SOCIAL FACTORS, NORMAL PRESSURE HYDROCEPHALUS AND MILD COGNITIVE IMPAIRMENT IN PATIENTS WITH ALZHEIMER DEMENTIA: A RETROSPECTIVE COHORT ANALYSIS.","authors":"Oluranti Omolara Babalola , Adebobola Imeh-Nathaniel (PhD) , Addison Niles (MD) , Richard L. Goodwin (PhD) , Laurie Theriot Roley (MD) , Ohmar Win (MD) , Thomas I. Nathaniel (PhD)","doi":"10.1016/j.jagp.2025.04.039","DOIUrl":"10.1016/j.jagp.2025.04.039","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite tauhe significant burden of Alzheimer's Dementia (AD) with Normal Pressure Hydrocephalus (NPH) and Mild Cognitive Impairment (MCI), placed on the aging population, their loved ones, and healthcare systems, these conditions remain under-researched. The overlap of NPH and MCI symptoms in persons with AD presents challenges for diagnosis, however, timely and effective management of these comorbidities can help prevent the progression to severe dementia. This study aims to examine the relationship between sociodemographic factors and psychotropic medication use in AD patients diagnosed with NPH and MCI, using the Social Determinants of Health (SDH) model.</div></div><div><h3>Methods</h3><div>The study analyzed 33,735 patients diagnosed with MCI (n=33,064) or NPH (n=671) between February 2016 and August 2021 at Prisma Health-Upstate South Carolina. Multivariable logistic regression identified key factors associated with NPH and MCI, including age, race, and medication use.</div></div><div><h3>Results</h3><div>NPH patients were older (69.38 ± 16.42 vs. 63.19 ± 21.78 years) and predominantly White (92.1% vs. 80.7%). Tobacco use (OR = 1.175, 95% CI, 1.004-1.375) and buspirone use (OR = 1.415, 95% CI, 1.116-1.794) were positively associated with NPH while being Black (OR = 0.388, 95% CI, 0.277-0.542) and risperidone use (OR = 0.217, 95% CI, 0.103-0.459) were associated with MCI. Sex-stratified analyses revealed that men with NPH were more likely to use SSRIs, while women were more likely to use memantine and buspirone.</div></div><div><h3>Conclusions</h3><div>The SDH framework highlighted disparities in diagnosis, revealing that White patients with AD are more likely to be diagnosed with NPH, potentially due to better access to healthcare. These findings emphasize the need for targeted interventions that address social factors, improve access to psychotropic medications, and reduce healthcare disparities to enhance outcomes for AD patients with NPH and MCI.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S27"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614141","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.2025.04.103
Vivek Mathesh , Kayla Murphy , Mashal Ali , Christopher Clark , Natalie Provenzale , Abhisek Khandai , Mustafa Husain
Introduction
Background: It is estimated that only 1/3rd of US adults will detail an Advance Directive in their lifetime. Advance directive completion is associated with a decreased risk of hospitalization, higher concordance between the individual’s end-of-life wishes with the provided care, and amelioration of the caregiver’s stress (Sedini et al., 2022). However, little is known about the intersection of psychiatric diagnoses, including neurocognitive disorders, on MAD usage. Thus, the goal of this study is to establish a robust framework on MAD usage through a novel EMR analysis of a large metroplex city population and elucidate how the adoption of MADs is influenced by psychiatric diagnoses.
Methods
Methods: A retrospective analysis of electronic record encounters for all adults (age > = 18 years) with a 2022 inpatient admission (n = 41,421) at Parkland Memorial hospital was conducted. To identify the presence of an Advance Directive, these records were queried for attachments with MAD-related titles. MAD adoption rates among patients with and without psychiatric diagnoses were compared.
Results
Results: 41,421 patients were included in the study (age= 43.75 ± 17.53 years, mean ± SD) from which 15,143 patients identified as male, and 26,278 patients identified as female. Across all patients, the adoption of medical advance directives was 8.75%. Among those who had a psychiatric diagnosis, 14.0% of patients utilized a form of advance directive while, among those who did not have a psychiatric diagnosis, only 6.1% had an advance directive (p < 0.001). Compared to the population without a psychiatric diagnosis, those that had diagnoses related to neurocognitive disorders had a 25.7% higher use rate of advance directives (p < 0.001). Similarly, comparing patients from other psychiatric disorder groups to the general population, the Anxiety/Depression, Substance Use Disorder, and Schizophrenia/Bipolar, had a 17.6%, 11.7%, and 10.5% increase in MAD usage, respectively (p < 0.001 for all three comparisons).
Conclusions
Conclusion: Despite known healthcare disparities for patients with psychiatric disorders, our results indicated that MAD usage is greater amongst those who have a psychiatric diagnosis compared to patients who do not. In particular, patients with neurocognitive disorders had higher rates of MAD usage, especially in comparison to patients with other psychiatric diagnoses. Further studies will investigate the potential confounding effects of age, race, and gender on MAD usage in patients with psychiatric comorbidities. Particularly given the health disparities faced by patients with neurocognitive disorders and other psychiatric diagnoses, medical centers must create systems-level interventions to promote inclusive and empowering MAD usage amongst older adults.
{"title":"101. EFFECTS OF PSYCHIATRIC DIAGNOSIS ON MEDICAL DIRECTIVE USAGE IN OLDER ADULTS: A LARGE DATASET EMR ANALYSIS AT A SAFETY-NET METROPLEX HOSPITAL","authors":"Vivek Mathesh , Kayla Murphy , Mashal Ali , Christopher Clark , Natalie Provenzale , Abhisek Khandai , Mustafa Husain","doi":"10.1016/j.jagp.2025.04.103","DOIUrl":"10.1016/j.jagp.2025.04.103","url":null,"abstract":"<div><h3>Introduction</h3><div>Background: It is estimated that only 1/3rd of US adults will detail an Advance Directive in their lifetime. Advance directive completion is associated with a decreased risk of hospitalization, higher concordance between the individual’s end-of-life wishes with the provided care, and amelioration of the caregiver’s stress (Sedini et al., 2022). However, little is known about the intersection of psychiatric diagnoses, including neurocognitive disorders, on MAD usage. Thus, the goal of this study is to establish a robust framework on MAD usage through a novel EMR analysis of a large metroplex city population and elucidate how the adoption of MADs is influenced by psychiatric diagnoses.</div></div><div><h3>Methods</h3><div>Methods: A retrospective analysis of electronic record encounters for all adults (age > = 18 years) with a 2022 inpatient admission (n = 41,421) at Parkland Memorial hospital was conducted. To identify the presence of an Advance Directive, these records were queried for attachments with MAD-related titles. MAD adoption rates among patients with and without psychiatric diagnoses were compared.</div></div><div><h3>Results</h3><div>Results: 41,421 patients were included in the study (age= 43.75 ± 17.53 years, mean ± SD) from which 15,143 patients identified as male, and 26,278 patients identified as female. Across all patients, the adoption of medical advance directives was 8.75%. Among those who had a psychiatric diagnosis, 14.0% of patients utilized a form of advance directive while, among those who did not have a psychiatric diagnosis, only 6.1% had an advance directive (p < 0.001). Compared to the population without a psychiatric diagnosis, those that had diagnoses related to neurocognitive disorders had a 25.7% higher use rate of advance directives (p < 0.001). Similarly, comparing patients from other psychiatric disorder groups to the general population, the Anxiety/Depression, Substance Use Disorder, and Schizophrenia/Bipolar, had a 17.6%, 11.7%, and 10.5% increase in MAD usage, respectively (p < 0.001 for all three comparisons).</div></div><div><h3>Conclusions</h3><div>Conclusion: Despite known healthcare disparities for patients with psychiatric disorders, our results indicated that MAD usage is greater amongst those who have a psychiatric diagnosis compared to patients who do not. In particular, patients with neurocognitive disorders had higher rates of MAD usage, especially in comparison to patients with other psychiatric diagnoses. Further studies will investigate the potential confounding effects of age, race, and gender on MAD usage in patients with psychiatric comorbidities. Particularly given the health disparities faced by patients with neurocognitive disorders and other psychiatric diagnoses, medical centers must create systems-level interventions to promote inclusive and empowering MAD usage amongst older adults.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S75"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614270","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.2025.04.056
Courtney Lee , Yutong Zhu , Heather Doherty , Oded Bein , Nili Solomonov
<div><h3>Introduction</h3><div>Older adults with depression experience deficits in processing socially rewarding experiences. These deficits include blunted reward anticipation – reduced expectation that pleasurable social experiences will occur in the future. Reduced reward anticipation is associated with greater anhedonia severity and lower tendency to seek rewarding experiences. We leveraged latent-cause inference, a computational and conceptual framework for cognitive learning processes, to investigate social reward deficits in late-life depression. We hypothesized that blunted reward anticipation might result from clustering rewarding and non-rewarding events together, instead of accurately distinguishing them. This clustering in turn could lead to anticipation of negative or neutral, rather than positive, social experiences in the future. We aimed to investigate whether depressed older adults, compared to healthy controls, show poorer social reward learning (i.e. reduced segregation between rewarding and non-rewarding social stimuli).</div></div><div><h3>Methods</h3><div>Fifty-eight participants (mean age: 64.2 years [SD: 7.0], 42 female [72.4%]) were included in the study: 25 older adults with late-life depression (mean age: 65.0 [SD: 7.0] years, 23 female [92.0%]) and 33 healthy controls (mean age: 63.6 [SD: 7.0] years, 19 female [57.6%]). Participants completed our novel “Social Task for Assessment of Reward” (STAR) task four times over 9 weeks (baseline, week 3, 6, and 9). The task consisted of 70 trials: 35 social reward trials (a cue of anticipating social reward feedback); 35 non-reward trials (a cue of anticipating no social reward feedback). We applied mixed-level linear models to investigate differential effects of cue response over time in depressed older adults vs. healthy controls.</div></div><div><h3>Results</h3><div>We found that both depressed and healthy control individuals showed faster reaction times for anticipated social reward vs. non-reward trials (F1, 13288 = 7.89, p = 0.004989). Further, the depressed group, vs. healthy controls, showed smaller differences in reaction times between social reward and non-reward trials (F1, 13288 = 6.13, p = 0.01333). This effect did not change over time (F1, 13288 = 0.665, p = 0.5737), suggesting persistent diminished segregation of social reward and non-reward trials.</div></div><div><h3>Conclusions</h3><div>Our findings suggest that depressed older adults, compared to healthy controls, show reduced segregation between rewarding and non-rewarding social stimuli. This lower segregation might indicate poorer social reward learning in late-life depression, specifically reduced anticipation of socially rewarding outcomes. Our results can inform the development of interventions to restore adaptive segregation between rewarding and non-rewarding events to improve social reward learning. Specifically, future work will investigate whether psychotherapy for increasing engagement in socially
{"title":"54. REWARD LEARNING IN LATE-LIFE DEPRESSION: A NOVEL LATENT-CAUSE INFERENCE APPROACH","authors":"Courtney Lee , Yutong Zhu , Heather Doherty , Oded Bein , Nili Solomonov","doi":"10.1016/j.jagp.2025.04.056","DOIUrl":"10.1016/j.jagp.2025.04.056","url":null,"abstract":"<div><h3>Introduction</h3><div>Older adults with depression experience deficits in processing socially rewarding experiences. These deficits include blunted reward anticipation – reduced expectation that pleasurable social experiences will occur in the future. Reduced reward anticipation is associated with greater anhedonia severity and lower tendency to seek rewarding experiences. We leveraged latent-cause inference, a computational and conceptual framework for cognitive learning processes, to investigate social reward deficits in late-life depression. We hypothesized that blunted reward anticipation might result from clustering rewarding and non-rewarding events together, instead of accurately distinguishing them. This clustering in turn could lead to anticipation of negative or neutral, rather than positive, social experiences in the future. We aimed to investigate whether depressed older adults, compared to healthy controls, show poorer social reward learning (i.e. reduced segregation between rewarding and non-rewarding social stimuli).</div></div><div><h3>Methods</h3><div>Fifty-eight participants (mean age: 64.2 years [SD: 7.0], 42 female [72.4%]) were included in the study: 25 older adults with late-life depression (mean age: 65.0 [SD: 7.0] years, 23 female [92.0%]) and 33 healthy controls (mean age: 63.6 [SD: 7.0] years, 19 female [57.6%]). Participants completed our novel “Social Task for Assessment of Reward” (STAR) task four times over 9 weeks (baseline, week 3, 6, and 9). The task consisted of 70 trials: 35 social reward trials (a cue of anticipating social reward feedback); 35 non-reward trials (a cue of anticipating no social reward feedback). We applied mixed-level linear models to investigate differential effects of cue response over time in depressed older adults vs. healthy controls.</div></div><div><h3>Results</h3><div>We found that both depressed and healthy control individuals showed faster reaction times for anticipated social reward vs. non-reward trials (F1, 13288 = 7.89, p = 0.004989). Further, the depressed group, vs. healthy controls, showed smaller differences in reaction times between social reward and non-reward trials (F1, 13288 = 6.13, p = 0.01333). This effect did not change over time (F1, 13288 = 0.665, p = 0.5737), suggesting persistent diminished segregation of social reward and non-reward trials.</div></div><div><h3>Conclusions</h3><div>Our findings suggest that depressed older adults, compared to healthy controls, show reduced segregation between rewarding and non-rewarding social stimuli. This lower segregation might indicate poorer social reward learning in late-life depression, specifically reduced anticipation of socially rewarding outcomes. Our results can inform the development of interventions to restore adaptive segregation between rewarding and non-rewarding events to improve social reward learning. Specifically, future work will investigate whether psychotherapy for increasing engagement in socially ","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S40"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614397","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.2025.04.058
Karisma Pathak , Ricardo Salazar
Introduction
Neurobiological studies to date suggest that psychosis in AD and related dementias may be associated with distinct imaging, genetic, neuropathological, and CSF biomarkers. Notably, most of the neurobiological studies to date have focused on patients with established dementia, given that psychotic symptoms are much rarer in prodromal states and may be confused with primary psychiatric pathology. Further study of psychosis-associated biomarkers in patients with prodromal conditions is clearly required.
Methods
We describe the case of a previously healthy woman in her middle 70s with new-onset and prominent visual hallucinations referred for neuropsychiatric evaluation after an extensive medical work-up by neurology to rule out organic causes. A thorough psychiatric, neurological, and cognitive evaluation was conducted. We conducted an FDG-PET evaluation to further elucidate the underlying pathophysiology.
Results
We report for the first time in the literature a case of the Phantom Boarder Phenomenon (PB), in which animals (snakes) and insects (spiders) have entered or are living in the patient's home despite evidence to the contrary. The patient experiences fear, anxiety, social isolation, living alone with no interpersonal relationships, and personal loss. Extensive medical, neurological, ophthalmological, and psychiatric workup and evaluation was completely normal, except for the FDG-PET findings that demonstrated early signs of synaptic dysfunction on bilateral temporal lobes.
Conclusions
Our case report supports the notion found in other studies that identified the temporal lobes as the neurobiological substrate of positive BPSD and FDG-PET as a potential instrument to predict their development.
{"title":"56. BACK TO THE FUTURE: VISUAL HALLUCINATIONS CAPTURED ON FDG-PET IN ADVANCE OF GROSS COGNITIVE IMPAIRMENT: A CASE FOR ETIOPATHOLOGICAL REDEFINITION OF ALZHEIMER'S DISEASE.","authors":"Karisma Pathak , Ricardo Salazar","doi":"10.1016/j.jagp.2025.04.058","DOIUrl":"10.1016/j.jagp.2025.04.058","url":null,"abstract":"<div><h3>Introduction</h3><div>Neurobiological studies to date suggest that psychosis in AD and related dementias may be associated with distinct imaging, genetic, neuropathological, and CSF biomarkers. Notably, most of the neurobiological studies to date have focused on patients with established dementia, given that psychotic symptoms are much rarer in prodromal states and may be confused with primary psychiatric pathology. Further study of psychosis-associated biomarkers in patients with prodromal conditions is clearly required.</div></div><div><h3>Methods</h3><div>We describe the case of a previously healthy woman in her middle 70s with new-onset and prominent visual hallucinations referred for neuropsychiatric evaluation after an extensive medical work-up by neurology to rule out organic causes. A thorough psychiatric, neurological, and cognitive evaluation was conducted. We conducted an FDG-PET evaluation to further elucidate the underlying pathophysiology.</div></div><div><h3>Results</h3><div>We report for the first time in the literature a case of the Phantom Boarder Phenomenon (PB), in which animals (snakes) and insects (spiders) have entered or are living in the patient's home despite evidence to the contrary. The patient experiences fear, anxiety, social isolation, living alone with no interpersonal relationships, and personal loss. Extensive medical, neurological, ophthalmological, and psychiatric workup and evaluation was completely normal, except for the FDG-PET findings that demonstrated early signs of synaptic dysfunction on bilateral temporal lobes.</div></div><div><h3>Conclusions</h3><div>Our case report supports the notion found in other studies that identified the temporal lobes as the neurobiological substrate of positive BPSD and FDG-PET as a potential instrument to predict their development.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S42"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614399","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.2025.04.086
Woo Ri Bae , Katharine Brewster
<div><h3>Introduction</h3><div>Culturally attuned care is crucial in providing effective psychiatric care to a diverse population of older adults and is considered a requirement under demonstrable knowledge in geriatric psychiatry fellowship training per the guidelines of the Accreditation Council for Graduate Medical Education. However, the availability and tailoring of teaching in culturally attuned psychiatric practice for geriatric populations vary greatly and are often limited. This project aims to address these concerns by administering a didactic session focusing on cultural humility. Cultural humility focuses on deconstructing power imbalance in the patient-physician relationship and committing to lifelong learning and self-reflection that enhances collaboration with patients from diverse backgrounds, acknowledges historical injustices, and promotes equitable care. Cultural humility emphasizes a patient-centered approach where the attitude of physician as student and patient as expert of the patient’s own experience are promoted. This in contrast to cultural competency which may imply that patient diversity and cultures can be mastered within a limited body of knowledge and time, such as impressions about different ethnic groups which in turn may continue to counterproductively foster harmful stereotypes and a narrow, stagnant stance toward caring for patients from different cultural backgrounds.</div></div><div><h3>Methods</h3><div>We will design a one hour-long didactic to be given to geriatric psychiatry faculty, geriatric psychiatry fellows, and general psychiatry resident trainees following the format shown in Table 1. Pre- and post-session surveys regarding knowledge and self-assessment on aspects relevant to cultural humility using Likert scales will be administered. Surveys will also include open-ended questions on perceived necessity of and objective feedback on didactic session. Learning objectives are as following; after the didactic session, learners will be able to 1) define the key attitudes of cultural humility, 2) discuss at least two ways that historical origins of inequity and discrimination toward different cultural identities impacts mental health of older persons, 3) apply the concept of identity and social location to discuss power dynamics in the patient-physician relationship, 4) identify cultural dimensions of the self and consider how these dimensions impact how the self moves through the world, and 6) show future interest in continuing the practice of cultural humility practice in professional endeavors.</div></div><div><h3>Results</h3><div>Results are pending as the didactic and pre- and post-didactic surveys will be administered in December, 2024 and all data will be collected by January, 2025 for presentation at AAGP in March, 2025.</div></div><div><h3>Conclusions</h3><div>Continued efforts are needed to integrate cultural humility training into broader educational frameworks to better serve the needs of a di
{"title":"84. EVALUATION OF A DIDACTIC SESSION ON CULTURAL HUMILITY FOR GERIATRIC PSYCHIATRY TRAINEES AND PRACTITIONERS","authors":"Woo Ri Bae , Katharine Brewster","doi":"10.1016/j.jagp.2025.04.086","DOIUrl":"10.1016/j.jagp.2025.04.086","url":null,"abstract":"<div><h3>Introduction</h3><div>Culturally attuned care is crucial in providing effective psychiatric care to a diverse population of older adults and is considered a requirement under demonstrable knowledge in geriatric psychiatry fellowship training per the guidelines of the Accreditation Council for Graduate Medical Education. However, the availability and tailoring of teaching in culturally attuned psychiatric practice for geriatric populations vary greatly and are often limited. This project aims to address these concerns by administering a didactic session focusing on cultural humility. Cultural humility focuses on deconstructing power imbalance in the patient-physician relationship and committing to lifelong learning and self-reflection that enhances collaboration with patients from diverse backgrounds, acknowledges historical injustices, and promotes equitable care. Cultural humility emphasizes a patient-centered approach where the attitude of physician as student and patient as expert of the patient’s own experience are promoted. This in contrast to cultural competency which may imply that patient diversity and cultures can be mastered within a limited body of knowledge and time, such as impressions about different ethnic groups which in turn may continue to counterproductively foster harmful stereotypes and a narrow, stagnant stance toward caring for patients from different cultural backgrounds.</div></div><div><h3>Methods</h3><div>We will design a one hour-long didactic to be given to geriatric psychiatry faculty, geriatric psychiatry fellows, and general psychiatry resident trainees following the format shown in Table 1. Pre- and post-session surveys regarding knowledge and self-assessment on aspects relevant to cultural humility using Likert scales will be administered. Surveys will also include open-ended questions on perceived necessity of and objective feedback on didactic session. Learning objectives are as following; after the didactic session, learners will be able to 1) define the key attitudes of cultural humility, 2) discuss at least two ways that historical origins of inequity and discrimination toward different cultural identities impacts mental health of older persons, 3) apply the concept of identity and social location to discuss power dynamics in the patient-physician relationship, 4) identify cultural dimensions of the self and consider how these dimensions impact how the self moves through the world, and 6) show future interest in continuing the practice of cultural humility practice in professional endeavors.</div></div><div><h3>Results</h3><div>Results are pending as the didactic and pre- and post-didactic surveys will be administered in December, 2024 and all data will be collected by January, 2025 for presentation at AAGP in March, 2025.</div></div><div><h3>Conclusions</h3><div>Continued efforts are needed to integrate cultural humility training into broader educational frameworks to better serve the needs of a di","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S61-S62"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614412","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.2025.04.012
Laura van Dyck , Parnika Saxena
Introduction
Parkinson's disease (PD) symptoms, including emotional and communication challenges, can impair social functioning. Social isolation and loneliness have been linked to greater symptom severity and reduced quality of life in individuals with PD. We aim to highlight interventions by providers to improve social isolation and loneliness in patients with PD.
Methods
A comprehensive literature and policy review was conducted, examining clinical research, advocacy projects, and relevant legislative efforts focused on addressing loneliness and socioemotional symptoms in PD.
Results
The growing focus on recognizing and mitigating loneliness in PD has led to recommendations from experts, including the need for heightened awareness, routine screening, and targeted interventions. Among these interventions, social prescribing—a systematic approach addressing patients' social needs via community-based interventions—has gained attention. However, existing evidence supporting social prescribing primarily stems from single-payer healthcare systems, with limited research investigating its effectiveness in the context of U.S. healthcare payment models. Furthermore, literature highlights the importance of enhancing awareness not only of loneliness in PD but also of broader socio-emotional symptoms, such as difficulties with emotional facial expressions, emotional recognition, and vocal expressions.
Conclusions
Healthcare providers should prioritize screening and identification of loneliness and socioemotional symptoms in PD. Recommendations include patient and caregiver education, vocal and respiratory exercises (e.g., group singing), psychological interventions (e.g. mindfulness, ACT, CBT), and social prescribing, such as the VA Compassionate Contact Corps Program. Providers may widen their reach by advocating for policies, including reimbursement for care companions in PD.
{"title":"9. MENTAL HEALTHCARE STRATEGIES FOR SOCIAL ISOLATION AND LONELINESS IN PARKINSON’S DISEASE","authors":"Laura van Dyck , Parnika Saxena","doi":"10.1016/j.jagp.2025.04.012","DOIUrl":"10.1016/j.jagp.2025.04.012","url":null,"abstract":"<div><h3>Introduction</h3><div>Parkinson's disease (PD) symptoms, including emotional and communication challenges, can impair social functioning. Social isolation and loneliness have been linked to greater symptom severity and reduced quality of life in individuals with PD. We aim to highlight interventions by providers to improve social isolation and loneliness in patients with PD.</div></div><div><h3>Methods</h3><div>A comprehensive literature and policy review was conducted, examining clinical research, advocacy projects, and relevant legislative efforts focused on addressing loneliness and socioemotional symptoms in PD.</div></div><div><h3>Results</h3><div>The growing focus on recognizing and mitigating loneliness in PD has led to recommendations from experts, including the need for heightened awareness, routine screening, and targeted interventions. Among these interventions, social prescribing—a systematic approach addressing patients' social needs via community-based interventions—has gained attention. However, existing evidence supporting social prescribing primarily stems from single-payer healthcare systems, with limited research investigating its effectiveness in the context of U.S. healthcare payment models. Furthermore, literature highlights the importance of enhancing awareness not only of loneliness in PD but also of broader socio-emotional symptoms, such as difficulties with emotional facial expressions, emotional recognition, and vocal expressions.</div></div><div><h3>Conclusions</h3><div>Healthcare providers should prioritize screening and identification of loneliness and socioemotional symptoms in PD. Recommendations include patient and caregiver education, vocal and respiratory exercises (e.g., group singing), psychological interventions (e.g. mindfulness, ACT, CBT), and social prescribing, such as the VA Compassionate Contact Corps Program. Providers may widen their reach by advocating for policies, including reimbursement for care companions in PD.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S7"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613899","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.2025.04.016
Ira Yenko , Feng Vankee Lin , Christine Gould , Ryan Pate , Maryam Makowski , Oceanna Li , Vanessa Silva , Dolores Gallagher-Thompsom , Erin Cassidy-Eagle
<div><h3>Introduction</h3><div>Well-being is defined broadly, but typically includes promoting a combination of health, resilience, quality of life and connection. Positive psychological interventions move beyond the goal of simply decreasing symptoms and disorder rates and gravitate towards life enhancing and skill development. This psychological wellness group focuses on improving quality of life and skill development that aim to build resilience to life’s challenges, increase motivation to engage in positive self-care and drive to find purpose in engaging with and helping others. Our multi-modal well-being group targets a broad range of well-being dimensions including cognitive, behavioral, emotional, social, and physical health parameters. Group interventions harness the power of social connection while offering a cost effective and efficient means to reach a broad range of older patients that might otherwise be unable to access care. The overall aim of this project is to utilize an iterative process to continually improve and innovate a rotating psychological wellness group for older adults.</div></div><div><h3>Methods</h3><div>This program includes a psychological wellness group offering for older adults with 8 modules covering a collection of topics that support optimal psychological wellness and promote health and resilience (i.e. digital tools and mobile apps, value-based behavioral activation to improve your mood, eating for a healthy brain, caring for the caregiver, introduction to mindfulness, improving your sleep, physical activity and strategies for managing anxiety) that are held weekly, ranging in duration from 2-4 weeks, over a 7 month period. Well-being is broadly defined, including the existence of over 100 self-report measures to date, and our shift in measurement aims to provide clarity in definition and impact of our intervention. Having tried various well-being, loneliness, affect based, depression, anxiety, coping and resilience-based surveys, the team has worked to identify evidenced based measures that will capture our variables of interest and reflect change within the duration of the intervention. Evidence-based and lifestyle interventions target skill development, create opportunities for practice and provide expert feedback within the context of a socially engaged and supportive peer environment. Participants were referred from outpatient psychiatry clinics, geriatric medicine providers in medical centers and local community organizations servicing older adults. Inclusion criteria: Participants must be 65+ years old, English speaking, absent a diagnosis of dementia and open to group treatment.</div></div><div><h3>Results</h3><div>Older adults (N=19) were enrolled in the second wave of the psychological wellness group, including 9 males and 10 females with a mean age of 71. Summarized in Table One, the baseline (T1) and follow-up measures collected for T2 (6 weeks), T3 (12 weeks), T4 (18 weeks) and T5 (23 weeks) inclu
{"title":"13. OPTIMIZING THE DESIGN AND MEASUREMENT OF A MULTI-MODULE GROUP INTERVENTION TO IMPROVE WELL-BEING IN OLDER ADULTS","authors":"Ira Yenko , Feng Vankee Lin , Christine Gould , Ryan Pate , Maryam Makowski , Oceanna Li , Vanessa Silva , Dolores Gallagher-Thompsom , Erin Cassidy-Eagle","doi":"10.1016/j.jagp.2025.04.016","DOIUrl":"10.1016/j.jagp.2025.04.016","url":null,"abstract":"<div><h3>Introduction</h3><div>Well-being is defined broadly, but typically includes promoting a combination of health, resilience, quality of life and connection. Positive psychological interventions move beyond the goal of simply decreasing symptoms and disorder rates and gravitate towards life enhancing and skill development. This psychological wellness group focuses on improving quality of life and skill development that aim to build resilience to life’s challenges, increase motivation to engage in positive self-care and drive to find purpose in engaging with and helping others. Our multi-modal well-being group targets a broad range of well-being dimensions including cognitive, behavioral, emotional, social, and physical health parameters. Group interventions harness the power of social connection while offering a cost effective and efficient means to reach a broad range of older patients that might otherwise be unable to access care. The overall aim of this project is to utilize an iterative process to continually improve and innovate a rotating psychological wellness group for older adults.</div></div><div><h3>Methods</h3><div>This program includes a psychological wellness group offering for older adults with 8 modules covering a collection of topics that support optimal psychological wellness and promote health and resilience (i.e. digital tools and mobile apps, value-based behavioral activation to improve your mood, eating for a healthy brain, caring for the caregiver, introduction to mindfulness, improving your sleep, physical activity and strategies for managing anxiety) that are held weekly, ranging in duration from 2-4 weeks, over a 7 month period. Well-being is broadly defined, including the existence of over 100 self-report measures to date, and our shift in measurement aims to provide clarity in definition and impact of our intervention. Having tried various well-being, loneliness, affect based, depression, anxiety, coping and resilience-based surveys, the team has worked to identify evidenced based measures that will capture our variables of interest and reflect change within the duration of the intervention. Evidence-based and lifestyle interventions target skill development, create opportunities for practice and provide expert feedback within the context of a socially engaged and supportive peer environment. Participants were referred from outpatient psychiatry clinics, geriatric medicine providers in medical centers and local community organizations servicing older adults. Inclusion criteria: Participants must be 65+ years old, English speaking, absent a diagnosis of dementia and open to group treatment.</div></div><div><h3>Results</h3><div>Older adults (N=19) were enrolled in the second wave of the psychological wellness group, including 9 males and 10 females with a mean age of 71. Summarized in Table One, the baseline (T1) and follow-up measures collected for T2 (6 weeks), T3 (12 weeks), T4 (18 weeks) and T5 (23 weeks) inclu","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S10"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613903","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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