More than 1.5 million people have been diagnosed with dementia in Russia. Although we have all the necessary doctors and medicines, there is no clear, expert-approved special care system for people with dementia: caregivers do not have a manual for working with people with cognitive impairments. Our adapted web-guide and mobile application aim to educate professional and informal caregivers, and society about the principles of taking care for people with dementia, it’s any age prevention, creating an environment of equality.

The objective of this study is to explore the level of raising awareness of the Russian society about dementia after the implementation of our digital technologies.

Conducting an in-depth expert interview and a focus group with caregivers who got acquainted with the adapted ISupport guide were applied in order to evaluate the appropriateness of care practice for people with dementia in terms of medical standards and to uncover practical infelicities and improve them. Collected data and respondent’s replies analyses, content-analysis that we made became the basic principles of our new application. The quantitative method allows us to track user activity and assess the level of social involvement in dementia issues. Moreover, we have collected caregivers' opinions after they used our application and web-version for the first time by virtue of a qualitative method.

We have reached various aims during our ISupport implementation and working on the research project. First, the number of users of our mobile application is steadily growing (+ 4 people per day at the launch stage). Second, we have received a lot of feedback about our ISupport web version: “it is easy to use; it has a good design, sipid content and a logical structure, which in turn facilitates the process of caring for a person with dementia. Third, medical experts approved our adaptation, web-version and mobile application and recommended it for use in Russian-speaking countries.

we have come to both theoretical and practical results of ISupport implementation in Russia and successfully launched two digital projects. Thanks to the work we have done the dementia issue in Russia will become more popular among society and will prevent the disease of thousands of people.

Why should you pay attention to personality pathology in geriatric psychiatry? To what extent is mental well-being determined by this? How does that relate to the influence of mental disorders? Does the Alternative Dimensional Model of Personality pathology (AMPD) as proposed by the DSM-5 provide more insight into this than the DSM-IV and DSM-5 categorical diagnoses of personality disorders?

These questions were examined in baseline data of 145 patients included in our randomized controlled trial (RCT) into group Schema therapy enriched with psychomotor therapy in older patients with a personality disorder (see Oude Voshaar in this symposium). Mental well-being was measured by a combination of psychological distress (53-item Brief Symptom Inventory), positive mental health (Warwick-Edinburgh Mental Well-being Scale), assessment of own health (RAND-36), and satisfaction with life (Cantrill’s ladder). Personality pathology was assessed according to the categorical personality model using the Structured Clincal Interview for Personality Disorder (SCID-II) as well as the AMDP DSM-5 model using the Severity Indices of Personality Problems (SIPP-short form) and the Personality Iventory for DSM-5 (PID-25). The relationship between personality pathology and mental well-being was investigated using multivariate regression analysis.

Three quarters of the included people with a personality disorder also had another psychiatric disorder (beyond personality pathology). However, personality pathology was found to be responsible for the bulk of the mental health burden and outweighed the influence of these psychiatric disorders. Personality dimensions were highly predictive of mental well-being. This contrasted with the absence of any influence from categorical personality disorders. Although dimensions of personality functioning – and in particular Identity Integration – were the primary predictors of mental well-being, pathological traits added significant predictive value (particularly Disinhibition and Negative Affectivity).

Personality pathology seriously affects the mental well-being of patients and exceeds the impact of comorbid psychiatric disorders. Contrary to the assumption in the alternative DSM-5 and ICD-10 model, both personality functioning and pathological traits contribute to this impact on mental well-being. Screening and systematic assessment of personality pathology in geriatric psychiatry seems warranted.

Different types of psychotherapy have been shown to be successful in treating personality disorders in younger age groups. Nevertheless, well-powered, randomized controlled trials evaluating effectiveness of these therapies in older are lacking. That is why we set up the first randomized controlled trial worldwide into the effect and cost-effectiveness of psychotherapy in older patients with a personality disorder.

We randomized 145 patients (mean age 68 years, range 60 – 80, 65% females) with a cluster B and/or C personality disorder to either group schema therapy enriched with psychomotor therapy (GST+PMT) or to usual care (UC) in specialized geriatric mental health care. The effects were measured after 6 months (end of therapy) and 12 and 18 months (one-year follow-up). Primary outcome measure was psychological distress, as measured with the 53-item Brief Symptom Inventory (BSI-53). Secondary outcome measures were mental well-being, assessed with the Warwick-Edinburgh Mental Well-being Scale, and personality functioning assessed with the Severity Indices of Personality Problems – Short Form (SIPP-SF). Intention to treat analyses using linear mixed models were applied to compare GST+PMT with UC.

Group schema therapy significantly outperformed usual care with an medium effect-size of 0.4 post-treatment, which faded out to a small effect-size of 0.2 at the end of follow-up on the primary outcome parameter. Interestingly, the lower effect-size during follow-up could be explained by a slower treatment response in the usual care condition as post-treatment results of schema therapy were fully maintained during follow-up. Similar results were found with respect to improvement of mental well-being and improvement of personality functioning, although effect-sizes of the latter were a little bit smaller. Age, sex, level of education, and/or cognitive functioning had no impact of these outcomes.

Schema therapy enriched with psychomotor therapy is more effective for the treatment of personality disorder in later life than usual care (which often consists of drug treatment combined with supportive nurse-led care and/or individual psychotherapy).

Approximately one third of older adults (≥ 60 years) with a posttraumatic stress disorder (PTSD) also suffer from a comorbid personality disorder. Emerging evidence shows that in Eye Movement Desensitization and Reprocessing (EMDR) therapy can be beneficial for personality disorders. Since personality disorders are associated with several adverse events, the present study aims to investigate whether EMDR in older adults with PTSD will improve personality functioning.

A multi-center feasibility study was conducted with 24 older PTSD-patients (60-83 years). PTSD was assessed with the Clinician-Administered PTSD Scale-5 (CAPS-5). All participants received weekly 1-hour sessions of EMDR therapy for PTSD up to a maximum of 9 months. The primary outcome was change in personality dysfunction, assessed by Severity Indices of Personality Problems–Short Form (SIPP-SF) at baseline and end of treatment. Secondary outcome was pre-post difference in the presence of (any) personality disorder according to DSM-IV criteria as measured with the Structured Clinical Interview for DSM-IV Axis-II PDs (SCID-II). All analyses were adjusted for PTSD severity, therapy duration, and other treatment (co-interventions) which was kept constant.

A linear mixed model approach showed an increase in SIPP-SF scores from pre- to posttreatment, a significant influence of pre-post CAPS-5 for the total sample (F(1,37.5)=6.95), p=.012) and a marginal significant effect of other treatment (F(1,21.9)=4.04), p=.057). No significant main effects of time, therapy duration (3, 6, or 9 months), CAPS-5 by time was found (all p>.05).

EMDR treatment resulted in improved personality functioning. Other treatment next to EMDR had a negative impact on the increased of personality functioning.

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

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

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

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

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

tDCS application to the DLPFC is associated with the improvements of executive function, memory enhancement, language, processing speed, global cognitive symptoms and apathy over time after treatment. DLB is the second most common form of degenerative dementia. There is no FDA-approved medications that can slow, stop or improve the progression of cognitive declines in DLB. Identifying effective treatments is a critical issue for DLB. In neuropathology, extracelluar α-syn oligomers interfere with the expression of long-term potentiation(LTP), and influence memory and learning. tDCS has been proposed to affect long-term synaptic plasticity through LTP and long-term depression, thereby improving cognitive ability. So far, only two studies have evaluated the effect of tDCS in DLB. In this pilot study, we investigate the effect of tDCS on left DLPFC in DLB.

Fourteen DLB aged 55-90 years (mean age 76.4, with 4 males and 10 females) were included in a double-blind, randomized, sham-controlled cross over design study. DLB diagnostics is according to DSM-5 criteria. CDR ratings for DLB participants ranged from 0.5 to 2. The active tDCS (or sham) process consists of daily sessions of active tDCS (or sham) for 10 consecutive days. The anodal electrode was placed over the left DLPFC and the cathodal electrode was placed over the right supraorbital area, with a current intensity of 2 mA and an electrode size of 25 cm2 for 30 min in a session. Before and after these treatment sessions, all subjects received a series of neuropsychological tests, including CDR, MMSE, CASI, NPI and WCST. Chi-square test, Wilcoxon signed ranks test and Mann-Whitney U test were used to assess differences in participant demographic characteristics and to compare differences among groups.

The active tDCS group showed significant improvements on the three items of CASI, ‘language ability’, ‘concentration and calculation’, ‘categorical verbal fluency’, after active stimulations. There is no improvement in MMSE, CASI, NPI and WCST scores in the sham groups.

These results suggest that left DLPFC anodal, and right deltoid cathodal tDCS, may have some cognitive benefits in DLB. Larger-scale trials are needed to confirm the effect of tDCS in DLB.

Key words: Transcranial Direct Current Stimulation, Dementia with Lewy Bodies, cognitive function, Wisconsin Card Sorting Test, left DLPFC

Transcranial direct current stimulation (tDCS) has been proposed to affect long-term synaptic plasticity through LTP and LTD, thereby improving cognitive ability. In pathology, the amyloid deposits in AD disrupts the balance between long-term potentiation (LTP) and long-term depression (LTD) of neuronal cells and synaptic plasticity. An increasing number of studies have been concluded a positive therapeutic effect on cognition in AD. In brain stimulation, dorsolateral prefrontal cortex (DLPFC) was associated with improvements in memory enhancement, language, processing speed, global cognitive symptoms, and apathy over a period of treatment. Theoretically, the aftereffect of tDCS would need to be re-stimulated by tDCS to maintain its delayed plastic response benefits. In this pilot study, we investigate the maintenance effects of continuing tDCS at three different times, weekly, every two weeks, and every four weeks, for 12 weeks.

Twenty-eight AD participants aged 55-90 years were enrolled (mean age 72.7, 77.3, and 76.2 in the three groups - maintained weekly (7 cases), biweekly (9 cases) and every 4 weeks (12 cases)). The anodal electrode was placed over the left dorsal lateral prefrontal cortex and the cathodal electrode was placed over the right supraorbital area. In each active session, we applied a current intensity of 2 mA and an electrode size of 25 cm2 for 30 min. All subjects received a series of neuropsychological assessments including CDR, MMSE, CASI and WCST at (1) baseline, (2) post-10sessions of tDCS (in 2weeks), and (3) post-maintenance phase (total of 12 weeks). Chi-square tests, Wilcoxon signed rank tests and Mann-Whitney U tests were used to assess differences in participant demographic characteristics and to compare differences in test scores between groups.

After 10 sessions of tDCS stimulations, the total CASI scores in the 1-week group improved significantly from baseline to 2 weeks. However, there are no significant difference in MMSE, CASI or WCST between baseline and after maintain phase stimulations in each group.

Although tDCS has a positive effect in AD, it is recommended to prolong the number of tDCS stimulations, such as 20 sessions in 4 weeks.

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

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

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

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

Explore end-user evaluations and feedback focused on lifestyle change in a large-scale multidomain online intervention targeting modifiable risk factors for dementia.

Online survey and semi-structured interviews at conclusion of the Maintain Your Brain (MYB) randomized controlled trial. Participants were 55-77 years of age at baseline, and had engaged in assessments, brain training, nutrition and physical activity, and mental health modules over three years. Of 5,260 participants invited, 2,386 completed online surveys and 1,589 of these respondents provided free text comments. Nearly 250 survey respondents agreed to be contacted for additional interviews; 70 of these were invited, 40 interviewed. Survey respondents and interview completers endorsed whether they had made lifestyle changes because of MYB participation and whether they would continue healthy lifestyle changes going forward. Interview participants endorsed whether they thought similar programs can be useful in delaying or preventing dementia, whether their views regarding this type of program had changed over time, answered open-ended follow-up questions and provided additional feedback. Data were summarized using descriptive statistics and explored using multiple qualitative methods.

Of survey respondents, 90.5% endorsed intention to continue a healthier lifestyle; 63.2% endorsed that lifestyle changes had occurred. Interview participants thought similar programs could be useful in delaying or preventing dementia, but some were unsure. Trial participation had not changed many individuals’ views about online lifestyle programs. Survey free-text and interview comments indicated diversity in pre-intervention knowledge, lifestyle and health-related behavior. Many respondents reported improved knowledge and awareness, some detailed relevant and continued lifestyle change. Those who were already well informed and/or leading healthy lifestyles explained that trial participation had confirmed their existing practices. Trial characteristics, personal characteristics, social relationships and significant events impacted whether respondents had made and/or continued changes. More flexible, adaptive individually tailored goals and timely feedback were requested to better support change.

Surveyed participants who engaged in the 3-year MYB online multidomain dementia risk reduction program reported lifestyle changes and intention to continue having a healthier lifestyle. Older adults in this study suggested that similar online programs need to provide flexible, individualized guidance and feedback to support lifestyle change.

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

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

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

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

Meaning and purpose in life has demonstrated positive effects on physical and mental health and loneliness. We wanted to understand whether, among older adult couples, the impact of meaning and purpose in life on loneliness was mitigated by their assessment of the quality of their relationship with their partner, and their social support from family and friends.

Participants were 101 nondemented older adults living with a spouse or partner and participating in an ongoing longitudinal study of couples. As part of their baseline visit, they completed a series of questionnaires to measure demographic information, physical and psychological well-being, loneliness, meaning and purpose in life, quality of dyadic relationship (measured by the Dyadic Adjustment Scale), and various aspects of social support (instrumental, informational, and emotional).

The average age of participants was 74.7 (SD = 6.71) and 49% were female. Bivariate correlations demonstrated statistically significant relationships between loneliness and meaning and purpose in life, relationship satisfaction, and emotional, informational and instrumental support but not age and gender. In a multiple regression analysis, meaning and purpose in life was the strongest predictor of loneliness (β = - 0.322, p < 0.001); relationship quality (β = -0.263, p = 0.005), emotional (β = -0.229, p = 0.048) and instrumental support (β = -0.203, p = 0.024), also predicted loneliness, F(5,95) = 12.19, p < 0.001, adjusted R2= 0.36.

In this study, all participants were older adults and members of a couple. Even when they rated their relationships with their partners as having high quality, they nevertheless expressed more loneliness when they had less meaning and purpose in life. While satisfaction with instrumental and emotional support had a positive impact on loneliness; perhaps surprisingly, relationship quality was less important than meaning and purpose in life. Apparently, having a sense of meaning and purpose in life is an ongoing need that extends to old age. This finding, if replicated in a larger longitudinal study has implications for social policy that facilitates inclusion of older adults in meaningful roles, rather than having them age out.

Health disparities between communities with greater and lesser advantages are a global concern. In the USA, self-identified race as African American (AA) is consistently associated with mild cognitive impairment (MCI) and dementia, compared to Americans of European descent. In a prospective population-based study, we sought to confirm this association and investigate potential explanatory factors.

The Monongahela-Youghiogheny Healthy Aging Team (MYHAT) and Seniors Project 15104 (SP15104) studies recruited adults aged 65+ years from a group of small towns of lower socioeconomic status in the US. MYHAT recruited by age-stratified random sampling from the voter registration list for all towns; SP15104 recruited by intensive community engagement from three towns with populations that are 60% AA. Based on the Clinical Dementia Rating (CDR), MCI was defined as CDR=0.5 and dementia as CDR > 1. Using Cox proportional hazard models, we modeled time to incident CDR > 0.5 from baseline as a function of race (AA vs. all other), other demographics, and several other covariates at baseline.

The sample of 2120 individuals was 8% AA, and 62% female, with median age of 73y, and median educational level of partial college. During follow up of up to 14.5 years, 499 participants developed new-onset MCI/dementia (CDR >0.5). Cox models revealed that being AA was significantly associated with incident CDR > 0.5 (HR=1.45. 95% CI:1.01,2.10). Inclusion of age, sex, and education in the model increased the HR for race to 1.63 (1.1, 2.3). Adding number of regularly taken prescription drugs (reflecting overall morbidity), depression symptoms, preceding year alcohol consumption, and number of visits to emergency or urgent care together reduced the HR to 1.4 (0.96, 2.0), no longer statistically significant

In this population-based cohort study, self-identified African Americans had an about 40% elevated risk of developing MCI/dementia. Adjusting for demographics, the significant association between race and incident MCI/dementia was attenuated by variables reflecting depression, greater general morbidity, and lesser access to regular health services. These variables possibly reflect downstream effects of historic discrimination, but couldstill be modifiable risk factors for MCI/dementia. Addressing them could potentially mitigate ethno-racial disparities in cognitive impairment.

Telehealth has been an important method of health care delivery during the pandemic, particularly for older adults who have been more vulnerable to the physical and psychosocial impacts of the pandemic and associated isolation. Older adults have specific medical and mental health care needs that would benefit from having access to geriatric speciality services, however these services may be difficult to access especially for those living in rural areas. Though the use of technology and telehealth has greatly expanded during the pandemic, many health systems and clinicians lack the necessary knowledge, skills and attitudes to fully integrate technology in the health care of older adults. General telehealth competencies are available to guide educators, however, competencies to address the unique needs of older adults have yet to be developed.

This literature review was conducted to evaluate what approaches are needed for clinicians to gain skills and knowledge in order to competently deliver telehealth services to older adults.

The review was completed using the six-stage scoping review process in line with the PRISMA checklist in PubMed/Medline and other databases from years 2000 to 2023 based on concept areas of (I) education/competencies, (II) telehealth delivery and (III) older adults.

From a total of 813 articles, the authors found 88 eligible for full text review and 16 papers sufficiency relevant to the search criteria. Some evidence exists for telehealth competencies specifically for clinicians caring for older adults. Themes that emerged include the role of interprofessional and experiential learning, telepresence, technology training and support, and adaptations for older adults. Education of clinicians and trainees increased knowledge of its usefulness and improved attitudes related to acceptance and utilization. Training rather than ad hoc exposure to telehealth technology was emphasized. Clinician/student-provided training improved access and acceptance to telehealth in older adults. Suggested adaptations for older patients included the involvement of caregivers in the visit, especially for patients with cognitive impairment.

It appears that training – more than ad hoc experience – for clinicians and trainees increases knowledge, skills and attitudes toward telehealth for the care of older adults. Additional research is needed to define training interventions, cross-sectional versus longitudinal approaches and specify competencies (i.e., skills) and optimal learning methods.

Despite a need to provide support to people with dementia and informal caregivers to live well with dementia, the availability of psychological interventions to enhance wellbeing and support mental health problems such as depression for people with dementia are limited. A potential solution is behavioural activation, an evidence-based intervention for depression that seeks to target behavioural avoidance. Behavioural activation can be delivered in a written self-help format, with support provided by an informal caregiver, who in turn receives guidance from a healthcare professional. However, it is necessary to develop and tailor self-help interventions to the needs and preferences of specific populations.

To explore the needs and preferences of people with dementia, informal caregivers, and professional stakeholders to ensure cultural appropriateness, relevancy, and acceptability of the intervention.

Participatory action research with co-design principles using semi-structured interviews and focus groups. People with dementia (n=8), informal caregivers (n=19), healthcare professionals (n=18), and community stakeholders (n=7) were provided with draft versions of the behavioral activation written self-help intervention and a proposed intervention delivery model. Open-ended questions explored preferences concerning preferred intervention delivery setting, type of support and guidance provided, perceived relevance of the intervention content and language, and ways to enhance relevancy, cultural appropriateness, and acceptability.

Analysis resulted in an overarching theme: Tailoring and flexibility, and three categories: Intervention process, material and context; Support and guidance; and Time. Results informed adaptations to the intervention content and delivery model, including: (1) reducing the amount of material to minimise treatment burden; (2) increasing the relevance of case stories and illustrations to Swedish society and culture; (3) modernising the design and illustrations; (4) including a case story of a person with young onset-dementia; (5) increasing the flexibility of the delivery model (e.g., delivery outside of traditional health care settings); and (6) providing additional guidance to informal caregivers.

Stakeholders expressed a need for tailoring and flexibility throughout intervention delivery, and for cultural adaptations to intervention content to improve perceived appropriateness and relevance. A planned feasibility study will examine the feasibility, acceptability, relevancy and cultural appropriateness of the intervention and delivery model.

To explore barriers towards mental health services for older adults with symptoms of depression and/or anxiety in a low-resource community in Lima, Peru. We explored these barriers from the perspective of older adults and health providers.

We conducted an interview-based qualitative study. The first set of interviews was carried out between October 2018 and February 2019, and the second, between January 2022 and September 2022. In the first sample, we interviewed 38 older adults ≥60 years with symptoms of depression (Patient Health Questionnaire-9 ≥ 10), anxiety (Beck Anxiety Inventory ≥ 16), or those who had previous experience using formal mental health care irrespective of current symptoms. In the second sample, we included 20 health providers (8 psychologists, 2 general practitioners, 2 nurses, 4 psychiatrists, 4 social workers). We used an inductive thematic data analysis.

We identified two main barriers: stigma towards mental health conditions and care, and ageism. Stigma and ageism interacted with each other and exacerbated other barriers to mental health services. Stigma led to negative labels for people with mental health conditions and shame among older adults to disclose their feelings to health providers. Looking at the health system, health care facilities were described as not being age friendly. Additionally, aside from psychologists and psychiatrists, most providers mentioned little previous training in mental health care, but even less about the nuances of treating mental health challenges in old age. Among older adults, other important barriers were the accumulated mistrust towards health professionals and lack of knowledge about existing services and how they work. Importantly, older adults mentioned competing priorities, for example, not having time to seek care because they needed to work to obtain food. Other barriers included hidden costs incurred for transportation to health centers or to obtain medications. For older adults with diminished physical mobility, lack of accompaniment to attend health appointments was another important barrier.

Community-based mental health interventions towards older adults need to address ageism and mental health stigma to improve access to care. Furthermore, training for health providers must be improved and expanded to prioritize older adult mental health care.

The numbers of older people experiencing both homelessness and Alzheimer’s disease and related dementias are growing, yet their complex health, housing and care needs remain undelineated and unmet. Older people experiencing homelessness have high levels of memory and cognitive impairment relative to stably housed age equivalent populations. In this study we aim to address a critical gap in understanding what can improve the care, support and experiences of older people experiencing homelessness with memory and other cognitive impairments.

To explore how stakeholders understand and experience memory problems among older people experiencing homelessness. We consider what they perceive to be meaningful outcomes for those living with memory problems and those supporting them and what gets in the way of achieving good care and support for these individuals.

We conducted reflexive thematic analysis of qualitative interviews (n=49) with 17 older people (aged ≥50 years) experiencing memory and other cognitive problems and homelessness, 15 hostel staff and managers, and 17 health, housing and social care practitioners working in England.

We identified four overarching themes. The population is not taken seriously; you ‘can’t see the wood for the trees’; risk of exploitation and vulnerability; and (dis)connection and social isolation. The transience of homelessness intensified the disorienting nature of memory and cognitive impairment. Older people experiencing homelessness and memory problems fall through gaps in service provision further fragmenting their lived experiences and intensified by cognitive difficulties. Those providing direct and indirect support required flexibility and persistence to advocate, provide care and safeguard individuals, with staff moving beyond traditionally commissioned roles to advocate, provide care and safeguard individuals.

Efforts to meet the needs of older people living with Alzheimer’s disease and related dementias and experiencing homelessness must reflect the complexity their lives and current service provision. These findings have been used to co-design a psychosocial care and support intervention for hostel staff to be tested in a feasibility trial.

Sleep disturbance affects all aspects of mental and physical functioning and quality of life and may lead to or worsen Alzheimer’s disease. Sleep disturbances in people with dementia living at home predicts care home admission and carer distress. Estimates of the prevalence of sleep disturbance vary, and it is unclear how prevalence rates differ according to setting. We conducted the first systematic review and meta-analysis on the prevalence of sleep disturbances in people living with dementia in the community. We aimed to examine demographic predictors and whether overall prevalence has changed over time.

We searched Embase, MEDLINE and PsycINFO for studies reporting the prevalence of sleep disturbances in people with dementia living at home. We meta-analysed data and calculated the pooled prevalence of sleep disturbances in people with dementia overall and in dementia subtypes. We used meta-regressions to investigate the effects of study characteristics, publication dates and participant demographics.

Eleven studies fulfilled the inclusion criteria. The pooled prevalence of any symptoms of sleep disturbance was 26% (95% confidence intervals (CI): 23-30%; n= 2719) and of clinically significant sleep disturbance 19% (95% CI: 13-25%; n= 2753). The pooled prevalence of sleep disturbance symptoms was significantly lower among people with Alzheimer’s disease (24%; 95% CI: 16-33%, n=310) than Lewy body dementia (49%; 95% CI: 37-61%, n=65). Meta-regression analysis did not find that publication year, participant’s age, sex and study quality predicted prevalence.

Sleep disturbances are common among people with dementia living in the community, especially in Lewy body dementia. There was no change in prevalence according to publication dates (between 2002 and 2018). This suggests that possible advances in treatment of sleep disturbance are not reflected in improvements for people living with dementia. This highlights the need to develop effective intervention strategies, reducing the prevalence of sleep disturbances in people living with dementia living at home in the community.