The triad of symptom groups of Alzheimer’s disease (AD) encompasses cognitive impairment (e.g. impaired memory or orientation), neuropsychiatric symptoms like apathy, depressive mood, delusions, hallucinations or anxiety, and functional impairment exclusively in complex activities of daily living (cADL, e.g. preparing meals, managing finances) in minor neurocognitive disorder due to AD and both in complex and basic ADL (bADL, e.g. dressing, toileting) in major neurocognitive disorder due to AD. These functional impairments are widely thought to be exclusively attributable to the cognitive deficits of the disease. Of note, mounting evidence indicates that neuropsychiatric symptoms are very common in AD and pose a heavy burden to both patients and their caregivers.

To unravel potential associations between neuropsychiatric symptoms and cADL and bADL in individuals with neurocognitive disorder due to AD by means of machine learning (ML).

The study included 189 cognitively intact older individuals (CI) and 130 with either minor or major neurocognitive disorder due to AD. Neuropsychiatric symptoms were captured with the Neuropsychiatric Inventory (NPI), covering delusions, hallucinations, aggression, depression, anxiety, apathy, elation, disinhibition, irritability, motor disturbance, nighttime behavioural disturbances and appetite disturbances; cognitive function was assessed with the Cognitive Telephone Screening Instrument (COGTEL); The Bristol ADL scale, an informant-rated measure, was employed for tapping performance of ADL. A variety of ML-models was constructed and trained/tested using a 5-fold cross validation, with SMOTE employed as a remedy for class imbalances. In all cases the features had been selected beforehand based on LASSO technique. The dependent variable was either cADL or bADL (after their discretization based on kMeans quantization). Additionally, the modelling of the diagnosis was also attempted within our ML framework.

Gradient Boosting models performed superiorly. cADL and bADL levels are predicted based on both deficits in cognitive domains and NPI variables with an accuracy of 82.3% and 84.8% respectively.

In addition, diagnosis can be predicted, with an accuracy of 83.5%, based on a model in which NPI and Bristol ADL variables were significant predictors.

cADL- and bADL performance in patients with AD is influenced by both cognitive deficits and neuropsychiatric symptoms.

Music therapy is frequently provided to patients at the end of life, and studies have shown a benefit in relief of symptoms and a positive impact on quality of life (QoL), but little is known regarding the effect of music therapy (MT) on caregivers. Caregivers are at risk for anxiety, emotional distress and experience anticipatory grief as the patient nears death. Caregivers are present with patients and may also benefit from MT.

To assess the impact of MT on caregivers for hospice patients and determine the feasibility of research in this population.

Twenty caregivers of patients hospitalized for general inpatient hospice care were enrolled. MT was provided by a board-certified music therapist, and sessions included pre-MT assessment, 20-45 minutes of MT, and post-MT assessment. Caregiver stress was measured with the Pearlin Role Overload Measure (ROM), QoL was measured with the Linear Analogue Self-Assessment (LASA), and depression and anxiety were measured with the Patient Health Questionnaire for Depression and Anxiety (PHQ-4). These three measures were taken pre-MT, post-MT and 6 months post-MT. Caregivers were also asked to complete a Music Therapy Program Survey post-MT.

The MT intervention was completed for 15/20 caregivers (75%). Of those who did not complete MT, 2 withdrew prior, 1 was not available, 1 patient passed during the MT session, and 1 patient died prior to MT. 14 caregivers completed pre-MT and post-MT assessments, and 9 caregivers completed assessments at all 3 timepoints. The MT Program Survey (post-MT assessment, n=14) showed 100% of caregivers were very satisfied with MT and would recommend to others, 78% found MT effective for stress relief, 69% for relaxation, 71% for spiritual support, 86% for emotional support, and 71% for feeling of wellness.

Research on MT is feasible for acute hospice care caregivers with a majority of caregivers consenting to research and about half completing surveys pre-MT, post-MT, and 6-months post-MT (9/20). Future larger studies should be conducted to better assess the impact of MT on caregivers.

COVID pandemic in India, lockdowns and an unprepared health system has affected wellbeing of older adults. Low public awareness about mental health issues and stigma also contribute to low help seeking. Exploring impact of COVID on mental health of older adults and understanding support needs is essential.

To examine mental wellbeing and coping strategies used by urban community residing older adults during the pandemic in India.

As part of an ongoing community engagement initiative with older adults and their families, an online survey was conducted during the first wave of the pandemic in April/May 2020. Sociodemographic details and information on coping strategies were gathered. The five-item General Health Questionnaire (GHQ) was used to screen for psychological distress and data were analyzed using descriptive statistics. Respondents were contacted again in May 2021 during the second COVID wave for a telephonic interview to understand current levels of distress and coping strategies. Consent was taken for audio recording and interviews were conducted using a semi-structured interview guide. Interviews were transcribed and analyzed using thematic analysis.

Respondents (N=54) aged between 40-86 years (Mn = 60; SD = 18.9). Majority were male (61%), retired or homemakers (57%) and widowed/unmarried (52%). Of the sample 70% had one or more pre-existing medical conditions. A score of ≥ 2 on GHQ in 66% respondents indicates psychological distress. Stressors included health and well-being of family (62%), difficulty managing household work (42%) and increase in family conflicts (17%). Although 72% discussed their worries with family/friends, only 25% considered speaking with a mental health professional indicating low help seeking. Of respondents contacted again, 40% citied ill health or being busy as reasons for refusal to participate. Of those who agreed, 33% reported psychological distress. In-depth interviews, showed use of online mental wellness sessions and yoga/meditation to be beneficial coping strategies. Need for more online support groups was also highlighted.

Psychological distress is present amongst community residing older adults in urban India. A change in attitude towards tele mental health must be leveraged to provide support for adults experiencing psychological distress.

Residents of long term care facilities (LTCFs) and their professional caregivers have been hit hard by the coronavirus. During the COVID-19 outbreak, many countries imposed national visitor-bans for LTCFs. In the Netherlands, the ban was in place from 20 March 2020 onwards and ended (partly) on 15 June 2020. The usual meaningful and pleasant day structure that is created through organized (group) activities, was heavily impacted by the visitor ban. It remains unclear which particular types of activities were stopped, whether ‘alternative’ activities were introduced that may acquire a structural character in the future, and how this affected care workers.

We conducted online questionnaire research among LTCF residents, family members and care professionals at two time points; six weeks after the visitor-ban was implemented (T1) and one week after the ban was (partly) lifted (T2). The three groups received questionnaires on the consequences of the COVID-19 outbreak and the restrictive measures in place. Respondents were recruited independently for each measurement. This study only uses care professionals’ data. The influence of the up- and downscaling of activities on care professionals’ burden and ability to provide care was investigated using multivariate multiple linear regression.

811 professionals completed the questionnaire during T1 and 324 care workers during T2. A decrease in regular group activities during the visitor-ban was reported. Especially exercise activities, creative activities and music activities were undertaken less frequently. Also domestic activities, such as eating together and watching television, took place less frequently as compared to before the visitor-ban.

Activities that could be easily done on the unit, with sufficient social distance, were undertaken more frequently, such as music activities, conversations and playing games in the living room. The impact of the up- and downscaling of activities on care professional burden, and the perceived ability to provide adequate care, will be presented.

Activities are an important means for residents of long term care facilities for obtaining pleasure and giving a meaningful structure to the day. Future lessons can be learned from the adjustments that had to be made in the range of activities offered during the visitor-ban.

People working in long-term care homes (LTCH) face ethical dilemmas about how to minimize the risk of spread of COVID-19, while also minimizing psychological hardship and other harms of infection control measures on residents. The Dementia Isolation Toolkit (www.dementiaisolationtoolkit.com; DIT) was developed to address the gap in ethical guidance for LTCH on how to safely and effectively isolate people with dementia while supporting the personhood and well-being of residents. In this presentation, we will present the DIT and report on the results of a survey of LTCH staff in Ontario, Canada on their experiences isolating residents in LTCH and the use of the DIT in supporting person-centred isolation care.

A link to an online survey was distributed to LTCH staff through provincial organizations and agencies as well as through social media and the DIT website. Inclusion criteria were LTCH staff working on-site at a LTCH since March 1, 2020, who had direct or indirect experience with the isolation/quarantine of LTCH residents. Results were summarized descriptively.

A broad sample of LTCH staff (n=207) participated in the survey, most of whom had experienced an outbreak in their LTCH. Dementia (96%) was the most important barrier to implementation of infection control measures in LTCH, followed by staff distress about the effects of isolation on residents (61%). Important facilitators for isolation included delivery of 1:1 activities in the resident’s room (81%) and designating essential caregivers to provide support (67%), while inadequate staffing levels were reported as a barrier (55%). 65% of respondents indicated some familiarity with the DIT, and of those who had used the toolkit, 62% found it helpful in supporting isolation care, particularly in developing care plans and making and communicating decisions. Of those who had used the DIT, 48% found it fairly or very helpful at reducing their level of distress.

Isolation as an infection control and prevention (ICP) measure in LTCH environments can be harmful to residents and create moral distress in staff. ICP guidance and support of LTCH needs to address how to minimize these harms by providing dementia-specific guidance such as in the DIT.

COVID-19 has caused the sudden closure of care homes to the outside world, to stem the virus from infecting some of the most vulnerable groups of people – older adults residing in care homes. With very little knowledge to date, we aimed to explore the impact of COVID-19 on care provision and visits in care homes from staff and family members’ perspectives.

Care home staff and family carers of people living with dementia (PLWD) across the UK were recruited via convenience sampling and participated via telephone or Zoom. Participants took part in a semi-structured remote interview. Baseline data were collected between October and November 2020, and follow-up interviews were collected throughout March 2021. Anonymised transcripts were analysed separately by two research team members using thematic analysis, with codes discussed and themes generated jointly, supported by research team input.

42 participants (26 family carers and 16 care home staff) took part in the baseline interviews, and 20 purposefully sampled participants (11 family carers and 9 care home staff) were followed up. Prior to vaccination roll out in the UK, at baseline, family carers expressed concern about a lack of clear guidance throughout the pandemic, with care homes delivering care differently and disparities noted in the levels and types of visiting allowed for family members. Lack of communication between care homes and family members, but also government and care homes, led to family carers feeling excluded and concerned about the well-being of their relative. Data on follow-up interviews are still being analysed.

This is the first empirical evidence to show how the pandemic has caused severe difficulties in providing adequate care for care home residents, with not only residents, but also care home staff and family carers being negatively affected. Follow-up data will shed light onto the impact of vaccination and eased visitation rights put in place since March 2021 on care delivery and connections between family carers and residents.

The COVID-19 pandemic precipitated widespread change across health and social care in England and Wales. A series of lockdowns and UK Government guidance designed to reduce the spread of COVID-19 which emphasised social distancing and increased use of personal protective equipment led to changes such as increased use of remote consultation technologies and the closure of services deemed non-essential. This included many services for people with dementia and their families, such as day centres and dementia cafes.

To explore the changes made to services during the pandemic and the impact of these changes on the delivery of good post-diagnostic dementia support.

Professionals who had previously been recruited to the ongoing PriDem qualitative study were approached for follow up interview. Eighteen interviews with a total of 21 professionals working in health, social care and the third sector were conducted using telephone or video conferencing.

Interviews were audio recorded, transcribed and checked prior to thematic analysis.

Key themes emerging from preliminary analysis of the data include: uncertainty about the future and the need to adapt quickly to shifting guidance; changing job roles and ways of working; the emotional and physical impact of the pandemic on staff working with people with dementia and their families; and the impact of changes made (e.g. increased PPE, remote working) on the ability to deliver post-diagnostic support. However, there were also some unintended positive outcomes of the changes. These included the ability to include family members living at a distance in remote consultations, allowing for more robust history-taking, as well as the uptake of technology to facilitate cross-sector and multidisciplinary working between professionals.

Delivering post-diagnostic dementia support during COVID-19 was challenging and forced dementia services to make adaptations. Participants expected that some of these changes would be incorporated into post-pandemic work, for example increased use of technology for multidisciplinary team meetings or blended approaches to patient-facing services involving both virtual and face to face work as appropriate. However, most participants agreed that it was not appropriate nor desirable to provide fully remote post-diagnostic support on a full time basis.

To prevent COVID-19 from spreading in long-term care facilities (LTCFs), the Dutch government took national restrictive measures, including a visitor-ban in LTCFs between mid-March and May 2020.

Physical visits were replaced by alternatives as telephone or video calls. This study examines the relationship between the involvement of family caregivers (informal caregivers, ICs) of people with dementia (PwD) living in LTCFs and IC mental health during the visitor-ban. Furthermore, we examine whether this relationship is moderated by the frequency of contact with PwD during the visitor-ban and resilience of ICs.

A cross-sectional study was carried out, 375 Dutch long-term care organizations were invited by email to participate. LTCFs sent eligible ICs a link to an anonymous online survey. Family involvement was assessed by the visiting frequency and doing social (e.g. drinking coffee), or social and task-related (e.g. laundry) activities during visits before the visitor-ban.

958 ICs of PwD participated. Contact frequency increased for 17% ICs and decreased for 25% compared to visiting frequency. 43% of ICs did only social activities and 57% social and task-related activities. ICs who visited their relatives at least once a week before the visitor-ban were more worried during the visitor-ban than those with less regular visits (main effect). Contact frequency during the visitor-ban was a moderating factor, ICs who visited the PwD daily before, but had at least weekly contact during the visitor-ban, worried less. No main effects for activity type were found on loneliness , however resilience was a moderating factor. Resilient ICs who did more diverse activities (task and social related) before the visitor-ban, experienced less loneliness during the visitor ban.

The results implicate that to reduce worries amongst ICs, LTCFs should facilitate in continuing contact with PwD during a visitor-ban, specifically in highly involved ICs. Also, non-resilient ICs that generally only do social activities are more prone to loneliness. It is advisable for healthcare and welfare professionals to reach out to this group, to help them with overcoming their loneliness.

The study’s main aim was to assess the end-of-life decision-making capacity and health-related values of older people with serious mental illness.

This was a cross-sectional, observational study, done at Weskoppies Psychiatric Hospital, Gauteng Province, South Africa that included 100 adults older than 60 years of age and diagnosed with serious mental illness.

Socio-demographic, diagnostic, and treatment data were collected before administration of the Mini- Cog and a semi-structured clinical assessment of end-of-life decision-making capacity. Finally, the standardized interview, Assessment of Capacity to Consent to Treatment, was administered. This standardised instrument uses a hypothetical vignette to assess decision-making capacity and explores healthcare-related values.

According to the semi-structured decision-making capacity assessment, 65% of participants had decision-making capacity for end-of-life decisions. The Assessment of Capacity to Consent to Treatment scores were significant (p<0.001) when compared to decision-making capacity. Significant correlations with impaired decision-making capacity included: lower scores on the Mini-Cog (p<0.001); a duration of serious mental illness of 30-39 years (p=0025); having a diagnosis of schizophrenia spectrum disorders (p=0.0007); and being admitted involuntarily (p<0.0001).

Two thirds of older people with serious mental illness had decision-making capacity and were able to engage in end-of-life care discussions. Healthcare providers have a duty to initiate advance care discussions, optimize decision-making capacity, and protect autonomous decision-making. Chronological age or diagnostic categories should never be used as reasons for discrimination, and older people with serious mental illness should receive end-of-life care in keeping with their preferences and values.

Medications with anticholinergic activity are widely prescribed for a variety of medical, surgical, and psychiatric illnesses. There is strong evidence that the cumulative anticholinergic properties of such medications (i.e., the anticholinergic burden) contributes to significant longer-term adverse effects, including dementia, impaired mobility, and increased mortality. Despite this, the anticholinergic burden is often not given due consideration when cliniciansprescribe or review medications in routine clinical practice. This is of particularrelevance in services working with elderly patient populations, who are both more likely to experience polypharmacy and more vulnerable to medication adverse effects. Greater awareness of the risks of anticholinergic prescribing may lead to improvements in longer-term cognitive and physical functioning,and subsequently decreased disease burden on individuals and society as a whole.

To identify and quantify anticholinergic burden among all patients currentlyattending a rural Psychiatry of Later Life service.

This was a cross-sectional observational study. Chart reviews were carried out on all patients open to the service at the time of the study in November 2020. Each patient’s medication regime was analysed to calculate its overall score onthe Anticholinergic Effect on Cognition Scale (AEC), using an online tool developed by South London and Maudsley NHS Foundation Trust. Other variables such as each patient’s age, sex, and cognitive status (categorized as no cognitive impairment; mild cognitive impairment (MCI); or dementia) were also documented. Data was anonymised on collection. AEC scores of 2 or morewere deemed to be at threshold for ‘review and withdraw or switch’ of medications.

A total of 80 patients were included in the study (48 female; mean age 77 [SD = 6.5] years). 45% of patients had a documented diagnosis of dementia, 11%had a documented diagnosis of MCI and 44% had no documented cognitive impairment. Overall, the majority of patients (53.75%) were found to have an AEC score of 2 or greater (AEC range 0-6, mean 2.5 [SD = 1.5]). Of patients with a diagnosis of dementia, 58% were found to have an AEC of 2 or greater.

The possible detrimental effects of prescribed medication on cognition and physical health are likely under-recognised in routine clinical practice. Greaterawareness of the anticholinergic properties of a wide variety of commonly prescribed medication may lead to more selective and informed prescribing.

Abstract has been accepted for a poster presentation at the British Association for Psychopharmacology Summer Meeting (July 2021), and at the European College of Neuropsychopharmacology Annual Congress (October 2021).