Western countries face an aging population and increasing number of people with chronic illnesses. Many countries have shifted from a focus on institutional care to home-based care due to growing healthcare costs and pressure on long-term care. Despite, the increasing difficulty for contemporary family structures to support community-dwelling older adults (CDOA) who need care.

However, about 50% of households own pets which may provide some social support for CDOA. A dearth of studies investigated the support pets provide to CDOA that receive long-term care but a better understanding of pets’ support in CDOA is needed to help develop healthcare protocols and interventions that account for pets in CDOA’s lives.

To add insight into pets’ roles in support systems and the meaning this has for CDOA.

This integrative review was based on qualitative studies on CDOA with pets (average age 65+). Due to few studies on CDOA with pets with chronic illnesses, this review also includes CDOA without a chronic disease. PubMed and PsycINFO, were searched with (MeSH) variations on terms of older adults, pets, and qualitative study-designs. Additionally, reference lists of systematic reviews and HABRI Central were searched. The included articles were inductively analysed in ATLAS.ti.

A total of 15 articles were included in the review. 28 subthemes were categorised in 7 bidirectional factors: social, care, physical health, emotional, cognitive, bonding, and behavioural. CDOA indicate that pets are very important in their lives and have a positive influence on their social environment, mental, and physical health. However, also negative aspects of pet ownership were discussed. Limitations of the review were the varying research questions and diversity of participants in the included studies. Furthermore, we identified a need in some CDOA to keep their pets as long as possible.

This review adds a more comprehensive view on the meaning and role of pets in providing support to CDOA. However, more research is needed into the effects of the revealed factors on the wellbeing of CDOA and healthcare organisations should consider the development of guidelines accounting for the pets of long-term care clients.

Research found that caregivers of relatives with dementia（RWD)were more vulnerable to chronic diseases than those caring for relatives with other diseases. Unfamiliarity with and/or difficulty in balancing their own health needs was common among the caregivers, from the findings of our previous studies and relevant literatures. Therefore, an educational and psycho-social support program named Chronic Disease Self-Management Support (CD-SMS) program was developed for spouse caregivers of RWD in Shanghai, China.

This study was to examine the effectiveness of the CD-SMS program on spouse caregivers’ health-related results, including caregiving self-efficacy, self-efficacy for chronic condition management, and their health behavior.

This study was a randomised, wait-list controlled design. A total of 53 participants with common chronic conditions were recruited and assigned to experimental (n = 25) and waiting-list control group (n=28) by stratified randomization. All participants received an illustrated psychoeducation booklet. The intervention group received six bio-weekly support group sessions, and the control group will receive the same support group sessions after the posttest. Participants in both groups received baseline and post-test assessments. The caregivers were assessed with the Chinese versions of Self-Efficacy for Managing Chronic Disease 6-item Scale, Self-Efficacy Questionnaire for Chinese Family Caregivers and Self-Management Behaviors Scale. The care recipients were measured with the Chinese version of Disability Assessment in Dementia.

A significant interaction between time and group was found in total scores of self-efficacy for managing chronic disease and caregiving self-efficacy for gathering information (P＜0.05). After intervention, caregivers in experimental group reported significant improvements in the total scores of self-efficacy for managing chronic disease, caregiving self-efficacy, and three self-management behaviors (stretching and strengthening exercise, cognitive symptom management, and communication with physicians). The care recipients’ levels of activities of daily living in each group were worse at posttest compared to those at baseline (P＜0.01).

The findings indicated that the CD-SMS program was effective in improving the caregivers’ confidence in balancing their caregiving management and their chronic health conditions management, and their main health behaviors were also improved.

After Alzheimer’s disease, Parkinson’ disease (PD) is the second most common age-related neurodegenerative disorder globally. Approximately 1 million individuals in the United States (US) have PD; every year 60,000 more Americans are diagnosed. PD is a movement disorder caused by dopamine insufficiency in the substantia nigra. The disease process is complicated by falls, constipation, dysphagia, insomnia, anxiety, depression, and behavioral/cognitive disorders. Upon diagnosis, evidence-based symptom management should include individualized nonpharmacologic and pharmacologic interventions along with lifestyle changes that will promote positive outcomes.

More than 50% of persons diagnosed with PD develop psychotic symptoms. Parkinson’s disease psychosis (PDP) is a non-motor symptom and consists primarily of hallucinations and delusions. PDP is caused by neurotransmitter changes in the brain, some related to long-term use of parkinsonian medications. In many cases, PDP symptoms are mis-diagnosed as a chronic co-morbid condition, such as mild cognitive impairment or dementia.

Symptoms run from benign to aggressive. Undiagnosed and untreated symptoms can accelerate. Delirium caused by medications or infections may contribute to psychosis. Rapid Eye Movement Sleep (REMS) Disorder associated with PD results in daytime sleepiness and acting out dreams. All symptoms profoundly impact formal and informal care partners. When underlying causes are identified by expert clinicians, symptoms may be reversible. There are many evidence-based paths to follow such as managing polypharmacy, appropriate prescribing patterns, and the effective use of nonpharmacologic interventions.

During this symposium the complexities of the disease are addressed including the toll PDP can have on the person living with PD, their care partner(s) and the interdisciplinary health care team. It is imperative clinicians can simultaneously manage the overlapping motor symptoms and PDP to prevent physical and mental disabilities and improve quality of life. After attending this session, clinicians will be able to provide quality care to individuals living with PDP and their care partners.

Inclusion is taken as a natural situation, until feelings of exclusion are perceived. Social relations are for human beings like water to plants. Social health has been defined in 1946 by the WHO as the social domain of health. It is an umbrella concept that covers how the individual relates to his or her social environment and vice versa. Social inclusion is a key marker or characteristic of social health, represented by specific markers such as participation in leisure activities.

We aim to study theoretical mechanisms and social health markers relevant to inclusion and cognitive functioning.

identification of mechanistic pathways and systematic review on the relationship between combinations of social health markers and cognitive functioning and dementia in healthy older adults.

We combined neurobiological and social pathways to guide our study. The search for social health markers yielded 4332 potentially relevant citations. Eleven articles were eligible for inclusion. Combining social health marker reflecting social exclusion (e.g. social isolation, financial deprivation, living alone and lacking basic social rights) revealed a significant risk factor for both the development of dementia and reduced cognitive functioning. A combination of a high educational level, high occupational complexity and participating in leisure activities was protective for good cognitive functioning and dementia.

Several social health markers are a pathway to social inclusion and to cognitive functioning, with markers reflecting exclusion being a risk factor, while those reflection inclusion are associated with protective effects. These findings open doors for interventions using the potential of social health in prevention of cognitive decline and dementia.

Emerging evidence describes impacts of the COVID-19 pandemic upon people living with dementia and their informal carers, however without evidence-based global comparisons to date. The aim of this international study was to explore and compare the impact of COVID-19 and associated public health restrictions on the lives of people living with dementia and informal carers and access to dementia care across five countries.

People with dementia and informal carers from the UK, Australia, Italy, India, and Poland participated in remote semi-structured interviews. Participants were asked about their experiences of the pandemic and how restrictions have impacted on their lives and care. Transcripts were analysed by researchers in each country using thematic analysis, then combined across sites.

Fifteen people living with dementia and 111 informal carers participated across the five countries. Four themes emerged: (1) Limited access and support; (2) Technology and issues accessing remote support; (3) Emotional impact; and (4) Decline of cognitive and physical health reported by carers. Whilst variations were noted, the pandemic has indirectly affected people with dementia and carers across all five countries. The pandemic removed access to social support services and thus increased carer burden. Remote services were not always provided and were limited in benefit and usability for those with dementia. Carers frequently described noticeably deteriorating cognitive and physical health in people with dementia.

The pandemic has amplified dementia as a global public health problem, and both people affected by the condition ad their carers need support to better access vital support services to live well. This is even more important with emerging new waves and new variants of the virus affecting different countries, in our globally connected world.

Limited access to medical and social services during the coronavirus outbreak has contributed to the exclusion of vulnerable populations, such as people with dementia and older adults. These limitations and the resulting social isolation have highlighted the importance of social relationships and their relationship to the mental health of these people. In the context of dementia, ‘social health’ (SH) can be defined as the role of social abilities for achieving a dynamic balance between opportunities and limitations. The concept encompasses the capacity and independency of an individual to participate in social activities alongside the influences of the surrounding social network.

Using a qualitative and quantitative approach, we will present social health and its determinants of people with dementia related to social care service closures and self-isolation during the SARS-CoV-2 pandemic. We present an analysis of the survey data from the cross-country population- based study and the semi-structured telephone interviews with people with and without dementia from Poland, UK, Australia and Italy aged 65 and over.

Measuring the Social Health Index in relation to experiencing self-isolation and changes in the use of services before and during the pandemic among the people with dementia, allow us to identify the level of SH and its determinants. Also, the qualitative results revealed the indirect consequences of the pandemic-related restrictions in the access to social care service and social isolation. Reduction of social support was significantly related to deficits in social health and well-being.

Our results highlight the emerging impact of health the current global epidemiological situation upon social health, with a particular focus on those affected by social disadvantage and isolation.

Social distancing rules and the closure of services associated with the COVID-19 pandemic have strongly impacted the physical and mental health of people with dementia. Digital technologies can represent an effective means to compensate for the distress associated with social distancing rules and the decreased use of in-person services. More specifically, technologies such as smartphones, tablets, and smart home systems can minimize the negative effects of social distancing and isolation, and the pressure on health and care systems. Indeed, they can provide a continuity of care and social connectedness, while decreasing exposure to risk. However, barriers such as digital literacy and lower income households can impede the access and use of digital technologies. The aim of this international study was to compare the use of technology by people with dementia from different care settings, and their informal carers across four countries (Italy, UK, Australia, and Poland).

People with dementia and informal carers were invited to participate in semi-structured interviews. Verbatim transcripts were analysed by researchers in each country using inductive thematic analysis.

A total of 141 people with dementia and carers (47 in Italy; 50 in the UK; 18 in Australia; 26 in Poland) were interviewed. The analysis identified three overarching themes: 1) different uses of technology (three subthemes); 2) benefits of technology (three subthemes); 3) limitations of technology (three subthemes). Results show that calls, video calls, and group-chats were effectively used across countries to guarantee the continuity of relationships with professionals, families, and small groups of peers. Telemedicine was used with varying levels of satisfaction. Furthermore, the benefits experienced by carers exceeded those for people with dementia. Similar barriers were reported across countries, and were strictly associated with dementia deficits, low level digital literacy, and the need for carer’s supervision.

These international findings highlight the importance to maximise the benefits related to the use of technology according to people with dementia’s impairment and care context. Moreover, it should be complementary to in-person care which should be provided, at least to some extent, even during pandemic times.

The number of research projects into residential aged care (RAC) during the COVID-19 pandemic is increasing, however there are limited data on the cross-country comparison of experiences residents living with dementia and their families. Our study aimed to 1) give an overview of the RAC restrictions and changes (visiting policy, governmental & health authorities’ advice, service delivery) implemented during the pandemic in Australia, Italy and the UK and 2) and their impact on people with dementia in RAC facilities and their families.

A total of 56 informal family carers of people with dementia residing in RAC took part in semi- structured interviews over the telephone or via Skype in Australia (n=6), Italy (n=25) and the UK (n=26) between July 2020 and March 2021. The interviews were recorded and translated verbatim. Transcripts were analysed by researchers in each country using thematic analysis, then combined across sites.

Inductive thematic analysis identified four overarching themes: 1) Adaptations implemented in RAC facilities due to the COVID-19 pandemic in Australia, Italy and the UK; 2) means of communication between RAC facility personnel, people with dementia living in RAC and family members; 3) impact of the implemented restrictions and changes in care provision due to the COVID-19 pandemic on people with dementia in RAC facilities and 4) impact of the implemented restrictions and changes in care provision due to the COVID-19 pandemic on families of people with dementia in RAC facilities. While differences between countries and facilities were identified, the restrictions and changes within the residential care system impacted families’ well-being, increased their worries about care quality and safety of people with dementia. The consequences of a lack or modified services for people with dementia included noticeable physical and mental health changes. Although the majority of the facilities implemented some form of video-communication between families and residents, those solutions were unable to replace face-to-face contact.

These findings demonstrate the need for implementing safe solutions which might facilitate more frequent in-person contact between families and residents with dementia preventing consequences in mental and physical health in both groups.

1. Dr. Gautam Saha (President, Indian Psychiatric Society) drgsaha@yahoo.co.in

2. Dr. G.Prasad Rao (President, Indian Association of Geriatric Mental Health) prasad40@gmail.com

3. Dr. Sudarshan Narsingh (President, Psychiatrists’ Association of Nepal & President, SAARC Psychiatric Federation) drsudar@yahoo.com

4. Dr. Wazizul Alam Chowdhury (President, Bangladesh Associa tion of Psychiatrists) bap@agni.com

5. Dr. Afzal Javed (President, World Psychiatric Association and Chairman, Pakistan Psychiatric Centre, Fountain House, Lahore) afzalj@gmail.com

Dr. Debanjan Banerjee (Old Age Psychiatrist, NIMHANS, Bangalore; Member, IPA Public Awareness and Advocacy Committee) dr.Djan88@gmail.com

To compare Lithium prescribing practices in a Psychiatry of Old Age (POA) Service in the North-West ofIreland among adults aged 65 years and over with best practice guidelines.

Review of the literature informed development of audit standards for Lithium prescribing. These included National Institute for Clinical Excellent (NICE) 2014 guidelines, The British National Formulary(2019) and Maudsley Prescribing Guidelines (2018). Data was collected retrospectively, using an audit-specific data collection tool, from clinical files of POA team caseload, aged 65 years or more and prescribed Lithium over the past year.

At the time of audit in February 2020, 18 patients were prescribed lithium, 67% female, average age 74.6 years. Of those prescribed Lithium; 50% (n=9) had depression, 44% (n=8) had bipolar affective disorder (BPAD) and 6% (n=1) schizoaffective disorder.

78% (n= 14) of patients met the NICE standard of 3-monthly lithium level. Lithium levels were checkedon average 4.5 times in past year, average lithium level was 0.61mmol/L across the group and 39% (n=7) had lithium level within recommended therapeutic range (0.6-0.8mmol/L).

83% of patients (n=15) met the NICE standards of 3 monthly renal tests. Taking into consideration mostrecent blood test results, 100% (n=18) had abnormal renal function.

Half (n=9) were initiated on lithium by POA service and of these, 56% (n=5) had documented renal impairment prior to initiation. Of patients on long term lithium at time of referral (n=9), almost half (n=4) had a documented history of lithium toxicity.

The results of this audit highlight room for improvement in lithium monitoring of older adults attending POA service. Furthermore, all patients prescribed lithium had impaired renal function. This is an important finding given the associations between those admitted to hospital with COVID-19 and co- morbid kidney disease and increased risk of inpatient death.

Our findings highlight the need for three monthly renal function monitoring in elderly prescribed lithiumgiven the additive adverse effects of increasing age and lithium on the kidney. Close working with specialised renal services to provide timely advice on renal management for those with renal impairment prescribed lithium is important to minimise adverse patient outcomes.

Younger-onset dementia (YOD) is a dementia of which symptom onset occurs at 65 years or less. There are approximately 27000 people in Australia with a YOD and the causes can range from Alzheimer’s dementia (AD), frontotemporal dementia (FTD), metabolic and genetic disorders. It is crucial to obtain a definitive diagnosis as soon as possible in order for appropriate treatment to take place and future planning. Previous research has reported 4-5 years to get a diagnosis (Draper et al. 2016) and factors associated with delay include younger age (van Vliet et al. 2013) and psychiatric comorbidity (Draper et al. 2016). We report on our experience of diagnostic delay.

This was a retrospective file review of 10 years of inpatients from Neuropsychiatry, Royal Melbourne Hospital, Australia. Neuropsychiatry is a tertiar service which provides assessment of people with cognitive, psychiatric, neurological and behavioural symptoms. Factors such as age of onset, number of services/specialists seen were extracted and analysed using multivariate regression.

Of the 306 individual patients who had a YOD, these were grouped into the major dementia groups (such as AD, FTD, Huntington’s disease, vascular dementia, alcohol-related dementia). The most commonly occurring dementia was AD (24.2%), followed by FTD (23%). There was an average of 3.7 years (SD=2.6), range 0.5-15 years, of delay to diagnosis. Cognitive impairment, as measured using the Neuropsychiatry Unit Cognitive Assessment (NUCOG) was moderate, with a mean score of 68.9 (SD=17.9). Within the groups of dementia, patients with Niemann-Pick type C (NPC) had the longest delay to diagnosis F(11,272)=3.677, p<0.0001, with 6.3 years delay. Age of symptom onset and number of specialists/services seen were the significant predictors of delay to diagnosis F(7, 212)=3.975, p<0.001, R211.6.

This was an eclectic group of people with YOD. The results of regression suggests that there are other factors which contribute to the delay, which are not just demographic related. Rarer disorders, such as NPC which present at an early age, and present with symptoms that are not cognitive in nature, can contribute to diagnostic delay.

To examine post-traumatic stress, depression, anxiety, and well-being in older adults under quarantine in the context of epidemics.

A systematic review of CINAHL, Ovid EBM Reviews, Ovid Embase, Ovid Medline, Ovid PsycINFO, Scopus, and Web of Science databases from 2000-2020 was conducted. Keywords included coronavirus, epidemic, quarantine, stress, mental health, and similar terms. Included studies enrolled participants under quarantine, quantitatively measured of mental health or psychological well-being, and characterized outcomes by age.

Of 894 initial results, 20 studies met criteria and were included in the analysis. Studies comprise a total of 106,553 participants from eight countries, age range 6-100, involved two epidemics (COVID- 19, SARS), and used 27 tools used to assess psychological responses to quarantine. The majority (70%) of the studies utilized recruited participants through online surveys, utilizing open web and snowball recruitment. Of the 20 studies, one found greater distress in older adults relative to younger adults on a COVID-19 distress scale, one study found no significant differences, and 18 studies found lower negative outcomes in older participants in at least one metric.

Older adults in this review generally have lower stress and less negative emotions under quarantine than younger adults. It is unknown how this compares to the pre-pandemic state. More representative and longitudinal studies are needed to better measure the impact of quarantine on the mental health of older adults.

As existing scales may not capture the full extent of pandemic’s psychological effects on older adults, clinicians must be vigilant in monitoring older adults’ mental health in quarantine.

When neurodegenerative disease (ND) is diagnosed, the family’s quality of life (FQoL) changes drastically. Within the concept of FQoL, the supports they receive from others at the community level and from services is one of the most important issues. Nonetheless, studies available using a mixed-methods approach are still limited. Consequently, the objective was to study the domains of support from services and support from others (emotional and practical), through the application of a quantitative instrument and the conduction of focus groups.

Three hundred relatives of people with ND, recruited from Regional Health Management of Castille and 14 Leon (Spain) completed the instrument FQOLS–ND, a specific scale for measuring quality of life in families caring for people with a ND. The mean age of the sample is 62.4 years and the majority are females (70%). In addition, a focus group was carried out with 10 family members (70% females, mean age= 61.6) aiming at the analysis of the quality of life domains.

The domains support of others (emotional and practical) and support from services achieved low quantitative levels specially in terms of achievement (Memotional=3.30; SDemotional= 1.21; Mpractical= 3.09, SDpractical= 1.26; Mservices= 2.83; SDservices= 1.02;). In the focus group, the main topics mentioned as negatively affecting the FQoL were social isolation, access and correct follow-up in specialized care services, lack of information on the diagnosis and progression of ND and on the needs of the person, and lack of empathy of professionals and others.

ND negatively and significantly affects the family as a whole. Despite this, the emotional and practical support they receive from both other community members and professionals and services is still very insufficient. Therefore, it is important to raise awareness of the needs of this population and to carry out transformations in the attention provided.

The pandemic has put a huge strain on people’s mental health, with varying restrictions affecting people’s lives. Little is known how the pandemic affects older adults’ mental health, particularly those living in low- and middle-income countries (LMICs) where restrictions are affecting people’s access to basic necessities. Thus, the aim of this 3-country study was to understand the long- term impacts of the pandemic on the mental well-being of older adults with and without dementia in LMICs.

We are collecting 30 baseline and 15 follow-up interviews with older adults (aged 60+), people with dementia, and family carers in Colombia, India, and Uganda, as well as a baseline and follow-up focus group with health and social are professionals in each country. Interviews are conducted remotely over the phone due to pandemic restrictions, with data collection taking place between March and July 2021. Transcripts are translated into English before being analysed using thematic analysis.

To date, we have completed close to 90 baseline interviews and 3 focus groups with health and social care professionals. Analysis is ongoing, but findings are capturing the detrimental second wave in India and follow-up interviews will capture the longitudinal impacts on mental health.

Whilst vaccines are starting to be rolled out in LMICs, albeit at different rates, the virus will likely take much longer to be somewhat managed in LMICs. This leaves more room for people’s physical as well as mental health to be impacted by the restrictions, and with often limited mental health service coverage, it is all the more important o understand the impact of the pandemic on older people’s mental health.

This study aimed to identify predictors of limitations in basic activities of daily living (BADL) among people with severe disabilities.

4075 long-term care beneficiaries with severe disabilities in Guangzhou, China, were included during July 2018 and March 2019. BADL was assessed using the Barthel index (BI). Muscle strength was measured by using the Lovett Rating Scale. Age, gender, comorbidities, and muscle strengths were collected as independent variables. Chi-square Automatic Interaction Detector (CHAID) method was used to examine associations between independent variables and item scores of the BI.

Muscle strength and history of stroke were parent node and child node for most of BADL limitations, respectively. Upper limb muscle strength (≤ 3) was a major predictor for dependence in feeding, grooming, toileting, dressing, and transfer, while lower limb muscle strength (≤ 3) was a major predictor for limitation in mobility.

Muscle strength was the strongest predictor of BADLs among people with severe disability. Muscle strength grading may be optimal for designing supporting strategies for people with severe disabilities.

Comprehensive Geriatric Assessments (CGAs) incorporate the key principles of integrated care delivery, which is regarded as the most effective approach of care provisioning to face challenges of dementia care, such as uncoordinated care, risk of hospitalizations, care planning and unmet needs. For this reason, implementing CGAs in care practice might be highly relevant, however, to do so, we must consider their psychometric characteristics.

To provide insight into the content and the reliability and validity of CGAs used in long-term care and home care settings.

A search strategy was conducted in PubMed, CINAHL, and Web of Science, targeting studies that have focused on the validity and reliability of available CGAs for long-term and home care settings. Studies in English and Spanish and published up to July 13, 2021, were considered.

A total of 72 studies reporting on the validity/reliability of 13 different CGAs were identified. For long-term care facilities, five CGAs were reported; for home care, eight assessment tools were targeted. Most of the CGAs covered a wide range of domains, such as Physical Health, Functional, Mental Health, and Social Status. Evidence for good to excellent validity and reliability was reported for various instruments.

Resident Assessment Instrument-Minimum Data Set (RAI-MDS) and subsequent updated instruments reported strong evidence of good to excellent validity and reliability for multiple countries. For this reason, interRAI LTCF and interRAI HC are recommended to be use for long-term and home care facilities, as they are the latest versions of the RAI-MDS.

This project is part of the Marie Skłodowska Curie Actions Innovative Training Network H2020-MSCA-ITN, under grant agreement number 813196