The quality of life (QoL) of professionals working in nursing homes is often impaired by the stress that they experience daily. This sustained stress is known as burnout. A syndrome that ends up negatively affecting all areas of life and decreasing their quality of life. Negative stereotypes can alter how professionals perceive older adults. The literature has supported the relationship between high levels of burnout and negative stereotyping. These may moderate the impact of stress as a function of how they perceive stressors as reported by Lazarus and Folkman (1984).

This study aimed to analyze how burnout affects professionals´ quality of life and how this relationship is moderated by their stereotypes towards the residents. The sample included 312 professionals working in nursing homes. Quality of life (QPL-35), burnout (MBI) and negative stereotypes towards older adults´ health, motivation and personality (CENVE) were measured. To analyze the data, we performed linear regression models.

We found a negative relationship between burnout and quality of life (p<0.001; R2=0.47). The results of the moderation analysis show that they are significant regarding total stereotypes variable (M1: b=0.10, SE=0.04, t=2.18, p=0.03), the health subscale (M2: b=0.14, SE=0.04, t=3.11, p<0.001) and the social- motivation subscale (M3: b=0.09, SE=0.05, t=1.79, p=0.07). In contrast, character-personality subscale did not show any significant moderation (M4: b=0.06, SE=0.05, t=1.25, p=0.21).

These results reflect the importance of investigating the role of stereotypes and their relationship with professionals´ quality of life and burnout. Future intervention programs that aim to prevent negative stereotypes are needed not only to improve residents´ quality of life, but also for professionals wellbeing and quality of life.

This research was funded by the Spanish Ministry of Economy and Competitiveness (grant no. PSI2016-79803-R).

Project ECHO is a virtual, case-based capacity-building education program for healthcare providers. It was developed in New Mexico, USA but, due to its effectiveness, the model has now spread to 40 countries around the globe. Baycrest, the Canadian Coalition for Seniors’ Mental Health and the Canadian Academy of Geriatric Psychiatry collaborated to launch a national ECHO for mental health and aging. This partnership, coordinated by a cross-Canadian Steering Group, allows for broad reach, including registration of learning partners from almost all Canadian provinces and territories. The program was funded by the RBC Foundation.

ECHO COE: Mental Health pilot consisted of 2 cycles:

• 6 weekly sessions focused on broader mental health topics (e.g., delirium, mood disorders)

• 10 weeks with more specific topics (e.g., substance use disorders, sleep disorders)

Needs assessments of healthcare providers and older adults informed the program curricula. Evaluation included weekly satisfaction surveys, and pre and post evaluations.

Participants:

• 154 healthcare providers participated in the 6-week session

• 39% of registrants were nurses or nurse practitioners, 35% allied health professionals, 14% physicians and 12% others

• 9 out of 10 provinces, 1 territory represented

Preliminary findings (based on the first 6 sessions):

• High overall satisfaction (average of 4.5 out of 5).

• 99% would recommend the program to others

• 67% had already shared information with team members and colleagues.

A national ECHO program is an effective way to bring together clinicians who work with and are interested in the mental health and wellbeing of older adults for education sessions, collaborative and mutual learning as well as for cross-jurisdictional knowledge transfer. Collaborative, cross-professional learning supports the exchange of best practice in mental health for older adults, supports the development of collegial national professional support and can address health system inequities. An international ECHO through IPA would be an exciting and valuable next step.

Comparing Ultra-brief (UB) Right Unilateral Electroconvulsive Therapy (RU ECT) to the existing literature, this case series highlights the use of the treatment with geriatric patients.

This is a retrospective chart review of 5 patients with catatonia who were successfully treated with UB RUL ECT. Medical records were reviewed for clinical data and ECT treatment. The existing literature is compared and contrasted with other published cases. Quick Inventory of Depressive Symptomatology (QIDS) was completed both pre-ECT and post-ECT. Clinical Global Impression–Improvement (CGI-I) scale was performed post-ECT. Response was defined as decrease of QIDS by 50% and remission was defined as QIDS ≤5. CGI response was defined as CGI-I ≤2.

All patients received UB RUL ECT treatment (mean age 67, 100% female). 20% (n=2) were caucasian. 60% had mood disorders and 40% had psychotic disorders. Number of treatments in the acute treatment course ranged from 5 to 20, charge was dosed at 6-10 times the seizure threshold determined at first treatment. All patients had a significant clinical response to ECT as reflected by clinical data, ECT procedure notes, and rating scales when available. All patients completed post ECT CGI-I. Response rate was 60% (n = 3). We also assessed QIDS scores for patients with comorbid depression. Out of these patients, 40% (n = 2) were unable to complete baseline QIDS secondary to symptoms severity. Mean baseline QIDS for the remaining patients was 9.67 (SD 1.53). Post-treatment QIDS was 3.67 (SD 5.51). Paired-samples t-test comparing these scores at baseline and post-ECT demonstrated a significance P value of 0.14. None of the patients experienced worsening of cognitive function.

UB RUL ECT is a safe and effective treatment for Catatonia. Our data demonstrate clinical improvement in patients with Catatonia with UB RUL ECT. In addition, this method may lower the burden of cognitive effects that can significantly benefit the older adult population. The literature is limited regarding the use of Ultra-brief (<0.37 milisec) Right Unilateral (RU) ECT in Catatonia. Additional studies will benefit from the inclusion of objective metrics such as Bush Francis Catatonia Scale, Scale for the Assessment of Psychotic Symptoms (SAPS), and the systematic evaluation of cognitive status and function.

Both neurological and psychiatric symptoms are observed among mental disorders and represent a challenge for the differential diagnosis, specially in old adults presenting behavioral changes. Investigations have documented manic/hypomanic symptoms from behavioral variant frontotemporal dementia(bvFTD), suggesting a relationship of bipolar disease (BD) with bvFTD.

This work aims to determine the relationship between patients with bipolar disease and behavioral variant frontotemporal dementia.

A non-systematic review of the literature is presented. Bibliographic selection was carried out through keyword research in MEDLINE and Google Scholar.

An early stage of bvFTD often displays a mix of behavioral disturbances and personality changes. Also, BP is associated with a higher risk of dementia in older adults and with cognitive impairment, where a subset of patients presents a neuroprogressive pattern during the disease course. It was shown a specific type of post-BD dementia with clinical features of bvFTD and cases of patients with marked manic symptoms for the first time in their life had subsequent diagnosis of FTD. Mutations in the progranulin gene (GRN) were the most frequent causes of autosomal dominant FTD and have also been reported in sporadic FTD. Genetic polymorphisms in this gene are also associated with schizophrenia and BD. An hypothetical model of shared mechanisms between bvFTD and BD was proposed, including specific mendelian mutations associated with genetic predisposition (e.g. brain-derived neurotrophic factor-BDNF gene) and environmental factors with an effect on cellular homeostasis (e.g. increased cell deaths, decreased synthesis of synaptic proteins) and an influence over behavioural and cognitive symptoms. Nevertheless, comparison of the executive functions, social cognition profiles and structural neuroimaging of bvFTD and elderly patients with BD showed difference in patterns.

Although BD is principally considered a neurodevelopment disorder, while FTD is a neurodegenerative disorder, follow-up studies of cognitive deficits, imaging, and genetics in BD patients could elucidate the possible correlation between these major diseases and may have implications for pathogenesis, as well as for treatment.

Aim of the present review study was to describe and compare the neurocognitive features of MCI which could predict its progression to DLB vs AD.

Progression of MCI to AD or DLB is a relatively recent field of study with emphasis on the clinical or neuropsychological features of MCI which could potentially predict its progression to specific types of dementia.

A literature review in the Pubmed database has been made, after the year 2005, using the key- words: neuropsychological assessment; MCI; AD; DLB; progression to dementia. Seventeen relevant articles have been found.

Data from most studies supports that, in MCI, impairment in executive, attentional and visuospatial functions, as well as letter fluency and fluctuating concentration are mainly related to progression to DLB. In contrast, prominent episodic and recognition memory deficits are mostly found in MCI which progresses in AD. Furthermore, non-amnestic MCI has been related most often to progression in DLB, whereas the amnestic type to AD, although memory loss may not necessarily predict the development of AD. Nevertheless, fewer studies suggest that MCI-DLB is related to cognitive profile similar to that of MCI-AD, while cognitive scoring alone does not accurately predict MCI-DLB vs MCI-AD. Interestingly, quantitative electroencephalogram has been found to help in predicting the progression of MCI to DLB, while preservation of hippocampal volume is associated with increased risk of DLB vs AD, especially in non-amnestic MCI. Moreover, specific patterns on neuroimaging MCI may predict progression to AD in contrast to DLB.

Predicting the progression of MCI to AD or DLB based on neuropsychological profiles is challenging and useful for early therapeutic interventions. More studies are needed, since there are some conflicting findings and, at present, the combination of clinical symptoms with neurocognitive assessment and neuroimaging is the ideal method for the prediction of MCI progression to various types of dementia.

The existing guidelines for the process of dementia diagnosis and treatment does not necessarily translate into optimal care and support for people with dementia. Such situation can have significant consequences. Misunderstanding of the new life situation as well as the negative perception of the diagnostic process itself are intensified by the limited options of post-diagnostic support. Especially in Poland, where the national dementia strategy has still not been implemented, experiences of people undergoing diagnosis and seeking support should be heard. By giving voice to people with dementia we can value their personal experiences, which due to the existing stigma, may often be overlooked and neglected.

The aim of the study is to examine factors (conditions, barriers, facilitators) to receiving a dementia diagnosis and post-diagnostic support from the perspective of people with dementia living in Poland. The research was conducted as part of the JPND project COGNISANCE.

Ten people with dementia diagnosed within last 24 months were interviewed with the use of selected projective techniques (word associations and third person expressive technique). An inductive qualitative content analysis approach has been implemented to analyse the obtained data.

Analysis revealed diverse categories encompassing broad spectrum of conditions, barriers and facilitators to receive a diagnosis and post-diagnostic support. People with dementia were prone to feeling positive emotions despite negative initial reactions during the diagnosis. Positive adaptation to the dementia were highly dependent on the empathetic attitude of the doctor and supportive family. Main needs were related to maintaining the independence, staying active, healthy and being socially connected. Interpersonal factors ensured sense of security and stability crucial for the well-being.

Presented results provide important insight into the current experiences of people with dementia and represent guidelines for care providers and policy makers in introducing the optimal solutions in dementia support.

Although formal treatments like antidepressants and psychotherapy may effectively reduce depression in nursing home residents, side effects and poor treatment adherence are common. To improve depression care, it is important to also learn from informal strategies already used successfully in daily practice, alongside or in absence of formal treatment. For example, although not prescribed as formal treatment, a care provider may seat a resident with depression at a table near the window. This may have antidepressant effects due to extra day light or pleasant views from the window.

To identify, categorize, and prioritize informal antidepressant strategies for residents already used in daily practice as reported by residents themselves, their relatives, and professional caregivers.

In the first Group Concept Mapping study, residents, relatives, and professional caregivers (N = 124) brainstormed on strategies to prevent or improve depression that may be performed by residents themselves. In the second study, the same participants (N = 110) reported on strategies others involved in residents’ lives could perform. In a second round of both studies, participants rated the expected effectiveness (N = 54, N = 51 respectively) and feasibility (N = 50 for both studies) of the strategies mentioned. In addition, strategies for both studies were sorted based on similarity in meaning by experts.

Six clusters appeared for actions to be undertaken by residents themselves, and five clusters for actions by others. The results showed that, for strategies by residents, the clusters ‘Being socially connected’ and ‘Participating in activities’, and for strategies by others, the cluster ‘Offering personal attention’ stand out the most in terms of high expected effectiveness. The cluster with strategies executed by residents that stood out as the most feasible was ‘Having a healthy living environment’. The most feasible clusters performed by others were ‘Offering personal attention’, ‘Using positive treatment/approach’, and ‘Using or adapting the physical environment’.

By using an innovative bottom-up participatory approach, this research shed light on various clusters of useful informal antidepressant strategies for daily practice. To test effectiveness and implementation, research is needed on these antidepressant strategies and their regular use in care.

To examine whether periodontal disease increases the risk of developing Alzheimer’s disease and related dementias (ADRD) among hepatitis C patients in Medicare claims data.

Periodontal disease and hepatitis C virus (HCV) represent chronic infectious statesthat are common in elderly adults. Both conditions have independently been associated with an increased risk for dementia. Chronic infections are thought to lead to neurodegenerative changes in the central nervous system possibly by promoting a proinflammatory state. This is consistent with growing literature on the etiological role of infections in dementia. No studies have evaluated the association of periodontal disease with dementia in HCV patients.

We used Medicare claims data for HCV patients to assess the incidence rate of ADRDwith and without exposure to periodontal disease between 2014 and 2017. Diagnosis of periodontal disease, HCV, and ADRD were based on ICD-9 and ICD-10 codes. A Cox multivariate regression model was used to estimate the association between periodontal disease and development of ADRD, controlling for age, gender, race, ZIP-level income and education, and medical comorbidities.

Of the 440,578 patients in the dataset, the incidence rate of ADRD in the periodontal disease group was higher compared to those without periodontal disease (10.77% vs. 9.27%, p<0.001, and those with periodontal disease developed ADRD earlier compared to those withoutperiodontal disease (1.15 vs. 1.78 years, p<0.001). The hazard of developing ADRD was 1.23 times higher in those with periodontal disease (95% CI, 1.19 to 1.27, p< 0.001) after adjusting for all covariates, including age.

Periodontal disease increased the risk of developing ADRD in HCV patients in anational Medicare claims dataset.

Reversible causes are thought to explain about eight percent of all dementias. Hypothyroidism is one of the most important causes of potentially reversible dementia. Deficits in memory, psychomotor slowing, general intelligence, and visuoperceptual skills are particularly involved and may not fully recover. We review a clinical case of a reversible dementia caused by hypothyroidism, in a patientfollowed in our institution.

Case report using clinical files, and brief literature review using Pubmed database, searching for the keywords “reversible dementia”, “hypothyroidism” and“psychosis”.

We present a case of a 76-year-old female patient admitted in our acute unitwith visual and auditive hallucinations and persecutory delusional ideation for 1 month. There was no previous psychiatric history. The patient was fully oriented in space, time and person, but there were clear memory deficits and sensitivity to antipsychotics. We used the Montreal Cognitive Assessment (MoCA) and the Frontal Assessment Battery (FAB), having the patient scored 17 on the former and 3 on the latter, failing in all tests except for grasping. On the blood tests, fT3 and fT4 levels werenear 0 and TSH was 40 µg/dL. We then discovered that the patient had a thyroidectomy 25 years ago and had been doing replacement treatment since then buthad discontinuated treatment on the previous six months. We also did magnetic resonance imaging that showed frontal microcirculatory changes but without clear atrophy. The patient was treated with aripiprazole 30mg and levothyroxine 0,150mg, being discharged after 1 month, without psychotic symptoms. About 1 year after, we repeated MoCa and FAB, scoring 27 and 16, respectively. The psychotic symptoms didn’t recur even after the antipsychotic discontinuation.

We present a case of hypothyroidism induced dementia with psychotic symptoms, that fully recovered with thyroid replacement treatment, without previous neurological or psychiatric history.

In a search for innovative dementia care strategies, a new research fields have been dedicated to design social robots for older adults with cognitive impairments and dementia in order to promote their quality of life through communication and social interactions. Although the results are promising, the quality of studies on effectiveness of social robots in elderly adults is still low due to several methodological limitations (1). Then, we aim to review the methodologies used so far for conducting studies with social robots in clinical and social settings with people with dementia and elderly adults.

Searches in Medline (PubMed), Web of Science, PsycInfo, and Cinahl yielded 33 studies included in the final review after applying inclusion and exclusion criteria. Reviews were conducted by two authors independently.

Across 33 papers, 23 different social robots were examined on elderly adults and PwD, investigating feasibility, usability and effectiveness. A variety of study designs such as RCTs, mixed methods, cross-sectional and cohort were employed. Individual and group-based interventions took place in private households, LTCFs and labs within a single session or multiple sessions. Data were collected through observation, questionnaires, interview and physiological tests. Most revealed improvements were found in mood, engagement and participation. However, improvements in QoL, depression and cognition were not significant.

Despite the promising results, due to the insufficient methodology, failures and ambitious findings remain within the many aspects of the enquiry. Appropriate RCT designs with large sample sizes and individual intervention sessions might be established for effectiveness studies. For feasibility/usability studies, a cohort design with long-term intervention would serve best. We also recommend a mixed method of data collection for any of three effectiveness, feasibility and usability study aims. Multiple interaction sessions running for more than one month might help researches to draw significant results and reveal the long-term impact of the robots.

It has been widely demonstrated that recent stressful events could impact wellbeing, nevertheless it is not clear whether stressful situations experienced in the pastand the internal resources used to deal with them can also influence older adult’s well- being. The purpose of this study was to evaluate the influence of stressful past events andemotional intelligence on negative affect, and to determine whether negative affect is related to older people’s wellbeing.

The Aging in Spain Longitudinal Study, Pilot Survey (ELES-PS) database wasused. The sample comprised 1747 participants (55.9% women), with ages between 50 to98 years-old (M = 66.2, SD = 10.6). Stressful past events were evaluated with a list of tenstressful events developed by the project team. Three items of the Trait-Meta-Mood scalewere used to assess emotional intelligence. In order to evaluate negative emotions, the PANAS scale of negative experience was used. Finally, life satisfaction was assessed using the Personal Wellbeing Index.

The results of the SEM model indicated that emotional intelligence predicted negative affect, and this in turn was related to participants wellbeing. However past stressful events showed no effect on either the emotional intelligence or on participants’ negative affect. Age was used as a control variable and influenced negative affect but didnot impact stressful past events.

Internal resources such as emotional intelligence appears to be more important than stressful past events in predicting successful aging.

Late-onset bipolar disorder (LOBD) remains an incompletely understood nosological entity, in reason of its complexity and the paucity of research in this issue. It is not yet clear whether LOBD is a “phenocopy” of the classic early-onset bipolar disorder (EOBD), sharing symptoms but having a different aetiology, or whether both have a common underlying vulnerability that interacts with age-specific triggering factors. Some authors have proposed that LOBD is a heterogeneous entity, comprising secondary mania (including organic brain disease), bipolarity in the context of dementia-like processes (BD type VI), and LOBD as expression of a lower vulnerability to bipolarity.

Female patient with previous medical history of hypertension and dyslipidaemia, and psychiatric history of recurrent severe depressive episodes since early age, with melancholic and psychotic features, had a first hypomanic episode at 76 years-old, under treatment with tricyclic antidepressant and electroconvulsive therapy. Meanwhile, she suffered a traumatic brain injury (TBI) complicated with subdural and subarachnoid hematoma, as well as intraventricular haemorrhage, which is an indirect sign of diffuse axonal injury (DAI). Later, at 79 years-old, she presented a mixed episode characterized by racing thoughts, flight of ideas, non-systematized persecutory and ruin delusions, hyposomnia, and ultradian alternation between dysphoric and depressive mood, psychomotor agitation and retardation, emotional lability, hypersyntonic contact and hostility. Medical conditions that could account for secondary mania were ruled out. This clinical picture subsided within few weeks under treatment with olanzapine and electroconvulsive therapy. After recovery memory deficits were noticed.

This case illustrates a “latent” BD, in a patient with previous recurrent depressive disorder, manifesting the first episode of mania in late life. Several triggering factors may have contributed to this longitudinal evolution, lowering the threshold to manifest mania, namely cerebrovascular risk factors, a possible underlying degenerative process and DAI secondary to TBI, which through structural dysconnectivity also contributes to cognitive dysfunction. The deleterious effect of recurrent and severe depressive episodes on cognition is well documented. The question of whether some forms of LOBD could constitute a special risk factor for developing dementia deserves further investigation.

Perceived health status is an important health indicator related to successfulaging and older people’s quality of life. Perceived health status depends on biological, social and psychological factors, for example, at a social level, depends on comparisons with the peer group that individuals carry out and on attitudes towards aging, ageism andhow older people believe they are viewed by society. The aim of this study was to exploreattitudes towards aging and self-perceptions of aging among Spanish middle age and older people and to identify the influence on perceived health status.

The sample comprised 1,124 individuals with ages between 50 to 98 years-old (M= 64.84, SD= 10.12) from the Aging in Spain Longitudinal Study database, Pilot Survey (ELES-PS).

Almost 70 per cent of the participants stated that old age begins at a specific chronological age and half of them considered that society treats older people with indifference. Self-perceptions of aging and attitudes towards aging were significant predictors that explain a 12.2% in the variance of perceived health status.

Results from this study highlight the importance of perceptions and attitudestowards aging for older adults’ health. Addressing negative self-perceptions of aging andnegative attitudes towards aging can be particularly useful because they are associated with more pessimistic expectancies about the aging process.

Stress can have a variety of detrimental effects on humans. From depression and anxiety to schizophrenia, stress plays a factor in the development of these diseases through neurochemical changes in the brain and elevated levels of hormones. Among the geriatric population, decreased sleep levels are known to be a frequent issue; insomnia rates among the senior population are much higher in frequency compared to any other age group. Sleep deprivation also leads to major consequences in the brain and sleep disruption is linked to neuropsychological illness; however, the specific mechanisms involved in these effects are not understood. This study focuses on the resilient effects of ΔFosB, a protein known to mediate resilience to stress and the direct effect of sleep deprivation on ΔFosB expression in areas known to mediate resilience to social stress. We hypothesize that ΔFosB may be part of the mechanism through which sleep alters resilience to social stress.

Mice were sleep-deprived for an eight-hour period for five days. After sleep deprivation they were subject to social defeat and underwent avoidance testing. The brains of these mice were removed, and immunohistochemistry analysis was conducted to determine ∆FosB expression in various sections of the brain.

The preliminary findings of this study indicates that sleep is altered in resilient animals and that sleep deprivation may lead to increased resilience to social defeat. The most significant decrease in ∆FosB expression was found in the prelimbic cortex, a change associated with resilience, and which was observed after chronic sleep deprivation. Contrarily, there was also an increase of ∆FosB expression in the nucleus accumbens.

These findings indicate that changes in ∆FosB activation in the brain is a significant factor for promoting resilient behavior in situations of social stress. In particular, a decrease in ∆FosB activation in the PLC plays a role in explaining how sleep deprivation contributes to decreased social resilience in situations of social stress.

Clinicians are encouraged to use non-pharmacologic interventions first as part of the treatment of responsive behaviours due to mental health conditions. Music therapy is an example of such an intervention. In recent years, there has been an increased research focus on individualized music (IM) because it considers patient’s personal music preferences. However, the findings of whether IM listening is more beneficial than general music listening has been inconsistent.

This study is to further compare the effects of IM and elevator (baseline) music listening on enjoyment behaviours of geriatric inpatients.

Fifteen participants were recruited from a geriatric psychiatry unit in an acute tertiary mental health facility in British Columbia, Canada. Their mean age was 74 years and their mean MMSE was 18. Each participant attended two 30-minute music listening sessions. Each session included a 15-minute baseline music playlist and a 15-minute IM playlist. The sequence of the two playlists was counterbalanced for each participant across the two sessions. The IM playlists were created by interviewing each participant with a personalized music preference questionnaire. The baseline (elevator) playlist was simply consisted of instrumental, non-lyrical jazz and classical music and was the same for every participant. The enjoyment behaviors during the sessions for each participant were measured by the Enjoyment Behavioral Coding Scheme (EBCS), which was developed for this project based on previous literature and was shown to have a good inter rater reliability.

The average total scores of the EBCS across two sessions of IM and baseline music listening were calculated for each participant. Paired samples t-test was used to compare the scores. Though the mean total score of the EBCS for IM session was higher than that for the baseline session, the t-test showed the difference did not reach statistical significance.

Participants appeared to enjoy both the IM and baseline music sessions equally.

During the Covid Health crisis, Belgium is one of the countries that currently counts a very high rate mortality among the elderly population.With more than 24,000 deaths, including more than 10 000 nursing home patients (for a total population of 11 million); this vulnerable population paid a heavy price during this pandemic. During the 2nd wave, we wanted to focus on the level of stress, anxiety, depression and loneliness among the Geriatric hospitalized population.

This prospective observational and multicentric study (CHU St Pierre and Hospital of Nivelles-Tubize) evaluated the psychological state of our patients hospitalized in Geriatrics from 16/11/2020 to 16/03/2021 (with a Minimal Mental State > 20/30) according to the Hospital Anxiety and Depression Scale (HAD) and to the Perceived Stress Scale(PSS).We also estimated their feeling of loneliness. We analysed their biographical, social and medical data as well as their Global Geriatric Evaluation. We will also observe if there are difference between patient living in Nursing Home (NH) or at home.

The sample (n=81) has an average age of 85 years and is predominantly female. The majority were widows with an average of 2 children living at home

Among the 81 geriatric inpatients, 30% scored positive for anxiety, rising to 57% with questionable cases. The depression scale was found to be certain for 17%, rising to 39% if doubtful cases are taken into account.We did not observe a significant difference between the two categories for the patients living at home or in Nursing Home. For the Perceived Stressed Scale, 65% had a high stress score, 15% a moderate score and 20% a low score. It can be noted that nursing home residents also suffer more from loneliness (56%) than people living at home (35%).

This study confirms that the pandemic has had a deleterious effect on the mental state of our elderly during the 2nd wave despite some efforts to reduce isolation. The high mortality rate could be explained by government mismanagement, a delay in action in NH, but also by a latent ageism in Belgium which it would be good to analyze after the pandemic.

Lithium has a narrow therapeutic index with a risk of toxicity and potential to increase morbidity and mortality, particularly in the elderly with co-morbid illness and polypharmacy. Lithium therapy and monitoring of lithium levels require precision and several guidelines have been issued including recommendations for strict control of lithium levels in the elderly population.

We evaluated the effect of implementation of a multifaceted management programme on the compliance with international practice standards for lithium monitoring in patients under the care of Psychiatry of Old Age (POA), Sligo Leitrim Mental Health Services in the North West of Ireland.

Results from a prior audit performed in February 2020 involving a cohort of 18 patients prescribed lithium under the care of POA were analysed and compared to accepted standards. The guideline used as the benchmark for compliance was the National Institute for Clinical Excellence (NICE) guidelines on the use and monitoring of lithium therapy, as published in 2014. Several deficits were found and therefore a designated Lithium Management Programme was established. A subsequent audit, performed using a simplified audit tool incorporating the NICE guidelines, delivered results which were directly compared to the initial findings and analysed to evaluate the effect of the implemented management programme.

In comparison with findings from 2020, there had been a significant improvement in most facets of lithium management and compliance to practice standards. Of particular note was the improvement of biochemical monitoring, side effect screening, polypharmacy surveillance, patient education and interdisciplinary communication.

The launch of a dedicated Lithium Management Programme with specific features aimed at identifying and addressing poor compliance with monitoring guidelines has led to improved adherence to accepted international practice standards. Our model provides a dynamic, multi-layered system which paves the way for better patient outcomes, timely access to care and furthering education for patients and staff members.