Depression is common among long term care (LTC) residents and has a considerable impact on their quality of life. Therefore, there has been an increased interest in interventions aiming at the reduction of depression among LTC residents. These interventions could be described as formal depression care and include psychosocial interventions (e.g., Creative Arts Interventions), psychotherapeutic interventions (e.g., Life Review) and/or (neuro-)biological interventions (e.g., psychopharmacotherapy). Previous research on the effectiveness of formal depression care suggests that treatments should be more individually tailored. Tailoring treatments, however, is a time- consuming process which may hinder the implementation in LTC. A more integrative approach targeting specific groups of nursing home residents is therefore preferred and may benefit both residents and staff. To do so, insight in moderator effects is needed to better understand and better match treatments to specific groups of LTC residents.

The aim of this study is to provide insight into (1) the effectiveness of interventions, (2) the influence of residents’ characteristics (e.g., residents with cognitive impairment versus residents with physical disabilities) and/or (3) the influence of contextual factors (e.g., group-based versus individual therapy) which may have an impact on the effectiveness of interventions.

Various databases (e.g., EBSCO, PubMed, COHRANE Library) are searched using a predefined search string, combining terms concerning our PICO elements (e.g., “Nursing Home Residents” (P), “Treatment” (I), “Depression” (O)). We only include a) randomized controlled trials investigating the use of formal depression treatments (independent variable), b) among LTC residents and, c) having used a standardized measurement tool for, d) depression (dependent variable). Results of this systematic search will be presented.

Eligible studies will further be screened and assessed for residents’ characteristics and/or contextual factors. A random-effects model will be used to calculate the pooled standardized mean difference (SMD) and to assess the strength of the effects of formal depression treatments on depression. Further subgroup-analysis and meta-regressions will be used to assess the potential moderator effects.

To better match treatments to LTC residents, more insight into the effectiveness, moderator effects and core components of the applied interventions is needed.

Depression is common among nursing home residents and has a considerable impact on their quality of life. Therefore, there has been an increased interest in interventions aiming at the reduction of depression among nursing home residents. These interventions could be categorized into formal and informal depression care. Formal care includes psychosocial, psychotherapeutic and/or (neuro-)biological interventions. Informal care can be provided by nursing home staff, alongside the formal care (e.g., letting sunlight into the room when one believes in the positive effects of daylight). Although many studies have been done about depression treatment in nursing homes, there is still a lack of insight into the effectiveness of interventions and how they differ among specific target groups (e.g., residents with cognitive impairment versus residents with physical disabilities). Moreover, research into informal care is rather rare. More insight is needed into the effect of formal and informal depression care and the mutually reinforcing effects of those strategies on nursing home residents. This insight is essential to better match treatments with residents and to provide a more comprehensive approach to counter depression.

The aim of this study is to gain insight in the use of formal and informal depression care and their associations with depression among nursing home residents.

A six month cohort study will be conducted.

Residents will be recruited in nursing homes across the Netherlands and Flanders (Belgium). To measure formal and informal care, newly developed tools will be cross-culturally validated: one to assess the provided formal care in nursing homes, two tools for measuring the used informal strategies. Depression outcomes will be measured with the Geriatric Depression Scale, Cornell Scale for Depression in Dementia, and the Nijmegen-Observer-Rated Depression-scale). Baseline measurements and cross- sectional analyses will be performed and repeated after six months. The intended associations will be assessed using multiple regression analysis.

To develop a good depression care policy, a more comprehensive approach is needed and may benefit both residents and staff.

Autoimune dementias are underrecognized clinical entities, frequently misdiagnosed as neurodegenerative or prion disorders. However, the prognosis is vastly different since immunotherapy can treat these conditions and restore functionality.

To reflect on autoimmune dementias, briefly presenting the autoimmune syndromes, how to diagnose them and some clinical cues to be attentive of.

Literature search on Pubmed and Google Scholar.

The incidence and prevalence of autoimmune dementias are unknown, but autoimmune and inflammatory causes account for 20% of dementia in patients younger than 45 years of age.

Autoimmune dementias are classified according to syndromic presentation, specific serologic markers, or histopathologic findings.

Patients with autoimmune dementias usually present with an acute or subacute disorder of memory, thinking, or behaviour. Clinical clues that can help clinicians identify autoimmune dementias include six of the following: (i) rapidly progressive or fluctuating course; (ii) multifocal and diverse clinical presentations; (iii) personal or family history of autoimmunity; (iv) detection of inflammatory markers in the cerebrospinal fluid; (v) presence of a neural-specific autoantibody and (vi) favourable response to a trial of immunotherapy. Also, unsuspected cancer, new or recurrent, may manifest neurologically as autoimmune dementia.

In evaluating patients with dementia and autoimmune disease, clinicians should be aware of the possible coexistence of these disorders.

Recognition of clinical and serologic clues to autoimmune dementia allows early and sustained treatment. Misdiagnosis of a potentially reversible condition as a progressive neurodegenerative disorder can have devastating consequences for the patient and family.

Over half of the households in The Netherlands have one or more pets. In elderly people, owning a pet is associated with a better quality of life and less loneliness, anxiety, depression and agitation. Many non-residential long term care (LTC) clients rely on support of others to take care of their pets. However, that may place a significant burden on the social support network of the LTC client. Issues relevant to keeping pets are not explicitly incorporated in the Dutch Long-term Care Act. Many LTC organizations have no instruments for care workers, clients and their family (1) to consolidate the positive role of pets for clients’ quality of life and (2) to address whether it is possible to keep the pets and to organize care accordingly.

To help care workers, clients and their family to gain insight into the role of the pets in the clients’ life and their social support network; to develop practical instruments that help making decisions about owning and caring for pets.

PLAN: In months 0-16, a narrative systematic review will be conducted (STUDY 1.1) on the meaning of pets for elderly people in general. A qualitative STUDY 1.2 with LTC clients, their informal carers and care professionals will validate and further explore the topic. STUDY 1.3 and 1.4 develop and (cognitively) validate work cards for interviews of clients and relatives by care providers. In months 17-29, an Experience based co-design method (STUDIES 2.1-2.3) will be used to develop the PET@home toolkit. The method includes (1) discovery interviews (10 clients and their family), (2) focus groups with healthcare providers (N = 2x6); (3) focus groups with 6-8 clients and informal and professional carers. In STUDY 3.1, potential users will pre-test the Toolkit. In months 30-34, a process evaluation (STUDY 3.2) is performed in 10-15 clients. A dissemination and an implementation plan will be developed.

The project will result in an innovative PET@home toolkit that will help to assess the pets role in the clients’ quality of life and support network, and will help making decisions about owning and caring for pets.

In Ireland, approximately 65,000 people live with memory problems/dementia (PWMP). Most live in the community, supported by informal caregivers such as relatives. A comprehensive resilience-building psychosocial intervention (CREST) to strengthen intra- and interpersonal resources was piloted by PWMP and caregiver dyads, local GPs, and the community.

An advisory forum of PWMP, caregivers, and dementia advocacy representatives provided guidance on the intervention design and materials (e.g., interview guides), to ensure they addressed the needs of PWMP and caregivers. The 15-week CREST intervention comprised three components: cognitive stimulation therapy for PWMP (CST; 7 weeks), physical exercise for PWMP and partners from the community (8 weeks), and dementia education for key supporters of PWMP: caregivers (6 weeks), GPs, and the community (one-off events). Intervention processes (e.g., recruitment, data collection measures) were evaluated at each stage by PWMP and caregivers through qualitative (verbal feedback, interviews) and quantitative methods (ratings, questionnaires), to ensure they were feasible and acceptable.

Nine PWMP/caregiver dyads were recruited and completed the CREST intervention; attendance was consistently high (90-95%) throughout. The dyads reported that the recruitment materials, phone calls, and letters from the research team were helpful and easy to understand. Feedback from PWMP, caregivers, event attendees, and programme facilitators confirmed that the intervention content and delivery were acceptable. Minor changes were recommended, and changes which facilitated participation by the PWMP during this pilot (e.g., giving verbal rather than written feedback, larger-print handouts) were implemented immediately. The PWMP enjoyed the CST activities (e.g., collages, tasting childhood sweets) and the “bit of fun” the group shared; some also perceived improvements in concentration and confidence. The PWMP enjoyed the group Exercise sessions, particularly the social aspects (e.g., “banter”, exercising with partners), and some reported improved fitness and feeling less breathless. Caregivers felt better informed about managing dementia and communicating with PWMP and enjoyed sharing experiences with other caregivers. Attendees at the community and GP education events reported improved knowledge of dementia.

The involvement of the PWMP and caregivers was valuable to the iteration of the pilot CREST intervention. Consultations with both groups are ongoing to inform future research priorities.

Stroke is the third leading cause of death and one of the most common causes of disability and depression. Depression, which is the most common disorder after stroke, is associated with limited functionality, reduced self-care, and increased mortality.

The aim of the present study was to investigate the presence of depressive symptomatology and the degree of functionality in patients after stroke. Additionally, the relationship between the above parameters, as well as their correlation with socio-demographic characteristics and clinical factors of these patients were explored.

A total of 110 patients after stroke (69 men and 41 women) with a mean age of 69.3 ± 13.7 years were recruited and completed (a) a sociodemographic-clinical questionnaire, (b) the Center for Epidemiological Studies-depression (CES-D) scale, and (c) Barthel Index.

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.

76.4% of the participants had ischemic stroke; while the 76.4% were married and the 60% were retired. The 74.5% of our study participants were at risk for depression. 33.6% of our sample were receiving antidepressant treatment. Patients living alone had a higher depressive symptomatology score. Depression was significantly correlated negatively with patients’ degree of functionality and independence. Of the participants in our sample, a percentage of 14.5% had received a disability pension, while 6.4% stated that they had no employment for health reasons, which is indicative of the disruption of their functioning.

The onset of depressive symptoms is common among survivors after stroke. Lonely living, as well as loss of functionality may lead to the appearance of depressive symptoms. Early detection and management of depression may facilitate patient’s compliance to the rehabilitation program in order to achieve optimal therapeutic results and ensure a better quality of life.

Individuals may consider stroke complications as a threat to their well-being and self- esteem. Anger often occurs in patients after stroke and can disrupt the course of patient’s recovery.

The aim of the present study was to investigate anger expression and degree of functionality in patients after stroke. Additionally, the relationship between the above parameters, as well as their correlation with socio-demographic characteristics and clinical factors of these patients were explored.

A total of 110 patients after stroke (69 men and 41 women) with a mean age of 69.3 ± 13.7 years were recruited and completed (a) a sociodemographic-clinical questionnaire, (b) the State - Trait Anger Expression Inventory and (c) Barthel Index.

76.4% of the participants had ischemic stroke; while the 60% were retired. and the 20% of the sample showed severe to total dependence on self-care of basic parameters such as mobility, personal hygiene, feeding, incontinence and standing alone using the toilet. There was a positive statistically significant correlation between the degree of functionality and anger control. Patient, who were more independent and functional, exhibited more control of their anger. Women had statistically significant lower functionality/ independence score (BI) and anger-in score than men. Finally, patients with a history of prior stroke had higher anger-out score compared to patients with no previous history.

People with a previous history were more likely to suffer from greater and/or permanent functional impairment, disability, dependence, and experience emotional distress for longer periods of time. Women usually take care of other family members. Their inability to fulfill their role as well as their own dependence make the situation even more stressful, resulting in expressing anger. The results can be exploited by health professionals in order to recognize patients’ difficulties in rehabilitation programs.

After stroke, patients may have to accept and face many changes and complications that affect their quality of life. Consequently, they may feel a variety of emotions such as fear, anxiety, denial, depression, anger, rage. Depression is the most common complication after stroke. Anger often occurs in the acute phase of stroke but also during the chronic phase of the patient’s recovery.

To explore the relationship between depressive symptoms and anger expression among stroke survivors.

A literature review was conducted in PubMed and Scopus database.

Patients, who exhibited more depressive symptoms, seemed to control less their anger. Further research has shown the effectiveness of both pharmacological and other therapeutic interventions that have a simultaneous effect on both reducing anger expression and level of depression. The way individuals express their anger remain a crucial question. There are three main categories of anger expression. Individuals may anger-out when they tend to openly express anger, usually in negative and aggressive ways, or they anger-in when they experience but suppress the open expression of anger. Finally, individuals may control their anger. The main goal of an individual in this case is to reduce and eliminate these feelings, so the expression of anger could be more controlled.

Given all the negative effects of post stroke depression and anger, as those emotional states are responsible for a wide range of health-related behaviors, it is important to incorporate the above concepts in both theoretical and practical fields of health sciences in order to reduce their impact and improve the quality of services provided in post stroke rehabilitation programs.

A significant proportion of patents under hemodialysis treatment manifest anxiety symptoms, which may affect compliance to treatment and quality of life.

The aim of the present study was to investigate anxiety levels of patients under hemodialysis treatment, as well as the relationship between socio-demographic/clinical factors and anxiety.

A total of 105 patients with chronic kidney failure under hemodialysis treatment (64 men and 41 women) with a mean age of 72.51 ± 7.55 years were recruited and completed (a) a demographic questionnaire and (b) the State-Trait Anxiety Inventory.

58.1% of the participants were male; while the 59.6% of the participants were married and the 60.2% were retired. Our participants exhibited higher state, trait and total anxiety levels compared to general population. There were a statistically significant association between factors, including patients’ functionality, gender, physical exercise, hemodialysis complications, marital status, educational level and anxiety levels. Women exhibited a statistically significant higher state anxiety levels compared to men. Widowed participants, that is, people living alone who had experienced the loss of a beloved one, reported higher state, trait and total anxiety levels. Finally, people with higher education showed lower trait and total anxiety. Individuals who were capable of taking care of themselves reported lower state, trait and total anxiety levels with a statistically significant difference compared to those who needed external help. Additionally, those who physically exercised exhibited statistically significant lower state, trait and total anxiety levels compared to those who didn’t exercise.

The conclusions of the present study could be a critical point in determining guidelines that would substantially contribute to the improvement of the psychological state of patients undergoing hemodialysis treatment.

Quality of life of a significant proportion of patents under hemodialysis treatment is determined by their health locus of control beliefs (internal, external, chance).

The aim of the present study was to investigate health locus of control of patients under hemodialysis treatment. Moreover, the relationship between socio-demographic, clinical, psychological factors and health locus of control was explored.

A total of 105 patients with chronic kidney failure under hemodialysis treatment (64 men and 41 women) with a mean age of 72.51 ± 7.55 years were recruited and completed (a) a demographic questionnaire, (b) the Multidisciplinary Health Locus of Control Scale and (c) the State-Trait Anxiety Inventory.

Internal locus of control (the degree to which participants feel they are in control of their own health) fluctuates lower, while locus of control from others (the degree that participants believe that others -doctors- control their health) and luck (the degree to which participants believe their health is a matter of luck) fluctuates higher in our participants than general population. State, trait and total anxiety levels were significantly correlated negatively with internal locus of control and positively with “chance” locus of control scale in the present study.

Our participants seemed to feel highly dependent from others, such as treating physicians, nurses, family, hemodialysis machine resulting in a limited sense of freedom and autonomy. Understanding health locus of control beliefs among Greek hemodialysis patients may help health professionals to implement appropriate counseling intervention programs and improve patient psychological state and provided services.

Suicide is a tragic and distressing phenomenon. The problem of suicide in late life is often neglected by medical professionals, policy makers and the general public. Suicidal behavior in older adults (65 years old and over) is a major public health issue in many countries. Suicide rates are highest among the elderly.

To investigate the main factors associated with suicidal ideation, attempts and completed suicide among the elderly.

A literature review was carried out in PubMed and Scopus database.

Depression is the most relevant cause found, combined with chronic physical suffering, loss, bereavement, abandonment, loneliness, family conflicts and social exclusion. Differences in gender, ethnicity, the ageing process, social issues and cultural backgrounds are also major contributing factors. The major causal factors for attempted suicide are degenerative and chronic diseases, physical dependence and disability, physical and psychological pain, mental and neurocognitive disturbances and suffering. The issue of suicide prevention in the elderly is also addressed.

The negative effects on families, friends and communities following a suicide reinforce the urgency for a better understanding and prevention of suicide. Suicide associated with depression in the elderly can be prevented, provided the person is properly treated. Innovative strategies should improve resilience and positive aging, engage family and community support networks, reach vulnerable older adults, and promote health professionals’ knowledge on elderly suicide.

Atherosclerosis can result in serious cardiovascular disease (CVD) and is associated with inflammation and psychopharmacological treatment in bipolar disorder. We attempt to investigate the effects of lithium and inflammation on the atherosclerotic development in older bipolar adults at high risk for cardiovascular disease.

The euthymic out-patients with bipolar I disorder aged over 45 years and concurrent endocrine or cardiovascular disease were recruited to measure their bilateral carotid intima media thickness (CIMT) and circulating levels of lithium, valproate, sTNF-R1, sIL-6R, and lipid profile. All clinical information were obtained by directly interviewing patients and reviewing all medical records.

Forty eight patients with mean 48.3 years old and mean 27.2 years of age at illness onset were recruited. After controlling for the body mass index, multivariate regression analyses showed that older age, lower lithium level, and higher plasma sTNF-R1 level were associated with higher CIMT and collectively accounting for 33.1% of the variance in CIMT. Blood level of low density lipid or valproate has none relationship with CIMT.

Lithium treatment may protect older bipolar patient, even those at high risk for CVD, from atherosclerotic development. Furthermore, persistent inflammatory activation, particularly macrophage activation, may be associated with the accelerating development of atherosclerosis.