In recognition of the challenges faced by older persons deprived of their liberty, a call was made for input into the 2022 report to the United Nations Human Rights Council (HRC) on older persons. This Position Statement outlines the views of two global organizations, the International Psychogeriatric Association (IPA) and the World Psychiatric Association Section of Old Age Psychiatry (WPA-SOAP), working together to provide rights and dignity-based mental health services to older persons and it was sent to the Independent Expert on the enjoyment of all human rights by older persons at HRC.

The world is ageing fast with a renewed emphasis on comprehensive healthcare for older people. This has created a paradigm shift towards rights and social justice-based approach to augment the medical model of mental healthcare. Dignity is one such construct embedded into the human-rights approach. It comprises of self-respect and worthiness of an individual as well as social acceptance of his/her identity. Dignity is a multi-faceted concept and consists of privacy, independence, inclusion, autonomy, etc. It includes community participation, functional abilities, rights to sexuality and oral healthcare, outcomes which are often neglected in conventional psychogeriatric care. Ageism and fear of ageing can exacerbate social stereotypes thereby compromising dignity in older people and risk of elder abuse.

Geriatric psychiatry is uniquely positioned to equip mental healthcare with a ‘dignity-based’ approach promoting social connectedness and health equality. This further needs integration into all levels of public health for better access and holistic psychosocial management.

With this background and on the backdrop on the unique psychosocial challenges posed by the COVID- 19 pandemic, this symposium glances at various dimensions of dignity-based psychogeriatric care:

• – Practical approach towards dignity promotion in healthcare using an attributional model

• – Perspectives, healthcare challenges and research from LMIC like Brazil and India related to dignity among older people and its impact on ageism and human rights

• – Rights-based geriatric mental healthcare in the developed nations

• – Finally, an urgent call for Convention on human rights of older persons for promoting dignity in healthcare and combatting ageism

The National Cannabis Survey results indicates that cannabis consumption among older adults has been accelerating at a much faster pace than other age groups in Canada. Internationally, an increasing number of countries and U.S. states have also legalized medical and non-medical cannabis.

More than 1500 physicians, nurse practitioners, other healthcare providers, healthcare students, older adults and caregivers of older adults responded to a needs assessment survey on Cannabis and Older Adults distributed by the Canadian Coalition for Seniors’ Mental Health (CCSMH) in the fall of 2020.

Responses showed that 89% of physicians and nurse practitioners and 76% of other healthcare providers are aware of older patients in their practice using cannabis. Despite this fact, only 39% of physicians and nurse practitioners and 26% of other healthcare providers feel strongly or very strongly that they have sufficient knowledge and expertise to address older patients’ and their

caregivers’ questions about cannabis.

Older adults who responded to the survey indicated that their most common reasons for using cannabis were pain, sleep and anxiety. Fifty-one percent responded that they had talked to their doctor or healthcare provider about cannabis but 41% of those older adults stated that their doctor or healthcare provider were unable to answer their questions. Older adults reported they access information on cannabis from the internet (45%), physicians (40%), friends and family (34%), cannabis stores and clinics (28%), the media (24%), and other healthcare providers (16%). Fifty-four percent of older adult respondents who use cannabis do so with a prescription or medical authorization from their physician/nurse practitioner for medical/therapeutic reasons. One quarter of respondents indicated they use cannabis for non-medical reasons (for recreational use).

Although there is a reported gap in knowledge regarding cannabis and older adults, physicians, nurse practitioners, other healthcare providers and healthcare students all reported they are eager to learn more about how to talk with patients, how to authorize and prescribe cannabis appropriately, how to mitigate risks and assess for cannabis use disorder in older adults. CCSMH will be launching a physician- accredited e-learning course on Cannabis and Older Adults in January 2022.

Geriatric psychiatry was officially recognized as a subspecialty by the Royal College of Physicians and Surgeons of Canada (RCPSC) in 2009, with the first RCPSC exam written in 2013 (Andrew and Shea, 2010). The unique mental health needs of Canadians’ seniors requires geriatric psychiatrists trained to address them (Herrmann, 2004), but current rates of recruitment in informal fellowship programs have been inadequate (Bragg et al., 2012). One hope of subspeciality recognition was to increase recruitment in Canada, but there have been some challenges in accrediting psychiatrists already caring for older adults. Many currently practicing geriatric psychiatrists have elected to take the Royal College examination, with >120 graduates in the first year, 2013, but others have been more ambivalent. In this letter, we perform a preliminary exploration of the prevalence and correlates of disinterest in completing the RCPSC geriatric psychiatry examination.

This new section to the guidelines was added due to the recognition that clinical milestones are useful indices of the progression of dementia in patients with Alzheimer's disease and could help in the development of stage-specific targeted therapy. This review specifically looks at clinical milestones that could be used in clinical trials, such as global function, function, behaviour, caregiver burden, and quality of life milestones. It also addresses the possible use of biological and surrogate markers for use as milestones - which may eventually replace clinical milestones. It concludes that current definitions of dementia must be broadened beyond cognition alone to include some of the domains listed.