Due to communication difficulties, pain assessment in people living with dementia (PLWD) is challenging. In this study we explore vocalisations and facial expressions during assessment of pain and provide evidence in regards to clinical impact of pain assessment, as part of a targeted care program.

In order to determine key facial and vocalisation features and their relationship with pain we analysed a total of 22,194 pain assessments in PLWD (n = 3,144) from 34 different Australian residential aged care homes. Pain assessments were conducted using PainChek, which is a technology-based system comprised of three key components: point-of-care AI-powered application, training and digital analytics. Additionally, we examine the 6-months clinical impact of introducing this system, as part of a wider psychosocial care intervention (i.e., the Reconnect program) in the UK care home setting. Here we focus on how this pain assessment system contributed to the use of psychotropics and issues such as safeguarding.

Likelihood of vocalization feature presence varied based on the intensity of pain. In this regard, sighing and screaming were more likely during experience of higher pain (eight times). During experience of severe pain eyelid tightening was the most frequent facial expression (48.6%) whereas higher pain levels were mostly predicted by horizontal mouth stretch feature. Use of PainChek system as part of the Reconnect program contributed to a more consistent pain management approach, benzodiazepine reduction (29%) and cessation (46%) and reduction of antipsychotic prescribing (22%). Compared to the 6 monthly period from the year prior to implementation of the Reconnect program, a 92% reduction in safeguarding events was reported.

In this study we demonstrate the potential to digitally phenotype key pain behaviours such as vocalizations and facial expressions using the PainChek system. We also evidence the positive impact of pain assessment combined with psychosocial care, on use of psychotropics and safeguarding incidents.

Virtual Reality (VR)-based meditation has shown to help reduce, stress, anxiety, sadness, and anger in younger adults. However, this has not been extensively studied in older adults. Furthermore, there are no standard guidelines on how VR mindfulness interventions should be implemented to ensure successful outcomes in different cultures and languages. The availability of affordable hardware raises the possibility of VR being used in low-income countries. The goal of this study is to describe and highlight some key considerations and challenges when implementing low-cost VR mindfulness interventions with older adults in Quito, Ecuador.

We created a guided mindfulness intervention using low-cost VR (smartphones and Destek V5 headsets) for older adults with anxiety in Quito, Ecuador. This project is a collaboration between the Technology and Aging Lab at McLean Hospital and the Universidad San Francisco de Quito in Ecuador. Our goal was to recruit 20 older adults with anxiety from various outpatient settings in Quito. We used the free “Sites in VR” app and selected different nature scenes for each intervention. The intervention consists of a total of 10 sessions each lasting 30 minutes. We assessed depression using the Geriatric Depression Scale (GDS), and anxiety with the Generalized Anxiety Disorder 7-item scale (GAD-7). In addition, we also administered the Mindfulness Attention Awareness Scale (MAAS) and the Behavior Activation for Depression scale (BADS).

At the time of writing, we have reached 100% of our recruitment goal and anticipate completing data analysis by January 2023. Qualitatively, our intervention revealed barriers to designing scalable VR Spanish language interventions in Latin America. Some of the main difficulties we encountered are described below: (i) There are very few virtual reality videos (360° videos) that are available for use with the DesTeK VS VR Headset in Spanish. We therefore, used a standardized Spanish narration to guide the mindfulness practice based on a script used in the United States. (ii) We found that majority of the available content is not suitable for mindfulness. Using the application Sites in VR remedied this concern, as it provides static 360° images, suitable for mindfulness. (iii) Not all technology necessary for VR interventions is readily available in Latin America: smartphones sold in Latin America do not always have a gyroscope sensor.

Mindfulness interventions using virtual reality may be an effective way to address stress and mood symptoms in older adults across cultures. However, there are many culture-specific aspects that must be addressed before applying these interventions in different cultures. This study, conducted in Latin America, is an initial step toward the establishment of best practices and standardized low-cost VR mindfulness intervention in older adults, and many aspects addressed here may be generalizable to other cultures, settings, and countries.

This international symposium combining experts from Canada, Australia and the USA and supported by the American Association for Geriatric Psychiatry will present an update on the recent advances in therapeutic interventions for late life mood and cognitive disorders, including late life depression, anxiety and apathy associated with dementia, and preventive strategies including mind-body interventions. Four leaders of the field will present the summary of novel studies: starting with Dr. Benoit Mulsant (CA) presenting the results of the recently completed OPTIMUM study of novel strategies optimizing treatment of late-life treatment resistant depression. He will be followed by Dr. Krista Lanctot’ (CA) update on novel therapies for apathy associated with Alzheimer’s disease, and Dr Nancy Pachana (AU) will present on non-pharmacological approaches to treatment of anxiety associated with neurodegenerative disorders. Finally, Dr. Helen Lavretsky (USA) will present on the recent studies of mind-body therapies used to treat and prevent late life depression and cognitive decline, along with the discussion of the underlying neurobiological mechanisms. The panel will conclude with a brief discussion of future directions in the development of therapeutic interventions.

Treatment-resistant depression in late life has been understudied and is lacking evidence supporting augmentation or switching strategies. Recently completed OPTIMUM multi-site study (funded by the PCORI) sought to compare effectiveness of augmentation strategies (bupropion or aripiprazole) to switch to bupropion, in the first step of 1-week acute treatment followed by randomization into the 2nd step of augmentation with Lithium or switch to nortriptyline. The augmentation strategies in the first step produced the most robust response compared to switching, and did not differ in the 2nd step. Primary outcomes included remission rates and wellbeing measures. A discussion of future directions will be provided at the end of this presentation.

In those with Alzheimer’s disease, apathy is common and associated with decreased quality of life, increased risk of decline and increased mortality. As such, apathy is increasingly recognized as an important treatment target. Recent advances in diagnosis and treatment will be reviewed.

In this presentation, several methodological issues will be discussed, such the importance and prevalence of apathy in Alzheimer’s disease (AD); current diagnostic criteria for apathy in neurocognitive disorders, and will present the results of recent pharmacologic interventions for apathy in AD.

In this presentation, new focused and innovative treatments for anxiety in persons with Alzheimer's and Parkinson's disease with co-morbid anxiety will be discussed. Anxiety is common in Alzheimer's Disease and Parkinson's disease and contributes to increased disability and poorer quality of life. Yet only a small fraction of such patients received any form of treatment for mental health issues. Non-pharmacological approaches to address anxiety are advantageous in these populations. Research on tailored CBT and innovations such as virtual reality approaches for these groups will be discussed.

Standard pharmacological therapies for treatment of late life depression offer limited efficacy with the downside of adverse events and drug-drug interaction. Novel strategies are needed for more effective and safe treatment and prevention strategies for mood and cognitive disorders in late life. This presentation will focus on the recently completed studies of Tai Chi for treatment of late life depression, and yoga for prevention of cognitive decline in older women at risk for Alzheimer’s disease. Neural and peripheral biomarkers of treatment response will be described. Future directions in mind-body therapies research will be outlined.

Neuropsychiatric symptoms of dementia (NPSD) are diverse and prevalent group of symptoms that impose significant challenge for people living with dementia (PLWD), their caregivers, and the system of care. Quality standards in all jurisdictions stipulate that individualized, non-pharmacological intervention for NPSD needs to be provided to PLWD before pharmacological interventions are used due to modest effect size and the risks involved in using the latter. Implementation of individualized non-pharmacological plan of care face many challenges including limited staffing, issues with skill development in formal and informal caregivers, difficulty in achieving individualization of behavioral plans with precision, issues with environmental design to name few. To that end, technology has been proposed to address some of these challenges with significant promise at the proof-of-concept level but real-life implementation remains limited.

At the Ontario Shores Centre for Mental Health Sciences in Whitby, Ontario, in collaboration with Ontario Tech University, we have established the “Advancement for Dementia Care Centre”, whereby technological solutions are tested at the point of care considering implementation challenges and engaging formal and informal caregivers in the co-design and implementation of these interventions.

In this symposium, we aim to provide a framework for the successful implementation of different technological solutions for PLWD and NPSD and present the design and preliminary data from four projects that use technology to facilitate standardized, individualized non-pharmacological care for PLWD and their caregivers. The symposium will have 4 talks:

1. 1- Rationale and review of technological solutions to detect emotional distress in PLWD

2. 2- virtual reality to provide reminiscence therapy for PLWD

3. 3- virtual reality to provide caregiver skill development and problem solving

4. 4- the use of simulation platform to provide microcredentialing of health care providers

The objectives of this symposium are:

1. 1- discuss opportunities and challenges related to implementing technological solutions for NPSD at the point of care

2. 2- discuss a framework for co-designing technological solutions with caregivers at the point of care

3. 3- discuss rationale and preliminary findings of 4 projects implemented at the point of care for PLWD presenting with NPSD

This symposium is presented by a multi-ethnic, interprofessional panel including earlier career knowledge mobilization caregiver intervention scientist, a mid career nurse PhD scientist, and a senior clinician investigator geriatric psychiatrist representing a large collaboration team including technology developers, caregivers, engineers, knowledge users and clinicians.

Agitation and aggression (AA) occur frequently in patients with dementia (PwD), and cause distress to PwD and caregivers. This study will investigate whether physiological parameters, such as actigraphy, heart rate variability, temperature, and electrodermal activity, measured via wearable sensors, correlate with AA in PwD. It will also explore whether these parameters could be compiled to create a pre-agitation biometric marker capable of predicting episodes of AA in PwD.

This study will take place at Ontario Shores Centre for Mental Health Sciences. Thirty inpatient participants who are inpatients, males, and females, aged 60 or older, with clinically significant AA, and diagnosis of Major Neurocognitive Disorder will be recruited. Participants will wear the device for 48 to 72 hours on three occasions during an 8-week study period. Participant demographics and clinical measures used to assess behavior will be collected at specific time intervals during the study period.

Ceiling mounted cameras and clinical data are collected to annotate episodes of AA, which will allow identification of peripheral physiological markers “signature” unique to the patient

the algorithm connecting wearable devices, cloud and cameras was tested on healthy volunteers and demonstrated feasibility and reliability. The feasibility of implementation in PwD has been demonstrated in our sample of PwD previously in a sample of 6 participants. Feasibility in this larger sample will be assessed. Correlation analysis between physiological measures, camera capture of agitation onset and clinical measures will be calculated to identify agitation events and pre-agitation triggers. Various machine learning and features extraction/exploration techniques will be used to test whether physiological measures can detect exact time of agitation and predict pre-agitation triggers. This study will provide a reasonable estimation of sample size needed to detect a meaningful effect size, which will be determined from the prediction model.

Early detection of AA in PwD will allow caregivers to offer timely and personalized interventions which will help avoid crises and critical incidents and improve quality of life in PwD and their caregivers.

Dementia care is a critical area of need in the community and institutional settings, with estimated one-third of seniors younger than 80 years of age with dementia living in institutional settings and this proportion increases to 42% for those 80 years and older in Canada. It is of critical importance to promote excellence and best practices in dementia care by preparing for well-trained dementia workforce through capacity building.

This project developed a dementia care micro-credential education to enable competency development of new graduates and upskilling of workers through simulation-based learning. This micro-credential program leveraged interdisciplinary partnership, to develop nine core modules related to best practices in dementia care, facilitated with a Gamified Educational Network (GEN). GEN is an evidence-based learning management platform that provides learners with a simulated and immersive experience to engage them in a virtual learning environment that allows for rich experiential interaction with other users and its content.

Face and content validity was established by an inter-professional committee including geriatric psychiatry, nursing, social work, occupational therapy, behavioral therapy, knowledge mobilization and simulation education experts. Next phase will begin to establish construct validity. It is expected that GEN will have a positive impact on increasing learner’s motivation and engagement in the educational tasks, as well as improving learner’s competencies and outcomes through its multi-modal approaches, including gamification (usage of game-based elements in a non-game context to engage learners and promote learning), active observational practice, independent hands-on practice, case-based discussion, peer-to-peer assessment, expert facilitated feedback, skills debriefing and reflective practice.

This micro-credential program will provide an enhanced dementia care curriculum for building capacity of existing workers, and those entering into the workforce to promote a dementia-friendly environment for older adults.

Reminiscence therapy (RT) is a multi-sensory treatment that uses a combination of sight, touch, taste, smell and sound to help people with dementia (PWD) remember events, people and places from their past lives. Currently, digital technologies such as mobile applications and immersive solutions including virtual and augmented reality, are gaining momentum as supplementary tools for RT. This paper presents a usability study of a web-based and virtual reality application to understand the limitations and opportunities of digital platforms for facilitating engaging experiences for PWD towards recalling memories, while easing the therapy process for the caregivers.

A total of fifteen healthcare caregivers were recruited from the Geriatric Dementia Unit and Geriatric Transitional Unit in Ontario Shores Center for Mental Health Sciences, Ontario Canada. Usability feedback from the caregivers were collected from the interviews after the completion of the System Usability Scale (SUS) questionnaire.

Healthcare caregivers found both web-based and virtual reality (VRRT) usable with SUS score above average (68/100), but required improvements related to the onboarding training of caregivers. The interview revealed four overarching themes related to the VRRT: (1) Ease of use; (2) Positive impact on caregiving; (3) Potential reduction in behavioral symptoms; (4) Feasibility of promoting social connection during COVID-19 pandemic.

Next steps will focus on improving the user experience and expanding the application for immersive VR supporting head-mounted displays, hand tracking, and physiological measures, as well as conducting a usability study with PWD to expand our understanding of using RT digital tools with various levels of immersion.

Caring for persons with dementia (PWD) leads to disproportionate vulnerability to physical, mental, and social adverse health consequences among caregivers (CGs). The VR-SIMS CARERS Initiative aims to engage Knowledge Users (KUs), older adults and community stakeholders in the co-design of a Virtual Reality (VR) simulation training environment for dementia caregivers, and to explore end-user’s perspectives, design and implementation challenges and opportunities (e.g. digital literacy, technology readiness, VR acceptability), to ensure that the resulting “Minimally Viable Prototype” is clinically efficacious, scalable and sustainable.

The specific objectives of this study are to:

1. 1. employ a co-design approach to develop and validate an immersive VR simulation training environment for CGs to be in touch with realities of caregiving, practice communications and behavioural management of PWD based on the well-established CARERS Program;

2. 2. to evaluate feasibility, acceptability, tolerability informed by VR-CORE Framework and Hybrid development-implementation design, and to explore issues around implementation of the VR simulation training platform; and

3. 3. to conduct pilot testing to examine a) initial clinical efficacy of VR-based CG training in improving quality of relationship with PWD, competence, resilience, and reducing depression and stress in dementia CGs and its b) readiness for implementation in the community.

VR-SIMS CARERS innovation is intended to be an accessible, scalable and sustainable VR simulation training platform that will support CGs in the practice and acquisition of essential dementia caregiving skills, enhancing their caregiving competence and resilience. Training CGs to recognize and manage stressors can lower their risk of overall mental health decline.

The use of health care technology to support informal and formal caregivers in decision making for proper guidance of care for people with dementia, is rising over the last decade. For example, (tools within) electronic health records systems, technological devices such as wearables and devices using sensor technology (domotics) are more and more available in health care. Recent developments of artificial intelligence (e.g. machine learning, deep-learning, text mining) can be useful to provide a more advanced use of sensor and other data, and contribute to a better guidance of (person)centered care. However, the use of health care technology (and the data it accumulates) could – when used appropriately and meeting the needs of (in)formal care workers who use this technology- help to relieve the burden of care (in times of lack of staff resources), delay nursing home admission and reduce corresponding costs. Unfortunately, some of these developments, not always meet the needs of care workers and informal caregivers caring for people with dementia.

For health care technology to be able to contribute to personalized dementia care, a combination of innovation (novel technology) and implementation is necessary. A wider use of novel technology on a broader scale is necessary to generate impact. For a proper implementation, several factors such as staff opinions that may be reluctant to using novel technology, data safety and ethical issues have to be taken into account. In addition, a proper training guiding the process of implementation is crucial.

In this workshop, we will provide several examples of applications in health care based on data usage and sensor technology: (1) the use of (the combination of) qualitative and quantitative data for personalized health care, (2) wearable sensors to measure stress, a phenomenon that is regarded as an early warning for the onset of challenging behavior in people with dementia, (3) combination of ambient and body mounted sensors to monitor challenging behavior and to prevent further deterioration, (4) the practical use of communication, tracking and sensor technology to support welfare to people with dementia and caregivers in the community.

In conclusion, this symposium will give insight in the challenges of designing novel technology and its implementation into daily practice, to assist informal and formal cares to be able to deliver person-centered care.

The increasing availability of data offers new possibilities for supporting quality of care in long-term care (LTC) for older adults, also for dementia care units in nursing homes. Examples are quantitative data in electronic health records (i.e. medication), data collected by technological devices such as sensors and wearables (i.e. data related to psychical and mental health including for example heart rate and sleeping patterns), but also qualitative data stored in texts (e.g. transcribed conversations about perceived quality of life). LTC organisations currently lack tools to interpret and integrate the data in the shared decision-making (SDM) process. This project investigates the necessities for data-informed SDM.

The study was conducted in co-design with the knowledge group ‘Data Science’ residing in the Living Lab in Ageing and Long-Term Care, Maastricht. A focus group-setting, in which a diverse set of stakeholders, including data/ICT-specialists, care managers and client representatives, took place to discuss bottlenecks, possibilities and solutions related to data-informed SDM.

In total, representatives (n=18) from 7 care organisations participated in three separated focus groups. This resulted in several themes that were deemed necessary for data-informed SDM: 1) an organisational vision on data and data-informed SDM, 2) investment in data-driven care SDM, 3) the instalment of multidisciplinary teams, including clients, informal and formal caregivers, 4) a planned implementation process is needed, and 5) the use of living lab constructions.

A well-thought-out, integral learning process, including a vision statement on data and the installation of multidisciplinary teams working on data-problems, is deemed necessary in order for LTC organisations to accomplish data-informed SDM. A concrete step-by-step plan, which can provide LTC organizations with tools to embed data in the current SDM process, is suggested to help organisations in their quest to data-informed personal care.

Measuring and monitoring stress has potential benefits for the care and self-management of stressors for people with dementia. Early identification of stressors may help to cope with challenging behaviours (CB), occurring in up to 80% of nursing home residents with dementia. The identification of stressors causing CB is difficult (as often residents cannot themselves indicate what is experienced as stressful or relaxing), hampering the psychosocial approach. Several studies have found that skin conductance and heart activity can be used as a proxy for stress. Measuring these physiological parameters using wearable sensors, might be helpful to identify (de)stressors and consequently, a psychosocial treatment approach. Therefore, wearables are promising as a supportive technology in the care of people with dementia and CB. However, stakeholders (i.e., (in)formal caregivers of people with dementia) indicate that current available (wearable) systems to measure stress are not fit for purpose within the everyday care of people with dementia. In addition, due to legislation, not all systems are allowed. The purpose of the current research is to develop a system prototype together with different stakeholders.

A prototype of a system measuring stress suitable in the care for people with dementia will be developed during different iterations between September 2022-July 2024. A community of stakeholders will be built, in which the needs, requirements and evaluations of people with dementia, (in)formal caregivers, legal- and IT-experts, will be collected through literature studies, focus groups, interviews and co-design sessions. The system will be developed and adjusted appropriately, taking social, technical and legal requirements into account.

Preliminary results will be presented regarding identified requirements for initial system prototypes as well as lessons learned from first iterations with conceptual and working prototypes. Implications for the care and self-management of people with dementia will be discussed.

Neuropsychiatric symptoms (NPS) are common in affected individuals and can be challenging for (in)formal caregivers. Therefore, they are also referred to as challenging behaviors (CBs). Sensor technology measuring context and behavior can be assistive to effectively manage CBs in an objective fashion. Sensors can help support healthcare professionals, such as nurses, by enabling remote monitoring and alarming on early-stage behavioral changes associated with CBs. This might/ will improve the quality of life (QoL) for both caregivers and clients living in a nursing homes (NH).

In the project “MOnitoring Onbegrepen Gedrag bij Dementie met sensortechnologie” (MOOD-Sense), we aim to develop such a monitoring system. Our research focuses on two questions 1) How to develop and implement a monitoring system within the context of nursing homes with parameters on environment, physiology, and behavior, identify and process relevant precursors of challenging behavior with this monitoring system and 2) gain insight in which behaviors are challenging according to nurses and how they are described. This will be represented in an ontology such that sensor data can be translated into the same conceptual information.

The first research question will be examined with a set of experiments in the field (in NH) with an iterative approach. Insights from previous experiments on usability and added value of sensors will be used to improve successive experiments. During each experiment, multiple participants (clients with dementia and CBs) are monitored with both ambient and wearable sensors. For the second research question a qualitative approach is employed, using focus groups (FG) and consensus methods. These FGs will be held amongst nursing staff who are involved in daily care tasks for people with dementia. Subsequently, consensus methods are used to align behavioral descriptors/labels.

early findings will be presented at the symposium

Within this project we expect to find precursors of challenging behavior in a personalized fashion based on nurse’s expert knowledge and sensor data. In order to develop a monitoring system that can be embedded within NH’s, real-time alarming, in-situ behavior recognition and trustworthiness are part of our technological requirements. Just-in-time interventions may then be deployed to prevent behavior escalation or the persistence of undesirable situations.

Dementia is not an unavoidable consequence of aging, but for most home-dwelling people with dementia (PwD) a result of complex chronic health conditions. About 95% of PwD have multimorbidity, which requires a multicomponent approach and interdisciplinary collaboration to support patients and relatives, and to implement welfare technology and smart solutions.

The LIVE@Home.Path study is a 2-year, mixed-method, stepped-wedged, cluster randomized controlled trial, including home-dwelling PwD and their informal caregivers (N=320 dyads) in Norway (May 2019 – December 2021), to investigate the efficacy of the multicomponent LIVE intervention (LIVE is the acronym for Learning, Innovation, Volunteerism, and Empowerment) on resource utilization and use of welfare technology. The intervention was implemented by a skilled coordinator from the municipality with high focus on use, usefulness, and experiences in welfare technology, both at baseline and during the implementation period.

At baseline, we found that most participants had traditional equipment such as stove guards (43.3%), social alarms (39.5%) or everyday technology (45.3%) (e.g., calendar, door locks). A social alarm was more often available for alone-living elderly women, while tracking devices (14.9%) were associated with lower age. Everyday technology was more often available for women at increased age, higher comorbidity, and poor instrumental activities of daily living (IADL). In people with severe dementia, welfare technology was associated with poor IADL function, children as the main caregiver (61.3%), and having caregivers who contributed 81–100% to their care (49.5%).

We describe unmet potential for communication, tracking, and sensing technology and especially, for devices not offered by the municipalities. In our symposium, we will present early findings on the implementation effect of welfare technology and participants experiences related to usage and awareness.

Outcomes and care experiences for people with dementia are worse than for those without the condition and the workforce is in crisis. High quality care requires adequate training that includes an understanding of those living with the condition.

Time for Dementia is an educational programme in which healthcare students visit a person with dementia and their family carer over a two-year period (Banerjee et al., 2017). People with dementia and their carers are our ‘experts’ and teach students about life with dementia, healthcare experiences and what helps them to live well with dementia. The aim of the programme is to improve student attitudes, knowledge, and empathy towards dementia.

Since 2014, 6500 healthcare students, including medical, nursing and allied health professions, have undertaken the programme in the UK at 7 different universities. Research indicates that there are higher levels of knowledge and positive attitudes in students undertaking the programme, compared to those who did not. This symposium will present several sub-studies outlining what has been learned so far from the mixed methods evaluation of Time for Dementia. The symposium will include 3 speakers on 3 key themes:

1. 1. The development and delivery of Time for Dementia programme and educational outcomes for students.

2. 2. The factors influencing career preferences for working with people with dementia.

3. 3. The development of empathy towards people with dementia in undergraduate healthcare students

Key take-aways

• How to deliver a lived experience programme at scale.

• The value of a lived experience education programme.

• How undergraduate education can shape empathy and career preferences.

The future healthcare workforce needs the skills, attitudes, and empathy to better meet the needs of those with dementia. Time for Dementia is an educational programme in which healthcare students from a range of professional groups visit a person with dementia and their family carer over a two-year period. The first phase of research demonstrated positive outcomes for students (Banerjee et al., 2021; Daley et al., 2020). Here we discuss the most recent findings from the second phase.

to evaluate the impact of Time for Dementia on student attitudes, knowledge and empathy towards dementia, and satisfaction of students and families.

A mixed methods longitudinal cohort study was conducted between 2014- 2021. Measures of dementia knowledge, attitudes and empathy were administered to healthcare students at five universities in the south of England before and after (24 months) they completed the Time for Dementia programme. Data were also collected at equivalent time points for a control group of students who had not taken part in the programme. Outcomes were modelled using multilevel linear regression models. Satisfaction surveys were completed by students and families at the end of the programme.

2,700 intervention group students, 562 control group students and 803 families consented to participate in the research. Students undertaking the Time for Dementia programme had higher levels of knowledge and positive attitudes at follow-up compared to equivalent students who did not undertake the programme. Satisfaction was high for both students and families, with both perceiving benefits of taking part.

The results suggest the Time for Dementia programme is effective in improving the knowledge and attitudes of healthcare students across different professional groups and universities. It also demonstrates that dementia education that meaningfully involves people with dementia and their carers can be delivered at scale for healthcare professionals.

With population ageing, an emergent issue in workforce planning is how to ensure that future healthcare professionals are both competent and willing to work with older adults with complex needs. This includes dementia care; which is widely recognised as a policy and practice priority. Yet research suggests that working with older people is unattractive to undergraduate healthcare students. However, how students view a career working with people with dementia is not well understood, in either related specialities (such as geriatrics or old age mental health) or as a general clinical interest.

This sequential mixed methods study aimed to identify the factors that contribute to preferences for working with people with dementia. A summary of three papers will be presented:

1. 1) Preferences of nursing and medical students for working with older adults and people with dementia: a systematic review.

2. 2) Preferences of newly qualified healthcare professionals for working with people with dementia: a qualitative study (n=27).

3. 3) Student nurses' career preferences for working with people with dementia: A longitudinal cohort study (n=840).

The findings from these studies have contributed to the development of a conceptual framework for understanding career preferences for working with people with dementia in students and newly qualified nurses. key factors related to dementia preferences include:

• Student characteristics (e.g. gender, attitudes and knowledge) and whether students perceive their attributes are aligned with dementia care;

• Impact of experiences including dementia educational programmes;

• Importance of making a difference to patients’ lives;

• Perception of working with people with dementia as a ‘different type of care’;

• Perceptions of people with dementia including care challenges;

• Career characteristics.

The findings will be discussed in relation to implications for education and policy for how preferences for working with people with dementia may be developed in line with workforce needs.

Globally, dementia prevalence is rising. In the UK, over a million people are expected to be impacted by dementia by 2050. One in four hospital beds are occupied by a person with dementia, and it is inevitable that healthcare professionals will work with people with dementia during their career and across a variety of settings. To deliver effective person-centered care, healthcare professionals need to have the capacity and skills to practice with empathy. Greater empathy can lead to better patient relationships, reduced burnout, and enhanced recognition of personhood. However, people with dementia frequently report episodes of care that lack empathetic approaches. To improve the quality of care, high quality dementia education needs to be provided at undergraduate level. To inform the design and delivery of suitable educational resources, this study aimed to understand the major factors that impact the development of empathy towards people with dementia during undergraduate education.

A constructivist, longitudinal grounded theory study (Charmaz, 2014) was conducted. Data were collected in 2019 using semi-structured interviews with undergraduate nursing, physiotherapy, and medical students (n=30). A second interview was completed with students (n=26) eighteen months later. Emergent findings were informed by simultaneous data collection and analysis using constant comparison techniques, and the use of theoretical memo writing.

Preliminary findings suggested that the development of empathy towards people with dementia was impacted by social and emotional exposure during undergraduate years. Data centered on four sub-categories. While there were barriers connecting and understanding people with dementia, students experienced conflicting expectations about empathy more widely. Positive and negative cultural experiences during placement led to emotional changes and a shift in ideals.

Environments that promote empathetic practice during clinical placement could impact the development of empathy in undergraduate healthcare education more widely. This study highlights a need for educational design that focuses on both the patient and the environment.

In the years since the beginning of the SARS-CoV-2 pandemic, research has revealed that patients with infection can experience cognitive and other neurological symptoms that do not always remit following infection clearance. Older people tend to be at particularly high risk of decline following infection.

This symposium will report studies of post-acute sequelae of Covid-19, with particular attention toward cognitive and other neurological symptoms in an aging population. It will emphasize the importance of methodological rigor in studies going forward, including large and representative samples and comprehensive, longitudinal cognitive assessments.

The symposium will consist of three talks and discussion.

The first talk will summarize what is known about cognitive symptoms in post-acute Covid-19 and discuss biological and environmental mechanisms that may account for these symptoms. Importantly it will propose ways in which ongoing and future studies of post-acute cognitive symptoms can enhance scientific rigor and make recommendations for assessment and management of patients with post-acute cognitive sequelae of Covid-19. The second talk will review first- and second-wave findings of cognitive functioning in the context of neurological, pulmonological, and other psychological and daily functioning factors from a longitudinal study of recovered asymptomatic, severe, and never-infected patients. It will reveal small to medium sized effects of Covid-19 disease status in several areas of cognition, in addition to other medical outcomes, with more severe effects found in older adults relative to younger people. The third talk will present data collected in 139 older adults approximately seven months after diagnosis with Covid-19. It reports higher levels of subjective (67.2%) relative to objective (4.7%) cognitive dysfunction and finds that severity of subjective cognitive dysfunction was predicted by psychiatric distress, but not demographic, illness, or objective cognitive functioning.

Cognitive decline can occur following infection with Covid-19, and older adults are at particularly increased risk relative to the general population. Objective assessment of cognitive functioning is imperative, and future studies must employ rigorous scientific methodology to elucidate the nature and trajectory of cognitive functioning in post-acute Covid-19. Findings will inform best practices for diagnosing and managing cognitive impairment in clinical populations.

Covid-19 infection is associated with increased rates of acute and post-acute cognitive dysfunction that may portend significant consequences for patient functioning and quality of life.

This lecture will 1) summarize what is known about cognitive symptoms in post-acute Covid-19; 2) discuss biological and environmental mechanisms that may account for these symptoms; 3) propose ways in which ongoing and future studies of post-acute cognitive symptoms can enhance scientific rigor; and 4) make recommendations for assessment and management of patients with post-acute cognitive sequelae of Covid-19.

The literature on post-acute Covid-19 sequelae was reviewed, with particular attention toward limitations in methodology.

Depending on how it is assessed, Covid-19 cognitive dysfunction occurs in a subset of patients (~ 24%) of all age groups, across the spectrum of disease severity, and may persist following viral resolution. Early cognitive studies were limited by methodological shortcomings, secondary to Covid-19’s virulence and transmissibility. Most studies have resorted to suboptimal cognitive assessments such as self-report measures, which are distal measures of brain functioning, or brief dementia screeners that provide objective data but are insensitive to subtle cognitive impairment. Small sample sizes also plague existing studies, resulting in low power, limited external validity, and an inability to properly control for potential confounders. Despite the disproportionate impact of COVID-19 on racial and ethnic minorities, these populations remain underrepresented in cognitive studies. Further, the degree to which pre-existing risk factors for cognitive impairment and other pandemic-related factors (e.g., social isolation, depression, anxiety, PTSD) may contribute to post-COVID-19 cognitive dysfunction are unknown, marking the need for appropriate comparison groups. The range and severity of cognitive sequelae are varied. There appear to be meaningful differences in the experiences of COVID-19 patients who were hospitalized versus those who were not. Similarly, younger individuals greatly differ from older individuals in terms of pre-existing risk factors, comorbidities, and consequently, cognitive profiles.

While studies to date examining subjective and objective post-acute Covid-19 cognitive functioning have been invaluable in unmasking post-acute neuropsychiatric symptoms of Covid-19, it is imperative that future studies employ rigorous methodological approaches across diverse samples. In the meantime, patients’ complaints of post-acute cognitive decline must be taken seriously, but also measured objectively, with a consideration toward pre-existing factors that portend greater or lesser likelihood of cognitive difficulties following Covid-19 infection.

Clarity about the common cognitive phenomena associated with “brain fog” and attention or memory problems after the initial resolution of COVID-19 infection is needed.

To systematically study cognitive sequelae in the context of neurological, pulmonological, and other critical psychological and daily functioning factors.

160 participants were seen at three study visits over 12 months. Participants comprised 52 Asymptomatic/Mild (ASY) remitted Covid-19 patients, 52 severe (SEV) remitted Covid-19 patients and 56 control (CTL) participants. Neurocognitive function, pulmonary health, neurological status, serum biomarkers NSE and Nf-L, and neuroradiological scans were assessed at baseline and 12 months. A shorter examination of neurocognition, lung function, and neurological status only was conducted at the 6-month visit (Visit 2).

In initial analyses of the first wave of data, complex attention, language, and short-term verbal and visual memory differed between healthy controls and Covid-19 patients. Generally, the neurocognitive performance of the ASY cohort lay between that of the more SEV and CTL. There was a similar pattern of results regarding lung function and brain volume. No differences were found for serum biomarkers NSE or Nf-L. Currently, the second wave of data is almost finished being collected. Data collection will be complete in early Spring of 2023. Initial longitudinal findings will be analyzed and presented.

Small to medium-sized effects of Covid-19 disease status in several areas of cognition (language, complex attention, and short-term memory), certain aspects of neurological function, pulmonary function, and brain morphology were found at the baseline visit. Older adults were more likely to be severely affected by Covid-19 and thus more severely affected from a neurocognitive perspective than younger age groups.

Subjective cognitive dysfunction is often reported following SARS-CoV-2 infection. Studies of outpatients and primarily younger adults suggest that mood symptoms and fatigue are also common and may contribute to subjective cognitive dysfunction.

Understanding factors driving subjective cognitive dysfunction is important to guiding treatment interventions for older patients with persistent post-COVID-19 cognitive complaints.

We will present data demonstrating the demographic factors, illness characteristics, psychiatric symptoms, and objective cognitive performances that predict persistent subjective cognitive dysfunction in older post-COVID-19 patients and contrast these with findings from their younger counterparts.

Approximately seven months after COVID-19 diagnosis, patients in the Johns Hopkins Post- Acute COVID-19 Team (JH PACT) multidisciplinary clinic underwent a telephone-based clinical assessment evaluating depression, anxiety, fatigue and subjective cognitive complaints. Patients also completed objective tests of neuropsychological functioning assessing processing speed, language, learning, memory, and executive functioning. Of the >400 patients assessed to date, 139 were ≥60 years of age (M 67.9; 60.4% female, M education 14.1 years, 54% ICU).

In preliminary analyses among older adults, a greater proportion of patients reported subjective cognitive dysfunction (67.2%) relative to the proportion producing a cognitive composite ≥1.5 SD below expectation (4.7%). Psychiatric symptoms were also common (PHQ-9 ≥ 10 in 22.5%, GAD-7 ≥ 10 in 12.3%). Linear regression models revealed that among older adults, severity of subjective cognitive dysfunction was predicted by psychiatric distress, but not demographic, illness or objective cognitive functioning. In contrast, subjective cognitive difficulties were predicted by a combination of demographic, illness, and objective cognitive variables among younger patients.

Among patients followed in a long-COVID-19 clinic, we observe high rates of clinically significant psychiatric distress and subjective cognitive dysfunction but relatively less frequent objective cognitive deficits. Among older adults, cognitive concerns appear driven by neuropsychiatric symptoms and may be appropriate targets for intervention. We will present ongoing work evaluating predictors of cognitive complaints including performance across specific cognitive domains in > 400 patients.