Objectives: Leveraging the non-monolithic structure of Latin America, which represents a large variability in social determinants of health (SDoH) and high levels of genetic admixture, we aim to evaluate the relative contributions of SDoH and genetic ancestry in predicting dementia risk in Latin American populations

Methods: Community-dwelling participants aged 65 and older (N = 3808) from Cuba, Dominican Republic, Mexico, and Peru completed the 10/66 protocol assessments. Dementia was diagnosed using the cross-culturally validated 10/66 algorithm. The primary outcome measured was the risk of developing dementia. Multivariate linear regression models adjusted for SDoH were used in the main analysis.

Results: We observed extensive three-way (African/European/Native American) genetic ancestry variation between countries. Individuals with higher proportions of Native American (>70%) and African American (>70%) ancestry were more likely to exhibit factors contributing to worse SDoH, such as lower educational levels (p <0.001), lower SES (p < 0.001), and higher frequency of vascular risk factors (p < 0.001). In unadjusted analysis, American individuals with predominant African ancestry exhibited a higher dementia frequency (p = 0.03) and both Native and African ancestry predominant groups showed lower cognitive performance relative to those with higher European ancestry (p < 0.001). However, after adjusting for measures of SDoH, there was no association between ancestry proportion and dementia probability, and ancestry proportions no longer significantly accounted for the variance in cognitive performance (African predominant p = 0.31 [–0.19, 0.59] and Native predominant p = 0.74 [–0.24, 0.33]).

Conclusions: The findings suggest that social and environmental factors play a more crucial role than genetic ancestry in predicting dementia risk in Latin American populations. This underscores the need for public health strategies and policies that address these social determinants to reduce dementia risk in these communities effectively.

Substance use disorders (SUDs) among older adults represent a growing but often overlooked public health crisis. This presentation explores the prevalence, impact, and management of SUDs in later life, focusing on alcohol, cannabis, and opiate use, as well as misuse of over the counter (OTC) medications.

Aging populations are increasingly at risk of developing SUDs due to factors such as chronic pain, mental health disorders, and social isolation. The physiological changes associated with aging also alter drug metabolism and increase susceptibility to adverse effects. Despite being the most common SUD in older adults, alcohol misuse often goes undetected. Cannabis use is rising among seniors due to changing legal landscapes, presenting both potential therapeutic benefits and risks. Opiate dependency often stems from chronic pain management, necessitating best practices for opiate use and alternatives. Additionally, misuse of OTC medications, such as sleep aids and pain relievers, is a growing concern.

Effective management of SUDs in older adults requires a multidisciplinary approach, integrating medical, psychological, and social support. Key principles include comprehensive assessment, personalized treatment plans considering comorbidities and polypharmacy, behavioral interventions, and ongoing education for healthcare providers on age-specific SUD challenges and management. Addressing SUDs in older adults is crucial for improving quality of life and reducing healthcare costs. This presentation aims to highlight the significance of early detection, appropriate intervention, and the importance of a holistic approach to managing SUDs in the aging population.

The Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders (CDDR) and Non-Substance Uses Addictions in Old Age (NSUAOA)- Carlos Augusto de Mendonça Lima, M.D., MSci., DSci.

The Eleventh Revision of the World Health Organization’s International Classification of Diseases (ICD-11) represents major, comprehensive revision of the ICD in the last 30 years, and incorporates major advances in scientific evidence, best clinical practices and health information systems The Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders (CDDR), led by the WHO Department of Mental Health and Substance Use, constitutes the most broadly international, multilingual, multidisciplinary and participative revision process ever implemented for a classification of mental disorders.

The CDDR are an integral part of ICD-11, and have been developed specifically for the ICD-11 mental, behavioural and neurodevelopmental disorders chapter, providing substantially more detailed information needed to understand and apply this part of the classification.

A major improvement in the ICD-11 CDDR is the consistency of structure and information across major categories. The information provided for the main disorder categories in the CDDR is organized under the following headings:

• Essential features

• Additional clinical features

• Boundary with normality

• Course features

• Developmental presentations

• Culture-related features

• Sex- and/or gender-related features

• Boundaries with other disorders and conditions (differential diagnosis).

Yet we regret thar age was not considered in this list of headings. This is a missing opportunity to provide specific care for older persons and develop research to study the potential influence of the ageing process on the clinical features of mental health conditions. This is particularly true in the case of NSUAOA, an area that has been particularly neglected besides the increase of the number of older adults in the global population.

At this lecture, it will be presented the CDDR criteria to classify the NSUAOA.

Non-Substance Addictions in Later Life in Emerging Crisis Dr. M.S. Renuka Prasad, BSc, MBBS, FRC Psych. (UK), DGM (UK), FRCPC, DFCPA, DFAPA

The generation known as “baby boomers” is the fastest growing segment of our society globally. Substance Use Disorders among this group is a growing health problem universally. Non-Substance Use Addiction is not far behind, but is getting far less attention, in spite of its impact on these individuals and their families, which could be devastating, but cannot be underestimated. This presentation aims to assess the epidemiology, impact and treatment of Non-Substance Use Addictions, like Gambling, Internet addiction in Later Life. Evaluated studies, indicate this cohort of these individuals are at higher risk of substantial negative impact socially, along with other medical and psychiatric comorbidities.

The current treatment models to address this new wave of older individuals, with Non- Substance Use Addiction behavior, are inadequate. The field of Geriatric Psychiatry, Geriatric Addiction Medicine, Social Services all must come together to address this emerging health concern.

Summary: Ageism is defined as prejudice, discrimination, and stereotypes towards people because of their age. Ageism can be directed towards individuals of all ages and be either positive or negative. Ageism can operate at the institutional level directed via legal and social policies, at the meso level as evident in interpersonal relations and at the micro level directed by people towards their own age and aging. Ageism can be experienced either consciously with full awareness or unconsciously, without the agent of ageism and/or the target of ageism being fully aware of it. The following presentations will address ageism in relation to older persons because of its well- known detrimental effects. An important aspect of ageism concerns the fact that it does not occur in silo. Instead, it is often age in intersection with other forms of discrimination, which results in the marginalization of older persons. Perel-Levin will analyse how ageism and age-based discrimination intersect with other forms of biases, discrimination, and inequalities based, such as disability, gender, gender identity and sexual orientation, ethnic background, and socioeconomic status. The presentation by Daichman will focus on age in intersection with gender by stressing the vulnerable place of older women and relate this to elder abuse. Ayalon will highlight self- directed ageism and intergenerational conflict as they manifest in older persons’ political activism. Finally, Rabheru will discuss findings concerning ageism in Canada based on data obtained from a diverse array of stakeholders, including researchers, healthcare professionals, social service providers, older persons, and advocates. Kalache will moderate the session and conclude with applied tools to ensure the human rights of older persons in the face of institutional, interactional, and intrapersonalageism.

Introduction: The international demographic data indicates a growth in the population of older people, which is why it is necessary to begin to talk about the process of aging with disabilities from a bio-psycho-socio-functional approach and their socio-family environment according to the pillars of the Decade of Healthy Aging (2021-2030).

Taking into account disability situations in older persons as the guiding thread of concern about the increase on frailties, these presentations will highlight different contributions that open a debate regarding the challenge and the complexity to approach older persons with disabilities in gerontological work, the psychological aspects and the existing legal framework.

Objectives: This Symposium seeks to put on the scientific agenda a topic that make us rethink and reevaluate our intervention practices with a comprehensive approach to older people with disabilities.

Methods: Scientific communications and empirical research.

Results: Empirical data will be provided in reference to each Symposium’s speakers presentations.

Conclusions: It is hoped to raise questions about whether it is possible to achieve the paradigm change from older persons as an object of care to a subject of law.

Keywords: Gerontology, Disability, Autonomy, Legal Framework

Symposium Coordinator: Cecilia Volpe

Speakers

Dr Wanda Gisbert, Geriatrician: Comprehensive approach to frailty as a predictor of disability. Dr Isabel Lovrincevich, Lawyer: Autonomy and dependence in old age. Psychologist Bibiana Kompel: A topic that challenges us: New Psycho Gerontological approach.

Introduction: Impulsivity is a common feature of human behavior, often described in psychopathology, but evanescent and lacking a strict, clear and singular definition. The question is, can a person control his or her actions? The turning point for our interest is impulse control in the elderly. Falls, accidents, transgressions against the law and an altered family life may be the consequences of the impulsive spectrum without ignoring consequences such as pathological gambling, traffic accident, lethal fracture and even suicide. Certain neurological, psychiatric, and geriatric pathologies present with Impulsivity with impulsivity generally undetected. It is often mistaken for a character trait of old age, leading to stigmatization and“ageism’’.

Objectives: To highlight the importance of the clinical presentation of Impulsivity in older adults for its early diagnosis and therapy.

Methods: PUBMED literature review. Presentation of clinical cases in an interdisciplinary sharing Presentation of clinical cases in an interdisciplinary sharing.

Results: Early diagnosis of Impulsivity and its treatment offers a better quality of life to the patient and his family. Impulsivity is a symptom that involves several diseases, which is why its early diagnosis and adequate therapy allows a better quality of life for the elderly and the environment, since it may be a risk factor for early institutionalization.

Conclusions: It is a subject that is not often addressed and is usually solved by polymedicating. We consider the need for a differential diagnosis for an appropriate therapy.

Summary: Apathy is one of the most common neuropsychiatric symptoms in dementia, mainly in Alzheimer’s disease and lobar frontal degeneration. Although diagnostic criteria guidelines have been developed to facilitate diagnosis and multiple drugs have been evaluated for treatment, apathy remains a very important challenge in clinical practice. The Objectives of the symposium is that specialists from Favaloro Foundation University Hospital Memory clinic in Buenos Aires provide an update on the evidence available for both the apathy diagnosis and treatment (pharmacological and non-pharmacological) patients with dementia, as well as showing that will come in the near future. The specialists will base the dissertation both on the available evidence and on their robust clinical experience in the dementia field. The presentation will focus on the available evidence diagnosis, differential diagnosis, and the best therapeutic tools available, pharmacological and non-pharmacological. Learning and knowing about apathy is essential for correct management.

Up today, apathy diagnosis is based on clinical signs and symptoms. General diagnostic criteria and specific criteria for some diseases have been developed. Memory clinic specialist will show the available tools and evidence for apathy diagnosis, the best way to differentiate from other similar disease/symptoms and will provide their robust clinical experience in this field.

Treatment of apathy is still a challenge in clinical practice. Several pharmacological treatments did not show clear symptoms improvement so non pharmacological treatment has become a fundamental tool for the patients- A specialized neurophysiologist will provide the actual techniques utilized in daily practice to treat apathy in dementia patients.

Pharmacological treatment for apathy is still a challenge. Multiple drugs have been tested in clinical trials but without significant symptoms improvement. Memory clinic specialist will show available evidence for pharmacological treatment for apathy and will provide their experience in clinical practice for subject management.

Considering that available pharmacological treatment for apathy did not show strong symptoms improvement, there is an unmet need to find a treatment for apathy- Specialist will present available information for ongoing research for apathy.

Overview: This highly interactive session will present an overview of a range of tools and approaches that utilize artificial intelligence (AI) in the mental health care of older adults and persons with dementia. This includes a review of existing evidence around the use of AI for diagnosis, monitoring and intervention. This session will also serve as a forum for perspectives and feedback from IPA membership around what they believe to be the biggest needs and gaps around the use of AI in the clinical realm. This session will also introduce the new IPA task force for AI in psycho geriatrics.

Our world is rapidly aging, with medical and public health advancements extending lifespans without necessarily enhancing the quality of those additional years. Individuals in their later years aspire to preserve dignity, maintain autonomy and independence, foster social inclusion, uphold justice and equality, be respected for their identity, and pursue good health, security, purpose and engagement throughout their lives. Unfortunately, ageism is pervasive and has a significant negative impact on the lives of older individuals. Ageism is the root source of severe violations of the human rights of older persons, incontrovertibly uncovered by the COVID-19 pandemic. Ageism not only damages global health and harms the world’s economy, but also poses a major barrier for older persons everywhere, especially in preventing them from receiving the human rights-based care and support they deserve. This approach to health specifically aims at realizing the right to health and other health-related human rights. These rights translate as social determinants of health and can be integrated into clinical practice. Their implementation is mainly dependent of political will and fair distribution of money, power and resources. Planning health care and support for older persons should be guided by human rights standards and principles with final goal of the empowerment of rights-holders to effectively claim their health rights.

Setting the scene: International Human Rights, Mental Health and Older persons

We all are, in principle, covered by the international human rights system. However, the current international human rights framework does neither include explicit guarantee against ageism, nor explicit obligation on States to take active measures to eliminate ageism and its discriminatory consequences. Older persons are very rarely mentioned in human rights treaties. All rights are equally important as set out in the International Bill of Human Rights (Universal Declaration of Human Rights; the International Covenant for Civil and Political Rights; and the International Covenant for Economic, Social, and Cultural Rights) and all international human rights treaties. Everyone, whoever and wherever they are, has an inherent right to the highest attainable standard of health, including the right to available, accessible, acceptable and affordable good quality care; and the right to liberty, independence and inclusion in the community. Unfortunately, older people with mental health conditions or cognitive decline experience a wide range of human rights violations. Coercive practices, social exclusion and discrimination are still too prevalent compounded by the lack of basic rights such as food and adequate housing. This presentation will discuss how the human rights legal framework can be applied to mental health care and support while advocating for better protection of the human rights of older persons through a dedicated UN Convention.

Alzheimer’s disease is a neurodegenerative disorder affecting over 55 million people worldwide, with 300,000 sufferers residing in Argentina. Over the last 10 years with the emergence of monoclonal antibodies, we have witnessed a radical change in our approach to Alzheimer’s disease. Today, we can see the lesion of Alzheimer’s disease in the living brain up to 17 years before the onset of symptoms. Furthermore, we have developed blood tests that allow us to identify those at risk to have amyloid in the brain and, in the last two years, a new group of disease-modifying treatments has been approved for clinical use. What remains to be elucidated is how these revolutionary changes will impact patient care and perceptions of Alzheimer’s disease in society. Additionally, how these new, often expensive tools to fight Alzheimer’s disease will be accessible in developing countries is also unknown. These issues will be discussed during our presentation with a panel of experts in the field. Dr. Reich will present the latest advances on biomarkers and new treatments, Dr. Aguilar will discuss the implications of this new approach for the diagnosis and treatment of Alzheimer’s disease around the world, and Dr. Mintzer will discuss different options that will make these treatments available in developing countries with a focus on Latin America.

Digital mental health - The use of apps, the internet, mobile technologies, virtual reality, and social media for mental health and wellness - rapidly rose in popularity during COVID-19 and continues to expand in the post- COVID-19 era. There is a general recognition of the value and contribution of digital technologies in providing personalized mental health care tools, including health education, health promotion, health maintenance, diagnosis, treatment, interventions, and rehabilitation.

Globally, around 14% of adults aged 60 and over live with mental health conditions, with depression and anxiety being the most common. In Hong Kong, a recent study found that 14% of older adults said they had displayed signs of depression, and 12% had experienced anxiety. Critical risk factors for mental health conditions in older adults include social isolation, loneliness, reduced mobility, and frailty. However, many mental health problems are unrecognized and untreated. Lack of available mental health services, stigma, and cost are significant barriers to help-seeking.

The high prevalence rates of mental health problems and low levels of access to traditional mental health services, combined with the rapid development of digital and emerging technologies, led to the rapid development of digital mental health services. We would like to know whether digital mental health works for older adults and what factors contribute to the success of digital mental health interventions.

This symposium brings together a group of multidisciplinary researchers in digital mental health. We will present our work and collectively address four key areas:

1. 1. Digital engagement, social support and mental health of older adults.

2. 2. Associations between social networks and technology acceptance with depressive symptoms in community- dwelling older adults.

3. 3. The effectiveness of a Digital Buddy program on mental well-being and depressive symptoms of older adults.

4. 4. The effectiveness of a therapeutic virtual reality experience program on mental well-being in older adults living with physical disabilities in long-term care facilities.

The symposium intends to stimulate global collaboration towards strengthening principles in digital mental health while elucidating additional factors that influence this technology-enabled approach to support older adults in diverse contexts to achieve optimal mental well-being.

Abstract 1: Digital engagement, social support and mental health: Latent profile analysis on the intergenerational digital divide in Hong Kong

Bobo Hi-Po Lau*1, Eric Ngai-Yin Shum1, Chi-Pun Liu2, Fu-Fai Fong2, Alex Pak-Ki Kwok3, Alex Chi-Keung Chan4,5

1. Department of Counselling & Psychology, Hong Kong Shue Yan University, Hong Kong

2. Department of Social Work, Hong Kong Shue Yan University, Hong Kong

3. Data Science and Policy Studies Programme, Faculty of Social Science, The Chinese University of Hong Kong, HongKong

4. Translational Research Centre for Digital Mental Health, Tung Wah College, Hong Kong

5. School of Arts and Humanities, Tung Wah College, Hong Kong

*presenting and corresponding author

Objectives: The pandemic has resulted in pervasive digital transformation in our daily lives, particularly those of older adults. In Hong Kong, smartphone ownership among older adults rose from 68.1% in 2020 to 90.7% in 2022. Accordingly, the intergenerational digital divide and its implication on older adults’ well-being may have changed, and this study was conducted to address this.

Methods: A telephone survey with a random sample of 878 adults was conducted from December 2023 to January 2024 (Response rate = 42%). Based on Van Dijk (2013)’s Resources and Appropriation Theory, we operationalized the digital divide by ownership of smart devices, literacy (solving tech problems by oneself, literacy in information search, social media, handling documents, online shopping/payment, and online collaboration), and usage (daily smartphone and laptop usage, frequency of using social media, online payment, m-health, entertainment apps, and information apps). Latent profile analysis was conducted on these indicators.

Results: Three classes were revealed – Low (12.0%), Intermediate (41.8%), and High (46.2%), with significantly different distributions by age groups (<55: 3.5%, 23.2%, 73.3%; 55+: 20.1%, 59.7%, 20.1%). Low and High had the lowest and highest scores, with Intermediate in between on most indicators (e.g., Low, Intermediate, and High groups owned 1.6, 2.4 & 3.1 devices, and the mean hours of daily smartphone use were 2.8, 4.2, & 5.3, respectively), except social media and information search literacies where Intermediate and High were comparable. While high (vs low) correlated with greater ‘activity and vigor’ (from WHO-5 Well-Being Index) and social support across age groups, entertainment apps conveyed more mental health benefits for older adults (Aged 55+). Associations of poor literacies with mental health were also less detrimental to older adults than younger groups.

Conclusions: Against ageist assumptions, digital engagement predicted mental health and social support for all ages, yet finer indicators revealed an age-related divide in mental health. Practitioners should continue engaging with all ages to enhance digital inclusivity yet segment their efforts by capitalizing on the age-relevant positive impact of digital engagement, such as using the entertainment element of digital technologies when working with older adults.

Abstract 2: The associations of technology acceptance and social networks with depressive symptoms in community-dwelling older adults

Authors: Rick Yiu Cho Kwan*1, 2, Janet Lok Chun Lee3, Jing-jing Su4, Vivian Lou5,6

1. 1. Translational Research Centre for Digital Mental Health, Tung Wah College, Hong Kong

2. 2. School of Nursing, Tung Wah College, Hong Kong

3. 3. Department of Rehabilitation Sciences, The Hong Kong Polytechnic University

4. 4. School of Nursing, The Hong Kong Polytechnic University

5. 5. Department of Social Work & Social Administration, The University of Hong Kong

6. 6. Sau Po Centre on Ageing, The University of Hong Kong

*presenting and corresponding author

Objectives: The study’s Objectives was to examine the associations between social networks and technology acceptance with depressive symptoms in community-dwelling older adults.

Methods: This was a cross-sectional survey conducted in community settings in Hong Kong. Eligible participants were community-dwelling old adults aged ≥ 60 years. Variables included social network, measured by the 6-item Lubben Social Network Scale; depressive symptoms, measured by the 9-item Patient Health Questionnaire; and technology acceptance, measured by the 14-item Senior Technology Acceptance Model. Hierarchy linear regression was employed to examine their associations. The independent variables were social network and technology acceptance. The dependent variable was depressive symptoms. Covariates included age and gender. Unadjusted models of the two independent variables were constructed. It was followed by three models including different independent variables, including [Model 1: social network], [Model 2: social network + technology acceptance], and [Model 3: social network + technology acceptance + covariates]. R2-changes were computed between models.

Results: This study recruited 380 eligible participants with a mean age of 66.5, and most participants were female (57.4%). In the unadjusted model, social network (β = –0.081, p = 0.010) and technology acceptance (β = –0.041, p < 0.001) were significantly associated with depressive symptoms. In Model 1, social network (β = –0.081) was significantly associated with depressive symptoms. The R2 is 0.017 and the R2- change was significant (p = 0.010). In Model 2, social networks became insignificant (β = –0.041, p = 0.180) after adding technology acceptance (β = – 0.058, p < 0.001) which was significantly associated with depressive symptoms. The R2 is 0.124 and the R2–change was significant (p < 0.001). In Model 3, the effect of social networks remained insignificant (β = 0.019, p < = 0.903), and the technology acceptance remained significant (β = – 0.051, p = 0.011). The R2 was 0.124 and the R2 -change was insignificant (p = 0.692).

Conclusions: Social networks are known to be protective against depressive symptoms in the literature that was also observed in this study. However, depressive symptoms are more associated with technology acceptance than social networks and the effect is not affected by age or gender. Older adults’ psychological well-being may be improved by fostering a positive attitude towards technology use and the healthcare system. Policies could offer older adults technology learning for better mental well-being and depression prevention.

Abstract 3: The effects of Digital Buddy on the mental well-being and depressive symptoms of older adults: A cluster randomized controlled trial

Authors: Sally Chan*1, Rick Yiu Cho Kwan1,2, Edward Man Fuk Leung3, Teresa Bik Kwan Tsien4, Fowie Ng1,5

1. 1. Translational Research Centre for Digital Mental Health, Tung Wah College, Hong Kong

2. 2. School of Nursing, Tung Wah College, Hong Kong

3. 3. Hong Kong Association of Gerontology, Hong Kong

4. 4. Department of Applied Social Sciences, The Hong Kong Polytechnic University, HongKong

5. 5. School of Management, Tung Wah College, Hong Kong

*presenting and corresponding author

Objectives: The study’s Objectives was to evaluate the effectiveness of a Digital Buddy program on mental well- being and depressive symptoms of older adults.

Methods: This study employed a multi-center, cluster-randomized, two-parallel-group, non- inferiority, controlled trial design with a 1:1 group allocation ratio. Participants were recruited in elderly community centers and nursing homes and were eligible if they were aged > 60 years and mentally capacitated. Participants were clustered by centers and randomly allocated into two groups. In the intervention group, a series of face-to-face training sessions for a minimum of 23 hours of 14 sessions at a trainer-to-participant ratio of 1:10 were provided by Digital Buddies (i.e., young volunteers) to participants for six months. The training contents included face-to-face transfer of technological skills about using various useful apps on smartphones and educational videos promoting mental health care. The training contents were packaged as an app and launch-able on the website. The participants were tele-mentored using smartphones by Digital Buddies during the intervention period. In the control group, participants received the usual care. The outcomes included mental well-being measured by the World Health Organization Five Well-being Index and depressive symptoms measured by the 9-item Patient Health Questionnaire. The outcomes were measured at baseline and post-intervention. Generalized estimating equations were used to examine the within-group and interaction outcomes. effects of “groups” and “time points” on the outcomes.

Results: The study recruited 310 eligible participants from 40 centers. The mean age of participants was 74.2 years, and most of the participants were female (64%). Each group comprised equally 155 participants. The result showed that mental well-being was significantly improved after the intervention in the intervention group (p < 0.001) but not in the control group (p = 0.106). The interaction effect on mental well-being was not significant (p = 0.132). The depressive symptoms were significantly reduced after the intervention in the intervention group (p = 0.047) but not in the control group (p = 0.398). The interaction effect on depressive symptoms was not significant (p = 0.601).

Conclusions: The Digital Buddy programme promoted mental well-being and reduced depressive symptoms in older adults but its effect might not be superior to the usual care.

Abstract 4: The effect of therapeutic virtual reality experience on the mental well-being and loneliness of older adults living with physical disabilities in long-term care facilities: Preliminary findings of an ongoing randomized controlled trial

Authors: Fowie Ng*1,2, Rick Yiu Cho Kwan1,3, Linda Chiu Wa Lam4, Rebecca Choy Yung5, Sally Chan*1

1. 1. Translational Research Centre for Digital Mental Health, Tung Wah College, Hong Kong

2. 2. School of Management, Tung Wah College, Hong Kong

3. 3. School of Nursing, Tung Wah College, Hong Kong

4. 4. Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong

5. 5. Golden Age Foundation, Hong Kong

*presenting and corresponding author

Objectives: The Objectives of the study was to evaluate the effectiveness of a therapeutic virtual reality experience program on mental well-being in older adults living with physical disabilities in long-term care facilities.

Methods: This study employed an assessor-blinded, two-parallel-group, non-inferiority, randomized controlled trial with a 1:1 group allocation ratio. Eligible participants are aged ≥ 60 years and living with physical disabilities. Participants were recruited in long-term care facilities (LTCF). Participants were individually randomized into groups. In the intervention group, participants received a 6-week virtual reality experience (VRE) program for 12 sessions, and each session lasted for one hour with two sessions per week. In each session, the program was delivered by a trained young volunteer at a trainer-to-participant ratio of 1:3, and the participants within the same group were immersed in the same virtual environment. Each session comprises three parts: 1) briefing and setup, 2) virtual reality experience, and 3) debriefing. The 12 VRE sessions developed into three therapeutic themes: natural scenery, outdoor leisure, and reminiscence. The participants were immersed in a therapeutic virtual environment in the VRE via head-mount devices. The young volunteers facilitated participants to explore in the virtual environment. The facilitator invited participants to share their VRE in the group during the debriefing. In the control group, participants received the usual care. The outcomes were mental well-being as measured by the World Health Organization Five Well- being Index and loneliness as measured by the 6-item De Jong Gierveld Loneliness Scale and measured at baseline and post-intervention. Generalized estimating equations were used to examine the within-group and interaction effects of “groups” and “time points” on theoutcomes.

Results: The trial started in February 2024, is ongoing with >30 LTCFs indicated interest to participate in the study and is expected to be completed by December 2024. It aims to recruit 216 participants. It is hypothesized that the program will promote mental well-being and reduce loneliness more than in the usual care provided by LTCFs.

Conclusions: The preliminary findings will be presented at the conference. The data of >50% of the expected participants will be reported

Globally, there is an observed increase in the elderly population. In Puerto Rico, 30% of the population is over 60 years old, positioning it as the sixth country worldwide with the highest aging population. This presentation discusses the demographic profile, ageism, stigma, the ethics of care, spirituality, and specialized therapeutic interventions.

Ageism is characterized by a series of stereotypes, prejudices, and discrimination, primarily rooted in social constructs. It occurs across organizations, political structures, and individual and social attitudes. This social phenomenon is a predisposing factor for social stigma, defined by sociologist Ervin Goffman (1963) as a discreditable mark borne by those who possess it.

Grandparents who raise their grandchildren face diverse psychosocial effects stemming from interactions with professionals, the State, and society in their role as caregivers, impacting their physical and mental health. Through qualitative Methods, reflections are proposed on these elderly individuals who are socially expected

to be cared for in this stage of life yet find themselves becoming caregivers for others. The effects of stigma and self-stigma on their daily and family lives are examined.

The ethics of care and spirituality are crucial factors contributing to a fuller and more resilient life for the elderly. Emphasizing the need to recognize and value caregiving relationships, not only as individual actions but as social practices that sustain common well-being, is essential.

Both the ethical principles of care and spirituality can be vital sources of comfort and strength, creating an environment of love that benefits the entire family.

This presentation not only provides a comprehensive view of the current situation of the elderly in Puerto Rico but also proposes practical and effective solutions to improve their quality of life and well-being. Attention to this social sector requires effective therapeutic interventions based on evidence, which positively impact the care and treatment of the elderly, providing crucial support for their well-being and stable mentalhealth.

With a focus on continuous improvement, this study seeks to foster a greater understanding and concrete actions that benefit this vulnerable population, ensuring comprehensive and dignified care during their years of greatest need.

Introducing the Profile of the Elderly in Puerto Rico and Social Stigmatization Speaker: Dra. Florencia Velázquez-Morales

Keywords: older adults, biopsychosocial, stigma, ageism, social construct, quality of life, elderly, spirituality, Puerto Rico

Summary: In the current world context, there is an increase in the population of older adults and a decrease in generational turnover. In the local context of Puerto Rico, this phenomenon is not an isolated fact of reality and is reflected in the growing number of older adults. According to the latest statistics, 30% of the current population is over 60 years old, making the island the sixth most aging country in the world. This poses a series of challenges that deserve special attention from the various fields of human behavior. For this reason, this paper focuses on addressing the various critical aspects related to the elderly, addressing the demographic profile and ageism as a predisposing factor of stigma.

To make an x-ray of this demographic group is much more than a statistical look, it deserves to be deepened in the biopsychosocial and spiritual aspects that allow a better understanding and attention to their needs. Ageism is a behavior characterized by a series of stereotypes, prejudices and discrimination against older adults, whose origin lies mainly in social and cultural constructs towards the population under Discussion. Its manifestation occurs at diverse levels and takes different forms, transversal in organizations and political structures, as well as in attitudes and beliefs towards older people. The presence of ageism in our environment requires greater and more specific attention, from a multidisciplinary and multisectoral approach. (Martínez, et. al., 2022).

This social phenomenon acts as a predisposing factor to social stigma, defined by the sociologist Ervin Goffman (1963) as a discrediting mark on those who bear it, which excludes them from the rest of society. He divides stigma into three categories: bodily abominations, character flaws, and tribal associations, which have a series of consequences such as social isolation, lack of access, and psychological effects, among others. Stigma can function as a barrier to accessing mental health services and negatively influence factors such as treatment adherence, symptom severity, or suicide risk. (Aguilar, 2023) It is important to address the stigma and ageism that make them invisible and underestimate their abilities to improve their quality of life.

The Role of Grandparents Speaker: Dr. José Luis Sierra

Keywords: grandparent caregivers, family dynamics, health, education, Puerto Rico, stigma, qualitative research.

Summary: Custodial grandparent families, where grandparents are the primary caregivers for their grandchildren, are often excluded from the traditionally constructed and socially privileged family model. These families face significant challenges related to health, self-care, and childcare due to difficulties in accessing and being recognized for social services. Redefining family meanings is crucial, as is listening to their perspectives on life. Statistical variations in the number of custodial grandparent families suggest that they are facing increasing challenges or that economic conditions in Puerto Rico prevent them from assuming caregiving roles as they would like.

The literature indicates that health and education are the most critical areas where these families face difficulties, impacting the family unit. Grandparents raising their grandchildren experience various psychosocial effects due to interactions with professionals, the state, and society in their caregiving role, affecting their physical and mental health. Through in-depth interviews and qualitative Methods, this presentation will reflect on these older adults who, instead of being cared for in this stage of life, become caregivers. The effects of stigma and self- stigma on their daily and family life will be explored. Reflections will be presented from a critical theoretical perspective, highlighting, and problematizing the situation.

Recommendations for policies and practices that improve support for these families in Puerto Rico will also be discussed. Emphasis will be placed on the need for public policies that include financial subsidies, tax exemptions, access to mental health and wellness services, training programs, and awareness campaigns to recognize and support the role of grandparent caregivers.

In consistent, the presentation will address how a better understanding and attention to the needs of grandparents can significantly improve their quality of life and well-being, thus benefiting the family as a whole and society in general.

The Ethics of Care and Spirituality in Elderly Care Presenter: Dra. Marieli Rivera Ortiz

Keywords: ethics of care, spirituality, elderly caregivers, Puerto Rico, interdependence, resilience.

The ethics of care is a normative approach emphasizing caregiving relationships and their underlying motivations. It recognizes the importance of interpersonal relationships and human interdependence, highlighting the shared responsibility in caring for others. The ethics of care can be defined as a practice and value that responds to human needs, building trust and connections between people (Held, 2006). In the context of grandparents caring for their grandchildren, this perspective becomes particularly significant, especially in Puerto Rico, where many grandparents find themselves in such roles.

It is crucial to recognize and value caregiving relationships not only as individual actions but also as social practices that sustain community well-being. Grandparent caregivers, through their ability to provide emotional stability and support, promote the moral and social development of children in an environment of trust and reciprocity. However, this responsibility brings significant challenges, such as feelings of loss, resentment, guilt, and considerable financial and emotional tensions.

In Puerto Rico, data from the Puerto Rico Community Survey (2014 –2018) by the U.S. Census Bureau indicate that approximately 89,369 grandparents live with their grandchildren. Of this group, around 41.4%, equivalent to 36,961 grandparents, bear the primary responsibility for their grandchildren’s care.

Given the significant number of grandparents who assume primary caregiving responsibilities in Puerto Rico, it is essential to consider the ethics of care and the importance of spirituality as factors contributing to a more fulfilling and resilient life for the elderly. Integrating spiritual care into their support provides an additional source of resilience and solace, enhancing their ability to create a stable and loving environment for the children under their care. In this scenario, grandparent caregivers not only improve their own well-being but also leave a lasting legacy of emotional strength and peace for future generations.

This presentation aims to explore how the ethics of care and spirituality can enhance the well- being and resilience of elderly caregivers in Puerto Rico. By acknowledging the shared responsibility and interdependence in caregiving, we can better support those who play such a vital role in their families andcommunities.

Therapeutic Interventions with the Elderly Presenter: Lic. Yanina Gisela Góngora

Keywords: caregiver grandparents, resilience, strengths model, therapeutic intervention, Puerto Rico, mental health.

The role of grandparents as primary caregivers for their grandchildren in Puerto Rico presents significant emotional and practical challenges, especially in later stages of life. Addressing these challenges not only meets daily practical needs but also promotes emotional well-being, essential for fostering lasting resilience.

This presentation aims to explore and evaluate the effectiveness of therapeutic interventions based on the strengths model to enhance the resilience and emotional well-being of caregiver grandparents in Puerto Rico. Assuming parental roles at an advanced age can profoundly impact the mental health and well-being of grandparents, exacerbating stress and anxiety. The lack of support from public policies aggravates these challenges, making it urgent to increase institutional and community recognition and support. In this context, the strengths model, which focuses on identifying and enhancing individuals’ internal capacities and resources, has proven effective in improving resilience and emotional well-being. A study by Fox et al. (2022) demonstrated that a strengths-based educational intervention significantly improved caregiver grandparents’ self-efficacy, with sustained effects over time. This approach acknowledges that everyone possesses knowledge, talents, skills, and resources to build a life according to their own terms and goals (Saleebey, 2006).

This research will review previous studies, academic articles, and institutional reports on the effectiveness of strengths-based interventions for caregiver grandparents. Academic databases and recognized sources will be utilized to compile and analyze relevant information. Moreover, this therapeutic approach not only offers individual solutions but also promotes the creation of support networks within the community and family, essential for alleviating caregiving burdens. This approach effectively addresses the complexities of intergenerational caregiving, proposing a support model that can be replicated and adapted in different contexts and communities.

Strengths-based interventions showed sustained improvements in caregiver grandparents’ self- efficacy, indicating their feasibility and effectiveness. Finally, recommended public policies include financial subsidies, tax exemptions, access to mental health and wellness services, training programs, and awareness campaigns to recognize and support caregiver grandparents. In consistent, a holistic approach encompassing therapeutic interventions, the strengths model, and community and institutional support is crucial for improving elderly caregivers’ well-being and mental health in Puerto Rico.

Summary: Provide a vision of the current situation of ageing and dementia in Latin America and the Caribbean (LAC). The importance of assessing the needs of people with dementia, supporting families, integrating risk reduction strategies, healthy ageing, promoting training programs to support primary care, and promoting new advances in the Microgliota axis concept will be highlighted—brain intestine. Despite the enormous burden that dementia generates, it continues to be an underdiagnosed entity. It is essential to control its prevalence, incidence, as well as its different social repercussions. It is crucial to promote direct actions aimed at reducing risk, disseminating knowledge of dementia, and promoting new lines of research that contribute to a healthier life for patients and their families.

Microglia microbiota aging- Dr A Kabanchik

In recent years, research interest arose in microglia-microbiota, normal and pathological aging, and new therapeutics. The Objectives of this presentation is to collaborate with the dissemination of this research and stimulate new developments. Concepts, functions, modifications linked to microglia, microbiota and gut brain axis were defined during the aging process associated with the increase in intestinal permeability, neuroinflammation and its impact on stress, depression and cognitive impairment. During aging, microglia changes from the resting state to the activated state and contributes to the development of neurogenerative diseases. Dystrophic microglia is differentiated, characteristic of aging, from hypertrophic microglia. Dysbiosis of the gut microbiota could lead to increased permeability of the gastrointestinal tract, which induces a higher level of circulating bacterial products. Changes observed in the intestinal microbiota could be the cause or result of neuroinflammation or alterations in the microglia. In older people, microbiota dysbiosis alters the homeostasis of the microenvironment and the status and function of the microglia.

Conclusions: The regulation of microglia was proposed as a potentially effective therapeutic strategy in chronic inflammatory pathologies. Remodeling of the brain intestinal axis using psychobiotics appears promising in reversing depressive symptomatology. The continued exploration of the intersection of the microbiota, immunology and biology has great therapeutic promise.

Dementia training needs of primary care professionals- Dr Tomás León

Background: Chilean guidelines, as most Latin-American and global recommendations, suggest that most people with dementia and their care partners should be managed in primary care. However, the knowledge and confidence of primary care teams in managing dementia is low, and training programs to support primary care are either lacking or unsuccessful in increasing the confidence of primary care teams.

Objectives: Create and evaluate an online course on dementia for primary care.

Methods: Qualitative research Methods were used, including focus group interviews with health professionals and individual interviews with people with dementia and their care partners to identify the primary needs regarding dementia. An online course was created, and an analysis was performed on the pre and post-course survey results.

Results: The primary needs identified by health professionals were the diagnosis process, treatment and interpersonal skills. More than 50% of the sample expressed low confidence in making a diKerential diagnosis. Less than 30% of the sample felt confident in providing post-diagnostic support and non-pharmacological interventions. For people with dementia and care partners’ primary needs were diagnosis disclosure and post- diagnosis support. Initial results show improvement in their confidence in diagnosis, treatment, and care and support for caregivers.

Conclusions: Our study supported the need for more training in dementia for primary care and identified additional educational content not usually included in standard dementia education. Including the voices of care partners and people with dementia was novel and ensured that dementia training in Chile was informed and tailored to the needs of the people who matter most. Expansion and adaptation for the Latin American public is ongoing.

Dementia in Latin America and the Caribbean: situation and future challenges- Cecilia M Serrano, MD, PhD

Dementia is a major global health problem that has social and economic repercussions. It is one of the main factors that contribute to producing dependency and disability in older people and, although its prevalence and incidence increase exponentially with age, it is not part of normal aging. Despite the enormous burden that dementia poses, it remains an underdiagnosed disorder. Latin America has great sociocultural diversity and further studies are necessary to identify people with dementia.

Objectives: Identify the prevalence of dementia in the region, provide knowledge to the population and health professionals and be able to make an early diagnosis.

Results: More than 55 million people live with dementia in the world, (68% of patients reside in low- and middle- income countries). A good practice guide for the management of dementia in Latin America and the MoCA test adapted to our environment (Argentine version) to screen for mild cognitive impairment in the population are presented.

Conclusions: Promoting the use of harmonized Methodsologies to address dementia can contribute to generating direct actions aimed at reducing the risk of dementia and leading to healthier lives for people with dementia and their families.

HEALTHY AGEING: GROUP DEVICE WITH ELDERLY PEOPLE

We are going through the decade of healthy aging which, according to the WHO, attempts to promote and maintain functional capacity, allowing well-being in older people. Old age is heterogeneous, it is a complex process that manifests itself in different facets, such as physiological, emotional, economic and interpersonal, which influence functioning and social well-being. Active ageing is a strategic tool to face the problem mentioned.

Objectives: The Neurology and Social Services proposed forming a group with older people, within the hospital for prevention. It is intended for participants to enable the promotion of their rights and prioritize accompaniment focused on the individual, from an interdisciplinary perspective.

Methods: The Group is called Conociendo-Nos, for people over 60 years of age, which is carried out in a hospital, with an open call for two hours per week. It consists of the participation of professionals who, using different strategies, address issues related to comprehensive health, promoting exchange, and learning about the group.

Results: The participation of older people in this type of activity has grown throughout these years, with minimal dropout. This contributes to keeping them physically, mentally and socially active, preserving functional capacity in ageing and promoting the generation of links between participants and the health system.

Conclusions: Although some older people have little experience participating in group activities, this space helps their inclusion from a gerontological perspective, promoting healthy ageing.

Introduction: Recently researchers started investigating brain aging and what factors can influence the way our brains age. As it is unclear at this point whether psychosocial stressor influence brain aging, the aim of the study was to investigate the association between psychosocial stress and brain aging.

Methods: Data from the German population-based cohort Study of Health in Pomerania (N = 991; age range 20– 78 years) were used to calculate a total psychosocial stress score by combining sub-scores from five domains: stress related to the living situation, the occupational situation, the social situation, danger experiences, and emotions. Associations with brain aging, indicated by an MRI-derived score quantifying age-related brain atrophy, were estimated by using regression models adjusted for age, gender, education, diabetes, problematic alcohol consumption, smoking, and hypertension.

Results: High emotional stress came with a relative risk of 1.21 (CI95% = 1.04 – 1.41) for advanced brain aging in fully adjusted models. Mental health symptoms additionally influenced brain aging, as statistically significant interactions between emotional stress and mental health symptoms on advanced brain aging indicate.

Discussion: Among the psychosocial stressors that we investigated; emotional stress seems to be relevant regarding brain aging. More research is needed to explore the potential pathways.

Introduction: Previous studies have shown that people with low socioeconomic status have more white matter hyperintensities (WMH) when they get older. In this study, we wanted to analyze to what extent education and income explain differences in WMH. Further, we wanted to identify lifestyle risk factors that are associated with WMH among people with low and high education or income.

Methods: A total of n = 1,185 dementia-free participants aged 40–80 years from the population-based study of the Leipzig Research Centre for Civilization Diseases (LIFE) in Leipzig, Germany, were analyzed. Information was obtained in standardized interviews. WMH (including the derived Fazekas scores) were assessed using automated segmentation of high- resolution T1-weighted anatomical and fluid-attenuated inversion recovery (FLAIR) MRI.

Results: Income and WMH were significantly associated in univariate analyses but did not remain statistically significant after adjusting for age, gender, arterial hypertension, heart disease, and APOE e4 allele. Education was significantly associated with Fazekas scores but not with WMH and not after Bonferroni correction. After combining the lifestyle risk factors in a factor analysis, results from adjusted models indicated only statistically significant associations between higher distress and more WMH as well as between obesity and deeper WMH.

Discussion: Differences in WMH between individuals with low and high education or income may be the result form differences in risk factors. Further research needs to explore the potential pathways.

Background: Alzheimer’s disease, as a major disease that seriously jeopardizes the health and safety of human life, and its association with mild cognitive impairment (MCI) a clear diagnosis is essential for prevention and treatment. In clinical work, there are many patients who reject the option of Aβ-PET because of its expensive price and radiopacity. It is well known that the onset of Alzheimer’s disease is closely related to ApoE genotype, age, and education, and the eye movements of patients with Alzheimer’s disease also differ significantly from those of patients with mild cognitive impairment and the normal population. And we found in our clinic that many patients with Alzheimer’s disease develop significant tongue fissures. Based on this, we developed a machine learning tool based on the combined analysis of genotype, tongue cracking, eye movements, age, and education to help patients definitively diagnose either MCI or Alzheimer’s disease.

Methods: We recruited 22 patients with subjective cognitive decline, 11 with Alzheimer’s disease and 11 with MCI, based on the results of neuropsychological scales assessed in the clinic (MMSE, MoCA, etc.) and the exclusion of other causes of dementia such as vascular dementia. We collected blood samples, tongue image and eye movement data and their basic information from the patients, and we measured and calculated the ratio of the longest tongue crack to the upper lingual segment where the crack was located. We built a new machine learning tool for diagnosing Alzheimer’s disease and MCI based on the combined analysis of genotype, tongue cracking, eye movements, age and education using Rstudio software with support vector machines (SVM) and used Rstudio to fill in missing values due to random factors.

Results: Our machine learning model for diagnosing Alzheimer’s disease and MCI based on genotype, tongue cleft, eye movement, age, and education analysis had an AUC value of 0.875, which was significantly better than the traditional machine learning model without tongue cracking analysis (AUC value of 0.708).

Conclusions: The machine learning tool we developed for the diagnosis of Alzheimer’s disease and MCI has excellent performance in differentiating between Alzheimer’s disease and MCI and possesses a greater potential value for assisting in clinical diagnosis in the future.