The Intensive Initial Support Team for Dementia (IPIST) is a multidisciplinary outreach team that provides intensive initial assessment and support for dementia in Japan, introduced based on the Memory Service in the UK. All municipalities are required to establish at least one team, which consists of at least one physician and two professional staffs such as public health nurses and care workers. IPIST usually complete the work within approximately six months, including consultation with medical specialists and introduction of public supports. IPIST sometimes faces “complex case” that is difficult to manage. Because complex cases often have psychiatric problems, accessibility to psychiatric resources is important for IPIST. This study investigated the percentage of psychiatric professionals among IPIST members and the characteristics of complex cases they face.

Through all 1741 municipalities in Japan, a questionnaire was distributed to each IPIST regarding the complex cases they experienced during April-September 2020. The questionnaire asked for the characteristics of each IPIST (e.g., specialty of the team physician, availability of staff with psychiatric expertise, etc.) and which of the 12 categories each complex case fit into, allowing multiple choice.

We could collect responses from 1291 IPISTs. 43.3% of IPISTs had a psychiatrist, 43.1% had an internal medicine physician, 13.4% had a neurologist, and 17.0% had some other physician as their team physician. In addition, 59.4% of the teams had medical staff members with psychiatric experience, including psychiatrists. A total of 7340 cases were reported as complex cases. While the most common category for difficulties in case management was “refusal of services” (19.5%), factors requiring psychiatric intervention such as “behavioral and psychological symptoms of dementia” (16.0%), “co-occurring mental illness” (7.3%), “complaints from neighbors” (7.1%), and “trash-house” (4.3%) were also frequently observed.

The survey revealed that many IPISTs already had psychiatrists and other professionals with clinical psychiatric experience, and that they managed a lot of complex cases with issues that would be the target of psychiatric intervention. We believe early psychiatric engagement is important in many complex cases in outreach support for community residents with suspected dementia.

Although sexual violence (SV) is increasingly recognized as a major public health problem, older people are ignored in policies and practices on SV. Research on prevalence and impact of SV in older adults is limited and Belgian figures on the subject are non-existent. This mixed-methods study aimed to better understand the nature, magnitude and mental health impact of SV in older adults in Belgium.

We conducted face-to-face interviews trough structured questionnaires with 513 older adults (70+) across Belgium and 100 old age psychiatry patients. Quantitative data were triangulated with qualitative data from 15 in-depth interviews with older SV victims.

Over 44% of Belgian older adults and 57% of old age psychiatry patients experienced SV during their lifetime, 8% and 7% respectively in the past 12-months. Lifetime exposure to SV was associated with depression (p=0.001), anxiety (p=0.001) and PTSD in older adults with chronic disease/disability (p=0.002) or lower education level (p<0.001). A minority of victims (40%) disclosed their experiences to their informal network and 4% sought professional help. Older victims are willing to share their experiences, but ask health care workers to initiate the conversation.

This study highlights the importance of recognizing older adults as a risk group for SV and the need for tailored care for older victims. Health care professionals working with older adults need to be qualitatively trained to initiate a conversation around SV and its mental health impact in old age through training, screening tools and care procedures.

A significant number of patients with COVID-19 experience prolonged symptoms well known as Long-COVID that can occurred between 3 to 24 weeks after acute phase. Most frequent symptoms expressed are fatigue, and cognitive dysfunction, but few studies have investigated the effect in outpatients ‘elderly population. A recent Study followed hospitalized seniors for COVID-19; 22% complain “Brain Fog” one year later correlated with cognitive impairment. It is a challenge to recognized symptoms as “Brain Fog” or fatigue in a frail population affected by dementia (pwd) that yet experience cognitive impairment and disability.

This observational study wants to evaluate the effect of COVID on clinical, cognitive, functional and frailty indices before infection and after in a sample of older pwd matching with control group in outpatients setting.

We collected 67 pwd and COVID infection between March 2020 and 2022 followed by Memory Clinic with pre and post geriatric assessment compared with 41 older people with dementia in control group without COVID-19. The geriatric assessment describes comorbility (CIRS), cognitive performance (MMSE), functional assessment (IADL. ADL), psychological and behavioral symptoms (NPI) and frailty evaluation (CFS) at baseline T0 (within 6 moths before COVID infections), at T1 (4-6 moths after ) and T2 (12 months after). Death is recorder for both groups

Both groups are similar for demographic and clinical characteristics at the baseline. We calculated Delta value T0-T1 and T1-T2 for clinical variables and compared case and control group. As compared to control group, COVID group showed significantly worsening in comorbility in T1 and in disability (ADL) in T1 and T2, meanwhile challenging behavior improve during the time. Both in T1 and T2 COVID group develops in worst frailty compared to control group. None difference in mortality between groups. A possible information bias is that it is not possible to exclude presence of asymptomatic covid case in control group.

COVID infection in older pwd seems to chance and speed up the natural frailty curve in people with dementia. Is it an effect of a hidden Long COVID? The study open new hypothesis in neurodegenerative implication of prolonged neuroinflammation caused by COVID brain infection.

To test vitamin D3 and omega-3s for late-life depression prevention under the National Academy of Medicine framework for indicated (targeting subthreshold depression) and selective (targeting presence of high-risk factors) prevention.

VITamin D and OmegA-3 TriaL (VITAL) is a 2x2 factorial trial of vitamin D3 (2000 IU/day) and/or omega-3s (1 g/day) for cardiovascular and cancer prevention (enrollment: November 2011-March 2014; end date: December 31, 2017). In this targeted prevention study, we included 720 VITAL clinical sub-cohort participants who completed neurobehavioral assessments at baseline and 2 years (91.9% retention). High-risk factors were: subthreshold or clinical anxiety, impaired activities of daily living, physical/functional limitation, medical comorbidity, cognitive impairment, caregiving burden, problem drinking, and low psychosocial support. Co-primary outcomes were: incident major depression (MDD), adjudicated using DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition); change in mood (Patient Health Questionnaire-9 [PHQ-9]). We used exact tests to determine treatment effects on MDD incidence and repeated measures models to determine treatment effects on PHQ-9.

11.1% had subthreshold depression, 60.8% had ≥1 high-risk factors, MDD incidence=4.7% (5.0% among completers), and mean PHQ-9 change=0.02 points. Among those with subthreshold depression, the MDD risk ratio (95% confidence intervals)=0.36 (0.06 to 1.28) for vitamin D3 and 0.85 (0.25 to 2.92) for omega-3s, compared to placebos; results were also null among those with ≥1 high-risk factors [vitamin D3 vs. placebo: 0.63 (0.25 to 1.53); omega-3s vs. placebo: 1.08 (0.46 to 2.71)]. There were no significant differences in PHQ-9 change comparing either supplement with placebo.

Neither vitamin D3 nor omega-3s showed benefits for indicated and selective prevention of late-life depression; statistical power was limited.

Active ageing is the maintenance of positive subjective well-being, good physical, social and mental health in later life. It aligns with the ‘successful ageing’ narrative where obligation to undertake activities is deemed beneficial to health status (Swallow 2019). How this narrative plays out for people with mild cognitive impairment (MCI) which is not dementia has not been considered.

My PhD investigated experiences of people over 60 with MCI who engaged within an active ageing intervention. The APPLE-tree (AT) programme stands for Active Prevention in People at risk of dementia through Lifestyle, Behaviour change and Technology to build Resilience (Cooper et al 2019). It aims to facilitate active ageing in people who are limited by cognitive impairment. I explored how older people with memory impairments situate themselves within this active ageing health intervention and how policies and practices reconfigure MCI.

I adopted an ethnographic approach, undertaking participant observations and semi structured interviews with participants. I followed two 20 week programs, undertaking 65 field notes and conducting 16 interviews with participants. I used reflexive thematic analysis to analyse the results through Nvivo.

Four themes with sub-themes were identified.

• Arrival into the intervention – learning, listening, knowing, and doing active aging. Participants navigated fears and uncertainties of MCI with their expectations of active ageing.

• Being an individual in a group experience – retaining a sense of self whilst embracing the collective unknown. Participants reconfigured their MCI through a tension between individual responsibility and a collective group experience.

• Managing uncertainly and attempting to create certainty through navigating knowledge. Active ageing changed how participants viewed and dealt with MCI with attempts to clarify knowledge of dementia risk.

• Being an active ager; actively able to be active and participate in active ageing. Individuals demonstrated engagement through sharing achievements, ability and inabilities.

Active ageing is a collective habitus, with absence of clear knowledge and direction creating a mismatch between rhetoric and lived experiences of people with MCI. Ultimately results inform the development of concepts in social gerontological theory and active ageing

The literature has shown depression to be associated with an increased risk of dementia. In addition, hormone therapy can be a responsive treatment option for a certain type of depression. In this study, we examined the association between hormone therapy, including lifetime oral contraceptive (OC) use, and hormone replacement therapy (HRT) after menopause with the occurrence of dementia among female patients with depression.

The South Korean national claims data from January 1, 2005, to December 31, 2018, was used. Female subjects aged 40 years or older with depression were included in the analyses. Information on hormone therapy was identifed from health examination data and followed up for the occurrence of dementia during the average follow-up period of 7.72 years.

Among 209,588 subjects, 23,555 were diagnosed with Alzheimer’s disease (AD) and 3023 with vascular dementia (VD). Lifetime OC usage was associated with a decreased risk of AD (OC use for < 1 year: HR, 0.92 [95% CI, 0.88–0.97]; OC use for ≥ 1 year: HR, 0.89 [95% CI, 0.84–0.94]), and HRT after menopause was associated with a decreased risk of AD (HRT for < 2 years: HR, 0.84 [95% CI, 0.79–0.89]; HRT for 2–5 years: HR, 0.80 [95% CI, 0.74–0.88]; and HRT for ≥ 5 years : HR, 0.78 [95% CI, 0.71–0.85]) and VD (HRT < 2 years: HR, 0.82 [95% CI, 0.71–0.96]; HRT for 2–5 years: HR, 0.81 [95% CI, 0.64–1.02]; and HRT for ≥ 5 years: HR, 0.61 [95% CI, 0.47–0.79]).

In this nationwide cohort study, lifetime OC use was associated with a decreased risk of AD, and HRT after menopause was associated with a decreased risk of AD and VD among female patients with depression. However, further studies are needed to establish causality.

Despite the advantages of Virtual Reality (VR), the increase in anxiety caused by motion sickness makes it difficult to apply to patients with depression and anxiety. We studied correlation between skin conductance and anxiety in VR.

We conducted a clinical study of 81 healthy volunteers with high stress, which was defined as a score of 20 or more on the Perceived Stress Scale-10 (PSS-10). We used STAI-X-1 to measure anxiety, and Galvanic Skin Response to measure skin conductance. This study used an open, randomized, crossover design. The videos consisted of two types, less dizzying video (G1) and more dizzying video (G3). We divided into two groups with exposure order, G1 after watching G3 (Order 1), and G3 after watching G1 (Order 2).

Anxiety significantly decreased in the Order 2 group (p < 0.035), whereas there was no significant change in anxiety in the Order 1 group. In both groups, skin conductance significantly increased after exposure to dizzying video. The skin conductance of the Order 1 group mean (SD) was 1.61 (1.07) (p < 0.0001), and the Order 2 group was 0.92 (0.90) (p < 0.0001). There was no significant difference between two groups (p = 0.077).

It is possible to reduce skin conductance and anxiety by viewing less dizzying VR video first and then viewing more dizzying video later.

Time in nature is increasingly recognised as beneficial for people living with dementia, with research often focusing on the benefits of physical activity, proximity to natural environments and social interactions. However, limited research has investigated the role of purpose while gardening for people living with dementia. Purposeful activities are often lacking in programs for people living with dementia, who are sometimes excluded and have their capabilities underestimated, especially those with younger-onset dementia. Yet, these purposeful activities may be key to supporting people living with dementia to retain a sense of self-worth and connection to their communities.

This project documented participants’ experiences of purposeful activity in the form of volunteering at a farm producing food for community members in need.

Individuals living with dementia participated in farming activities over several weeks to help grow food for people in need. During this time, participants completed ‘walking interviews’, discussing the tasks undertaken, their perspectives on these tasks, how these activities fitted in with their own ways of being, and how they felt spending time in nature. Walking interviews provide contextual and environmental cues that may facilitate emotional and sensory connection in a way that traditional interviews do not. Their shorter and more flexible time frame provides additional adaptability for people living with dementia.

Walking interviews were audio-recorded, transcribed and thematically analysed. These analyses describe participants’ experiences at the farm, related to purpose in life. These included participants’ connection to times in their lives when they provided support, assistance or service to others, and their experience of engaging with the natural environment.

This research contributes to understanding of benefits of purpose-focused time in nature, including that it provides an opportunity for people living with dementia to connect with different points in their lives when they have held other forms of purpose. Tips on setting up such a safe, enjoyable, inclusive gardening project are provided. Additional research into meaningful engagement in natural settings is warranted for people living with dementia, especially when it involves activities with benefit to communities.

This project was supported by the Australian Association of Gerontology’s Hal Kendig Research Development Program.

Changes in lifestyle factors are known to affect mood. However, there is insufficient evidence supporting the association between smoking, alcohol consumption, physical activity and depression in middle-aged women who are likely to experience rapid hormonal changes.

We used a nationwide database of medical records in South Korea. 901,721 premenopausal and 943,710 postmenopausal women aged 40 years or older included in this study. Information on smoking, alcohol consumption, physical activity was identified from health examination data and followed up for the occurrence of depression using claims data.

Compared with never-smokers, ex-smokers and current smokers among premenopausal and postmenopausal women showed an increased risk of depression in a dose-dependent manner (aHR 1.13 for ex-smokers; aHR 1.23 for current smokers). Compared with non-drinkers, mild drinkers showed a decreased risk of depression (aHR 0.98 for premenopausal women; aHR 0.95 for postmenopausal women), and heavy drinkers showed an increased risk of depression both among premenopausal (aHR 1.20) and postmenopausal women (aHR 1.05). The risk of depression due to smoking and heavy alcohol consumption was higher in premenopausal women than in postmenopausal women. Compared with those who had not engaged in regular physical activity, those who had engaged showed a decreased risk of depression both among premenopausal (aHR 0.96) and postmenopausal women (aHR 0.95).

Smoking and heavy alcohol consumption increased the risk of depression, and the increased risk was prominent in premenopausal than in postmenopausal women. Regular physical activity decreased the risk of depression both in premenopausal and postmenopausal women.

The aim of this review was to describe the usage and effectiveness of errorless learning in activities of daily living (ADL) and instrumental activities of daily living (IADL) rehabilitation methods reported in the literature over the past 10 years.

Two databases were searched (PubMed, EMBASE) using the key words “errorless learning and ADL and IADL”. Articles published in the last 10 years in English were considered.

4 studies were identified that included 94 people with Alzheimer's disease (AD) and 129 people with stroke (104 with amnesia and 25 with ideational apraxia ).

One study on AD patients showed that it is possible for them to re-learn relevant IADL activities using the errorless learning (EL) and spaced retrieval (SR) techniques and to maintain these gains for at least 3 months (t =2.811; df =22.246; p=0.010).

In another study on AD patients, participants with AD had to re-learn three IADLs. All three learning methods (including EL) had similar efficiency (F(2,94)=21,99). However, the intervention resulted in greater improvement in actual IADL task performance than in explicit knowledge.

In another study, structured ADL re-training in stroke survivors with amnesia significantly increased functional independence (MD: 4.90, SE=1.4, 95% confidence interval) and shortened time of hospitalisation (mean difference: 5.22, SE= 1.4, 95% CI: 1.8, 8.7).

The fourth study presented a model in which patients with post-stroke ideational apraxia attended tea making training sessions during which progress was monitored and feedback was provided via a computer system. A qualitative analysis of errors was conducted before training, and the most common errors observed were those related to kettlebell and continuous perseveration. After training, the frequency of errors decreased for all error types except for skipping a step.

The results of the studies discussed demonstrate the wide range of applications of error-free learning protocols in both AD patients and post-stroke patients. A clearly specified but flexible training protocol, together with information on error distribution, provide pointers for further refinement of task model approaches in ADL and IADL rehabilitation.

INDUCT (Interdisciplinary Network for Dementia Using Current Technology), and DISTINCT (Dementia Inter-sectorial strategy for training and innovation network for current technology) are two Marie Sklodowska-Curie funded International Training Networks that aimed to develop a multi-disciplinary, inter-sectorial educational research framework for Europe to improve technology and care for people with dementia, and to provide the evidence to show how technology can improve the lives of people with dementia.

In INDUCT (2016-2020) 15 Early Stage Researchers worked on projects in the areas of Technology to support everyday life; technology to promote meaningful activities; and healthcare technology. In DISTINCT (2019-2023) 15 Early Stage Researchers worked on technology to promote Social health in three domains: fulfilling ones potential and obligations in society, managing one’s own life, and participation in social and other meaningful activities.

Both networks adopted three transversal objectives: 1) To determine practical, cognitive and social factors needed to make technology more useable for people with dementia; 2) To evaluate the effectiveness of specific contemporary technology; 3) To trace facilitators and barriers for implementation of technology in dementia care.

The main recommendations resulting from all research projects are integrated in a web-based digital Best Practice Guidance on Human Interaction with Technology in Dementia which was recently updated (Dec 2022 and June 2023) and will be presented at the congress. The recommendations are meant for different target groups, i.e. people in different stages of dementia, their (in)formal carers, policy makers, designers and researchers, who can easily find the recommendations relevant to them in the Best Practice Guidance by means of a digital selection tool.

The INDUCT/DISTINCT Best Practice Guidance informs on how to improve the development, usage, impact and implementation of technology for people with dementia in various technology areas. This Best Practice Guidance is the result of intensive collaborative partnership of INDUCT and DISTINCT with academic and non-academic partners as well as the involvement of representatives of the different target groups throughout the projects.

Depression is common in neurodegenerative diseases, and a psychiatric diagnosis of late-life depression (LLD) may be changed to neurodegenerative disease during the follow-up period. The aim of this study was to identify clinical characteristics of LLD that might be prodromal state of neurodegenerative diseases.

We conducted a retrospective chart review to collect data (registered between April 2012 and September 2022) from individuals who received electroconvulsive therapy (ECT) for their severe depressive episodes due to major depressive disorder (MDD) or bipolar disorder, were aged 60 years and older, and were followed up more than one year. We compared clinical characteristics between individuals whose diagnosis changed from LLD to neurodegenerative disease (ND) and those whose diagnoses didnʼt change (non-ND). Between-group differences were examined using Mann-Whitney U test for continuous variables as well as χ2 tests and Fisherʼs exact tests for categorical variables.

In total, 99 patients (14 patients in ND and 85 patients in non-ND.) were included. All individuals in ND group were diagnosed with MDD. Individuals in ND group showed significantly older onset age, less family history of psychiatric disorders, and tended to show less melancholic features, less ineffective to antidepressants for the current episode. They required ECT because of the need for rapid recovery than non-ND.

Among individuals with late-life mood disorders requiring ECT for their severe depressive episodes which require rapid recovery, higher age of onset and no family history of psychiatric disorder may suggest the presence of neurodegenerative diseases.

Dementia poses significant and sustained challenges to global society. Diagnosis can lead to increased feelings of loneliness and social isolation. People with dementia living alone are particularly at risk. Considering the growing number of technologies proposed to aid people with dementia address social isolation and loneliness, we reviewed the existing literature.

To collate and summarize current evidence for digital technologies to prevent social isolation and loneliness for people with dementia.

Following the PRISMA guidelines, we systematically searched five databases to identify studies of digital technologies designed to support or prevent social isolation or loneliness for people with dementia. Pre-specified outcomes included social isolation, loneliness, and quality of life. We used deductive thematic analysis to synthesize the major themes emerging from the studies.

Ten studies met our inclusion criteria where all studies reported improvements in quality of life and seven reported benefits regarding social inclusion or a reduction in loneliness. Technologies were varied across purpose, delivery format, theoretical models, and levels of personalization. Two studies clearly described the involvement of people with dementia in the study design and five technologies were available outside the research context.

There is limited—but increasing—evidence that technologies hold potential to improve quality of life and reduce isolation/loneliness for people with dementia. Results presented are largely based in small-scale research studies. Involvement of people with dementia was limited and few research concepts are reaching implementation. Closer collaboration with people with dementia to provide affordable, inclusive, and person-centered solutions is urgently required.

Observer rating scales are necessary to evaluate the risk of suicide because individuals at risk for suicide are often unwilling to seek help on their own. Reliability and validity were evaluated for the newly developed Suicide Screening Questionnaire-Observer Rating (SSQ-OR).

Preliminary items were assessed by 251 experts online and 25 questions were selected. 328 individuals at high-risk and 661 controls from 12 Crisis Response Centers and 5 university counseling centers were recruited to complete SSQ-OR, Beck Scale for Suicide Ideation (BSSI) and Patient Health Questionnaire-9 (PHQ-9). In a 6 months follow-up, we reached out to 176 participants to ask whether they had experienced a suicidal thought, plan, or attempt since the baseline assessment. Cronbach's 慣, Mann-Whitney U test, Spearman's correlation, factor analyses, Receiver operating characteristic (ROC) analysis and logistic regression analysis were used to verify the SSQ-OR.

Structural validity was supported by a two-factor solution using exploratory and confirmatory factor analyses. Excellent model fit indices for the two-factor structure using exploratory factor analysis were confirmed (RMSEA = 0.033, TLI = 0.980, CFI = 0.983). The SSQ-OR demonstrated strong internal consistency. The concurrent validity based on the correlations with other self-reported indicators of suicidal potential-BSSI and PHQ-9- revealed substantial relationships. The high-risk group was effectively characterized by a cut-off point of 4, with a sensitivity of 0.73 and a specificity of 0.79. The SSQ-OR scores were significant predictors of suicidal thoughts and behaviors within 6 months.

The SSQ-OR exhibits sound psychometric properties, and could be used as a complement to a self-report or clinical-administered scale to screen suicide risk comprehensively.

By 2030, 1 in 6 people in the world will be aged 60 years or over (World Health Organization, 2022). This Manifesto is the result of the work undertaken by the Task Force of the Italian Association of Psychology working in the field of Clinical Psychology of Ageing. There is a general belief that older people do not benefit from psychological interventions, due to the prejudice that they may be less psychologically flexible or unable to change and/or improve their functioning. However, current evidence suggests that psychological interventions, including both more and less structured ones, are equally effective for older and working-age adults. Therefore, the aim of this Manifesto was to highlight the specific role of the Clinical Psychology in enabling older adults to overcome the multiple challenges associated with the ageing process and disease-related issues.

We reviewed existing empirical and conceptual literature on main issues in clinical work with older adults.

We identified and thoroughly described areas of major interest, such as theoretical models on how we think, feel and act towards age and ageism; prevention of emotional distress and cognitive decline and promotion of older adults’ psychological health in community; multidimensional assessment and evidence-based psychological interventions, also mediated by technology, for healthy older adults and those living with chronic disease such as dementia. Attention to psychological issues related to informal and formal caregiving, as well as the need for education, training and public engagement will be highlighted.

With a population living longer worldwide, it is essential to introduce and formalize initiatives to reduce health inequities and improve the lives of older people and their families. This should take place in communities able to foster the abilities of older people, while providing them with access to quality long-term care, if needed.

In the last decades, the issue of caring for a sick parent at young age has received increased attention due to recent changes in society. The term “carer” (also known as caregiver) refers to anyone who carries out, on a regular and unpaid basis, significant caring tasks for a friend or family member who cannot cope alone because of an illness or other condition. Existing evidence suggests that young carers tend to have more mental health problems and more difficulties in behavioral, psychosocial, and academic adjustment than their peers without an ill parent. Since caring can be viewed as a natural extension of family relationships, young people often do not receive support from social policy, health and social services. Therefore, the aim of this review was to systematically ascertain the literature on psychological interventions for young carers (aged 11-30 years), aimed to promote their mental health and well-being, thus mitigating the psychosocial impact of caring on their development.

A systematic literature search was performed in CINAHL, PsycINFO, PubMed and Scopus; in addition, reference lists from reviewed papers were used to identify additional relevant studies. A rigorous screening process was followed, and a checklist for qualitative and observational studies was used to assess the methodological quality of the studies. Narrative synthesis of the selected articles was carried out.

Only 9 studies were included. Interventions had a different nature and mixed evidence on their efficacy emerged. Moreover, several methodological concerns limited study replicability.

Given the clinical relevance of this topic, it is important that these interventions and the new ones will undergo rigorous evaluation. Effective interventions for young carers may also lead to considerable savings in healthcare and societal costs.

In nursing home residents, outcomes are often assessed using proxies, especially in residents with severe cognitive problems. Although caregivers are commonly involved as proxies, studies assessing their agreement for proxy measures are scarce. Therefore, secondary analysis was performed on a dataset with proxy-reported scores of several scales in Dutch and Flemish nursing home residents with and without dementia.

To assess the agreement between the observations of 81 pairs of caregivers, we calculated Cohen’s Kappa, Weighted Kappa, and Prevalence- and Bias-Adjusted Kappa (PABAK and PABAK- OS for ordinal data) coefficients for the items on the Nijmegen observer-rated depression scale for detection of depression in nursing home residents (NORD), the social wellbeing of nursing-home residents scale (SWON-3), and two subscales (i.e., “social relations” and “having something to do”) of the QUALIDEM. In addition, coefficients were calculated for the item concerning subjective judgment of the residents’ depressive symptoms (“no,” “yes, mild or light,” or “yes, severe”) and for the item concerning whether the caregivers believed a depression diagnosis had been established (“yes,” “no”).

In general, PABAK and PABAK-OS coefficients were higher than the Cohen’s and Weighted Kappa coefficients, suggesting a considerable amount of prevalence or bias. For the total sample, most items were above .40, indicating acceptable agreement. The results showed higher levels of agreement for proxy scores of residents with lower levels of dementia, compared to residents with more severe dementia.

The general finding of different levels of agreement between coefficients with and without correction for prevalence and bias, suggest the importance of exploring both values to enable adequate interpretation of the reliability of these items. The result of limited levels of agreement between caregivers concerning residents with more severe dementia underscores challenges for measurements in this population. We believe that practitioners and researchers should be aware of these challenges when using and interpreting scores derived from proxies. Moreover, understanding why different raters reach different conclusions regarding the same residents is important for interpreting the meaning of proxy-reported scores.

It is estimated that there are 55 million people living with dementias globally. With so few effective treatments available for dementias, it is vital that services optimise the management of risk factors for patients to slow their disease progression as much as possible. Commonly prescribed medications with anticholinergic effects can cause iatrogenic cognitive impairment and lead to faster decline in people living with dementia. United Kingdom (UK) national guidelines recommend minimising their use when assessing people with suspected dementia or during medication reviews of people with dementia. We proposed to audit how many people were being referred to memory assessment services in two UK locations with a significant anticholinergic burden, which medications were responsible, and whether this impacted on diagnosis.

We developed an audit tool based on national guidelines to gather data on the age, gender, medications, diagnosis and cognitive impairment of the first 50 patients assessed in the Memory Assessment Services in Wolverhampton and Walsall in 2022. We used the anticholinergic effect on cognition scale (AEC) to measure patients’ anticholinergic burdens and identify the most frequently prescribed medications.

We collected data from 30 patients from Wolverhampton and 20 patients from Walsall. Across the two locations, only 10% presented with a significant anticholinergic burden, with 24% having some anticholinergic burden that was not considered significant. Every patient with a significant anticholinergic burden was later diagnosed with dementia.

Most of the anticholinergic medications that were prescribed are generally prescribed for psychiatric or neurological indications and the most frequently prescribed drug was amitriptyline.

The prescription of anticholinergic medications was not as prevalent as predicted in our sample. It may be that anticholinergic medication are less prescribed for physical illnesses as alternatives that do not cross the blood-brain barrier are available. Psychogeriatricians are well placed to review the anticholinergic medications that are commonly prescribed during the assessment of suspected dementia, due to their familiarity with these medications. In response to our findings, we plan to update our memory clinic assessment tools to highlight the need for clinicians to review patients’ anticholinergic burden during assessment.