Pharmacogenomic testing for antidepressant medication selection is widely available, and patients with treatment-resistant depression regularly inquire about it. Psychiatrists and primary care providers have little guidance on when to obtain pharmacogenomic testing. We reviewed the characteristics and outcomes of a sample of geriatric patients who received this testing.

Retrospective review of patients ages 65 and older with ICD-10 diagnoses of depressive disorders (F32.0-F33.9), followed at Mayo Clinic Rochester, who received pharmacogenomic testing between 1/1/2018 and 12/31/2022 to guide antidepressant medication selection. Patients were included if there were Patient Health Questionnaire 9-item (PHQ-9) depression rating scores up to 3 months before and 3 months after pharmacogenomic testing. Demographic information, cytochrome P-450 CYP2D6 and CYP2C19 phenotypes, PHQ-9 scores, ordering provider (psychiatrist or primary care provider), and resulting medication changes were collected. Paired t-tests compared differences between before and after PHQ-9, with statistical significance p<0.05.

Approximately 1% of patients with a depressive disorder received pharmacogenomic testing. After limiting to patients with PHQ-9 before and after testing, 287 patients met inclusion criteria. 66% were female, mean age 72.3 yrs (±SD 5.7, range 65.0-90.7), and 95% were Caucasian. CYP2D6 phenotypes were 9% poor, 48% intermediate, 39% extensive (normal), 3% rapid metabolizer. CYP2C19 phenotypes were 3% poor, 25% intermediate, 39% extensive, 33% rapid metabolizer. Mean PHQ-9 before testing was 10.8 (±SD 6.4), and after testing was 9.8 (±SD 6.5) (p=0.0041). Data collection regarding ordering provider and medication changes were still pending.

The clinical utilization of pharmacogenomic testing appeared to be low. CYP2D6 and CYP2C19 phenotypes were as expected (except for more 2C19 rapid metabolizers), suggesting treatment resistance was less likely related to these genetic factors. There was a statistically significant decrease of 1 point in the mean PHQ-9, which would not be clinically significant. However, many other factors still need to be explored, such as details about medications and gene-medication interactions, ordering provider’s knowledge about pharmacogenomic testing, whether medication changes were made, aging factors influencing pharmacokinetics, medical and psychosocial burdens, and other concurrent treatments. Further research will hopefully allow more practical guidance on whether and when to obtain pharmacogenomic testing.

In the past decade, researchers and advocates have taken important steps toward understanding the full costs of Alzheimer’s disease and related dementias. However, our current approach to framing these costs does not fully consider the behavioral symptoms of dementia, notably agitation. Agitation in Alzheimer’s disease contributes to negative social and financial outcomes for people with the condition, their care partners, and health systems. When left untreated, the negative impact of these outcomes is exacerbated, yet the full scale of this impact is unknown. “Cost Considerations of Untreated Agitation” seeks to propose a framework to help in evaluating the variables that impact these costs.

We created a model that investigates each stage of Alzheimer’s disease with agitation. This model assesses direct, indirect, and intangible costs of the disease. Direct costs include professional caregiving, non-pharmacological intervention, nursing home costs, healthcare professional consultations, and hospitalizations. Indirect costs included loss of income and value of unpaid caregiving. Intangible costs include the mental health impact of agitation on individuals living with Alzheimer’s and their care partners. Additionally, we used quality-adjusted life years to measure disease burden and health outcomes. Finally, we leveraged qualitative research to overlay the experience of care partners and individuals with lived experience to bring their voice to this work.

Results are a tentative framework and describe what additional research and input is necessary in order to create a version with which one can assess the comprehensive costs of untreated agitation in Alzheimer’s. This framework will include perspectives and feedback from individuals with lived experience, care partners, and key opinion leaders in Alzheimer’s research from across the world.

Agitation has severe consequences on individuals, families, and health systems. Oftentimes one of the first symptoms of Alzheimer’s or dementia, agitation can increase the caregiving responsibilities, trigger placement into nursing homes, and cause severe emotional and physical toll on care partners. We cannot understand the full costs of dementia or AD until we account for untreated agitation vis-à-vis a multi-symptom assessment, therefore an accepted framework is necessary in order to fully consider the costs of untreated agitation.

In 2014, IPA advanced the field of Alzheimer’s care by offering a definition of agitation. Yet, as the definition rightly notes, agitation “can bear very different meanings to different people.” This becomes more complex as we consider how different cultural and socioeconomic communities talk about agitation – both within their communities and outside them.

“Articulating Agitation: Towards Culturally Competent Care” seeks to better understand how people living with dementia (PLWD) and care partners talk about agitation from a multi-cultural perspective. This project focuses on discussions of agitation within Black, LGBTQ+, and white American populations.

This project prioritizes the first-hand testimony of people with lived experience, both PLWD and care partners. We conducted a series of interviews with members from Black, LGBTQ+, and white communities in 2021 and 2022 to gain authentic testimony. Interviews were led by members of the respective communities, with our research team on “listen only” mode.

There are notable differences in how each community talks about agitation – including identifying early symptoms; conversations with families, communities, and HCPs; and determining pathways for care and treatment. From our conversations with members of the Black community we heard statements like, “what goes on in the house stays in the house, we don’t discuss [dementia] with other people” and “our people don’t trust a lot of stuff being put out there by doctors and scientists”. From the LGBTQ+ community we heard statements like “I definitely felt that we weren’t taken as seriously or heard because we were two women”. All underscore the sweeping implications of history, stigma, bias, and culture on how diverse communities experience and respond to agitation and care.

Culturally competent care for agitation among PLWD and care partners requires HCPs and other supporters to balance two things at once: the standard diagnostic definition of agitation, but also the cultural humility and openness to listen and seek to understand how PLWD and care partners express their experiences and observations with agitation.

We present a case that shows a very favourable response of the antidepressant vortioxetine in the functional and cognitive recovery in a patient with Chronic Fatigue Syndrome and its role as a pain modulator.

This is an observational study using a clinical case. An 80-year-old female patient admitted to the Postacute care unit for recovering her functional baseline following surgical intervention for a hip fracture. On admission, the main symptom was residual pain at the level of the operated lower limb, as well as allodynia and a tingling sensation, which did not subside with conventional analgesia. During admission she also presented, insomnia, daytime hypersomnolence, bradypsychia, and emotional instability in the form of easy crying. It is worth mentioning that prior to admission the patient presented with multiple nonspecific somatic complaints, such as fatigue, headache, myalgia, and arthralgia, adding over time, great difficulty in planning and performing household tasks. The functional progress of the patient during admission was very slow, mainly due to the combination of lack of engagement, together with episodes of irritability, restlessness and suffering from fear of falling syndrome. Given the suspicion of previously undiagnosed Chronic Fatigue Syndrome, exacerbated by the decline in her functional baseline after surgery, treatment was started with vortioxetine in addition to non-pharmacological measures and psychotherapy, obtaining excellent results in approximately 4 weeks.

Great effectiveness of vortioxetine in the treatment of Chronic Fatigue Syndrome and in the control of concomitant pain (despite that indication is not included in the molecule's data sheet). The patient followed a very favourable evolution achieving, on discharge, an ad integrum recovery of her functional state.

As presented in this case, treatment with multimodal antidepressant treatment (vortioxetine) could have positive impact for patients with Chronic Fatigue Syndrome, achieving improvements in the affective-cognitive aspect and controlling the pain related to this syndrome, avoiding polypharmacy.

of this presentation are to:

• Describe the Chronic Grief Management Intervention-Video (CGMI-V) – an ongoing stage I clinical trial

• Describe the profile of the study sample using baseline data

to pilot-test the CGMI-V for establishing effect sizes in caregiver outcomes including chronic grief, symptoms of depression and anxiety, positive states of mind, satisfaction with care in the facility and conflict with staff.

Participants were randomized to either a control condition or to CGMI-V, a manualized intervention delivered on-line over eight consecutive weeks to family caregivers of persons diagnosed with dementia who were placed in long-term care. Caregivers were measured with standardized demographic and situational surveys (baseline only) and with the following instruments at weeks 8 and 24:

• Knowledge of Alzheimer’s (FKAT)

• Marwit-Meuser Caregiver Grief Inventory (MM-CGI)

• CES-D 20

• Family Perception of Caregiver Role

• Family Perception of Caregiving Tool

• State Trait Anxiety Instrument

• Positive States of Mind

Recruitment was conducted via direct contacts with facilities, radio and online advertising.

For the purposes of this presentation, we are reporting only baseline demographic and situational characteristics of the entire sample. Enrollment closed in November, 2022. The study remains open for follow-up only. The final sample size is 99 participants (Intervention=50; Control=49) recruited from across 14 states in the USA.

Sample characteristics illuminate similarities across dementia caregivers who placed family members with dementia in long-term facilities across 14 states in the USA. These findings may inform future grief interventions.

The present study aims to determine the prevalence estimates of MBI and specific MBI domains in a large sample of the general population, by degree of cognitive impairment (CI).

A representative community sample of individuals aged 55+ (n=4803) (ZARADEMP Study) was studied. MBI, and specific MBI domains, were assessed according to ISTAART-AA MBI criteria, using the Geriatric Mental State (GMS). In accordance with these criteria, clinically significant anxiety, depression, and dementia were excluded. For the standardized degree of CI Perneczky et al. ́s criteria were applied: normal (MMSE 30), questionable (MMSE 26-29), mild CI (MMSE 21-25), moderate-severe CI (MMSE <21).

The prevalence of MBI, and specifically the domain Decrease Motivation (DM), increased progressively and significantly by degree of CI, the differences being significant between all cognitive groups. After control by age and education, DM was 2- and 4.5-times more frequent in subjects with mild CI (10.6%) and moderate-severe CI (18.3%), respectively, than in cognitive normal (5.8%). Affective Dysregulation (AD) was 1.7-times more frequent in mild CI (26.4%) (vs 20.4% in normal). Impulsive Dyscontrol (ID) was 2- and 7.9-times more frequent in mild CI (8%) and moderate-severe CI (23.5%) than in cognitive normal (4.7%). And Abnormal Perception and Thoughts (APT) was 6-times more frequent in moderate-severe CI (10%) (vs 1.4% in cognitive normal).

Our results confirm an increase of MBI prevalence across the spectrum of CI. However, each specific domain of MBI shows a different pattern of association with CI. Our results support the relevance of studying MBI domains independently.

Anxiety and depressive disorders are among the most frequently diagnosed mental health problems in older adults. Despite the availability of effective treatments, underutilization of mental health care services is problematic and more pronounced in the older population compared to young adults. Stigma of mental illness may be one explanation for this underutilization as it may impede help-seeking and participation in treatment. The objective of this study was to compare older and young adults on different types of stigma related to depression and anxiety while adjusting for potentially confounding variables.

Young adults aged 18 to 36 years (n = 96) and older adults aged 60 years and over (n = 103) completed questionnaires measuring self-stigma, personal stigma, and perceived stigma related to anxiety and depression.

We found that older adults have higher levels of personal stigma but lower levels of perceived stigma and self-stigma than young adults.

The results provide some support for the idea that older adults have greater stigma for mental illness and suggest the importance of age-differentiated interventions for reducing the stigma of mental illness.

Only a small proportion of older adults with generalized anxiety disorder (GAD) seek professional help. One reason is the lack of access to mental health professionals licensed to provide psychotherapy. One way to improve access to psychotherapy is through guided self- help (GSH). GSH based on the principles of cognitive-behavior therapy (GSH-CBT) can be guided by trained lay providers (LPs). The purpose of this poster is to report preliminary results from a multisite randomized controlled trial testing the efficacy of a GSH-CBT guided by LPs for GAD in older adults.

The sample included 150 participants (≥ 60 years old) with a diagnosis of threshold or subthreshold GAD randomly assigned to: 1) GSH-CBT guided by LPs (n = 75) or 2) waiting list (n = 75). The GSH-CBT lasted 15 weeks. Participants used a manual presenting weekly reading and at-home exercises. They also received weekly support calls (30 minutes maximum) by LPs (undergraduate psychology students) supervised by psychologists. Repeated-measures regression models were used to compare changes in the groups before and after 15 weeks on three outcomes: severity of GAD symptoms (Generalized Anxiety Disorder 7-item; GAD-7), tendency to worry (Penn State Worry Questionnaire; PSWQ), and level of anxiety (Geriatric Anxiety Inventory; GAI).

At the first assessment, both groups were similar in terms of age, sex, level of education, marital status, occupation, and did not differ significantly on outcomes. The GSH- CBT group decreased significantly on all three outcomes (GAD-7: -4.8, 95% CI [-5.7, -3.8], PSWQ: -11.7; 95% CI [-13.6, -9.9], GAI: -5.3 95% CI [-6.5, -4.1]) while the waiting list group remained stable over 15 weeks (GAD-7: -0.3, 95% CI [-1.2, 0.6], PSWQ: 0.7; 95% CI [-1.2, 2.5], GAI: -0.7 95% CI [-1.9, -0.5]).

GSH-CBT guided by LPs appears to be an effective intervention for reducing severity of GAD symptoms, tendency to worry, and level of anxiety in older people with GAD. Further analyses will be conducted to test whether the intervention differs in efficacy between participants with a threshold vs. subthreshold GAD. The maintenance of long-term gains (6 and 12 months after the intervention) will also be tested.

Cognitive Reserve (CR) developed from observation that several individuals show fewer cognitive impairment compared to others with the same brain injuries or neuropathology. Cognitive reserve is a potentially modifiable characteristic. Most of studies on cognitive reserve were conducted on chronic progressive diseases such as dementia. This study aims to define the role of cognitive reserve in geriatric delirium cases.

This case-control study was conducted in the acute geriatric inpatient of Cipto Mangunkusumo Hospital, Jakarta, Indonesia on June to September 2019 that consisted of 33 subjects with delirium and 33 controls. The measurement of cognitive reserve was done using the Indonesian adaptation of Cognitive Reserve Index questionnaire (CRIq) with 3 subscales, i.e. Education, Work Activity and Leisure Time.

We found that the CRIq scores of delirium patients were lower compared to the non-delirium controls both on total and each subscores, with a statistically significant mean difference (p<0,01). Patients with low-medium cognitive reserve also more likely to develop delirium compared to those with medium-high cognitive reserve (OR 9; 95% CI 2.86 to 28.22).

Low cognitive reserve may serve as a risk factor for delirium in the elderly. The measure of CRI in the geriatric inpatients unit can be used to determine those at risk of developing delirium. Further research are warranted to elaborate potentially modifiable variables of cognitive reserve to minimize the risk of delirium.

BPSD is typically treated as a singular entity. Yet it is heterogeneous and challenges simple phenotyping by behavioral inventory. Some investigators recognize BPSD more as ‘obstreperous,’ disruptive behavior, or unwanted behavior. Others conceptualize it as a neuropsychiatric entity with an underlying pathobiology, or as the expression of an unmet need. Treatments for BPSD have been challenging since before the first clinical trials with chlorpromazine.

We systematically reviewed interventional studies to understand the successes, limitations, and knowledge gaps in terms of methodology that might misinform practice. Questions addressed included: What do these studies look like? How is BPRS operationalized, and does it vary between studies? What interventions have been tested? How are we measuring eligibility and outcomes? Are there methodological factors that influence the outcomes and validity of these trials? Are the trials methods fit for purpose and how can we better test interventions?

From a search yielding 6497 candidate studies, we included 474 of which 413 were randomized, 340 parallel group, 197 double-blinded, 51 unblinded. About 30% were in nursing homes only and 20% outpatient only. Most NH studies were drug studies; most outpatient studies were non-pharmacological. Over time, study durations consolidated to 6–12-week treatment periods and samples grew exceptionally large, involving 400 to 1200 participants.

Of studies that specified a target, 171 were for ‘agitation.’ 50 investigated sleep disturbance, 25 apathy, 25 depression, 21 psychosis. 150 described only ‘BPSD’ or ‘neuropsychiatric symptoms.’ Two-thirds of the agitation studies were single drug interventions; most used a scale score cut-off to define agitation. Important characteristics, secular trends in design, and quality of the BPSD studies will be detailed.

The important trends in methods for interventions and assessment of BPSD are not necessarily toward quality. Eligibility criteria have become designed for convenience, are misspecified relying on the same scales used for outcomes, although randomization is the rule, allocation concealment and treatment blinding is poor. There is marked autoregression of outcomes. Studies have become larger and designed to detect small effects even when clinical meaning is uncertain. BPSD studies need reconsideration and a few simple fixes to better discover effective treatments. Only a little care is needed to improve the quality and reliability of studies. This includes study management that is independent of patient selection and outcomes and from most procedures, and truly blinded assessments.

The aim of this study was to examine the structural change in the hippocampal subfields in early-onset (EO) mild cognitive impairment (MCI) patients associated with the APOE ε4 carrier state.

This study had 50 subjects aged 55-63 years, all of whom were diagnosed with amnestic MCI at baseline via the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Packet (CERAD-K). The EO-MCI patients were divided into the MCI continued (MCIcont) and Alzheimer’s disease (AD) converted (ADconv) groups 2 years later. The volumes of hippocampal subfields were measured for all the subjects. The calculations were based on the change of the volumes between the 2-year-interval brain Magnetic resonance image (MRI) scans between MCIcont and ADconv groups according to the Apolipoprotein ε4 (APOE ε4) carrier state.

There was a significant correlation between APOE ε4 allele and structural changes in several hippocampal subfields. The volume reduction in cornus ammonis 1 (CA1) field and subiculum, especially in the APOE ε4 carriers. The significance was more prominent in ADconv group.

These results suggest that the possession of APOE ε4 allele may lead to significantly greater predilection for the structural changes in hippocampal subfields, showing significant changes, especially in the ADconv patients compared with MCIcont patients.

Rapid societal changes occurred during the course of the 20th century. Previous literature has found an increase in depression over time for younger and middle- aged populations. Among older adults, the prevalence of major depression has been found to be stable over time, while for the milder forms, the findings are limited by the largely non-representative nature of analyzed samples. Given the dramatic secular changes in several factors linked to old-age depression, a careful examination of depressive symptom burden and prevalence of depression in representative cohorts of similarly-aged older adults separated in time is required.

We will analyze data on 2,041 older adults from the Swedish National Study on Aging and Care in Kungsholmen. Separate individuals, aged 60 and 81 years were assessed with a Comprehensive Psychopathological Rating Scale (CPRS) during detailed clinical examinations, separated in time by 15 years (2001 vs. 2016). Information on 21 depressive symptoms, is subsequently combined into diagnoses of major depression (presence of at least one core symptom [low mood and/or loss of interest], and at least five out of the nine symptoms); minor depression (presence of at least one core symptom, and two to four symptoms in total), and subsyndromal depression (presence of at least two symptoms in the absence of any other depression diagnoses). Psychosocial (loneliness, bereavement), behavioral (alcohol consumption, smoking), and functional factors (impairments in activities of daily living) are used as potential explanatory factors for any observed cohort differences in symptom burden or prevalence of depression.

For the 60-year old age-group, comparison of symptom burden and diagnostic status will be done across 739 participants assessed in 2001 and 677 people assessed in 2013. For the 81-year old age- group, comparisons will involve 236 people assessed in 2001, 194 people assessed in 2010, and 195 people assessed in 2016.

Preliminary results are expected by March, once data entry and cleaning are completed. We hypothesize that the burden of depressive symptoms and the prevalence of depression will be lower in later born cohorts and that explanatory factors may account for some of the cohort effect.

Motoric cognitive risk (MCR) syndrome is characterized by slow gait speed and subjective cognitive decline, which could predict future dementia. Previous research reported the associations between MCR and gray matter volume reduction in total and specific cortical regions and increased white matter hyperintensities in the brain. However, knowledge is scarce on the relationship between MCR and neuroimaging-derived brain age. The present study explored the association between MCR and brain-predicted age differences.

The present study is a cross-sectional study that involved 1,099 community- dwelling older adults in the Arakawa Ward, Tokyo, Japan, who were between 65 to 84 years old in 2016. In defining MCR, subjective cognitive decline was deemed positive for those who answered “Yes” to the question, “Do you feel that you have more problems with memory than most?” in the Geriatric Depression Scale. Slower gait speed was defined as walking slower than the -1 standard deviation of the age- and sex- stratified gait speed. Brain age was predicted on the 1,021 participants with brain magnetic resonance imaging without severe artifacts or lesions. We used the support vector regression algorithm using MATLAB's “fitrsvm” function, applying ten-fold cross-validation to the results of primary component analysis of the spatially normalized gray-matter images. We calculated the brain-predicted age difference (Brain-PAD) by subtracting the chronological age from the predicted brain age. After excluding the participants with dementia (N=23), the difference in the mean Brain-PAD between MCR+ and MCR- was compared with the Student's t-test. The association between MCR and Brain PAD was examined with multiple regression analyses, adjusting for clinical-demographical data.

The median ages were 72 for both MCR+ (N=96) and MCR- (N=902). The mean Brain-PAD was 3.29 for MCR+ and -0.19 for MCR- (p < .001, Hedges' g = -0.504). Multiple regression analysis showed a significant association between Brain- PAD and MCR (standardized β = 0.159, p < .001) after adjusting for covariates.

The present findings suggest that MCR reflects accelerated brain aging, which may increase the risk of neurodegeneration. Future studies should examine the longitudinal trajectories of brain age and incident dementia in participants with MCR.

Since its first implementation in 1998, significant evidence has been presented of the positive impact of the TimeSlips creative expression method for people with dementia in long-term care (LTC) settings. Our research with people with dementia in Colombia extends this evidence in important new directions: it is the longest TimeSlips study to date (at 32 consecutive weeks); it is the first to evaluate the feasibility of the online delivery of the method (in response to the strict COVID-19 quarantine in Colombia); it is the first study to investigate the impact of the TimeSlips method on the personhood, quality of life and psychological well- being of Spanish-speaking participants in non-LTC settings in the Global South.

Trained facilitators provided weekly, one-hour TimeSlips group storytelling sessions via Zoom over 32 consecutive weeks to eight participants with dementia. Semi- structured interviews of participants and care partners were conducted within one week of the final intervention. Thematic analysis evaluated the resultant qualitative data.

Our online implementation of the TimeSlips creative expression method reinforced key facets of participants’ personhood (self-expression and self-perception, which led in turn to increased care partner appreciation), had a positive impact on key domains of quality of life (mood, energy levels and cognitive function) and stimulated a key aspect of psychological well-being (the formation and maintenance of social ties).

Our study demonstrated that the online delivery of the TimeSlips method to participants who remain in their own homes is both feasible and effective. With more than 2.5 million people with dementia in Latin America (most of whom remain at home post-diagnosis) and a predicted 180% increase in prevalence to 2050 (compared with a 70% increase in Europe), our pioneering study offers important precedents for future, related research, in which a direct comparison between the benefits of online versus face-to-face delivery of the method would be important next step.

Although the previous studies indicated that impaired cerebrospinal fluid (CSF) dynamics might contribute to the pathophysiology of Alzheimer’s disease (AD), the longitudinal changes of CSF volumes in AD has been still unclear. In this study, using the methodology of quantitative assessment of CSF volumes in idiopathic normal pressure hydrocephalus (iNPH), we assessed longitudinal changes in CSF volumes in AD patients.

The subjects were the patients with mild cognitive impairment and dementia due to AD who visited Osaka University Hospital from November 2009 to October 2018. We excluded the patients with gait disturbances and MRI findings such as Disproportionately enlarged subarachnoid-space hydrocephalus (DESH), which was the suggestive finding of iNPH. For each subject, MRI was performed in the first visit and 1 year later. We quantitatively measured CSF volumes in DESH-related regions, such as ventricle systems (VS), Sylvian fissures (SF), and sulci at high convexity and the midline (SHM)., using an automatic brain volumetric software program (AVSIS) (Ishii et al. 2006, 2013). The ratio of each regional volume to the intracranial volume was calculated and we compared these parameters between two visits.

We enrolled 98 patients with AD (mean (SD) age = 76.0 (5.7)). Wilcoxon signed rank test revealed that, while the ratios of CSF volumes in VS and SF significantly increased during the one-year observation (VS: 4.01 (1.05) % vs 4.14 (1.09) %, p<0.001 ;SF: 1.40 (0.21) % vs 1.42 (0.22) %, p=0.007), those in SHM significantly decreased (4.30 (0.70) % vs 4.23 (0.69) %, p<0.001). The change ratio of relative volumes in VS was correlated with those in SF and SHM (r=0.451, p<0.001; r=-0.350, p<0.001).

In patients with AD, the CSF volumes in VS and SF increased while CSF volumes in SHM decreased. This trend of the longitudinal change was similar to the change in the patients with iNPH. The finding of this study indicates that, in the patients with AD, CSF dynamics may be impaired like the patients with iNPH.

Personal care interactions can provide important opportunities for caregivers to engage with a person living with advanced dementia but may also prove to be a difficult experience; why this so is not completely understood. We aimed to examine the person’s engagement and refusals of care in personal care interactions and identify both successful and difficult interpersonal dynamics to enable learning from each setting to inform educational resources.

One-off video-recorded observations of personal care interactions between caregivers (care-home staff or family carers) and people with advanced dementia in the UK (total observation time 03:01:52). Observations were analysed using the Menoh Park Engagement Scale (MPES) (Camp et al., 2015) and the Resistance-to-Care scale (RTC-DAT) (Mahoney, 2015) to score 5-minute video sections, and inductively with qualitative content analysis.

Active engagement of people with dementia was observed in 66% of observations. Refusals of care were present in 32% of observation time. Generally, caregivers emanated a nurturing attentiveness and people with dementia were focused and engaged throughout care activities. Rare difficult interactional components were characterised by the person with dementia appearing to show uneasiness and caregivers being flustered and uncertain. However, caregivers from both family and care-home settings were predominantly attuned to the person and skilled in effortlessly supporting them through the care activity.

Findings provide real-world empirical evidence which reenergises the concept of person-centredness in dementia care. Personal care activities typically created opportunities of engagement, rather than sites of conflict, for people with advanced dementia. The findings provide much needed insight into ways to improve care experiences for people with advanced dementia. Appropriate training/guidance for care-home staff and family carers could support more engaged and pleasurable care experiences for people with dementia.

Due to longevity, universal health coverage, declining population, and a stable society, it is estimated that the number of people with dementia will reach 10 million by the mid-21st century, accounting for 10% of the total population in Japan. To move toward a dementia-friendly community, it is essential to develop innovative and effective dementia care. However, human and economic resources are limited. Therefore, we focused on traditional Buddhist denominations that have organizations, educational systems, human resources, networks, and care venues. The fundamental question of this study is: Japanese Buddhism has created basis for mindfulness-based cognitive therapy, but is it also innovative in the care of older people?

We looked for papers that 1) were written in a medical rather than a religious context, 2) were written in English, and 3) dealt with the care of the older people in Japan.

1) Institutional care workers’ need for Buddhist priests for helping anxiety of older residents was reported. 2) Effectiveness of community cafés for the family caregivers of people with dementia in the Buddhist temples were reported. 3) Potentials of monthly visit to bereaved families, Buddhist priests’ tradition, as the outreach of grief care was suggested. 4) Care workers’ own ideas about death after working in the landscape of dying and death was reported by the interview which used Buddhist priests as the interviewers.

Participation of Buddhist priests as 1) spiritual cares for the residents in the institutions, 2) carers for the family carers in the community, 3) carers of the bereaved families in the outreach activity, and 4) carers for the care workers, were reported. However, robust evidence was not enough. From the standpoint of Japanese clinicians, there are too few papers compared to the actual contributions. More studies should be done which might also work as external monitoring. Traditional Buddhism in Japan has a closed membership system which is based on the family gravesite system and is generally not enthusiastic about propagation, which would also be compatible with a secular care system.