Although depression is a common co-morbid disorder in patients with mild cognitive impairment (MCI), not all patients with MCI exhibit depressive symptoms. This study aimed to investigate the effect of depression on cognitive and functional decline in MCI.

281 patients with MCI (MCI) defined by 0.5 score on Clinical Dementia Rating were included in the study. Patients were divided into three groups based on their Geriatric Depression Scale (GDS) scores: MCI without depression (GDS<10, n=50), MCI with mild depression (GDS10~19, n=120), and MCI with severe depression (GDS>20, n=111). Cognitive function tests (cognitive domains in CERAD-K including letter fluency, trail making test-A and B, and verbal learning test) and Blessed Dementia Scale-Activities of Daily Living (BDS-ADL) were measured. Group differences were analyzed using an analysis of variance (ANOVA). Correlation between GDS scores and BDS-ADL were analyzed.

An ANOVA test showed that activities of daily living differed significantly across groups (F(2, 276) = 13.53, p<0.001). Post-hoc analysis showed MCI with severe depression had a significantly higher mean BDS-ADL score compared with both MCI without depression and MCI with mild depression (both, p<0.001). Correlation analysis showed significant positive correlation between GDS and BDS-ADL (r=0.366, p<0.001). However, mean scores of cognitive function tests were not different among three groups.

The present study suggests that co-morbid depressive symptoms may have negative impact on functional status in patients with MCI. This may further suggest the importance of evaluation and treatment of depressive symptoms in patients with MCI.

COVID-19 is notorious for its neuropsychiatric sequelae. Some patients present with anosmia and cognitive and attention deficits, also known as “brain-fog”. In COVID-19 survivors, psychiatric manifestations such as depression, fatigue, anxiety, and neurocognitive impairments, also known as the “post-acute COVID-19 syndrome” or “long COVID”, were reported in 35% of the patients after the infection. New-onset anxiety, depression, psychosis, seizures, and even suicidal behaviors are also reported. Inflammation was proposed to be the pathophysiology.

The 68 year-old married female who lived with her husband did not have psychiatric history before this year. She had covid-19 infection 3 months prior to her psychiatric hospitalization. Although she had recovered, she started to have depressed mood, disrupted sleep and anhedonia since then. She became easily anxious and could hardly feed her cats as usual. She was not able to make decisions. She no longer did house chores that she had been doing. Poor appetite led to a loss of body weight from 46 to 40kgs. She had blunted emotional response, and could not cry after her cat died. She went to clinic for help, BZD and antidepressants were given, but the condition persisted. One week prior to hospitalization, her speech became weak, murmuring and could not finish a long sentence. The physiological change can be observed using wearable device. After 3 weeks of treatment, her heat rate, activity and sleep improved. The progress was also recorded via wearable devices and clinical scales.

In our patient, the depression was associated with circadian rhythm disruption, suicidal ideations and psychomotor slowing. This may reveal some special features of post-COVID depression. In previous studies, antidepressants have proved to be effective in treating post-COVID-19 depression. Sigma receptors are one of the possible mechanisms. Besides, agomelatine, with its melatonergic activity of regulating circadian rhythm, is proposed to have the potential to inhibit the virus from entering CNS. The activity pattern and circadian rhythm change will be discussed.

Social distance can be used to measure degrees of prejudice in people towards other members of a diverse social group. The objective of this study was to explore older adults’ perceptions of social distances toward older adults with depression, suicidal ideas, and suicide attempts.

A cross-sectional survey was conducted. Older adults were recruited by convenience from outpatient clinics of three hospitals in Taiwan.

A total of 327 older adults participated in this study. The mean scores of social distances toward older adults with depression, suicidal ideas, and suicide attempts were 20.8 (SD=4.2), 20.8 (SD=4.2), and 26.8 (SD=5.1), respectively. Participants had significantly higher scores on social distance toward older adults with suicide attempters than with depression (p<0.01) and suicidal ideas (p<0.01). Having them care for my family member was rated as the most disliked situation across three target groups. Participants’ social distances toward older adults with depression and suicidal ideas were influenced by their religious beliefs (p=0.02). Their social distance toward suicide attempters was influenced by their education level (p<0.01). Illiterates and college graduates tended to have significantly higher scores on social distance toward suicide attempters than junior high graduates did.

To the best of our knowledge, it was the first study to explore older adults’ perceptions of social distances toward older adults with depression, suicidal ideas, and suicide attempts. The results of this study can be used for further intervention of older adults to decrease prejudice against older adults with mental illness.

There is a large treatment gap for mental health conditions in sub-Saharan Africa where most of affected persons who receive any care do so from non-physician primary health care workers (PHCW). We examined the experience of PHCW who provide care for older people with depression in Nigerian primary health care (PHC) settings.

Using in-depth key informant interviews, we explored the views of 15 PHCWs, 11 of whom were community health workers (CHWs) and 4 were community health extension workers (CHEWs), selected from 10 rural and urban PHCs in South-Western Nigeria. Two additional focus group discussions, each comprising eight participants drawn from across different cadres of PHCW (N=16), were also conducted. Thematic analysis was carried out using a three-staged constant comparison technique to refine and categorise the data.

Four overall themes were identified around PHCWs’ experience of caring for older people with depression who presented to PHCs: depression presentation, treatment options, community outreach, and value of mobile technology. Participants identified depression in older people as being characterized by a range of behavioural, cognitive, sleep and bodily symptoms, which were often triggered by economic challenges and poor social support. Common treatment options used by PHCW included general advice and counselling, as well as vitamins and occasional sedatives. Although community outreach and follow-ups are parts of their expected work schedule, PHCW rarely implement these due to non-availability of transport facilities. Mobile technology was identified as a possible way of overcoming this constraint to providing community based mental healthcare for older people.

Our findings suggest that mobile technology could be a viable way to expand the quality of service provided to older persons with depression by including community outreach and follow-up.

Older adults are vulnerable to postoperative delirium after surgery and anesthesia, which may affect their cognitive function and increase depressive symptoms. Anesthesia nurses are dominant in the number of anesthesia medical teams. This study aimed to examine the differences between anesthesia nurses' self- perceived roles and competencies and their recognition of the roles and competencies of anesthesia specialty nurses.

A cross-sectional study was conducted. A structured questionnaire based on a guideline of the International Council of Nurses was designed.

The participated anesthesia nurses’ (N=200) scale scores and mean scores for each question on the self-perceived role and competency scales were lower than the scores on their recognition of the roles and competencies of anesthesia specialty nurse scales. Regarding the self-perceived roles, the scholar domain received the lowest score (Mean= 2.99, SD= 1.00), while the self-perceived competencies, the management domain received the lowest score (Mean = 3.81, SD = 0.67). Similarly, the scholar domain received the lowest score (mean = 3.34, SD = 1.068) in recognition of the roles of an anesthetic specialist nurse, while the management domain received the lowest score (mean = 4.18, SD = 0.58) in the recognition of the competencies of an anesthesia specialist nurse. Anesthesia nurses' self-perceived roles were affected by their nursing ladder and the hospital level at which anesthesia nurses work. Their self-perceived competencies were affected by their nursing ladder and salary. In addition, their recognition of the roles as anesthesia specialist nurses was affected by the hospital level at which anesthesia nurses work. The nursing ladder affected their recognition of the competencies of an anesthesia specialist nurse.

This study has demonstrated that anesthesia nurses must improve their self-perceptions of their roles and competencies to satisfy the expectations of their roles and competencies as anesthesia specialty nurses. The findings of this study could be used to develop future anesthesia nurse education and training programs to provide better care to elderly patients.

Psychobehavioral symptoms are one of the main causes of institutionalization. After the first months of institutionalization, it could be a good opportunity to consider deprescribing psychotropics, at the same time person-centered non-pharmacological measures should be implemented. Also, if dementia stage is moderate or advanced, acetylcholinesterase- olyph-inhibitor (AchEI) should be deprescribed.

To evaluate the difference between the number of psychotropic drugs in institutionalized patients and those who are at home.

We selected all the patients admitted in the Acute Geriatric Unit of “Hospital Universitario de Navarra” during May and June of two consecutive years (2021 and 2022). We collected demographic, administrative, functional and pathological variables, as well as delirium predisposing factors, drugs on admission and discharge and Drug-Burden-Index (DBI). A descriptive study was carried out and our hypothesis was analyzed.

658 patients were recluted with a medium age of 87.8, 55.6% were females, 44.5% had dementia and 22% were Institutionalized. The mean hospital stay was 5.8 days and 11.7% died. Functionally, the mean Barthel was 56.5 and Lawton 1.49. Regarding comorbidities: arterial hypertension (81%), Osteoarthritis (55%), heart failure (51%), dislipemia (47%), chronic kidney disease (42%), auricular fibrillation (39%), osteoporosis (33%) and diabetes (31%). Regarding geriatric syndromes: polypharmacy (87,5%), sleep disturbances (48%), hearing loss (43%), chronic pain (41,5%), visual loss and constipation (38%) and depression (33%). The main delirium predisposing factors were: age more than 80 (93.5%), olypharmacy, neurological disease (47%), altered senses, chronic pain and depression. Comparing psychotropic use between institutionalized and non institutionalized: psychotropics (78%vs69%), night psichotropics (72%vs63%), neuroleptics (37%vs18,5%), AchEI (13%vs6,5%), antiepileptics (21%14%). All of them p<0.05. However, there were no statistically significant differences in the use of benzodiazepines, antidepressant or antiparkinsonian.

Nowadays, institutionalized patients have more phsychotropic drugs than non-institutionalized ones, especially neuroleptics. Moreover, they are more frequent in patients with severe dementia. Maybe, the explanation is DEPRESCRIPTION AVOIDANCE due to an acute fear of a behavioral decompensation. We recommend educating in non-pharmacological measures and insisting on an adequacy of pharmacological prescriptions periodically.

Psychotropics are often used among dementia in order to reduce behavior problems. In patients with dementia, hospital admission is a stressful event, for hospitalization cause as well as for environment change. Consequently, delirium risk is high and this is proportional to dementia stage. In addition, it ́s known psychotropics promote delirium.

To evaluate if the patients admitted to an acute geriatric unit develop more delirium depending on dementia diagnosis and dementia stage and depending on the use of psychotropics. To analize if dementia and psychotropics are two independent risk factors for the development of delirium.

We selected all the patients admitted in the Acute Geriatric Unit of HUN during May and June of two consecutive years (2021 and 2022). We collected demographic, administrative, functional and pathological variables, as well as the onset of delirium: delirium signs on admission (DSA) and delirium diagnosis on discharge (DDD) and psychotropics use. A descriptive study was carried out to analyze the relationship between dementia and its stage (GDS), psychotropics use and delirium.

658 patients were recluted with a medium age of 87.8, 55.6% were females, 44.5% had dementia. The mean hospital stay was 5.8 days and 11.7% died. Functionally, the mean Barthel was 56.5 and Lawton 1.49. Regarding comorbidities, the most frequent ones were arterial hypertension(81%), Osteoarthritis(55%) and heart failure(51%). The main delirium predisposing factors were: age more than 80(93.5%), polypharmacy(87.5%), and neurological disease(47%). Comparing: -Dementia and non-dementia-patients: DSA(55.7%vs23.7;p0,000), DDD (43.7%vs17.5%;p0.000) -GDS 4-5 and GDS 6-7: DSA(52.7%vs57.2;p0.435), DDD (50.4%vs37.9%;p0.031). -Psychotropics-users and non-psychotropics-users: DSA(42.3%vs27.4%), DDD(31.6%vs22,5%). Night psychotropics DSA(41.8%vs31%), DDD(31.7%vs24%); neuroleptics DSA(53.1%vs33.6), DDD(45.2%vs24.3%); anticholinesterase DSA(51%vs36.9%), DDD(45.1%vs27.7%). All of them p<0.05.

Dementia and psychotropics are predisposing factors for delirium. Its effect is additive. Neuroleptics have the clearest relationship with delirium. We observed, as dementia was more severe, the risk of delirium was greater but the use of neuroleptics decreased. This could be due to the presence of more hypoactive phases in final stages.

Bridging the gap between clinical practice and research in health care is a challenging task. Living Labs are academic practice partnerships to stress the ambition to start up a longstanding collaboration, which have been developed and implemented in the Netherlands (Verbeek et al., 2020). The “PraWiDem” (“Living Lab Dementia”) project aims to adapt the Maastricht Living Lab approach to long-term dementia care in different regions in Germany.

A mixed methods approach was used to guide the adaptation of the Maastricht Living Lab. A focus group study investigated perspectives of people with dementia, informal carers and professionals on expectations and experiences concerning collaboration and networking between research and practice. A scoping review mapped international experiences in knowledge transfer practices and collaboration approaches in nursing care. Experts from the Maastricht Living Lab supported the research team in adapting the approach to the German national context. Parts of the German “Living Lab Dementia” concept were discussed with members of a recently formed research participation group of people with dementia (“experts by experience”).

In total, 10 focus groups and 5 individual interviews were conducted. Key themes include researchers’ and professionals’ skills, participation of people with dementia and informal carers, and multi-professional requirements. The scoping review identified 17 different approaches of knowledge translation and collaboration. Few approaches address the common development and implementation of knowledge and networking. Dutch experts recommend the early development of long-lasting strategies for collaboration. Experts by experience wish to participate, but traditional research methods may need to be adapted to allow their participation.

The “Living Lab Dementia” is currently under investigation in collaboration with institutional and community care services in three regions in Germany.

elderly patients are significantly impacted by MDD and are less responsive to treatment. ECT is used more often in older patients but has its drawbacks. There is a need for for novel antidepressants. Esketamine, is a FDA approved novel treatment to treatment resistant depression(TRD). Studies of esketamine nasal spray administered with a newly initiated oral antidepressant in TRD aged patients 18-64 years demonstrated rapid onset versus a newly initiated oral antidepressant plus placebo, with maintenance of the treatment effects following long term intermittent dosing. Side effects are dose related, psychotomimetic dissociative, elevation in HR+BP, cognitive impairment, hepatotoxicity and inflammation of bladder endothelium.

to review the current data regarding esketimine treatment in elderly TRD patients.

beside several case reports only 2 RCTs checked efficiency and safety in elderly patients. A pilot RCT of titrated subcutaneous ketamine in older patients with TRD was conducted in 2017. 16 participants> 60 years with TRD who relapsed after remission or did not remit in the RCT were than administered an open label phase. Up to 5 doses of ketamine (0.1 to 0.5 mg\kg) were administered with midazolam as an active control, randomly inserted. 12 ketamine treatments were given in separate sessions at least 1 week apart. Remitters in each phase were followed up for 6 months with MADRS scale. Results provided evidence for the efficacy and safety of ketamine in treating elderly depressed. There was a significant improvement in all ketamine dosages apart from 0.1 mg/kg. 7 participants reached remission. 5/7 had relapse than entered open trial and remitted again. Ochs-Ross, et al 2020 study,138 patients with TRD> 65 years received flexibly dosed esketamine nasal spray and new antidepressant or new antidepressant with placebo. The groups did not achieve statistical significance in MADRS score change from baseline to day 28. Patients with earlier onset of depression and younger patients (65-74) showed greater response to treatment.

Esketamine is safe in elderly TRD patients. There is not enough evidence to conclude if it is efficient. It seems that patients younger than 75 and with earlier onset of depression might benefit from esketamine.

A national prevalence study of early-onset dementia in Japan has provided data on their challenges and support needs, as documented by the individual and their family members. This study examined differences between 1) cases that the onset of early-onset dementia was detected by work colleagues, and 2) other cases.

After identifying medical or long-term care service offices used by people with early-onset dementia in 12 regions in Japan, a questionnaire was distributed to the individuals and their family members. The items surveyed were age at the time of the survey, gender, employment at the onset, age when the initial symptoms were detected, the person who detected the initial symptoms, and consideration received at the workplace. In this report, only those who were working at the onset were included in the analysis. Next, they were divided into two groups according to whether the person who detected the initial symptoms was a colleague or not, and a chi-square test was used to compare the two groups. This study was conducted with the approval of the Ethics Committee of the Tokyo Metropolitan Institute of Gerontology and Geriatric Medicine.

Of the 1035 questionnaires collected, 559 were were working at the time of onset of initial symptoms, and 149 (26.7%) of these cases were initially detected by a colleague. Comparison between groups revealed that the cases detected by colleagues 1) were recommended to see an occupational physician (P<0.001), 2) were referred to a specialist (P<0.001), 3) received consideration such as reassignment in the workplace (P<0.001), 4) received consideration regarding transportation (P=0.023), 5) had someone to talk to in the workplace (P<0.001), and 6) were significantly unlikely to receive no consideration at all (P=0.010).

Early-onset dementia was noticed by a colleague due to an increase mistake in the workplace but may have received reasonable accommodations that could have been considered by each workplace. The results of this study may help to promote dementia-friendly workplace strategies.

Quality of life is an essential outcome parameter in geriatric research; however, research to date offers mixed evidence about the factors associated with health-related quality of life (HRQOL) among people with dementia (PWDs). We aimed to identify factors relating to HRQOL among PWDs living in long-term care (LTC) facilities.

A total of 299 from 1,607 registered long-term care facilities were randomly selected in every administrative region of Taiwan. A cross-sectional two-phase survey, which included the demographic data, comorbidities, EuroQol-5 dimensions-5 levels (EQ-5D-5L), mini-mental state examination (MMSE) score, clinical dementia rating scores (CDR), behavioral and psychological symptoms of dementia, and activities of daily living (ADL) of PWDs, was then conducted from 2019 to 2020.

A total of 1,313 PWDs who self-completed EQ-5D-5L were enrolled in this analysis with a mean age of 76.43 ± 12.7 years. The mean utility and visual analogue scale (VAS) scores of EQ-5D-5L were 0.10 (standard deviation, SD = 0.48) and 66.57 (SD = 20.67), respectively. Multivariate linear regression analysis showed that higher scores in ADL, instrumental ADL, and lower CDR sum scores were associated with higher EQ-5D-5L utility scores. Higher ADL scores and higher MMSE scores were associated with higher scores in an EQ-5D-5L-VAS. More depressive symptoms were related to both lower utility score and lower EQ-5D-5L-VAS score.

Findings highlight the importance to recognize and to treat depression to maintain HRQOL of PWDs in LTC facilities. Longitudinal studies are needed to better understand the long-term changes in HRQOL of PWDs.

To evaluate and synthesise the evidence base on barriers and facilitators to accessing and using community-based social care in dementia.

Mixed-methods systematic review

Community-based social care

People living with dementia and unpaid carers

Seven databases were searched in March 2022, including English and German evidence published from 2005 focusing on inequalities in community-based social care for dementia across the globe. Titles and abstracts were screened by two reviewers, with all full texts screened by two reviewers also. Study quality was assessed using QualSyst.

From 3,904 screened records, 39 papers were included. The majority of studies were qualitative, with 23 countries represented. Barriers and facilitators could be categorised into the following five categories/themes: Situational, psychological, interpersonal, structural, and cultural. Barriers were notably more prominent than facilitators, and were multi-faceted, with many factors hindering or facilitating access to social care linked together.

People with dementia and carers experience significant barriers in accessing care in the community, and a varied approach on multiple levels is required to address systemic and individual-level barriers to enable more equitable access to care for all.

Many older adults in Colombia have lived through violent and stressful life events, particularly in areas of poverty where the problem of mental ill-health is commonly tigmatized in lower- and middle-income countries. The aim of this qualitative study was to understand the impact of stressful life events on the mental health and wellbeing of older Colombians living in areas of relative poverty.

Older adults (aged 60+) living in the Turbo region in Colombia were interviewed face-to-face between August and December 2021. Participants were recruited via snowball sampling based on criteria of ethnicity, gender, age, and place of residence. Transcripts were coded in Spanish and English by at least two research team members, using inductive thematic analysis.

Twenty-six older adults participated in the study. Four overarching themes were generated: Living in violent and dangerous communities; Disturbing gender violence and gender roles; Lack of mental health awareness; Coping mechanisms. Older adults experienced a long narrative of stressful life events, from their youth into old age. Younger generations appeared to disrespect older members of Society, and participants witnessed a constant availability of around them – both interpersonal and within their neighbourhoods. Without any mental health support or awareness, older adults coped by merely accepting the extreme situations or seeking solace in their faith.

The health system and Government need to build up trust in its institutions and generate an awareness of mental health, as older Colombians will not approach psychological support otherwise. Intergenerational community-based interventions embedded within neighbourhoods may provide a first avenue of mental health support.

The aim of this study was to determine the predictors of loneliness in informal caregivers of people with dementia in Chile during the Covid-19 pandemic.

195 Chilean informal caregivers responded to an online or telephone survey. They were asked about sociodemographic aspects, clinical and caregiving changes experienced by them and the person with dementia during the pandemic, perceived psychosocial support and loneliness.

Less years of formal education, lower income, low level of support with care tasks, living with the person with dementia, low social support, high levels of burden and depressive and anxious symptomatology were significantly related to higher loneliness. In contrast, carrying out physical and mental activity was significantly associated with lower feelings of loneliness. Almost half of the variability of loneliness was explained by higher depressive and anxious symptomatology (β = 0.53), low psychosocial support (β = -0.29) and living with the person with dementia (β = 0.16) (adjusted R2 = 0.48).

The risk of developing loneliness in informal caregivers of people with dementia is high. Special emphasis should be placed on developing interventions that improve the mental health of this group, as well as increasing their contact with formal and informal support networks. Thus, they would be able to cope with care tasks in a better way, reducing the likelihood of experiencing feelings of loneliness.

The aim of this study was to comprehend the role of character strengths as protective factors of grandparents ́ psychological well-being. Following the Lazarus and Folkman's stress model, our analyses incorporated three groups of variables (sociodemographic data, stress, and protective factors). Method: A sample of 536 grandparents participated in the study, which an average age of 70.23 (SD = 7.17). We conducted staged stepwise regression analyses to test our hypotheses.

Our results evidenced that younger grandparents and those providing supplementary care showed higher levels of psychological well-being than non-caregivers. Moreover, the analyses suggested that sociodemographic variables and the caregiving role lost their significance when psychological resources were taken into account. The character strengths of optimism, courage, humor, justice, problem-solving, and emotional intelligence explained the 32.7% of psychological well-being variance.

Our study stands out the influence of character strengths on the well-being of grandparents who develop a role as supplementary caregivers for their grandchildren. It is essential to carry out psychoeducational programs that enhance the resources that can benefit the psychological well-being of grandparents.

Some studies have shown that older people experience less experiential avoidance and more gratitude when they were compared with younger people (López, 2020). These variables might be important to improve the mental health of older people, especially in crisis situations.

Investigate the relationship between experiential avoidance (EA), gratitude and distress in old people post crisis COVID-19.

A cross-sectional study was carried out. Data from 361 people older than 60 years. The mean age was 68,44 (SD= 5.31), 62.9% were woman. The sample included in the cross-sectional analysis consisted of who provided data on the Acceptance and Action Questionnaire - II (AAQ–II; Bond et al., 2011), Gratitude subscale of the Values in Action Inventory of Strengths-Short Form (Littman-Ovadia, 2015) and Hospital Anxiety and Depression Scale (Zigmond & Snaith, 1983). Pearson´s correlations were used to explore the relationships among study variables including EA, gratitude, and emotional distress. Lineal regression analyses were used to investigate the incremental explained variance in emotional distress according to the main hypotheses. Standardized regression coefficients β were used to determine the relative contribution of these variables.

EA and gratitude were negatively correlated (r=-.27; p= <.000). Gratitude and emotional distress were negatively correlated (r=-.30; p= <.000). EA and emotional distress were positive correlated (r=.61; p= <.000). Regression analyses indicated that AAQ-II and gratitude were significant predictors of emotional distress among old people. AAQ-II and gratitude were added. AAQ-II and gratitude were significant predictor of emotional distress R2adj=62.7 % explain the model.

EA and gratitude are powerful factors to predict emotional distress in a crisis among older people. EA is an important construct in the understanding of emotional distress. This is an initial step to deep in the process of internal experiences and promoting gratitude can be very beneficial to generate programs to promote mental health in old people.