Objectives: Despite the increasing number of people with dementia (PWD), detection remains low worldwide. In Brazil, PWD is expected to triple by 2050, and diagnosis can be challenging, contributing to high and growing rates of underdiagnosis. At the moment, there is no national estimate of the under detection or characteristics of its distribution according to gender, age and region. We aimed to estimate the proportion of PWD not diagnosed in relation to the estimated number of PWD.

Methods: The number of diagnosed individuals were estimated based on national records of the prescription of anticholinesterases drugs (AChE) in 2022 for the treatment of mild and moderate stages of Alzheimer’s Disease (AD) held by the Unified Health System (SUS). Data were obtained from ftp://ftp.datasus.gov.br and drugs were dispensed according to the national clinical protocol. Studies from the national literature were consulted to estimate: (i) the number of people currently diagnosed with mild and moderate AD; (ii) the proportion of those who obtain AChE from SUS; (iii) the proportion of those who do not take AChE; and (iv) the proportion of AD related to other dementias. We assumed that the under-detection rate of AD would be similar to other dementias and 70% of the diagnosed AD individuals obtain AChE from SUS.

Results: More than 80% of the PWD 60+ are undetected (88.7%, 95% CI = 88.6–88.7). The poorest regions had higher rates (94.6% 95%, CI = 94.5–94.6) than the richest (84.8%, 95% CI = 84.7–84.8). Men had higher rates (89.8%, 95% CI = 89.7–89.9) than women (87.4%, 95% CI = 87.4–87.5). The youngest age group (60-64) had the highest rate (94.6%, 95% CI = 94.5–94.7) which decreased until 85–89 (84.3%, 95% CI = 84.2–84.4), before increasing again to 91.1% (95% CI = 91.0–91.2) among 90+.

Conclusions: Dementia under detection in Brazil is among the highest in the world. Fast populational aging and the highest rates among the youngest individuals are of concern as it may be related to late diagnosis. Gender and regional disparities also need to be considered when developing health policies.

Summary: Studies suggest that people in the early stages of Alzheimer’s dementia (AD), a disease first described in 1906, do not have sufficient support to cope with the disease process after a diagnosis (Solomon, 2016). AD is a neurodegenerative syndrome, caused by the progressive accumulation of plaques of amyloid beta proteins and tau proteins, which has no cure and eventually leads to death (Alzheimer’s Association, 2018). Support for people living with dementia, such as support groups, provides spaces in which they can feel free of stigma, understood, in safe environments and receive cognitive stimulation that contributes to their quality of life (Yale, 1995). The scarcity of information about the care preferences, available activities and rights of people living with dementia in Puerto Rico is a very under-researched area that could benefit the quality of life of said population (Vega, J., 2013). The present study, under the qualitative narrative life research approach, sought to address the experiences of people with Alzheimer’s Disease (AD) in the initial stages. The theoretical framework derived from the study on support groups for people with dementia by Yale (2009) and Frankl’s Logotherapy theory (2003) was used. The interviews, via virtual means, were carried out with six individuals chosen under the clinical criteria of a neurologist specializing in AD in a memory clinic in the metropolitan area of Puerto Rico. Through the administration of semi-structured questionnaires and the subsequent analysis of the counts, the need for additional services to those already available for said population was identified.

Summary: Specialist Memory Clinics play a crucial role in evaluating individuals suspected of dementia. While these clinics have long been established in developed economies, their introduction has only recently begun in developing countries. In Chile, Memory Clinics were implemented as part of the Chilean Memory Plan and the inclusion of dementia in the General Regime of Explicit Guarantees in Health. This legal framework ensures access to diagnosis and treatment for patients with dementia. The Chilean system prioritizes primary care, with specialist care reserved for cases where diagnosis or treatment cannot be adequately addressed at the primary care level. As a result, Memory Units serve only a subset of diagnosed dementia patients. So far, there is a lack of studies on the clinical profiles of patients evaluated in memory clinics and resourceutilization.

Objectives: This study aims to comprehensively describe patient demographics and clinical characteristics while examining the frequency of evaluations needed about their specific diagnoses and comorbidities.

Methods: We analyzed the total number of consultations, considering the primary diagnosis and any comorbidities present. Clinical records were managed using a customized web platform software, which enabled the healthcare team to document all patient interactions, including appointments, medication prescriptions, and care coordination.

Results: CMYN received 1,220 patients (57% women) and 36 caregivers in the first five years. Among the patients, 222 (20%) had mild cognitive impairment, while 622 (57%) had dementia, with 48% diagnosed with Alzheimer’s disease dementia and 58% with other types of dementia. More than 75% of patients had less than ten consultations. Patients with dementia had more consultations than those without, as presented in Table 1.

Conclusions: The recent establishment of Memory Clinics in developing countries addresses a crucial gap in specialist care for dementia patients. In our experience, the diagnosis and the number of comorbidities may predict the level of interventions patients require. A more comprehensive understanding of the patient profile and their needs will assist in tailoring resources for implementing memory clinics and estimating the cost of care. Further studies need to address the characteristics of patients that require specialist-levelattention.

Introduction and Objectives: Cognitive impairment-dementia is an increasing health concern with a major economic and social impact. This study aims to examine how it is currently approached in primary care practices in the Autonomous Community of Galicia, Spain.

Methods: A working group was formed between two scientific societies, which developed a survey that was sent online to 2206 primary care doctors, subsequently analysing the responses received.

Results: A total of 124 primary care doctors (5.3%) responded to the survey, 69.4% of which were women, with a mean age of 54 years. Out of these doctors, 92 (80%) have been working for more than 10 years, 30 (24.2%) have never received any training on the topic of study and only 31 (25%) have received some training in the last 5 years. The initial complaint derives from close relatives (76.6%) and this complaint usually entails memory problems (59.7%). The screening test used by 77.4% of the professionals is the MMSE with a higher prevalence among younger doctors (p-value 0.04). In the case of suspected cognitive impairment, doctors perform a cognitive assessment scale (96%), order a blood test (83.9%) and perform functional assessment scales (77.4%). They do so on a scheduled basis (79%). In total, 42.7% recognise that they reach the diagnosis in moderate dementia stages, hindered as a result of care-based reasons (66.9%). Doctors have difficulties in detecting the pathology associated with cognitive impairment in 52.4% of cases. In dementia management, 66.1% have difficulties in providing caregiver support and 42.7% with pharmacological treatment. In cases of advanced dementia, the problem is the lack of support from social services (47.6%), hospital specialists (45.2%) and the difficulty of pharmacological treatment (43.5%).

Conclusions: Primary care doctors report that the main barriers in the care for cognitive impairment-dementia are: training, healthcare organization, social, management of specific dementia treatments and associated pathologies and coordination with hospital care.

Key words: Primary care, cognitive impairment, dementia, screening, survey, attitudes

Introduction: Desatar Argentina is an interdisciplinary group of professionals dedicated to eliminating the use of physical restraints in gerontological care settings. Since its foundation in 2017 under the auspices of the Argentine Society of Gerontology and Geriatrics (SAGG), the group has been committed to promoting respect and dignity for older adults, guided by the International Convention on the Rights of Older Persons.

Mission: Desatar Argentina’s mission is to raise awareness about the harm caused by physical restraints and to promote strategies for their elimination, generating a cultural change within health and social care organizations. We aim to sensitize both society and healthcare professionals about the importance of respecting the dignity of older adults.

Trajectory: Since its inception, Desatar Argentina has undertaken numerous activities, including:

• In 2018, the first “Desatar para cuidar’’ event at LedorVador.

• In 2019, presenting the research on the effectiveness of a multicomponent intervention program to eliminate physical restraints in a long-term care facility (which also obtained an award) at the XVI Argentine Congress of Gerontology andGeriatrics.

• Publications in the SAGG Journal and other media to widely disseminate the group’s message.

• Training courses for care home professionals, focusing on tools and strategies to eliminate the use of physicalrestraints.

Future Perspectives: Desatar Argentina will continue to work to:

• Promote research and dissemination of new care modalities that prioritize the fundamental rights of olderadults.

• Foster ongoing training of health and social care professionals on the risks and alternatives to restraints.

• Promote sustainable cultural change within care centers to ensure a restraint-free environment focused on respect and dignity for older adults.

• Undertake the evaluation and assessment of chemical restraints.

• Promote the elimination of physical restraints in the hospital environment.

Conclusions: Desatar Argentina has shown that it is possible to eliminate physical restraints in long-term care facilities, significantly improving the quality of life for older adults. Continuous training and awareness-raising are essential to promote restraint-free care and transform organizational culture in favor of the rights and dignity of older adults.

Objectives: Experienced quality of care of older people using long term care is not sufficiently reflected in quantitative quality measures, like surveys or indicators. Therefore, care organizations increasingly use narrative approaches to collect and analyze experiences of clients, relatives, and professionals with quality of care. These Methods enable care organizations to share experiences, identify dilemmas in care provision and provide rich information for quality improvement. However, information about such Methods is scattered. The aim of this scoping review is to explore which types of narrative approaches are used for quality improvement in the long- term care setting for older people. The review identifies, among other things, types of narrative approaches, their goal and challenges.

Methods: A literature search (in Embase, Medline ALL, Web of Science Core Collection, CINAHL, PsycINFO, Sociological Abstracts – proquest, Social Services Abstracts, International Bibliography of the Social Sciences, Google Scholar) was performed from inception up to 28th of April 2022. Thirty-nine articles were included.

Results: Almost all included studies were from Western countries, in particular the Netherlands and Canada, and much focused on intramural care. Different types of narrative approaches were identified, such as a participatory or co-design, photovoice or interview approach. The goal of the approaches was directed at the client, care relationship, organization, or a combination of those levels. The agenda for quality improvement was usually informed by insights revealed during the execution of the narrative approach and researchers were often leading this process. Most approaches are used in practice only once at one or more locations. Findings and suggestions for further research will be discussed, for example about including people with cognitive impairments or relatives.

Conclusions: This scoping review revealed a variety of approaches that attempt to collect narrative information from older people, relatives, and professionals to improve quality of long- term care. Development opportunities for narrative approaches are structural embedding of narrative approaches in practice, including people with (severe) cognitive problems, and effect studies about achieved improvements.

Objectives: Older people living with mental illness, including schizophrenia and other psychotic disorders, experience increased physical morbidity and premature mortality rates compared to the general population. However, Advance Care Plans (ACP) are rarely documented in this group, despite ability to discuss end-of-life care and express wishes. The aim of this study is to explore mental health clinicians’ attitudes, experiences, and perceived barriers and facilitators to ACP with people living with psychotic illnesses, to better understand the reasons for this gap and develop a needs-responsive approach toimplementation.

Methods: This qualitative study involves focus groups of multidisciplinary mental health clinicians who work with people aged 55+ with psychotic illnesses. It is being conducted in three public mental health services in Sydney, Australia. Focus groups are audio-recorded, transcribed and analysed using reflexive thematic analysis, grounded within an interpretive description framework.

Results: Preliminary findings from an unsaturated sample of 12 multidisciplinary clinicians (psychiatrists, social workers, occupational therapists, psychologists) will be presented. Emerging themes regarding experiences of ACP include ‘no experience’, ‘not a priority’, ‘particular relevance for nursing home residents’ and ‘difficult to navigate consumer choices in the context of delusions’. Emerging themes in relation to attitudes about implementing ACP with people with psychotic illnesses include: ‘ACPs are needed’, ‘ambivalence’, ‘I don’t know how’, and ‘whose responsibility are ACPs?’. Barriers to ACP include: ‘misconceptions about ACP’, ‘misperceptions about psychotic illness’, ‘clinician uncertainty- capacity, emotional state, psychosis risk’, ‘systems issues’, ‘lack of knowledge and confidence’, and ‘interfering with therapeutic relationships’. Potential facilitators include: ‘get the timing right’, ‘make it multidisciplinary’, ‘opportunity to practice’, ‘embed in protocol’, ‘upskilling clinicians- modelling and training’, and ‘support from an external ACP role’.

Conclusions: Mental health clinicians may be the only healthcare professional in contact with an older person living with psychosis, providing unique opportunities to explore ACP. Clinicians recognise the need for ACP, the complexity of such Discussions, and importance of nuanced capacity assessment and appropriate timing. Proposed solutions to implementing ACP include combining targeted education with practical training for clinicians, embedding ACP in practice using a team approach and system change, or -alternatively-through a dedicated external ACP role.

Objectives: With the global growth of the population of older adults, the prevalence of mental health disorders in this age group is also increasing. Despite the high demand for prompt access to specialized care, referrals to geriatric psychiatry are still disproportionately low, as suggested by the review of current epidemiological studies. Research data evaluating referral patterns to geriatric specialists are limited and indicate that primary care providers play a key role in the referral process.

Methods: As a part of a year-long Archstone Learning Collaborative, a group of geriatric psychiatrists has had monthly meetings discussing various contemporary issues in geriatric psychiatry. One of the projects was to clarify a decision-making process for medical professionals and caregivers, to help them determine when to refer to geriatric specialists, including geriatric psychiatrists.

Results: We reviewed the most common criteria for referral to geriatric psychiatrists and other specialists with overlapping expertise in geriatric mental health care. We have worked on a diagram and a flowchart to help navigate the referral process. To empower primary care providers and other medical professionals, we created a flyer for caregivers, educating them on what signs and symptoms may indicate the need for seeking a referral to geriatric psychiatrists.

Discussion: Encouraging interdisciplinary collaboration and streamlining referral processes are crucial to fulfilling the increasing demand for geriatric psychiatry services. To guarantee older adults receive the specialized care they need, it is important to raise awareness among various medical professionals regarding the referral criteria and the roles of different geriatric specialty providers. Caregivers are essential to the referral process because they can identify warning signs and symptoms and seek referrals. Overall, this presentation offers insightful information about the referral process to geriatric psychiatry, intending to enhance access to mental health care for older adults with mental health disorders.

Objectives: To describe and analyze the knowledge and resources of Community Health Workers (CHWs) in delivering an evidence-based mental health community intervention for older adults with depression (VIDACTIVA’’) in an urban low-income setting in Lima, Peru. CHWs delivered a multi-component intervention that includes problem-solving, behavioral activation, and psychoeducation over eight sessions. We analyze data integrating CHWs perspectives to assess the feasibility and acceptability of the intervention.

Methods: We conducted a qualitative study with 16 CHWs aged 45 to 73 who delivered VIDACTIVA’’ program to 32 older adults. Over an 18-month period, we collected data through in-depth interviews with CHWs, field notes from weekly meetings with them to assess the progress of older adults, and an exploratory-artistic workshop that produced collages with poetic narratives and short testimonial videos. These data collection Methods aimed to elicit both individual and collective assessments of CHWs’ experiences delivering theprogram.

Beyond traditional data collection, we provided a reflective space for CHWs to consider the meaning of their work and identify lessons learned throughout the intervention.

Results: We identified three key learnings and resources employed by CHWs: 1) Trust and rapport: Good listening and establishing trustworthy interpersonal bonds were crucial in building rapport and respect when working with vulnerable older adults in insecure peri-urban areas of Lima. 2) Adapting session settings: CHWs adapted the conditions of the sessions to ensure viability, such as moving sessions from the older adults’ home to a public area where older adults felt safer discussing family issues. Additionally, CHWs sometimes refrained from wearing uniforms and ID cards that identified them as mental health agents to avoid the stigma associated with mental health illnesses. 3) Addressing urgent needs: CHWs took concrete actions to meet the urgent needs of the most vulnerable older adults, such as arranging medical appointments or accompanying them to the hospital.

Conclusions: CHWs primarily focused on strategies that build strong and intimate interpersonal bonds, which made the sessions viable, accepted, and appreciated by older adult participants. We highlight the importance of leveraging CHWs’ experience and knowledge as a critical factor for enhancing acceptability and feasibility in conducting community-based interventions.

Background: The COVID-19 pandemic resulted in reduced patient access and deferral of medical services. Long wait times for patients to access specialized medical care became a challenge to health care systems. Baycrest is an academic health sciences centre in Toronto, Canada, that specializes in post-acute and ambulatory care for older adults. As a result of deferred care, wait times for the mental health services increased significantly. This compelled the ambulatory mental health program to apply quality improvement Methods to identify and prioritize care for the most unwell people on the waitlist, while avoiding duplication of referrals between hospitals. This study aimed to assess the utility and feasibility of this new process.

Methods: The quality process involved a Rapid Design Event approach, where the mental health programs created inclusion and exclusion eligibility criteria and established a priority system to assign patients to one of three categories based on need: high priority, routine, and decline. Identification of high priority referrals was meant to allow the most unwell patients to be seen sooner. The central navigation process was refined through quality improvement huddles and standard feedback mechanisms. After three weeks of trialing the process, a sustainability plan to move to operations was applied, and results were continuously monitored through reports and improvement board huddles.

Results: In the first 3 months of implementation, the percentage of patients receiving meaningful clinical contact within 14 days of referral increased from 3.8% to 82.3%, with contact by a clinician within an average of 4 days. Across the ambulatory mental health programs, wait times for psychogeriatric assessment for high priority patients improved from 141 days to 31.8days. Factors leading to the improvement will bediscussed.

Conclusions: The central navigation and extended triage processes were found to be feasible and of great utility. The high priority patients who needed to be assessed sooner were identified through an extended triage process. Meaningful clinical contact was made within days and wait times reduced for those most in need. This demonstrated how a quality improvement process can lead to significant improvements in health care delivery.

Introduction: Dementia continues to be a global health concern owed to its increasing prevalence and coupled with physical and psychological burden. It is also the most feared diagnosis amongst older adults which may contribute to underdiagnosis. Pre-assessment counselling (PAC) may reduce fear and increase diagnoses when people with suspected cognitive impairment are empowered with choice and feel in control of their diagnosis journey.

Methods: This study recruited 10 clinicians from an NHS memory clinic in England, UK, and, using semi-structured interviews, sought to understand the mechanisms and effectiveness of PAC.

Results: Using reflective thematic analysis, 3 themes were found. 1. The person with dementia (PwD) is central in their diagnosis journey. 2. Candid conversations build strong therapeutic alliances. 3. Patients are more than their diagnoses.

Discussion: Clinicians emphasized the importance of timely diagnosis for the wellbeing of PwD, while also recognizing the need for patient-centred and collaborative approaches. Additionally, the study highlighted the significance of empowering PwD in decision-making processes, fostering resilience through comprehensive support, and addressing stigma through candid conversations to improve diagnostic outcomes and enhance patient engagement in dementia care. The study indicates that PAC is effective in enabling timely diagnoses, but there is a lack of dedicated appointments in NHS Trusts where PwD are empowered to manage their dementia journey and subsequent care.

Expressions in ANCD are viewed as a mode of communication and ascribing meaning for their presence the key step to developing individualized behavioral care plans. Existing dementia care philosophies (PIECES™, GPA™, DementiaAbility and Teepa Snow Dementia Workshops) offer general directions but fail assist in ascribing meaning for the individual or clustering of the constellation of, varied phenotypic presentation of expressions in ANCD. The first step was to establish a biopsychosocial model for the generation of expressions; as all existing models were dichotomized along biological and psychosocial lines. The next step was developing a classification for the various phenotypic manifestations of expressions. This involved collecting ‘alike’ symptoms into individual categories and giving each category title which adequately represented the symptoms therein. Formation of behavioral categories was justified using existing validated psychological theories. Five psychological theories used to justify existence of behavioral categories: Information Processing Theories, Motivational Theories, Emotional Regulation Theories, Developmental Theories and Theories on Compliance and Aggression. These theories were able to ascribe meaning to individual behavioral categories and derived from their lived experiences: their Personhood. The ascribed meaning offers a framework for developing an individualized behavioral care plan for the expressions represented in each behavioral category. This framework, titled, LuBAIR™ Paradigm was structured in the form of an evaluative framework, both quantitative and qualitative, and presented as full day workshops, between 2017 to 2019, to frontline staff trained in existing dementia care philosophies. 92% of the attendees affirmed this paradigm’s ability to offer better assistance in “behavior care planning”. Qualitative thematic analysis: An innovative, simplified, enhanced, and comprehensive approach to understanding the reasons for the occurrence and recognition and labeling of behaviors in PwNCD. This approach offers increased insight into the understanding of “meaning” of behaviors in PwNCD. The Journal of Aging and Social Change: Volume 12, Issue 1, 2021.

Objectives: Latin American longitudinal studies in family carers of people living with dementia (PLWD) are scarce. This study aimed to determine the trajectories of depressive and anxious symptomatology in Chilean family carers of PLWD over two years.

Methods: A telephone survey was conducted with 300 family caregivers of PLWD at baseline (T1) who responded to a survey about themselves, characteristics of the PLWD, and social factors. In the second wave, 208 carers participated (T2), and 155 in the third wave (T3). Latent Growth Curve and Latent Class Growth Mixture analyses were performed.

Results: Both depressive and anxious symptomatology increased significantly over time (p < 0.001). Ninety-five percent of carers, regardless of the level of depressive symptomatology at baseline, showed statistically significant trajectories of increase in depressive symptomatology (p < 0.001). In addition, 67% of carers (with low and high baseline levels) showed a significant progressive increase in anxious symptomatology (p < 0.005) and 33% remained at a moderate level of depressive symptomatology (p = 0.07). Finally, it was found that anxious symptomatology increased by 0.82 points more in women compared to men (p = 0.01).

Conclusions: The results emphasize the importance of ongoing screening for depressive and anxious symptomatology in carers over time, particularly in women. Health professionals in primary care should be capacitated to assess and offer timely and appropriate support to family carers of PLWD in order to improve their mental health. Finally, interventions for carers should be an essential part of national dementiaplans.

Objectives: There is a lack of research on differences between decision-making capacity and awareness according to age at onset of dementia. We investigated the relationship between decision-making capacity and awareness domains in people with young-(YOAD) and late-onset Alzheimer´s Disease (LOAD).

Methods: A cross-sectional study included 169 consecutively selected people with AD and their caregivers (124 people with LOAD and 45 people with YOAD). Decision-making capacity was assessed with the MacCAT-T and awareness with the ASPIDD scale.

Results: People with YOAD were more cognitively impaired, but more aware of their cognitive deficits and health condition, with moderate effect sizes. We did not find any other significant differences between the groups in the other domains of awareness. In addition, there were no significant differences in the domains of decision-making capacity between groups. All PwAD presented deficits in the domains of decision-making capacity with a greater impairment in the understanding domain (YOAD = mean 3.67, SD 1.57; LOAD = mean 3.80, SD 1.22). Understanding was the domain of MacCAT-T most significantly associated with awareness domains: ASPIDD Total (p < 0.001), awareness of cognitive deficits and health condition (p < 0.001), awareness of emotional state (p < 0.008), awareness of social functioning and relationships (p < 0.001), and awareness of impaired functional activity (p < 0.001). However, age at onset only impacted total ASPIDD (p < 0.013) and awareness of cognitive deficits and health condition (p < 0.001).

Conclusions: Better awareness involved better understanding in the YOAD group. Clinically, our findings shed light on the need to consider the differences in the domains of awareness and their relationship with other clinical aspects such as decision-making capacity according to age at onset of AD.

Objectives: Understanding how the importance of modifiable risk factors for dementia varies by cognitive status and sex is vital for the development of effective approaches to dementia prevention. We aimed to calculate population attributable fractions (PAFs) for incident dementia associated with sets of risk factors while exploring sex differences in individuals who are cognitively normal (CN) or has mild cognitive impairment (MCI).

Methods: Longitudinal data from the Rush University Memory and Aging Project (MAP) were analysed. Included participants were aged over 50 years and were CN or with a diagnosis of MCI at their baseline assessment. Analyses considered fifteen potential dementia risk factors covering cardiometabolic, lifestyle, psychosocial and sensory domains. We used Cox proportional hazard models to estimate the hazard ratios for incident dementia associated with dementia risk factors and calculated weighted PAFs. All analyses were repeated stratified by sex.

Results: The analytical sample comprised 754 cognitively normal participants (77.2% female) and 242 participants with a diagnosis of MCI (71.9% female), of whom 214 (28.4%) and 120 (49.6%) were diagnosed with dementia across the follow-up, respectively. Although the weighted overall PAF was similar for CN (24.7%) and MCI (25.2%) subgroups, sex differences were present in both. Compared to in females, PAFs were higher in males in both CN (42.5% vs. 25.1%) and MCI (51.6% vs 12.3%) subgroups. The profiles of contributing risk factors also varied by sex. In males, the highest PAFs were smoking (11.1%), vision impairment (6.2%) and stroke (6.0%) in CN and smoking (13.3%), physical inactivity (12.9%) and heart attack (7.9%) in MCI. In females, the highest PAFs were unmarried marital status (4.9%), depression (4.1%) and social isolation (3.8%) in CN and vision impairment (4.4%), increased alcohol intake (3.5%) and depression (2.6%) in MCI.

Conclusions: These findings support the notion that dementia risk is modifiable after the onset of MCI. They also highlight the potential benefits of considering an individual’s cognitive status and sex when formulating dementia prevention strategies.

Introduction: In public discourse and media, as well as in medical settings, dementia is often portrayed as a tragedy, a perspective that contributes to stigma. Descriptions using metaphors like decaying fruit, or statements labeling dementia as death in life’’ and a tsunami for healthcare systems,’’ not only perpetuate negative emotions like fear and helplessness, but also promote social distance. These dehumanizing expressions can intensify the suffering of those living with dementia and those around them, besides complicating understanding of the condition, exacerbating social isolation, and hindering timely medical attention. Questioning the narrative of dementia as a tragedy does not imply denying or underestimating the challenges and suffering associated with this condition. However, diagnosis should not hinder the recognition of moments of pleasure, the potential for internal growth of the person living with dementia and those around them, as well as the persistence of connection and dignity. The philosophy of ambiguity offers a useful framework for countering a stigmatizing narrative and addressing dementia with a more compassionate and nuanced approach. The philosophy of ambiguity, primarily expounded by Simone de Beauvoir, invites us to recognize the coexistence of multiple realities and the simultaneous presence of contradictions. This is reflected in the complex contradictions and paradoxes present in our experiences, both personal and social. Health itself is an ambiguous concept, representing not only the absence of illness but also a dynamic and multifaceted state, culturally and contextually influenced. By focusing on preserved abilities, we can contribute to the well-being of those living with dementia, reinforcing their dignity and self-esteem. The success of this approach depends on having adequate social support and an effective healthcare system. Understanding dementia in a broad social and cultural context allows us to overcome the traditional Manichean view that categorizes it strictly as either tragedy or well-being. It is crucial for medical personnel to use empathetic and respectful communication to maintain dignity and foster hope in those living with dementia. Listening carefully and avoiding stigmatizing language are fundamental to recognizing individual worth and creating a more compassionate and humane care environment.

Introduction: The ageing population with chronic kidney disease (CKD) has been increasing in developing countries and many of them are receiving Hemodialysis (HD) [1]. The prevalence of depression and other geriatric syndromes as well as the quality of life (QoL) in this population remains unknown since patients undergoing HD seldom receive a Comprehensive Geriatric Assessment (CGA) [2].

Objectives: To investigate the prevalence of depression and other geriatric syndromes as well as QoL in older patients with ESKD receiving HD.

Methods: In patients 50 years and older, receiving HD in a private tertiary hospital in northern Mexico, we applied a CGA consisting of functionality (Barthel and Lawton & Brody), comorbidity (Charlson Index), cognition (MoCA), depression (GDS), frailty (CFS), nutrition (MNA- SF), sarcopenia (EWSOP2), falls, and quality of life (OPQOL-Brief). Of 52 patients in the HD unit, 35 were eligible for the study. 9 patients did not give consent to participate in the study, resulting in a population of 26 patients.

Results: The mean age of the population was 68.85 years and 61% were women. Using a cut-off point of 5 points in the 15-item GDS to define the presence of depressive symptoms, 42.3% of the studied population presented depressive symptoms. Wefurther stratified the severity of this symptoms into mild, moderate and severe (Table1). Most patients presented mild depressive symptoms (72.81%).

Additionally, by OPQOL-Brief, the majority of patients (34%) reported having a very bad quality of life (Table 2). Of note, we also found that the median number of geriatric syndromes presented by each patient was 6, which is higher than what has been reported internationally in similar populations [2]. Of these, the most common geriatric syndromes were: dependence in Instrumented Activities of Daily Living (IADL) (92.3%), followed by cognitive impairment (84.6%) and inadequate nutritional status (80.8%).

Conclusions: Our findings revealed that 4 out 10 older patients with ESKD receiving HD presented depressive symptoms, however most of them presented only mild depressive symptoms. Additionally, the majority of patients reported having a very bad quality of life.

Objectives: Indoor air pollution exposure is harmful to people’s physical and mental health, especially in the elderly population, and represents a major issue for human health. Natural ventilation can improve indoor air quality and remove indoor contamination, thus reducing the adverse effects of indoor air pollution exposure on physical and mental health. Depressive symptoms are the most common mental health issue among elderly individuals. However, evidence linking the frequency of indoor natural ventilation to depressive symptoms in the elderly population is limited.

Methods: This study included 7887 individuals 65 years and older from 2017 to 2018 in the China Longitudinal Healthy Longevity Survey (CLHLS). The frequency of indoor natural ventilation was measured as the self-reported frequency of window opening per week in each season. Depressive symptoms were measured by the 10-item Center for Epidemiologic Studies Short Depression Scale (CES-D). Using a model adjusted for demographic, socio- economic, health status, and environmental factors, the correlation between indoor ventilation frequency and depressive symptoms was verified through logistic regression.

Results: Among the 7887 elderly people included in this study, 1952 (24.7%) had symptoms of depression. In the fully adjusted model, compared with the lower indoor overall ventilation frequency group (indoor ventilation frequency: 0–3 times/week), the higher indoor overall ventilation frequency group (indoor ventilation frequency: 6–8 times/week) showed a decrease in depressive symptoms by 33 % [OR: 0.67, 95 % (CI): 0.51–0.88]. Subgroup analysis and sensitivity analysis yielded similar results.

Conclusions: High frequency of indoor ventilation is significantly associated with the reduction of depressive symptoms in Chinese individuals 65 years old or older. This result provides strong evidence for health intervention and policy formulation. Encouraging an increase in indoor ventilation frequency will be an economically beneficial measure to promote healthy aging of the Chinese population.

Introduction: Late-life depression (LLD) is associated with cognitive deficit with risk of future dementia. By examining the entropy of the spontaneous brain activity, we aimed to understand the neural mechanism pertaining to cognitive decline in LLD.

Methods: We collected MRI scans in older adults with LLD (n = 32), mild cognitive impairment [MCI (n = 25)] and normal cognitive function [NC, (n = 47)]. Multiscale entropy analysis (MSE) was applied to resting-state fMRI data. Under the scale factor (tau) 1 and 2, reliable separation of fMRI data and noise was achieved. We calculated the brain entropy in 90 brain regions based on automated anatomical atlas (AAL). Due to exploratory nature of this study, we presented data of group-wise comparison in brain entropy between LLD vs. NC, MCI vs. NC, and LLD and MCD with a p-value below 0.001.

Results: The mean Mini-Mental State Examination (MMSE) score of LLD and MCI was 27.9 and 25.6. Under tau 2, we found higher brain entropy of LLD in left globus pallidus than MCI (p = 0.002) and NC (p = 0,009). Higher brain entropy of LLD than NC was also found in left frontal superior gyrus, left middle superior gyrus, left amygdala and left inferior parietal gyrus. The only brain region with higher brain entropy in MCI than control was left posterior cingulum (p-value = 0.015). Under tau 1, higher brain entropy was also found in LLD than in MCI in right orbital part of medial frontal gyrus and left globus pallidus (p-value = 0.007 and 0.005).

Conclusions: Our result is consistent with prior hypothesis where higher brain entropy was found during early aging process as compensation. We found such phenomenon particular in left globus pallidus in LLD, which could be served as a discriminative brain region. Being a key region in reward system, we hypothesis such region may be associated with apathy and with unique pathway of cognitive decline in LLD. We will undertake subsequent analysis longitudinally in this cohort

Key words: resting-state fMRI, Late-life depression, Brain entropy, globus pallidus, cognitive decline

The World Health Organization (WHO) proclaimed September 21 as World Alzheimer’s Disease Awareness Day and extended the observance to the entire month. Various awareness campaigns are being conducted around the world, with special emphasis on the importance of education to improve the quality of life for patients, families, and the community at large, and to eliminate stigma and ageism.

It is estimated that there are approximately 44 million people worldwide with some form of dementia, while in the United States it reaches 5.4 million. In Puerto Rico, it is estimated that there are approximately 60,000 people with Alzheimer’s disease. An AARP study (2021) showed that there are over 500,000 caregivers of older adults, making Puerto Rico one of the top three countries with the largest aging population and the 6th country in the world. While in Latin America and the Caribbean there is a prevalence between 6.2 and 6.5 per 100 adults aged 60 years or older (WHO).

This health and social situation require an educated and empowered society to meet the challenges. Muñoz et. al (2023) conducted a qualitative study with caregivers and found that 91% of the participants stated that training would help them provide better care to the elderly. Social work is one of the main disciplines dealing with this social phenomenon and should therefore play a leading role in education and therapeutic intervention.

For the past five years, the Department of Social Work at Inter-American University, Metro Campus, has joined and supported the cause through the celebration of the Alzheimer’s Symposium: A Perspective from the Academy. This event involves the entire university community, as well as the community at large, which includes caregivers, government and non- profit agencies, and professionals from various disciplines. There will be concurrent lectures, Discussions among local and international professionals, a film forum, poster presentations, artistic expressions, and educational tables. The 6th Symposium will be held on September 20, 2024. The Symposium is promoted through various media. This activity has generated alliances, recommendations and new educational projects that contribute to the well-being of older adults.