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.

The relationship between objective cognitive performance and physical frailty has been explored in the recent literature and cognitive frailty has emerged as a strong field of study in psychogerontology. However, less is known about the relationship between subjective cognitive status and physical frailty. The aim of this communication is to present the relationships found between subjective cognitive decline and physical frailty in the third wave of the Compostela Aging Study, the first in which frailty status has been studied.

Cognitive and neuropsychological, functional, and affective assessment was conducted with persons over 50 years of age with subjective memory complaints in the health area of Santiago de Compostela. 149 participants who completed the third wave of the study and who did not present dementia or other serious pathologies were selected. Mild Cognitive Impairment (MCI) was diagnosed according to the current criteria in a special meeting of the research team. In the participants without MCI, the intensity and severity of their complaints were assessed according to the Subjective Cognitive Decline (SCD) criteria. Physical frailty was assessed following the frailty phenotype as described by Fried et al.

Only 4 participants (2.7%) presented physical frailty (3, 4 or 5 criteria in the frailty phenotype). Of those presenting physical pre-frailty (1 or 2 criteria), 36 were MCI (23.8%), 33 SCD (21.9%) and 36 controls. Finally, 40 participants (26.5%) presented no frailty criteria (8 with MCI, 13 with SCD and 19 controls). Participants with SCD and pre-frailty were of intermediate age and they had more years of education than the group with MCI and pre-frailty, although these differences were not significant. They have significantly more symptoms of depression (GDS) and worse mental health status (GHQ-12) than participants without frailty and pre-frailty controls, and more symptoms of anxiety (GAD-7) than participants without frailty.

The relationship between subjective memory complaints and frailty could help to establish groups at special risk of cognitive impairment in phases prior to objective cognitive decline, being these groups particularly optimal targets for preventive intervention. However, a detailed characterization of these subgroups is still required.

It is well known that geriatric patients are at increased risk of developing comorbid medical and psychiatric conditions, and a large proportion of them are admitted to psychiatric liaison units (LPUs). The aim of this study is to determine which clinical differences between age groups (65- 74 years and ≥75 years) are statistically significant to potentially warrant special attention when referring to an LPU.

This is an observational, cross-sectional and comparative multicentre study. We collected data from 165 patients (≥65 years) admitted to 7 Spanish general hospitals and referred to each LPU from different departments. Data were collected over a period of one and a half months. Psychiatric examinations were performed during the patients' stay in the wards. The sample was divided into two age groups of patients and a comparative analysis was done.

We obtained a sample of 165 patients with a mean age of 76.03 years (42.10% < 75 years, 57.83% ≥ 75 years). We analysed several variables between two age groups: the youngest (65- 74 years) and the oldest (≥75 years). In the younger group (mean age 69.87 years), the mean Barthel index before admission was 93.23 (52.1% with independent ambulation) and at the time of our first assessment was 54.62, before 82.71 of the older group (mean age 80.63). The mean Lawton index was 4.44 (6.35 for the older group) and the Charlson index was 6.38 (5.6 for the older group). 21.11% reported falls in the last 6 months, compared to 27.6% in the older group. The most common reason for referral was anxiety/depression symptoms in both groups (52.12% and 56.53%) and agitation (24.46% in the older group). After the LPU visit, the main diagnoses were adjustment disorder in both groups (25.3% and 25.53%) and delirium in the older group (23.4%). Antidepressants and benzodiazepines were the most common psychotropic drugs prescribed before the LPU visit, and benzodiazepines were the most common drugs discontinued after the LPU visit in both groups.

Clinical differences were found between two age groups (65-74 years and ≥75 years) at LPU, which could allow professionals to improve their attention and interventions.

All older adults, including those already living with dementia, should be provided with adequate knowledge about dementia and be aware of how to navigate the social resources available to them. The purpose of this study was to develop a practical program to help older adults living in the community learn about cognitive decline and how to use related social resources.

Program participants included attendees of a community center for dementia support in a major Japanese city, as well as the residents of a large housing complex in the local area. Within the cohort, there were participants who willingly disclosed to having dementia. The program began in February 2021 and was held once a month for a total of 15 hour-long sessions. A participant survey was administered at each session to gather the demographic information of participants and their understanding of the program. Additionally, the staff conducted recorded verbal discussions about the program, which were then reviewed using thematic analysis.

The program structure was as follows: (1) participants decided the theme; (2) the first half of each session comprised lectures, while the second half included discussion and group work; and (3) rules for discussion were established (do not interrupt, do not unilaterally deny what people say, maintain confidentiality). The average number of participants per session was 12.1. Survey results indicated that 70.5% of participants were female and, in terms of age, the largest number of attendees were 81-90 years old (48.5 ). Most participants “understood the program content well” (72.5%) and indicated that “they would strongly like to participate again” (64.2%). The recorded participant discussions about the program were suggested, after review, to be more superficial as a result of Japanese people's particular attitude of not wanting to bother others.

Participants were highly satisfied with the program and were able to help develop a practical program for people living with dementia to learn effectively. A challenge was that participants had a “do not want to bother others” mindset, which could inhibit them from expressing their true wishes and make them less likely to use social resources.

Although people who attempted suicide tend to repeat suicide attempts, there is a lack of evidence on the association between psychiatric service factors and suicide reattempt among them.

We used a nationwide, population-based medical record database of South Korea to investigate the use of psychiatric services before and after the index suicide attempt and the association between psychiatric service factors after the index suicide attempt with the risk of suicide reattempt.

Among 5,874 people who had attempted suicide, the all-cause mortality within 3 months after the suicide attempt was 11.6%. Among all subjects who attempted suicide, 30.6% of them had used psychiatric services within 6 months before the suicide attempt; 43.7% of them had used psychiatric services within 3 months after the suicide attempt. Among individuals who had visited clinics following attempted suicide, the cumulative incidence of suicide reattempt over a mean follow-up period of 5.1 years was 3.4%. About half of suicide reattempts occurred within 1 year after the index suicide attempt. Referral to psychiatric services within 7 days was associated with a decreased risk of suicide reattempt (adjusted hazard ratio, 0.51; 95% confidence intervals, 0.29-0.89).

An early psychiatric referral within 1 week after a suicide attempt was associated with a decreased risk of suicide reattempt.

The pathways to diagnosis for people living with rare types of dementia are poorly understood. In Wales, a predominantly rural country, only 53% of people living with dementia have received a formal diagnosis of any form of dementia compared to 71% in England (Welsh Government, 2018). Some practitioners believe that a number of Welsh communities remain fearful of statutory services, particularly the large bilingual population who tend to access dementia services between 4.3 and 7.3 years later than monolinguists (Hedd Jones, 2018). This inevitably impacts on the numbers of people diagnosed with rarer forms of dementia and their ability to locate and negotiate appropriate pathways to access an accurate diagnosis. This study investigated the experience of people using these pathways to understand how a rare dementia diagnosis is delivered in Wales.

Ten semi-structured interviews were conducted with people living with a rare dementia or caring for a person with a rare dementia. These interviews considered the onset of symptoms, the experience of using healthcare services to receive a diagnosis and the support provided following diagnosis. The interview data was mapped across individual pathways and a thematic analysis was undertaken to explore shared perspectives.

A diagnosis of rare dementia was illustrated as a journey with five potentially recurring landmark points (initial contact, initial referrals, provider referrals, private referrals and diagnosis). Despite some identical diagnoses, no participants followed the same pathways with private healthcare often used to gain a degree of control over a pathway, if the person had the financial means to access this. Two themes were identified throughout the landmark points (involvement and dispute). Involvement illustrated the need to have a degree of control over the pathway whilst dispute acknowledged the overwhelming feeling that accessing a diagnosis often felt like a personal battle between those affected and health services, or between different aspects of health services themselves.

Whilst the experiences illustrated the unstructured pathways to a rare dementia diagnosis, these experiences will support services in Wales and countries with similar populations to consider how structured pathways can result in a timelier diagnosis and more supportive experiences.

Case conferences are described as a goal-oriented, systematic method that team members can use to develop person centred treatment actions for a particular care problem. However, not all case conferences have proven to be effective. The Norwegian Targeted Interdisciplinary Model for the Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) is an effective multicomponent model based on case conferences that informs approaches to behavioural and psychological symptoms in residents with dementia. Our aim was to explore how TIME case conferences structured based on cognitive behavioural therapy (CBT) contributed to person-centred actions and how the specific structure of the TIME may have contributed to the effectiveness of the model.

We used video observation of six case conferences. Videos in research provide extended opportunities for studying in detail the complexity of interactions that take place in social groups. We analysed these videos by iteratively watching them and performing a thematic cross-case analysis of their transcripts. Based on Habermas’s theory of communicative action, we emphasized what was talked about in the case conferences, and the display of communication between the participants in the case conferences.

Our findings showed that the theoretical principles behind the TIME, including both person- centred care and the inductive structure of CBT, reflected many aspects of Habermas’s theory of communicative actions. In particular, the TIME case conferences emphasized the lifeworld perspective for both residents, staff, and contributed to what Habermas labelled communicative rationality as a means to develop shared understanding among staff and create person-centred action.

One causal assumption of how and why the TIME case conferences contributed to the effectiveness of the TIME in reducing BPSD in nursing homes is that the specific inductive structure of the case conferences with the column technique based on the ABC method together with PCC emphasized the importance of the lifeworld for both the resident and the staff. Even though case conferences have been highlighted as useful, it is not indifferent how these case conferences are structured and conducted.

The Dementia Action Plan for Wales (UK), published in 2018, includes aims for improving assessment and diagnosis, as well as suggestions for what might characterise services that provide optimal support. Wales is a largely rural country, a factor shown previously to impede access to services. Suitable support for people living with rarer dementias is also limited, which may be further exacerbated by living in a rural area. This a relatively unexplored area of research.

This study explored diagnosis and post-diagnostic support experiences of people affected by dementia across Wales, as well as exploring any differences as a function of type of dementia (typical/rare), and rurality (rural/urban). Further, it sought to gain insight and recommendations from people living with dementia and their carers around how the process may be improved for people in Wales.

A survey was developed using a range of both closed- and open-ended questions. It explored respondents’ experiences guided by the aims of the Dementia Action Plan for Wales around diagnosis and post-diagnostic support. The survey was shared online, open to anyone living with, or caring for someone living with dementia in Wales.

71 respondents completed the survey (people with dementia, n=10; carers/family members, n=61), living in rural/semi-rural (n=37) and in urban/suburban (n=34) areas, and experiences from people affected by both rare (n=17) and typical (n=49) dementias are reported (plus n=5 with no specific diagnosis). The results identified several challenges in the provision of support, indicating that there is some way to go before realising the ambition of Wales becoming a dementia-friendly nation. There are, however, examples of satisfaction with services and testimonials of good practice.

The results of this work highlight areas to target within the Dementia Action Plan for Wales to improve support, and more broadly provide recommendations for improving policy and practice, based on the experiences and wishes of people with lived experience.

Identifying the risks of completed suicide in suicide survivors is essential for policies supporting family members of suicide victims. We aimed to determine the suicide risk of suicide survivors and identify the number of suicides per 100,000 population of suicide survivors, bereaved families of traffic accident victims, and bereaved families with non-suicide deaths.

This was a nationwide population-based cohort study in South Korea. The data were taken from the Korean National Health Insurance and Korea National Statistical Office between January 2008 and December 2017. The relationship between the decedent and the bereaved family was identified using the family database of the National Health Insurance Data. Age and gender were randomly matched 1:1 among 133,386 suicide deaths and non-suicide deaths. A proportional hazard model regression analysis was conducted after confirming the cumulative hazard using Kaplan-Meier curves to obtain the hazard ratio (HR) of completed suicide in suicide survivors.

Using 423,331 bereaved families of suicide victims and 420,978 bereaved families of non-suicide deaths as the control group, HR of completed suicide in suicidal survivors was found to be 2.755 [95% confidence limit (CL): 2.550-2.977]. HR for wives committing suicide after husbands' suicide was 5.096 (95% CL: 3.982-6.522), which was the highest HR among all relationships with suicide decedents. The average duration from suicide death to suicide of family members was 25.4 months. Among suicide survivors, the number of suicides per 100,000 people was 586, thrice that of people in bereaved families of traffic accident victims and in bereaved families of non-suicide deaths.

The risk of completed suicide was three times higher in suicide survivors than in bereaved families with non-suicide deaths, and it was highest in wives of suicide decedents. Thus, socio-environmental interventions for suicidal survivors must be expanded.

Depression and anxiety persist in a large number of patients after stroke. Anxiety affects around one third of patients during the first year. Nowadays, this phenomenon receives significantly less attention compared to other psychological problems, and poor psychological services after the onset of the disease were reported in previous studies. Some patients have access to specialized rehabilitation units (“Integrated Continuing Care Unit, UCCI”) that can ameliorate anxiety and significantly improve health-related quality-of-life (QoL), avoiding depression and improve patients' functional disability.

To analyze the associations between anxiety/depression symptoms and QoL in patients with chronic stroke, during and after discharge from UCCI.

An observational, longitudinal and descriptive study was carried out with patients with a clinical history of stroke discharged from hospitals in Portuguese central area, aged ≥65 years, without dementia diagnosis. Patients were observed at admission at the rehabilitation unit, discharge, and 6 and 12 months after discharge, and data were collected through a protocol composed of several self- completion instruments, namely the Hospital Anxiety and Depression Scale (HADS) and Stroke Specific Quality-of-Life Scale (SS-QoL). Data on clinical and demographic variables were collected and analyses performed to describe associations with HADS scores. Data were collected from August/2020 to July/2022 and analyzed using SPSS®,V.26.0.

A cohort of 154 stroke patients was assessed (M/F ratio=1.8, age 75±9 years). Anxiety scores were 6.8(4.8) (6 months) and 5.8(4.1) (12 months). Depression scores were 8.7(5.3) (6 months) and 8.1(4.7); (12 months). Anxiety total score at 6 months was significantly related (p<0.05) with 3 domains of SS- QoL (Personality, Social Role and Work/Productivity). However, no differences were found at 12 months. Depression was significantly related with all domains of SS-QoL except Vision (p<0.05).

HADS score for anxiety were normal (0-7) at 6 and 12 months; however, depression remain in the Borderline abnormal classification (8-10), 6 and 12 months after stroke, which appear to have a negative impact in almost all SS-QoL domains of patients with chronic stroke. The current study highlights the need to prevent depression symptoms after stroke as this can negatively affect the functional recovery of the entire ongoing rehabilitation process.

The aim of this study was to examine the potential contribution of Death Cafés to the creation of a society that is inclusive of death, which is necessary for ACP, through an analysis of the motivations and orientations of Death Cafés hosts to run Death Cafés.

Interviews were conducted with 16 host of Death Cafés. Interview transcripts were segmented, coded and categorized, focusing on motivations and orientations for running Death Cafés.

Motivation for running Death Cafés were categorized into four categories: “The bereavement experience of the host”, “The identity crisis of the host”, “Dissatisfaction with a society in which death is taboo”, and “Unlocking new possibilities for Buddhist temples”

The orientation of Death Cafés was categorized into two categories. Namely, “Personal growth” and “Community development”.

Attitudes towards the attendees with grief were categorized in two categories. “Not mentioned” and ” Welcome participation/refer to more appropriate projects “.

The characteristics of the host and venue were categorized as “Buddhist monk and/or Buddhist temple” and “Other”.

The relationship between these four factors was examined. When the host's bereavement experience was the motivation for starting the Death Cafés, they tended to regard death as an overwhelming experience and to run an individually oriented Death Cafés with the intention of personal growth. When the motivation for starting the Death Cafés was dissatisfaction with a society that considered death a taboo subject, attitudes towards death tended to be neutral and the café tended to be socially oriented with the intention of community development. Where the motivation for starting the Death Cafés was to expand the possibilities of the Buddhist temple, which was one of the subcategories of “Community development”, attitudes towards death were neutral and café tended to be both individual and socially oriented.

Death Cafés held in Buddhist temples may have the potential to contribute to the creation of a death-inclusive society in Japan and could be an ACP implementation strategy.

Most people living with dementia do so at home, comprising approximately 30 million people globally. Despite extensive research on psychotropic medication use in long-term care settings, there has been little comparative research looking at psychotropic use in people living with dementia at home.

The study aim was to systematically review the literature to identify factors associated with psychotropic medication use in people living with dementia at home.

The PROSPERO-registered review was conducted using PRISMA guidelines. A comprehensive search of four databases (2010 to 2020) was undertaken for the systematic review to identify empirical studies. A combination of MESH search terms for dementia, community-dwelling, and psychotropic medications were used. Suitable data were subject to meta-analysis using Comprehensive Meta-Analysis to calculate raw data to event rates and pooled, adjusted event rates for different modifier sub-analyses. Thematic analysis was utilised to synthesise emergent factors and a meta-analysis undertaken on suitable data.

The search identified 619 articles of which 39 met inclusion/exclusion criteria. Use of psychotropics ranged from 18.7% for anxiolytic/hypnotics, to 26.9% for antipsychotics and 33.1% for antidepressants. Thematic analysis suggested that psychotropic prescribing was associated with a range of patient and environmental factors, including, but not limited to: (i) age (<75yr; >90yr); (ii) gender (being male); (iii) more advanced functional decline; and (iv) living alone. There was a conspicuous absence of data pertaining to carer and prescriber factors. Significant associations were identified in the meta-analysis between psychotropic use and respite in full-time care or hospitalisation as well as co-morbid psychiatric illness.

The reasons for psychotropic prescribing in this population remain poorly understood. Significant associations and knowledge gaps identified here generate opportunities for further research and development of targeted interventions to improve care and meeting the needs of this population group. This includes cautionary trigger questions for prescribers including: What am I treating? Who am I treating? How will I measure response? How can I ensure that psychotropics initiated in respite/hospital are used short-term only?

Informal carers (unpaid family members and friends), are critical to millions worldwide for the ongoing delivery of health and well-being needs. However, the physical and mental wellbeing of caregivers is often poor including low levels of physical activity, frequently owed to contributing factors such as lack of time, lack of support and motivation. Thus, accessible evidence-based tools to facilitate physical activity for carers are urgently needed.

The aim of this study was to co-design and develop a novel mobile app to educate and support carers in the undertaking of regular physical activity. This is achieved via integration of the transtheoretical model of behaviour change and UK physical activity guidelines across 8 weeks of use.

We co-designed a mobile app, “CareFit,” by directly involving caregivers, health care professionals, and social care professionals in the requirements, capturing, and evaluation phases across a number of Agile Scrum development sprints. Requirements for CareFit were grounded in a combination of behavioural change science and UK government physical activity guidelines.

Participants identified different barriers and enablers to physical activity, such as a lack of time, recognition of existing activities, and concerns regarding safely undertaking physical activity. Requirements analysis highlighted the importance of simplicity in design and a need to anchor development around the everyday needs of caregivers (eg, easy-to-use video instructions, reducing text). Our final prototype app integrated guidance for undertaking physical activity at home through educational, physical activity, and communication components.

Integrating government guidelines with models of behavioural change into a mobile app to support the physical activity of carers is novel and holds future promise. Integrating core physical activity guidelines into a co-designed smartphone app with functionality such as a weekly planner and educational material for users is feasible acceptable and usable. Here we will document the latest developments on the project including an ongoing national study currently taking place in Scotland to test the prototype with 50 carers.