The prevalence of dementia in Chile is 1.06 %, meaning that over 200,000 people are affected. In 2017, the Ministry of Health launched the National Plan of Dementia, which proposed establishing a range of health-care services from primary care to Memory Units (MU).

MUs have emerged as a new health care service composed of multidisciplinary teams with the goal of improving diagnosis and management of dementia patients.

The creation and implementation of a MU should take into consideration the organization of a particular healthcare system. In this context, the evaluation of a Chilean MU might provide information for the standardization and replication of such a health service on a regional basis.

The objective of this paper was to evaluate the implementation processes of a MU using the RE-AIM model, a multi-component model aimed to assist the evaluation of the implementation of ongoing programs.

Regarding “R” (Reach): from March 2018 up to June 2019, a total of 510 patients were referred and assessed at the Hospital del Salvador. Most patients came from primary care (51.9 %) and from outpatient services at the Hospital (39.2 %), particularly from the Neurology (63.3%) and Psychiatry (16.0 %) departments. We estimated that the MU assessed 5.39% of dementia patients living in the area of referral.

In relationship with “E” (Effectiveness): of patients evaluated by the MU, 60 (11%) were discharged. Of these, 41 (66%) were referred to primary health care, 9 (17%) to other outpatient services, 6 (10%) to a specialized mental health care center, and 4 (7%) to a daycare center.

Due to the short lifespan of our MU, no other RE-AIM dimensions could be evaluated yet.

This was the first evaluation of the implementation of a MU in Chile as part of the Chilean Dementia Plan. It showed that it is possible to implement a MU in a Latin American country and improve access to dementia diagnosis, management, and treatment. Ongoing challenges include continuing to collect clinical data, creating research projects as part of the MU, and developing a MU protocol that can be adopted elsewhere in Chile and other Latin American countries.

Background: Dementia is a syndrome that affects multiple cognitive domains and causes functional decline. People with dementia (PwD) often experience pain, still could not report the symptom due to the decline in cognition that leads to communication problems. Therefore, pain in PwD is often underrecognized and undertreated. Many behavioral observation tools have been developed to help identify pain in PwD; the Pain Assessment in Advanced Dementia (PAINAD) scale is one of the recommended tools to evaluate pain in PwD. The PAINAD has been translated into many languages, yet not translated into Thai language. Since there is no pain assessment tool for PwD in Thailand.

Objective: This study aimed to assess the reliability"and validity of the PAINAD in Thai version (PAINAD-Th) for measuring pain in people with"PwD

Materials and Methods: The cross-cultural translation including forward translation and back-translation of PAINAD-Th were performed, then the content validity was assessed by the expert committee. Enrolled participants were inpatients aged 60 years or over, and had dementia with Functional Assessment Staging Test (FAST) of at least 6 which represented moderately severe stage. A research assistant recorded 5-minute videos of the participants, the first video was during the activity that could provoke the pain and the second video was at rest. Two trained nurses independently rated the pain of the participants by observing the videos using the PAINAD-Th to examine the inter-rater reliability and the concurrent validity of the test against the reference standard which was the numeric rating scale (NRS) rated by the expert committee. The same rating process was reproduced one week apart to explore the test-retest reliability.

Results: The content validity index of the PAINAD-Th was 1.00 and 0.93 (forward and back-translation, respectively)."The inter -rater and test-retest reliability showed an excellent intra-class correlation coefficient of"0.92 and 0.96, respectively. The concurrent validity was significantly correlated with the reference standard with an excellent intra-class correlation coefficient of"0.95.

Conclusions: The PAINAD-Th is a promising tool for pain evaluation in PwD as it provides an excellent concurrent validity against the reference standard. Also, it has excellent content validity, inter-rater, and test-retest reliability.

Deprescribing, an integral component of a continuum of good prescribing practices, is the process of medication withdrawal or dose reduction to correct or prevent medication-related complications, improve outcomes, and reduce costs. Deprescribing can be a challenge in patients with dementia. In this narrative review we evaluate topics related with deprescribing: what constitutes deprescribing, the importance to deprescribing for patients with dementia, the potential benefits, barriers and enablers of deprescribing and the deprescribing process.

Patients with dementia often have multiple comorbidities and have complex medication regimens. Also, they face challenges with medication adherence because of the nature of the disease. Proper medication adherence is important to prevent progression of these comorbidities and decline in overall health. However, as dementia progresses, the risk of taking certain medications may outweigh the benefits. In addition, older people, especially those with physical and mental decline, tend to experience lower efficacy of these medications along with a higher risk of drug adverse effects. As with prescribing or continuing medications, deprescribing brings with it the potential for harm as well as benefit. Other barriers to deprescription include concerns from the patients or the family, worries and doubts from the physician and some issues related to each health system. Many challenges for its execution have been described.

Recent studies report benefits and safety in the prescription of patients with dementia, reinforcing the importance of considering prescription in the reevaluation of the patient. Advance care planning is the cornerstone of palliative care, and prescription should be considered in this process.

Objective: To evaluate the effect of interaction with a robotic seal (PARO) for pain management in nursing home residents living with dementia.

Methods: Registered with the Australian New Zealand Clinical Trials Registry (ACTRN 12618000082202), a pilot randomized controlled trial followed by semi-structured interviews were conducted between January 2018 and January 2019. Forty-three residents aged ?65 years living with dementia and chronic pain were recruited from three nursing homes in Australia. Participants were randomized to either a PARO group (individual, non-facilitated, 30-minute sessions, five days per week for six weeks) or a usual care group using a computer-generated random number. Observational pain behaviors were rated by researchers using the Pain Assessment in Advanced Dementia (PAINAD) scale and staff-rated pain levels were measured by the numeric rating scale. Medications regularly prescribed and as needed were quantified by the Medication Quantification Scale-III (MQS-III). Generalized estimating equation model and thematic analysis were used to analyze the data.

Results: Participants in the PARO group had significantly lowered level of observed pain (-0.514, 95% confidence interval [CI] -0.774 to -0.254, p<0.001) and used fewer PRN medications (-1.175, 95% CI - 2.205 to -0.145, p=0.025) than those in usual care after controlling for age, gender, cognitive function and medications at baseline. There were no significant differences in staff-rated pain levels and regularly scheduled medications between the two groups. Interviews also indicated that the PARO intervention may reduce the pain experience through distraction and reminiscence of previous positive memories. Limitations of weight, voice and characteristics of PARO were identified.

Conclusions and Implications: PARO shows promise in reducing pain and medications for nursing home residents living with dementia and chronic pain. This intervention might be incorporated into daily practice as an alternative to manage pain in people with dementia. Care staff need to balance the benefits and limitations of incorporating social robots into their clinical practice and residents’ individualized preferences need to be considered. Larger randomized controlled trials with longer time frames are warranted to further test the use of PARO in long-term care settings.

Major depressive disorders (MDD) are common and disabling, and are linked to functional impairment and increased mortality. While current treatments for MDD are moderately effective, ultimately, up to one third of patients do not achieve full remission. Interestingly, while affective symptoms of depression resolve with the resolution of a depressive episode, cognitive impairment frequently persists, and has been identified as one of the most prominent predictors of illness recurrence. Additionally, MDD is well-recognised as a key risk factor for further cognitive decline and dementia. Yet, available treatments in MDD do not typically address cognitive impairment. Cognitive training (CT), represents a promising and novel therapeutic intervention in this regard. Our review systematically identified and quantitatively evaluated the evidence for CT in adults with MDD. Following PRISMA guidelines, eligible studies were selected according to pre-defined criteria delineating our target population (adults with clinically defined MDD), parameters for CT interventions (computer-or strategy-based, clinician-facilitated), and study design (controlled trials including pre/post cognitive and psychological or functional outcome data). Of 111 identified, nine studies met inclusion criteria. These studies were evaluated for methodological quality and risk of bias. Despite heterogeneity, qualitative and meta-analytic synthesis of study findings revealed significant improvements in cognitive and affective outcomes following CT, with pooled effect sizes ranging from moderate to large. Unfortunately, very few studies investigated ‘far transfer’ to broader domains of everyday functioning. Overall, given the strong evidence supporting the efficacy and value of CT in this context, CT should be considered as a primary therapeutic intervention in the holistic treatment of MDD.

The aging process is associated with a deterioration of the physiological systems, especially the homeostatic (nervous, immune and endocrine) systems with the consequent increase in morbidity and mortality. With the aging population, increasing number of studies focus on lifestyle interventions to slow down these aging derangements. Here, animal models can be useful to assess their long-term effects and potential value taking into advantage their shorter life span. In a previous work, old animals beneficed of 2 months of continuous cohabitation with adult, with improvements on behaviour, immune function and redox state as well as a higher longevity. However, their adult counterparts showed impairments in these parameters. In the present study, this social strategy was modified with the aim to improve the homeostatic systems in both the old and the adult animals.) Animals of the experimental group with “two old ICR-CD1 female mice cohabiting 15 minutes each day for 2 months with five adult mic” were studied and compared to adult and old controls. After this time, mice were submitted to a behavioural battery of tests to analyse their sensorimotor abilities, anxiety-like behaviours, and exploratory capacities. Peritoneal leukocytes were collected and several immune functions, oxidative and inflammatory stress parameters as well as catecholamine concentrations were assessed. When the adult mice reached old age the same parameters were again analysed. The life span of each animal was also recorded. Several mice of each group were sacrificed to obtain plasma and the hormone oxytocin was evaluated. The results show that old mice presented an improvement of behavioural capacities, immune functions and lower oxidative and inflammatory stress after the two months of social interaction with adult animals, and consequently they exhibited an extended life span. Adult mice, in general, did not show any changes after social interaction, but when they achieved old age an improvement of all the parameters studied and of longevity was observed in comparison with those mice that never had a social interaction with old animals. In conclusion, a short social interaction between old and adult individuals can be an excellent strategy for improving in both the health state and longevity.

Background: Loss of a spouse is a frequent occurrence in later life, with about 10% of the individuals finding themselves unable to cope and progressing to prolonged grief, risking further mental and physical problems.

Objective: The development and implementation of an online grief program, such as LEAVES (optimizing the menta L hEalth and resilience of older Adults that haVe lost th Eir spou Se via blended, online therapy), intends to improve prevention and treatment of prolonged grief, so that elderly mourners can continue to lead an active, meaningful and dignified life.

Methods: The LEAVES program, a project under AAL (Active and Assisted Living) 2019 Call for Sustainable Smart Solutions for Ageing Well, is in development by an international consortium and integrates academical, clinical and technical experts. The project will take place between February 2020 and January 2023 and involve real-life evaluation of 315 end-users. The Psychiatric Department at the Health Unit of Baixo Alentejo (ULSBA) will offer the service to its primary users, blending online services with telephone, video calls and face-to-face sessions. Widowed older adults >65 that express the need for help in mourning their spouse will be recruited in the community as well as via the geriatric psychiatry team and primary care.

Results: With LEAVES program we aim for older adults to process the loss of a spouse in a blended online/presential environment, detecting olders at risk for complications, reveal negative trends in their emotional life, and act to counter such trends. The evaluation will focus on wellbeing and involve several measures to assess grief symptoms, loneliness, hopelessness, satisfaction and quality of life. Conclusions: ULSBA will use LEAVES to improve clinical practice on preventing and managing prolonged grief as well as, after testing and validating it in this project, to save economical costs and improve effectiveness, both to hospital and patients.

Since its appearance, the COVID-19 pandemic has generated a state of alarm worldwide. Extraordinary confinement measures, only seen in times of war, have been implemented to halt the fast viral transmission, the consequent stress and overload of health systems and, mostly, the dead of the most vulnerable people. Physical and social isolation has changed the lifestyle we are used to, affecting our mood and mental health at a general level. However, the group of greatest risk and vulnerability are the elder age group, due to their higher incidence of frailty, their immunosenescence and comorbidities. Also, in this elder group of the population, the consequences of social isolation may be worse to handle, especially in those who live alone and do not have a family or a strong community bond. In the case of long-term institutionalized patients, these clinical scenarios are struggling to maintain their rehabilitation and care programs while desperately adapting to the dramatic situations due to the severe impact of COVID -19 in these care settings. To address this complex scenario, we developed and implemented the Santa Isabel Program, a series of recommendations for long-term care with the aim of guiding and promoting routines, activities and habits to help maintenance of psycho -motor function of older people during the state of alarm and thereafter. The Santa Isabel Program was defined as a general therapeutic resource with the selection of different modalities of physical activity (daily walk, adapted gymnastics and dance) and functional cognitive activity (meditation, relaxation, memory and attention). Chronogram, time and intensity levels were of adjustable dosage to respond to the needs and requirements of the elder people according to the severity and type of physical or cognitive impairment. In addition, specific indications were developed for cases of people with cognitive pathology (dementia). These guidelines were prepared for the professional team and support staff, in order to provide tools that allow them to resolve complex situations such as BPSD, the behavioral and psychological symptoms of dementia. Finally, audiovisual support sessions and video calls were incorporated to allow interaction with residents and the health team, safeguarding the COVID-19 infection prevention measures.

Background and objectives Support directly after the diagnosis is often experiences as inadequate by people with dementia and their family carers. In this phase, appropriate psychosocial support is important to adapt to and cope with the dementia diagnosis. Often, available support is focused on practical matters and not on the emotional impact of the diagnosis. Also, very often problems have already started to accumulate before support is provided. In the US, the intervention SHARE [Support, Health, Activities, Resources, Education] was therefore developed and studied. This intervention is innovative, because it is designed for dyads (e.g., the person with dementia and their family carer) dealing with early-stage dementia. Its’ primary goal is to enhance communication between people with dementia and their family carers and to prepare them for the future. Several years ago, the intervention was adjusted and pilot -tested in the Netherlands, with positive results. This RCT study evaluates the (cost-)effectiveness of the Dutch SHARE intervention.

Methods During four or five session and a pre-session, a healthcare psychologist carries out the intervention with dyads dealing with early-stage dementia. This to enhance skills of the dyad to cope with changes and stressors that might be expected in the future due to the dementia. The intervention takes place in an early stage when the person with dementia is still able to participate actively and before the family carer is overwhelmed by care-related stress. The primary outcome measurements are the quality of life of the person with dementia and self-efficacy of the family carer. Secondary outcomes are stress, communication in the relationship and perspective taking measured only for family carers. The design and procedures of the RCT will be presented in this session as well as the content of the intervention and demographic characteristics of participating dyads.

Conclusion This intervention increases the ability of the dyad to cope with the disease and capacity to deal with the situation, with positive experiences of participating dyads and professionals. The study enhances knowledge about psychosocial interventions for people with dementia and family carer

Lithium is the oldest and still one of the most frequently prescribed mood stabilizers in the treatment of bipolar disorder. Though, the implications of lithium use in the older population remain less understood. This work aims to provide an understanding of the impact of lithium in older age bipolar disorder, including tolerability and efficacy.

A non-systematic review was performed on PubMed database, using the key words “lithium older adult bipolar disorder” and references from recent international bipolar disorder guidelines.

There is an evidence base that lithium is effective in older age bipolar disorder. Aging-associated pharmacokinetic and pharmacodynamic changes as well as increased rates of medical comorbidities and polypharmacy predispose older patients to a higher risk of lithium toxicity. Careful monitoring and adjustment of lithium dosage is especially important in older adults to minimize the risk of toxicity.