SP - Psychiatry & Mental Health

Introduction: The Free-Cog is a brief cognitive test designed to capture decline in both general cognition and executive function. The Free-Cog has been validated by comparison with the Mini-Addenbrooke Cognitive Examination in a UK secondary care setting. Here, we compare Free-Cog to the routinely-used Mini-Mental State Examination (MMSE) and the Lawton-Brody Instrumental Activities of Daily Living (IADL) and Physical Self-Maintenance Scales (PSMS). 

Methods: Patients from three memory clinics were recruited (n=318 records). The Free-Cog, MMSE, IADL and PSMS were administered in-person (n=288), via telephone (n=17), or virtually using video conferencing (n=12). The four tests were compared using Pearson correlation and ability to discriminate based on dementia diagnosis using binary logistic regression and area under receiver operator characteristic (AUROC) curves. 

Preliminary results: In-person Free-Cog score correlations ranged from strong (MMSE; r=0.86, 95% Confidence Interval [CI]: [0.83-0.89], p<0.001), to moderate (IADL; r= 0.57, 95% CI: [0.48-0.65], p<0.001) to weak with the PSMS (r=0.28, 95% CI: [0.16-0.39], p<0.001). The Telephone Free-Cog only correlated significantly with MMSE (r=0.73, 95% CI: [0.39-0.90], p<0.001) and virtual Free-Cog with MMSE (r=0.92, 95% CI: [0.74-0.98], p<0.001) and IADL (r= 0.63, 95% CI: [0.09-0.88], p=0.03). Each 1-point increase in Free-Cog (Odds ratio [OR]: 0.75, 95% CI: [0.69-0.82], p<0.001) decreased the odds of being diagnosed with dementia, as the MMSE (OR: 0.66, 95%CI: [0.57-0.76], p<0.001), and IADL (OR: 0.70, 95% CI: [0.60-0.83], p<0.001). The MMSE (AUROC=0.82) followed by the IADL (AUROC=0.80), then Free-Cog (AUROC=0.79) best discriminated between dementia and diagnosed otherwise, whereas the PSMS was inadequate (AUROC=0.60). 

Conclusion: The Free-Cog appears to be a free-of-cost, valid alternative to the routinely-used MMSE, and supplements the IADL scale in capturing cognitive and functional changes associated with neurodegenerative diseases of cognition.

Background: Ireland has the highest rates of loneliness among EU countries, with those aged 80+ particularly vulnerable. Loneliness is a significant risk factor for various negative health outcomes. To address this, the Loneliness Research Network (LTRN) was established in November 2022 to ensure policy recommendations from Ireland’s national Loneliness Taskforce are informed by robust research. The LTRN’s first initiative aimed to identify research priorities, particularly in gerontology, to guide the future of loneliness research in Ireland.

Method: The study was conducted in two phases. Phase 1 involved a roundtable event in April 2024, attended by approximately 50 stakeholders, including NGOs, health professionals, individuals with lived experience, academics, private sector representatives, and government officials. Discussions at seven tables covered various loneliness research topics, with two tables focusing on loneliness in older adults. In Phase 2, LTRN members ranked 5–12 research priorities across different topics.

Results: The roundtable revealed diverse priorities, with limited overlap between outputs. Older adults were identified as a key group for research. Priorities included:

• Exploring the impacts of financial challenges in later life (e.g., rising living costs, housing insecurity) on loneliness.
• Developing a "universal toolkit" or service directory based on evidence of effective loneliness interventions.
• Understanding emotional or existential loneliness that persists despite social engagement improvements.

Conclusion: This study underscores loneliness as a critical issue in Ireland, highlighting the need for targeted research across demographics and contexts. The findings will inform the National Loneliness Taskforce’s efforts to develop, fund, and implement a cross-Government national strategy to reduce loneliness.

Introduction: Functional decline and restricted mobility are common issues among nursing home residents with dementia, resulting in frequent use of physiotherapy services. While these residents can typically articulate their therapy needs and preferences, these have not been investigated properly regarding physiotherapy and exercise, which may compromise therapy adherence. This study aims to explore the needs and preferences of nursing home residents with mild to moderate dementia in relation to physiotherapy and exercise interventions.

Methods: Semi-structured individual interviews were conducted with 15 nursing home residents diagnosed with mild to moderate dementia, who could understand and speak Dutch and were capable of providing informed consent. Thematic analysis was used to analyze interview data.

Results: A total of 82 unique codes were identified from the interviews, leading to four major themes: preferences regarding physiotherapy sessions; defining physiotherapy and exercise; exercise without physiotherapist supervision; communication. Generally, residents preferred physiotherapy that included exercise and advice aimed at maintaining independent physical functioning. Participants perceived physiotherapy as more intense compared to gymnastics classes, and it was not seen as applicable to all individuals. If safety and quality were ensured, exercises could be performed without physiotherapist supervision. While residents wanted their family caregivers to stay informed about their therapy, they mostly preferred to exercise with someone else.

Conclusions: Residents in our study expressed preferences regarding physiotherapy sessions, communication, and family caregiver involvement, which when implemented may enhance therapy adherence and effectiveness. Furthermore, a shift toward a more supervisory role for the physiotherapist, rather than the conventional "hands-on" approach, emerged as a possibility.

Background

Older adults were more likely to be socially isolated during the COVID-19 pandemic, with increased risk of depression and loneliness. The Behavioural Activation in Social Isolation (BASIL+) trial investigated whether a Behavioural Activation (BA) intervention delivered remotely could mitigate depression and loneliness in at-risk older people during the COVID-19 pandemic.

Methods

We undertook a multicentre randomised controlled trial [ISRCTN63034289] of BA to mitigate depression and loneliness among older adults (65+) with multiple long-term health conditions, including low mood or depression. BA was delivered remotely (telephone or video call) with intervention participants (n=218). Control participants received usual care, with existing COVID wellbeing resources (n=217). 

Results

Participants engaged with an average of 5.2 (SD 2.9) of 8 remote BA sessions. Adjusted mean difference (AMD) for depression (Patient Health Questionnaire-9, PHQ-9) at 3 months [primary outcome] was -1.65 (95% CI -2.54 to -0.75, p<0.001). There was an effect for BA on emotional loneliness at 3 months (AMD -0.37, 95% CI -0.68 to -0.06, p=0.02), but not social loneliness (AMD -0.05, 95% CI -0.33 to 0.23, p=0.72). For participants with lower severity depression symptoms (5-9 on the PHQ-9) at baseline, there was an effect AMD PHQ9 1.13 (95% CI –2.26 to 0.01, p=0.051), though this was less pronounced than for those scoring 10 or more at baseline (-2.48, 95% CI -3.81 to 1.16, p=0.0002).

Conclusion

Behavioural activation is an effective and potentially scalable intervention that can reduce symptoms of depression and emotional loneliness in at-risk groups in the short term. The findings of this trial add to the range of strategies to improve the mental health of older adults with multiple long-term conditions. These results can be helpful to policy makers beyond the pandemic in reducing the global burden of depression and addressing the health impacts of loneliness, particularly in at-risk groups.

TITLE:

Process Evaluation of the BASIL+ trial: a Behavioural Activation approach to addressing low mood and depression among older people with long-term conditions

AUTHORS:

Kate Bosanquet ¹, Elizabeth Newbronner ¹, Peter Coventry ^1,3, Leanne Shearsmith ⁵, Elizabeth Littlewood ^1,4, Della Bailey ¹, Andrew Henry ⁶, Lauren Burke ⁷, Eloise Ryde ^1,9, Dean McMillan ^1,2, David Ekers ^1,4, Simon Gilbody ^1,2, Carolyn A. Chew-Graham ⁸

¹ Department of Health Sciences, University of York, UK

² Hull York Medical School, University of York, Heslington, York, UK

³ York Environmental Sustainability Institute, University of York, York, UK

⁴ Tees Esk and Wear Valley NHS Foundation Trust, Research & Development, Flatts Lane Centre, Middlesbrough, UK 

⁵ Leeds Institute of Health Sciences, University of Leeds, Leeds UK

⁶ Homerton Healthcare NHS Foundation Trust, Hackney, London, UK

⁷ Manchester Institute of Education, University of Manchester, Manchester, UK

⁸ School of Medicine, Keele University, Staffordshire, UK

⁹ Improvement Academy, Yorkshire & Humber ARC, Bradford Institute for Health Research, Bradford, UK

Abstract

Older adults are at risk of low mood and depression, which can be exacerbated by long-term physical health conditions, leading to poorer health outcomes and increased mortality. The restrictions on social mixing during the COVID-19 pandemic heightened these risks. BASIL+ (Behavioural Activation in Social IsoLation) was a pragmatic randomised controlled trial conducted with patients recruited from general practices in England and Wales. It was designed to assess the effectiveness of behavioural activation in mitigating depression and loneliness among older people during the COVID-19 pandemic. A behavioural activation intervention, within a collaborative care framework, was delivered by telephone. Participants were offered up to eight weekly sessions with trained BASIL+ Support Workers. A qualitative process evaluation (conducted within the BASIL+ trial), used one-to-one semi-structured interviews to explore the experiences of trial participants, caregivers and BASIL Support Worker experiences. Three main themes emerged from the data analysis: 1) Engagement Dynamic: from Altruism to Self-Realisation; 2) Changing Behaviour and Improving Mood; and 3) Synergistic Nature of the Intervention Components. Findings suggest that the intervention effectively fostered self-awareness among older adults, giving them the confidence and skills to address low mood. Participant engagement with intervention materials varied, highlighting the importance of flexibility in delivery. BASIL+ Support Workers acted as key facilitators, guiding participants through the intervention process, fostering understanding, and providing crucial support. The collaborative care element ensured participants received comprehensive and holistic support, promoting improved mental and physical well-being. These findings underscore the adaptability and flexibility of the BASIL+ intervention, demonstrating its potential to address mental and physical health problems among individuals with varying needs and different starting points. The BASIL+ trial is registered with the ISRCTN registry (ISRCTN63034289).

Background

The overlap between physical and mental health is a common challenge for older adults, and many live with co-occurring physical and mental health disorders. Different service models have been adopted; however, the majority provide specialist mental health input to older adults with physical health needs in acute hospital trusts. Few service models are available providing comprehensive physical health input to older adults in secondary mental healthcare settings. Furthermore, little information is available regarding specific physical healthcare needs facing older people receiving specialist mental healthcare. The aim of this qualitative study was to determine the facilitators and barriers to delivering physical healthcare for older adult patients, their carers, and staff within specialist mental health settings (inpatients and community).

Methods

54 semi-structured interviews (REC:22/IEC08/0022) were conducted with different stakeholders (staff (n=28), patients (n=7), carers (n=19)) across two mental health trusts (Leicester, Nottingham). Interviews explored the facilitators and barriers to delivering physical healthcare to older people (aged >65 years) receiving secondary mental healthcare (dementia and functional disorders) with combined physical health needs. Interviews were audio recorded and transcribed verbatim. Data were analysed thematically, drawing on an underpinning framework of integrated care for individuals with multimorbidity (SELFIE).

Results

Three main themes were identified: 1) service delivery; focussing on care coordination and communication between services, 2) workforce; focussing on training and skills alongside support and availability of physical health expertise, 3) the individual with multimorbidity; focussing on mental-physical health interplay and patient experience.

Conclusions

The findings from this study can be used to inform service development to improve the provision of physical healthcare for older people receiving secondary mental healthcare in the UK, focussing on improving care coordination and communication between physical and mental health services, and upskilling and training mental health teams in physical health provision with appropriate support from physical health experts.

Introduction

Symptoms of depression and anxiety, with and without dementia, are common in older care home residents. It is postulated that that watching films can help residents to share emotions, enhance social connectedness and engage in reminiscence. As such, films can ameliorate depression and promote well-being. This scoping review summarises the evidence for the therapeutic benefits of film-based interventions in care homes.

Methods

Electronic databases MEDLINE, Embase, EMCare and CINAHL were searched for quantitative and qualitative studies in English including adults aged 65 years and older in years 2005-2023. The search terms were: older adults, dementia, depression, carers, caregivers, care homes, and film. 

Results 

Five studies met our criteria: Campbell-Sills, 2006, USA; Kim, 2014, Korea; Davison et al., 2016, Australia; Bjornskov et al., 2018, Denmark; and Breckenridge et al., 2020, UK. All subjects were care home residents except for Bjornskov et al., who included 63 institutional caregivers. The number of study participants ranged from 11 to 120. There was a female predominance throughout the studies, and all residents had dementia of varying severity. Study designs included: direct comparison of participants with mood/anxiety disorder versus controls (Campbell-Sills); non-equivalent control group pretest/posttest (Kim); randomised single-blind crossover (Davison); qualitative focus-group caregiver interviews (Bjornskov); and cross-sectional observation (Breckenridge). Observation/follow up periods ranged from 6 -10 weeks. Findings were as follows: Campbell-Sills: residents with mood/anxiety disorders were identified by suppressing negative emotions induced by films; Kim: group reminiscence therapy using cinema increased ego integrity and reduced depression severity; Davison et al: using a personal computer platform that included films resulted in reductions in anxiety, depression and agitation; Bjornskov et al.: caregivers reported that films can evoke reminiscence; Breckenridge et al.: small-group film viewing enhanced social connectivity.

Conclusion

Film screenings for ageing care home residents have the potential for improving mood and encouraging social connections.

Introduction: 

T2DM prevalence increased in the elderly, leading to cognitive impairment, depression and disability impacting quality of life. A study evaluated the mental health of geriatric T2DM patients receiving primary care in Merida. This would guide timely preventive and therapeutic interventions to enhance these patients' and families' quality of life.T2DM prevalence increased in the elderly, leading to cognitive impairment, depression and disability impacting quality of life. A study evaluated the mental health of geriatric T2DM patients receiving primary care in Merida. This would guide timely preventive and therapeutic interventions to enhance these patients' and families' quality of life.

Materials and Methods: 

This cross-sectional correlational study examined cognitive impairment and depression in 100 older adults (≥60 years) with type 2 diabetes mellitus attending diabetes clubs, and 100 non-diabetic older adults attending a geriatric clinic in Mérida, Venezuela, using the Mini-Mental State Examination and Geriatric Depression Scale. It analyzed the relationship between diabetes, cognitive impairment, and depression in this geriatric population, utilizing descriptive statistics, chi-square tests, correlations, regression analyses, and comparisons between groups, highlighting the importance of examining the impact of diabetes on cognitive function and depression in older adults and the relevance of addressing the needs of this vulnerable population.

Results: 

The results showed that older adults with type 2 diabetes mellitus (T2DM) had a higher risk of cognitive impairment and depression compared to older adults without T2DM. Specifically, 25% of older adults with T2DM had cognitive impairment, compared to only 5% of those without T2DM. Additionally, 20% of the T2DM group had depression, versus 10% in the non-diabetic group.

Conclusions: 

The study concluded that among older adults surveyed in Mérida, Venezuela, there was a female predominance aged 60-69 years, mostly married, with primary education and unemployed. While alcohol use increased cognitive impairment risk, diabetes was not associated with cognitive deficits or depression in this population. Lower education levels predicted higher rates of cognitive impairment. Depression positively influenced cognitive dysfunction, underscoring the importance of timely interventions in this population

“I would imagine it needed a review…” A qualitative study exploring the experiences of people with dementia and their informal carers of long-term condition reviews in primary care

Introduction

Multimorbidity is common for people with dementia (PWD) and is associated with increased healthcare utilisation and poorer outcomes. Part of the management of long-term conditions (LTCs) occurs through annual LTC reviews conducted in primary care. Little is known about the experiences or needs of people with dementia and informal carers in regard to LTC reviews.

Aim

To explore the experiences of PWD and their informal carers of the review and management of LTCs in primary care.

Method

Qualitative research study, protocol informed by discussion with people with lived experience as an informal carer. Institutional ethical approval (ref ETH2122-1035, University of East Anglia) was granted 25/3/2022. Semi-structured interviews were conducted with PWD and informal carers recruited through Join Dementia Research and local (to Norfolk, UK) charities. Thematic analysis was undertaken with reference to Braun and Clarke (2006).

Results

16 participants were interviewed: two PWD, 10 informal carers and two informal care/PWD dyads. Our findings fall into four main themes: 1) What matters to people; medication optimisation and holistic care 2) What is a review; the diversity of experiences 3) The importance of communication and 4) Preference for shared decision making.

Conclusion

Consideration should be given to ensuring patients and carers are aware when a LTC review will take place and providing an opportunity to be involved, thus allowing shared decision making and patient centred care. Further research into the clinician experience and their views on patients’ needs and how to meet them is required to inform how LTC reviews for people with dementia can be optimised.

Septum pellucidum is a double-membrane separating the frontal horns of the lateral ventricles of the brain. [1] Cavum septum pellucidum (CSP) refers to a potential space between these membranes. CSP is associated with some psychiatric disorders. [2] Radiological CSP has been evaluated as a possible in-vivo biomarker for chronic traumatic encephalopathy (CTE), a neurodegenerative condition affecting, particularly, retired athletes who experienced repetitive, low impact head trauma. [3]

Our study evaluated the incidence of radiological CSP among a cohort undergoing investigation for cognitive impairment in memory clinic. A list of patient Community Health Index (CHI) numbers corresponding to patients referred to CT brain from a community memory clinic in North West Glasgow between October 2019 and March 2020 was generated. Approval for use of imaging for research purposes was granted by local imaging department.

Images were viewed by first author following a session from second author on basic relevant anatomy. Positive cases were defined as those with a visible CSP. There were twenty-eight (n=28) cases in total. CSP was observed in one (n=1) case.

Radiological CSP has been suggested as a potential biomarker for CTE. While this study does not involve review of the clinical or personal history of the subjects, it does include a cohort with clinically-relevant symptoms. We included CT only, while current evidence makes observations on MRI [3]. Locally CT is more available and the initial assessment of such patients uses CT in the first instance. Further evidence is required to establish CSP as a reliable in vivo biomarker of CTE.

[1] Das et al, in StatPearls [Internet], 2022 [2] Wang et al, J Neuropsychiatry Clin Neurosci. 2020; 32(2):175-184 [3] Alosco et al Neurotherapeutics. 2021; 18(2):772-791