American Journal of Geriatric Psychiatry最新文献

{"title":"Contact","authors":"David L. Coulter M.D.","doi":"10.1016/j.jagp.2025.07.011","DOIUrl":"10.1016/j.jagp.2025.07.011","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 11","pages":"Pages 1247-1248"},"PeriodicalIF":3.8,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144926743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A National Survey of Nursing Home Clinicians to Explain Increased Valproate Prescribing","authors":"Jonathan D. Winter M.D. ,&nbsp;J. William Kerns M.D. ,&nbsp;Danya M. Qato PharmD, M.P.H., Ph.D. ,&nbsp;Linda Wastila B.S.Pharm, M.S.P.H., Ph.D. ,&nbsp;Katherine M. Winter C.F.N.P. ,&nbsp;Nicole Brandt PharmD, M.B.A. ,&nbsp;Christopher Winter B.S.N. ,&nbsp;Yu-Hua Fu M.S. ,&nbsp;Eposi Elonge M.S. ,&nbsp;Sarah R. Reves C-F.N.P., M.B.A. ,&nbsp;C.J. Christian Bergman M.D., C.M.D. ,&nbsp;Alex H. Krist M.D., M.P.H. ,&nbsp;Rebecca S. Etz Ph.D.","doi":"10.1016/j.jagp.2025.07.008","DOIUrl":"10.1016/j.jagp.2025.07.008","url":null,"abstract":"<div><h3>Objectives</h3><div>Valproate, an anti-seizure medication (ASM) approved for seizures, bipolar mania, and migraine prophylaxis, is increasingly used in nursing homes (NHs) for reasons unclear. Mandated NH reporting of ASMs began in October 2024, a requirement for other psychotropics since 2012. This study surveyed NH clinicians to explain why valproate is prescribed and why such prescribing is increasing.</div></div><div><h3>Design</h3><div>National cross-sectional survey. Developed by a multidisciplinary team using pilot data and existing literature, conducted anonymously via SurveyMonkey (November 2024–April 2025), and leveraging convenience sampling through crowdsourcing.</div></div><div><h3>Setting</h3><div>United States’ NHs.</div></div><div><h3>Participants</h3><div>A total of 159 NH clinician prescribers: 58% female, 73% white; 57% physicians, 43% advanced practice providers; 60% holding geriatric or psychiatric certifications.</div></div><div><h3>Results</h3><div>Ninety-seven percent of clinicians reported that off-label valproate use for psychiatric symptoms drove observed prevalence increases, while 74% affirmed such use individually. Few clinicians attributed gains to FDA-approved prescribing indications. Eighty-five percent identified efforts to reduce antipsychotics and benzodiazepines as key contributors to increases. Infrequent valproate dose reduction, staffing shortages, and limited access to nonpharmacologic interventions were also highlighted as causative factors. Generally, clinicians consider valproate low-to-moderate risk (93%) and effective for psychiatric symptoms in NHs (77%), though not superior to alternatives.</div></div><div><h3>Conclusions</h3><div>Clinicians report that perceived increases in NH valproate use are primarily off-label, and may reflect strategies to manage psychiatric symptoms while circumventing regulatory scrutiny emphasizing other psychotropic medications. They believe policies targeting high-risk psychotropic reduction while overlooking ASMs have driven unmonitored ASM increases with unclear safety and efficacy implications. Whether incorporating ASMs into reporting mandates existing for other psychotropics closes these regulatory gaps remains uncertain.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 11","pages":"Pages 1197-1206"},"PeriodicalIF":3.8,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144926741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Connecting and Learning","authors":"David C. Steffens M.D., M.H.S.","doi":"10.1016/j.jagp.2025.07.004","DOIUrl":"10.1016/j.jagp.2025.07.004","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 11","pages":"Pages 1240-1246"},"PeriodicalIF":3.8,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Avoiding Stigma and Sensationalism in Therapeutic Psilocybin Communications: Considerations for Reaching Older Patients","authors":"Charlotte M. Gillespie MSc,&nbsp;Jesse M. Bering PhD","doi":"10.1016/j.jagp.2025.07.003","DOIUrl":"10.1016/j.jagp.2025.07.003","url":null,"abstract":"<div><div>Psilocybin’s efficacy as a treatment for treatment-resistant depression (TRD) has led to a wave of new legislation permitting its usage in medical settings. Older adults are affected disproportionately by TRD and may be especially good candidates for this promising treatment. However, due to the drug’s past (and present) illicit status and exposure to historic antidrug messaging, older prospective patients may hold more stigmatized attitudes towards this treatment than those who are younger. Stigma and sensationalism pose special challenges for the dissemination of effective, accurate information about therapeutic psilocybin, with recent “hype” around the drug treatment possibly further alienating these individuals. Because current clinical communication strategies may be inadvertently reinforcing negative attitudes about psychedelics rather than reducing them, we offer some general communication guidelines for therapeutic psilocybin geared towards the older patient profile.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 12","pages":"Pages 1251-1259"},"PeriodicalIF":3.8,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144885034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating a Behavioral Intervention Into Elder Abuse Services Shows Promise in Treating Depression and PTSD in Elder Abuse Survivors","authors":"Amber Gum Ph.D.","doi":"10.1016/j.jagp.2025.07.001","DOIUrl":"10.1016/j.jagp.2025.07.001","url":null,"abstract":"","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 11","pages":"Pages 1131-1133"},"PeriodicalIF":3.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144791820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"36. ANOTHER DUALISM: COGNITIVE VERSUS PERSONALITY PREDICTORS OF RUMINATION IN LATER LIFE DEPRESSION","authors":"Allison Gregg ,&nbsp;Joseph Kim ,&nbsp;Jack Kaufman ,&nbsp;Jeremy Maciarz ,&nbsp;Vincent Koppelmans ,&nbsp;Scott Langenecker ,&nbsp;Regan Patrick ,&nbsp;Sara Weisenbach","doi":"10.1016/j.jagp.2025.04.038","DOIUrl":"10.1016/j.jagp.2025.04.038","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Rumination, a predisposing and perpetuating feature of depression, has been linked to personality and cognitive variables. However, little is known about their comparative influence on rumination. This study examined personality and cognition as predictors of rumination in early-onset, later life depression (LLD), for those with and without a history of depression. Exploratory analysis investigated this relationship in the subset of patients in a current depressive episode (state depression).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Participants were 76 adults aged 55-79 divided into two groups: “ever depressed” (N=35) including those with current or remitted depression, and “never depressed” (N=41) including those with no history of depression. A subset of the “ever depressed” group in a current depressive episode (N=18) were considered in the exploratory state depression analysis. Personality predictors were the five domains assessed by the NEO Personality Inventory – Revised (NEO-PI-R), openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism. Cognitive predictors were selected based on theory and existing support in the literature for their association with rumination, and included measures of executive function (Trail Making Test B, D-KEFS Color-Word Interference Condition 3, Wisconsin Card Sorting Test Perseverative Responses), attention (WAIS-IV Digit Span Forward), and global cognitive ability (Mini Mental Status Exam).&lt;/div&gt;&lt;div&gt;The omnibus analysis was conducted using hierarchical linear regression modelling for predictors of rumination, with variable blocks composed of 1) demographic factors (age, sex, education), 2) depression history (ever/never depressed), 3) all cognitive and personality variables, and 4) interaction terms (depression history x variable) for WCST Perseverative Errors and NEO-PI Neuroticism, the only variables with significant interaction effects in Block 3. Exploratory analysis considered whether results were influenced by depression severity for those in a current depressive episode, with hierarchical regression variable blocks of 1) demographic factors (age, sex, education), 2) MADRS score, and 3) WCST Perseverative Responses and NEO-PI Neuroticism Factor Score, along with their interaction terms based on depression severity (MADRS total score x variable).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Depression history was a significant predictor of rumination in the primary analysis and remained significant following inclusion of all cognitive and personality variables. Neuroticism (β=.39, p LESS THAN .001) and WCST Perseverative Responses (β=0.18, p LESS THAN .05) significantly predicted rumination, though their interaction terms with depression history were nonsignificant. After inclusion of the interaction terms, MMSE emerged as a significant predictor of rumination (β=.17, p LESS THAN .05), despite initial nonsignificance.&lt;/div&gt;&lt;div&gt;For the exploratory analys","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S26"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"39. APATHY IS ASSOCIATED WITH GAIT VELOCITY IN A SOUTH INDIAN COMMUNITY DWELLING COHORT","authors":"Matthew Engel ,&nbsp;Emmeline Ayers ,&nbsp;Joe Verghese ,&nbsp;Mirnova Ceïde","doi":"10.1016/j.jagp.2025.04.041","DOIUrl":"10.1016/j.jagp.2025.04.041","url":null,"abstract":"<div><h3>Introduction</h3><div>Apathy is frequently seen in neuropsychiatric diseases, including Parkinson disease and Alzheimer dementia, and may also be an independent risk factor for the development of motoric-cognitive risk syndrome (MCR). Existing literature on apathy has focused on community-dwelling cohorts from highly developed nations, such that the generalizability of work identifying a link between apathy and motoric-cognitive outcomes has not been fully demonstrated.</div></div><div><h3>Methods</h3><div>N=742 older adults were recruited from urban and rural areas in Kozhikode district, Kerala, India to participate in this cross-sectional study to examine the relationship between apathy, MCR, cognitive impairment, and other demographic characteristics. Apathy was assessed using the Apathy Evaluation Scale, and depression was measured with the Geriatric Depression Scale. MCR was defined as cognitive complaints and slow gait, with gait speed assessed as 1 SD below age- and sex-adjusted norms. Statistical analyses, including bivariate and regression models, were conducted to evaluate associations between apathy, gait velocity, and MCR using SPSS software.</div></div><div><h3>Results</h3><div>Compared with subjects in the lowest apathy tertile, those in the highest tertile were older (69.9 vs 67.5 years, p LESS THAN 0.0001), less physically active (0.9 vs 1.5 active days per week, p LESS THAN 0.05), in worse subjective general health (p LESS THAN 0.05) and had slower gait (74.9 vs 81.4 cm/s, p LESS THAN 0.005). High-apathy subjects also had lower ACE scores (79.3 vs 84.3, p LESS THAN 0.0001) and higher GDS scores (9.6 vs 5.6, p LESS THAN 0.0001), but not higher levels of dysphoria (p=0.1519). Before adjustment, apathy was found to negatively correlate with gait velocity (β = -0.112, p≤0.005), and this relationship was principally moderated by ACE score. Although subjects with MCR had higher levels of apathy compared to those without MCR (34.6 vs 31.4, p LESS THAN 0.01), prevalent MCR and apathy tertile were not significantly associated in logistic regression models.</div></div><div><h3>Conclusions</h3><div>Among community-dwelling older adults in Kerala, apathy is inversely associated with gait velocity but not prevalent MCR, and the former relationship is moderated by degree of cognitive impairment, as determined by ACE score. These findings suggest that apathy may exist on a continuum with gait slowing, MCR, and clinically significant dementia, but future longitudinal studies will be needed to determine a temporal relationship.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S28"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"63. BEST PRACTICES IN FAMILY CAREGIVER SUPPORT OF THE MEDICALLY COMPLEX OLDER ADULT","authors":"Ethan Lau","doi":"10.1016/j.jagp.2025.04.065","DOIUrl":"10.1016/j.jagp.2025.04.065","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Medically complex older adults in geriatric psychiatry often find themselves requiring additional layers of social support to access optimal care, including transportation to various medical appointments, housing support, and coordination of care between multiple specialties. Of particular importance is the need for psychosocial support in the form of close family, friends, and peers, especially since these key pillars of support tend to diminish with age. Preserving the wellbeing of these caregivers and mitigation of caregiver burden are among some of the major priorities in supporting these patients throughout their psychiatric care [1]. The purpose of this poster is to promote best practices in caregiver support and to raise awareness regarding the need for more research in this area.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This case focuses on Mr. M, a 69 yo male with a psychiatric history of schizophrenia and major depressive disorder with multiple medical comorbidities including malignant tumor of bladder currently undergoing chemotherapy. Patient’s clinical documents in our electronic medical records system were reviewed. A literature survey was performed on the topics of caregiver burden and strategies to alleviate this burden. Mr. M has had multiple suicide attempts in the past and four recorded psychiatric hospitalizations and has baseline aggression and perseverative speech concerning for neurocognitive dysfunction. Mr. M receives multiple layers of support that assist him in continuing to receive both psychiatric and medical care, including subsidies for independent living, case management, and his sister, Ms. S, who acts as his primary caregiver and attends all appointments with him. Mr. M has had multiple risks of eviction in the context of psychiatric decompensation as a result of medication nonadherence. However, Ms. S, as his primary caregiver, has assisted Mr. M in not only adherence to medication but also by advocating for him at home and at medical appointments. While Ms. S has cited the emotional and psychological constraints of long-term caregiving, acknowledgement of caregiver burden and provision of psychosocial support has helped in reducing caregiver distress.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The review of recent literature supports family caregiving as an important factor in promoting health in older adults while also providing best practice guidelines in how to mitigate caregiver burden and continue promoting patient health throughout the course of their psychiatric illness. These strategies are broadly categorized in three main groups: first, psychosocial interventions such as addressing information needs and providing communication and stress management skills; second, meditative interventions such as mindfulness-based cognitive therapy, acceptance and commitment therapy; third, physical activity interventions which promote psychological well-being [2]. Notably, evidence shows a reduct","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S46-S47"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2. GOING FURTHER TOGETHER: INTERDISCIPLINARY, COLLABORATIVE UNIVERSITY OF SOUTH CAROLINA BRAIN HEALTH NETWORK TO EMPOWER PATIENT-CENTERED APPROACHES TO INNOVATIVE DEMENTIA CARE","authors":"Shilpa Srinivasan ,&nbsp;Brad Cole MBA FACMPE ,&nbsp;James McMahon APRN ,&nbsp;Takia Woods BA, CCHW ,&nbsp;Amberly Osteen BS, CST ,&nbsp;Alice Bruce MD ,&nbsp;Leonardo Bonilha MD, PhD ,&nbsp;Julius Fridriksson PhD","doi":"10.1016/j.jagp.2025.04.005","DOIUrl":"10.1016/j.jagp.2025.04.005","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Approximately 6.9 million older Americans are living ith Alzheimer’s dementia (AD) and other dementias, ith prevalence increasing with age, affecting 5.0% of people ages 65-74 years, 13.2% of people ages 75-84 years, and 33.4% of people above age 85. While the diagnosis of Mild Cognitive Impairment (MCI) or dementia can facilitate access to treatment and interventions, delays in timely diagnosis, as well as coordination of care across caregivers and community resources serve as barriers, especially in primary care settings, where the majority of older adults receive their medical care. Such barriers include volume of primary care provider (PCP) visits with brief durations for each, lack of sufficient access to collateral informants, and variable confidence and expertise of PCPs to screen, diagnose and subsequently manage patients with cognitive disorders. With the advent of biomarkers for detection, disease-modifying therapies for the treatment of MCI and AD, and the growing focus on prevention and health promotion in midlife, responding to innovative approaches in diagnostics and therapeutics is a critical yet imminent challenge for PCPs and dementia specialists.&lt;/div&gt;&lt;div&gt;In response to these challenges and needs, the University of South Carolina (USC) Brain Health Network (BHN) was developed as a permanent, State-funded initiative with the main mission of ensuring statewide access to advanced, collaborative cognitive care, and to provide community support throughout South Carolina. Responding to needs assessment and focus groups of caregivers statewide, the BHN represents a collaborative, interdisciplinary partnership with health system providers (Primary Care, Geriatric Psychiatry, Neurology, etc.) to set up a seamless and integrated process to support front-line providers (PCPs) and aim to ensure persons with Alzheimer’s Disease and Related Dementias (ADRD) and their caregivers receive support and obtain a clear understanding of their health care system and care navigation in their community.&lt;/div&gt;&lt;div&gt;This poster describes the development and operational processes of the BHN, highlighting the interdisciplinary aspects of dementia care, as well as the interprofessional role of community health workers (CHW), through relationships with organizations and formal partnerships with the Alzheimer's Association and the Area Agency on Aging/Council of Government, including Area Agency on Aging departments statewide, to facilitate patient engagement and caregiver support state-wide to promote health and enhance care navigation across the continuum of dementia care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The BHN partners with health systems to achieve 3 main goals: (1) provide greater access and coordinated care for patients and caregivers, (2) provide further support and education for individuals diagnosed (and their caregivers), and (3) provide access to innovations in treatment and diagnostics, especially in under-serve","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S1-S3"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"17. SAINT FOR TREATMENT-RESISTANT DEPRESSION: REAL WORLD FINDINGS","authors":"Amy Grooms ,&nbsp;Margaret May-Martin ,&nbsp;Lou Ann Eads ,&nbsp;George James ,&nbsp;Laura Dunn","doi":"10.1016/j.jagp.2025.04.020","DOIUrl":"10.1016/j.jagp.2025.04.020","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Among older adults with major depressive disorder who receive pharmacologic treatment, it has been estimated that at least one-third do not respond to at least two adequate trials of antidepressants—i.e., the definition of treatment-resistant depression currently used by the FDA when considering indications for new therapies. Although electroconvulsive therapy (ECT) is a highly effective intervention for severe depression or depression with psychotic features, its use in older adults can be limited due to concerns for adverse side effects, including anterograde and retrograde amnesia, and increased risks in individuals with cardiovascular or neurologic comorbidities.&lt;/div&gt;&lt;div&gt;Repetitive transcranial magnetic stimulation (rTMS), particularly in the form of intermittent theta-burst stimulation (iTBS), has emerged as a promising non-invasive alternative for treatment of depression. The novel Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) protocol, which recently received FDA clearance, consists of ten daily high-dose sessions of iTBS targeting the left dorsolateral prefrontal cortex (DLPFC), which enables treatment time to be condensed into five days, rather than the typical four to six week course of conventional rTMS. The protocol also utilizes functional connectivity (fcMRI)-guided, personalized, algorithmic targeting of the region of the left DLPFC that is identified as being the most anticorrelated with the subgenual anterior cingulate cortex.&lt;/div&gt;&lt;div&gt;In the initial clinical trials, the SAINT protocol demonstrated impressive results, with over 80% of patients achieving remission in the open-label trial, and 50-80% meeting remission criteria at some point during the four week follow-up period in the randomized sham-controlled trial. However, studies evaluating the efficacy of SAINT in the geriatric population remain absent. Furthermore, real-world patient populations need to be treated to better gauge the effectiveness of this treatment outside of clinical trials.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The University of Arkansas for Medical Sciences (UAMS), through its Interventional Psychiatry Program, was the first site in the United States to offer SAINT to patients in a clinical setting. We received patient referrals from all over the United States, as well as, locally, with the majority being self-referrals. After a comprehensive psychiatric evaluation, patients were offered SAINT TMS if they met criteria for treatment resistant MDD without psychotic features and had no contraindications for the MRI or procedure. A resting-state fMRI was obtained for each patient in the Brain Research Institute housed within the psychiatry department at UAMS. The fMRI data was then uploaded to Magnus Medical to develop a personalized treatment target within the left DLPFC for each patient.&lt;/div&gt;&lt;div&gt;Each patient received ten sessions a day for 5 consecutive days. Each session lasted 10min and there was a min","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S13-S14"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}