American Journal of Geriatric Psychiatry最新文献

{"title":"72. LIMBIC-PREDOMINANT AMNESTIC NEURODEGENERATIVE SYNDROME PRESENTING AS VERY LATE-ONSET SCHIZOPHRENIA-LIKE PSYCHOSIS","authors":"Anne Waniger ,&nbsp;Maureen Shelton","doi":"10.1016/j.jagp.2025.04.074","DOIUrl":"10.1016/j.jagp.2025.04.074","url":null,"abstract":"<div><h3>Introduction</h3><div>Limbic-predominant amnestic neurodegenerative syndrome (LANS) is a newly recognized neurologic disorder. The clinical symptoms of LANS overlap with Alzheimer’s disease but are differentiated by an older age at initial evaluation (&gt; 80 years old), memory-predominant dysfunction, and slow clinical progression. In rare cases, it can present with neuropsychiatric symptoms and should be considered in the differential diagnosis of late-onset psychotic disorders in older adults.</div></div><div><h3>Methods</h3><div>We describe a case of LANS presenting with initial features of very late-onset schizophrenia-like psychosis (VLOSLP). We detail the clinical symptoms, neuropsychometric testing and neuroimaging.</div></div><div><h3>Results</h3><div>An 85 year-old female with no prior psychiatric history presented to clinic with a 9-month history of progressively worsening psychotic symptoms including auditory, visual, olfactory, and tactile hallucinations, and persecutory delusions. She did not have any negative symptoms and continued to function fairly well outside of anxiety related to her delusions. A screening cognitive exam revealed only mild deficits in memory. The patient underwent numerous evaluations including neuropsychometric testing, 48-hour EEG, and brain MRI, which were largely inconclusive or non-explanatory. FDG PET showed mild bilateral medial and inferior temporal hypometabolism. An evaluation with behavioral neurology revealed surface dyslexia and relatively weak semantic historical knowledge, which correlated with neuroimaging findings of right temporal hypometabolism. She was diagnosed with LANS, likely due to limbic-predominant age-related TDP-43 encephalopathy (LATE).</div></div><div><h3>Conclusions</h3><div>Symptoms of VLOSLP should raise suspicion for an underlying neurocognitive disorder, even in the absence of overt cognitive decline. VLOSLP may serve as an early or atypical psychiatric manifestation of a limbic-predominant amnestic neurodegenerative syndrome. These patients often present with circumscribed memory symptoms and relatively intact daily functioning, which can obscure the diagnosis of a neurodegenerative disorder. However, further investigation typically reveals impaired semantic memory, limbic hypometabolism, and absence of neocortical degeneration. Recognizing this relationship is crucial for guiding both diagnostic and therapeutic approaches and identifying patients at risk for progression to more pronounced cognitive decline or dementia.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S53"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613912","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":"64. JUST BREATHE: RECOGNITION AND TREATMENT OF SOMATIC SYMPTOM DISORDER IN OLDER ADULTS","authors":"Lauren Katzell ,&nbsp;Zobia Chunara ,&nbsp;Erica Garcia-Pittman","doi":"10.1016/j.jagp.2025.04.066","DOIUrl":"10.1016/j.jagp.2025.04.066","url":null,"abstract":"<div><h3>Introduction</h3><div>Somatic symptom disorder is characterized by one or more severe physical symptoms resulting in suffering or significant disruption of daily life, whether or not the etiology is medically explained. Increased prevalence of medical comorbidities in older adults can make it difficult to distinguish somatic manifestations of psychiatric disorders from medical ailments. There is a lack of clear guidelines for treatment of somatic symptom disorder in geriatric patients, particularly in patients with co-occurring mood instability that precludes use of SSRIs and SNRIs in treatment of anxiety leading to somatic manifestations. The purpose of this poster is to provide a review of evidence-based treatments for this condition and highlight the need for specific recommendations for treatment of this condition in older adults.</div></div><div><h3>Methods</h3><div>A literature review and a case description are utilized to explore evidence-based options for treatment of somatic symptom disorder in older adults.</div><div>A literature search was performed on PubMed using the key terms “somatic symptom disorder,” “geriatric,” and “treatment.” Additionally, we look at this case through the lens of a specific patient. Jane is an 86-year-old female with bipolar II disorder and major neurocognitive disorder. Her somatic symptom disorder (with predominant symptoms of intermittent gasping and dizziness) and co-occurring anxiety disorder were previously treated with antidepressants such as mirtazapine and sertraline. However, due to a subsequent mixed mood episode, alternative treatments needed to be considered.</div></div><div><h3>Results</h3><div>In initial review of the literature, effective strategies for treatment of somatic symptom disorder in elderly patients include cognitive behavioral therapy (CBT) (Verdurmen et al., 2017), antidepressants, consultation with the patient’s primary care provider (Kroenke, 2007), and relaxation techniques (Gould et al., 2019). However, many of these studies and reviews did not specifically focus on older adults in making these recommendations. Additionally, a study exploring the effectiveness of the addition of physical exercise to pharmacologic treatment for late-life depression found that physical exercise improves affective but not somatic manifestations of late-life depression; however, we cannot extrapolate this finding to somatic symptom disorder (Murri et al., 2018).</div><div>Ultimately, Jane’s symptoms and mood were stabilized with a combination of olanzapine and pregabalin. There is, however, limited evidence to support use of second-generation antipsychotics and pregabalin in treatment of somatic symptom disorder. While we provided psychoeducation on the somatic symptom disorder and recommended CBT, Jane was not open to pursuing therapy. Additionally, the patient’s cognitive decline is likely exacerbating symptoms and may limit her ability to meaningfully participate in psychotherapy. Psyc","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S47-S48"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614134","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":"59. SEROTONIN TOXICITY DURING ELECTROCONVULSIVE THERAPY FOR GERIATRIC DEPRESSION: A RETROSPECTIVE CASE SERIES","authors":"Andy Jan ,&nbsp;Ryan Pate ,&nbsp;Parnika Saxena","doi":"10.1016/j.jagp.2025.04.061","DOIUrl":"10.1016/j.jagp.2025.04.061","url":null,"abstract":"<div><h3>Introduction</h3><div>Serotonin syndrome is a rare, potentially lethal, adverse effect of serotonergic agents that classically presents as a triad of cognitive-behavioral changes, autonomic nervous system dysfunction, and neuromuscular abnormalities. Since serotonin syndrome was first described, there has been a growing emphasis on the early recognition of serotonin toxicity (a clinical diagnosis with features of but not meeting full criteria for serotonin syndrome) to prevent catastrophic consequences. Although serotonin toxicity is most commonly caused by use of two or more concurrent serotonergic medications, five cases in the literature have documented serotonin toxicity due to concurrent use of electroconvulsive therapy (ECT) and one or more serotonergic medications. To date, our understanding of why ECT may induce serotonin toxicity remains limited and speculative. Here, we report on three cases that meet Hunter’s criteria for serotonin toxicity in the setting of acute ECT treatment. We then provide case commentary, summarize hypotheses regarding ECT and serotonin toxicity, and discuss clinical implications and next steps for research.</div></div><div><h3>Methods</h3><div>Three cases of serotonin toxicity during acute ECT treatment of geriatric depression were reviewed, summarized, and analyzed retrospectively.</div></div><div><h3>Results</h3><div>Serotonin toxicity was suspected in case 1 given agitation, hyperreflexia, and tremor, and cases 2 and 3 given spontaneous clonus and hyperreflexia. Serotonin toxicity was treated in case 1 with medication dose reduction and ECT frequency reduction; case 2 with medication dose reduction and stopping ECT; case 3 with medication change and ECT frequency reduction.</div></div><div><h3>Conclusions</h3><div>At present, serotonin syndrome remains a clinical diagnosis and is often difficult to recognize in the early stages, especially in elderly patients receiving acute ECT treatment. ECT commonly causes cognitive side effects in the elderly in the acute phase including decreased orientation and amnesia, which can confound clinical evaluation. To further complicate matters, serotonin syndrome is wide ranging in its presentation from mild (akathisia, tremor, altered mentation, inducible clonus) to life-threatening (sustained clonus, muscular hypertonicity, and hyperthermia), and not all findings are always present in a single patient. Patients may under report symptoms due to cognitive side effects and severe signs like muscular hypertonicity can mask tremor and hyperreflexia on a clinical exam. Given this, we recommend a high index of suspicion for serotonin toxicity in elderly patients receiving ECT treatment with new-onset tremor, hyperreflexia, or clonus given early detection of serotonin toxicity and prompt removal of offending agents can prevent catastrophic outcomes. Further research is needed to optimize current clinical criteria and improve the tools used to screen and diagnose serotonin","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S43-S44"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614168","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":"99. ADAPTANGO PERFORMANCE PROCESS FOR OLDER ADULTS AND COMMUNITY HEALTH REHABILITATION","authors":"Kozbi Bayne ,&nbsp;Jill Bishop ,&nbsp;Madeleine Hackney","doi":"10.1016/j.jagp.2025.04.101","DOIUrl":"10.1016/j.jagp.2025.04.101","url":null,"abstract":"<div><h3>Introduction</h3><div>While dance has proved to be a more effective movement therapy than other exercise-based controls such as walking and aerobics, the interpersonal and creative impact of dance-based movement therapy for people with Parkinson’s Disease needs to be studied more. Intergenerational interventions engaging members across different age groups can reduce ageism, and intergenerational conversations about challenging topics often lead to greater mutual understanding between generations. APPROACH explores themes such as community building and justice as perceived by people with Parkinson’s and younger individuals before and after partnered choreography processes.  We will describe the interactions occurring during a three-month choreographic process and will define the impact of the instructor/older adult/young adult co-experience.  We aim to explore the thoughts, attitudes and perceptions of older (aged 60 plus years) and younger adults (aged 18-30 years) regarding challenging topics before and after engaging in an ADAPTANGO course.</div></div><div><h3>Methods</h3><div>Twenty dyads of people with Parkinson’s and younger adults will participate in a three-month choreographic workshop. Prior to choreography, participants will complete extensive baseline cognitive and creative testing. They will also complete self-reported measures focused on loneliness and quality of life. During the tenth choreographic class, participants will be interviewed to gain qualitative feedback about the extent to which APPROACH classes have impacted their well-being and their engagement intergenerational relationships.</div></div><div><h3>Results</h3><div>On the psychosocial level, we expect intergenerational bonding to occur that will quantitatively reduce depression and loneliness.</div><div>Based on prior work, we expect improved spatial cognition in PWP.</div><div>We expect creativity to increase across verbal, written and visual fields in younger and older adults.</div></div><div><h3>Conclusions</h3><div>Dance provides access to unique learning strategies that promote neuroplasticity—the brain’s ability to change because of experiences—to mitigate, and perhaps even heal, PD. Dance’s therapeutic potential has been the subject of numerous clinical studies over the last decade, and deserves consideration as a non-pharmacological intervention to improve PD patient health outcomes, especially in an intergenerational context.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S73-S74"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614268","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":"100. CROSS-SECTIONAL ASSOCIATIONS BETWEEN SLEEP and METABOLIC HEALTH: ROLES OF SCHIZOPHRENIA ILLNESS AND MEXICAN ETHNICITY","authors":"Jaifreen Bhangu ,&nbsp;Jerry McDonald ,&nbsp;Lisa Eyler ,&nbsp;Ellen Lee","doi":"10.1016/j.jagp.2025.04.102","DOIUrl":"10.1016/j.jagp.2025.04.102","url":null,"abstract":"<div><h3>Introduction</h3><div>People with schizophrenia (PwS) have a higher risk of developing coronary heart disease (CHD) and sleep disturbances are an important risk factor for CHD and poor metabolic health. Studies have demonstrated that PwS have a higher prevalence of metabolic syndrome (MetS) and sleep disturbances. One study observed poor subjective sleep quality and longer sleep latency were associated with having metabolic disorder in drug-naïve, Chinese PwS.</div><div>Mexican ethnicity may be a modifier between sleep and metabolic health, which has been understudied among PwS. Short sleep duration measured by wrist-worn actigraphy has been linked with poor metabolic outcomes in Hispanic individuals. Furthermore, one study observed that people from Mexico are more likely to be obese and have diabetes compared to people from South America or Cuba, rendering individuals from Mexico a particularly vulnerable population for worse metabolic outcomes. Despite this, research on sleep and metabolic health in PwS, especially among Mexican PwS, is limited.</div><div>This study aims to explore the associations between sleep quality and metabolic health in PwS compared to non-psychiatric comparison participants (NCs), with a focus on people of Mexican ethnicity compared to people of non-Hispanic white (NHW) backgrounds. We hypothesize that (1) PwS will exhibit worse sleep quality, objective sleep measures and metabolic health compared to NCs, and (2) worse sleep quality and objective sleep measures will be associated with poorer metabolic health in PwS and NCs. An exploratory analysis will investigate the modifying relationship of Mexican ethnicity on sleep quality and metabolic health.</div></div><div><h3>Methods</h3><div>The sample included 199 English-speaking community-dwelling participants aged 30-70 from San Diego, including 83 adults with schizophrenia or schizoaffective disorder and 116 non-psychiatric comparison participants. We divided the analyses into Study 1 and Study 2 to include subsets of participants with the relevant sleep data. Study 1 includes 199 individuals with subjective sleep quality measures, assessed with the Pittsburgh Sleep Quality Index (PSQI). The PSQI includes overall sleep quality and component scores such as sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction. Study 2 includes 61 individuals who had objective sleep quality, assessed with 5-day Fitbit activity trackers. Objective sleep measures included mean and variability of total sleep time, bedtime, and wake after sleep onset (WASO). For both Study 1 and Study 2, metabolic health measures included body mass index (BMI), hemoglobin A1c (HbA1c), insulin resistance (HOMA-IR), and number of MetS criteria. For MetS criteria, participants were required to meet at least three of the following: elevated waist circumference, triglycerides, HDL levels, or blood pressure.</div><div>Statistical","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S74-S75"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614269","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":"49. A PILOT STUDY ASSESSING THE FEASIBILITY OF ANIMATRONIC AND AI-DRIVEN HUMANOID ROBOTIC COMPANIONS IN GERIATRIC PSYCHIATRY CLINIC PATIENTS","authors":"Blaine Greenwald ,&nbsp;Amir Nikzad ,&nbsp;Jamie Scott ,&nbsp;Rehana Haque ,&nbsp;Aninditha Vengassery ,&nbsp;Honey Win ,&nbsp;Sukriti Mittal ,&nbsp;Bienvenida Austria","doi":"10.1016/j.jagp.2025.04.051","DOIUrl":"10.1016/j.jagp.2025.04.051","url":null,"abstract":"<div><h3>Introduction</h3><div>Emerging robotic technologies in health care, including animatronic and AI-driven humanoid companions, can serve as accessible psychosocial interventions for seniors. Although evidence exists demonstrating benefits in older individuals with loneliness and behavioral disturbances associated with dementia, to our knowledge, reports employing such technologies in explicit geriatric psychiatry outpatients are wanting. As such, a pilot feasibility study was undertaken in this population.</div></div><div><h3>Methods</h3><div>Following IRB submission and approval, two types of robotic companions (Joy for All Companion Pets [animatronic stuffed animal-like robots with autonomous and reflexive behaviors mimicking the actions of real pets, designed for people with dementia who are less able to engage in verbal interactions]; and ElliQ AI Care Companions [humanoid tabletop robots capable of conversational and emotional engagement especially intended for isolated elders with loneliness]) were initially selected to respectively test feasibility in two diagnostically homogeneous geriatric psychiatry clinic populations at Zucker Hillside Hospital/Northwell Health in Queens, NY: older patients with dementia and episodic aberrant behaviors; and late-life depressed patients living alone and expressing feelings of social isolation and loneliness. Investigators engaged parent companies of the two devices to achieve discounted rates for purchase. Attending gero-psychiatrists were solicited to refer appropriate patients for each modality. ElliQ devices were introduced to depressed patients, and animatronic pets introduced to caregivers of referred agitated dementia patients. Informed consent was then obtained. Enrolled patients interacted with robotic companions over an eight-week period with regular weekly follow-up communication to encourage/ensure continued participation. At the completion of the study period, surveys (Likert-like five-point scales [5 = positive top score]) were administered to patients and/or caregivers assessing diverse feasibility parameters.</div></div><div><h3>Results</h3><div>Twelve dementia patients were referred for engagement with companion pets; and eight depressed patients endorsing feelings of social isolation and loneliness were referred to utilize ElliQ. 58% (7/12) of dementia patients and 50% (4/8) of depressed patients completed the eight-week study. Reasons for non-completion included withdrawal of consent prior to initiation and nursing home admission. All other participants completed the 8-week study. The average satisfaction score was 4.7 for both devices. For the animatronic pet group, ratings (mean scores) included: general satisfaction (4.9), enrollment satisfaction (4.9), device maintenance (4.7), support (4.7) ease of use (4.9), interest in continued use (4.1), and likelihood of recommending (4.9). For the AI-driven humanoid companion (ElliQ) group, ratings (scores) were general satisfaction (","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S36"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614395","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":"93. A STEADI APPROACH: ASSESSING FALL RISK FACTORS IN A GERIATRIC PSYCHIATRY CLINIC","authors":"Kacie Shannon ,&nbsp;Kayla Murphy ,&nbsp;Lessley Chiriboga ,&nbsp;Molly Camp","doi":"10.1016/j.jagp.2025.04.095","DOIUrl":"10.1016/j.jagp.2025.04.095","url":null,"abstract":"<div><h3>Introduction</h3><div>Falls are a significant public health concern among older adults, representing the leading cause of disability and a major factor affecting quality of life. The risk of falls is particularly elevated in those with psychiatric conditions. Prior research has identified a correlation between psychiatric medications and fall risk, and further studies have identified medical co-morbidities— such as sleep disorders, neurocognitive impairments, and osteoporosis— as contributing to increased fragility and susceptibility to falls. While prior research has examined these factors individually, there remains a gap in the literature concerning the combined impact of psychiatric conditions, psychiatric medications, and medical co-morbidities on fall risk among older adults receiving psychiatric care. This study aims to fill this gap by using the CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) questionnaire to identify key contributors to fall risk in a geriatric psychiatry clinic.</div></div><div><h3>Methods</h3><div>The geriatric psychiatry clinic at University of Texas Southwestern Medical Center began administering the STEADI questionnaire with pre-visit check-in forms in September 2023. We extracted data from patients who completed the full questionnaire, including demographics, psychiatric medications, PHQ-9, GAD-7, and CHRT-SR7 scores, as well as diagnoses related to sleep, cognition, and bone health. To assess whether there was a significant difference in STEADI scores between individuals taking specific classes of medications (Yes/No), we conducted two-sample, two-tailed Z-tests for independent means in Microsoft Excel. Given that each group had a sufficiently large sample size (n ≥ 30), we assumed normality under the Central Limit Theorem. We also compared STEADI scores between in-person and virtual visits using the same Z-test approach. Additionally, we examined the relationship between PHQ-9, GAD-7, and CHRT-SR7 mood questionnaires and STEADI scores by performing Shapiro-Wilk normality tests, followed by Spearman correlation analyses.</div></div><div><h3>Results</h3><div>Data were extracted for 2,055 patients who completed the STEADI questionnaire. The cohort was 64.4% female (1,324 patients) with a mean age of 68.4 years. Racial demographics included 88.8% White (1,825), 7.6% Black (156), 3.0% Asian (62), with the remainder identifying as American Indian, Alaskan Native, Pacific Islander, multiple races, or unknown. Eighty-seven percent (1,783) identified as non-Hispanic, while 8.3% (170) identified as Hispanic. Among encounters, 1,232 were video visits, 726 were in-office visits, 94 were no-shows, and 3 visits were not characterized. Sixty-five percent of STEADI responses (2951 responses) scored ≥ 4, indicating a high fall risk.</div><div>Medication and Fall Risk:</div><div>SSRIs, benzodiazepines, and non-benzo hypnotics did not significantly impact fall risk (z=0.48, z=1.59, and z=-1.46, respectively","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S69"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614419","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":"85. PSYCHIATRIC EMERGENCY IN LATE-LIFE: A STORY DRIVEN CLASS TO CHALLENGE ATTITUDES AND PROVIDE LOCATION SPECIFIC TRAINING TOOLS","authors":"Wayles Haynes","doi":"10.1016/j.jagp.2025.04.087","DOIUrl":"10.1016/j.jagp.2025.04.087","url":null,"abstract":"<div><h3>Introduction</h3><div>According to the World Health Organization, by 2030 one in six people will be aged 60 and older with approximately 14% of older adults living with a mental health disorder. The Health Resources and Services Administration projects over a 42,000 psychiatrist workforce shortage by 2036 and by 2030 only one geriatric psychiatrist is estimated to be available for every 27,000 older adults. With current behavioral health resource limitations, patients are more likely than ever to be cared for in the emergency setting. The National Center for Health Statistics found that emergency department visits in 2020 for adults aged 60 and older had longer wait times, were more likely to be discharged with unmet needs, required high levels of care coordination, and had an increased likelihood of hospital admission. This shift of care location, increase of older adults with psychiatric needs, and insufficient geriatric psychiatry expertise makes training general psychiatry residents in diagnosis and management of psychiatric emergencies in late life critically important. To address these needs we created a story driven class to build knowledge, shift attitudes, and provide location specific training for PGY-1 and PGY-2 general psychiatry residents working in a psychiatric emergency service.</div></div><div><h3>Methods</h3><div>A learner needs assessment found that over 60% of PGY-1 and PGY-2 general psychiatry residents surveyed (n=19) reported a high to very high need for learning in identifying, managing, and reflecting on common geriatric psychiatry diagnosis and presentations in emergency care. This 60 minute class on psychiatric emergencies in late-life was created with the affective context learning theory and the push and pull learning design model to target both cognitive and affective learning. In the push and pull model, learning experiences are designed to address learner specific concerns, provide resources for motivated learners, and employ storytelling to create emotionally impactful experiences. The class examines common clinical presentations and challenges of psychiatric emergency care in late-life through an interactive lecture designed to foster discussion and provide relevant tools for clinical service specific training. Group results will be presented descriptively of Likert scale pre-posttest self-assessments.</div></div><div><h3>Results</h3><div>The class was taught one time at the University of New Mexico to PGY-1 and PGY-2 general psychiatry residents. Of the 20 participants, 13 completed both pre-posttest self-assessments. Confidence with learning objectives was assessed via a 5-point Likert scale. Residents reported increased confidence identifying acute concerns and common diagnosis, discussing management of common presentations, and reflecting on challenging presentations of geriatric psychiatry emergency care with over 50% normalized gain for all learning objectives (Table). Residents also reported incre","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S62-S63"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614425","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":"34. ENVIRONMENTAL TRIGGERS OF SPECIFIC SUBTYPES OF AGITATION IN PEOPLE WITH DEMENTIA: AN OBSERVATIONAL STUDY.","authors":"Robbe Decloedt ,&nbsp;Hannah Davidoff ,&nbsp;Alex Van Kraaij ,&nbsp;Erika Lutin ,&nbsp;Nick Van Helleputte ,&nbsp;Maarten De Vos ,&nbsp;Chris Van Hoof ,&nbsp;Maarten Van Den Bossche","doi":"10.1016/j.jagp.2025.04.036","DOIUrl":"10.1016/j.jagp.2025.04.036","url":null,"abstract":"<div><h3>Introduction</h3><div>Among the most critical behavioral and psychological symptoms of dementia, agitation can lead to decreased quality of life of people with dementia and their caregivers. Limited research exists quantifying environmental triggers of agitation or its subtypes. In this study, we aim to quantify the relationships between specific environmental factors and agitation, as well as specific agitation subtypes, such as motor and verbal agitation.</div></div><div><h3>Methods</h3><div>Using a cross-sectional repeated measures design, 37 people with dementia, admitted to a specialized neuropsychiatric ward for patients with dementia and severe behavioral and psychological problems, were each included for one week. During this period, the Pittsburgh Agitation Scale was filled in by the nurses on the ward following an Experience Sampling methodology to assess a patient’s agitation level on a momentary basis. Continuous environmental data (light, sound and temperature) was collected from fixed sensors mounted on the ward. Generalized linear mixed models were used to quantify relationships between environmental variables and outcome variables (agitation, motor agitation, and verbal agitation). These models accounted for the hierarchical nature of our dataset as well as confounding factors, such as time of day and the room-level location of the patient. The time window for analysis was selected through comparison of beta coefficient estimates across various window lengths. Models were built up sequentially, per outcome variable, using selected features per environmental modality.</div></div><div><h3>Results</h3><div>We found that different environmental factors were most informative for different subtypes of agitation: mean light level (β: -0.61, C.I.: -1.12 –0.10, p: .02) for motor agitation, and standard deviation of sound level (β: 0.68, C.I.: 0.34-1.02, p: LESS THAN .001) for verbal agitation. Contextual factors such as time of day (β range: 0.51-0.94) and room_x0002_level location (β range: 0.85-1.08) were also significant predictors of agitation.</div></div><div><h3>Conclusions</h3><div>Integrating the key differences in predictors between verbal and motor agitation, identified here, could substantially improve subtype-specific model performance. Overall, these findings can aid in the development of predictive models for agitation and enable subsequent just-in-time interventions, improving quality of life for both patients and caregivers.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Page S24"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614466","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":"75. LOSS OF INDEPENDENT LIVING: THE PROBLEM AND THE SOLUTION","authors":"Eric Bean","doi":"10.1016/j.jagp.2025.04.077","DOIUrl":"10.1016/j.jagp.2025.04.077","url":null,"abstract":"<div><h3>Introduction</h3><div>It is estimated that the number of older adults with mental illness will rise from 4 million in 1970 to 15 million by 2030. Loss of independent living among the elderly is frequently precipitated by psychiatric disorders that impair cognitive and functional capacities. Research shows that individuals who are given the opportunity to age in place generally live longer and report greater happiness than those forced into nursing homes. As the population ages, understanding the interplay between psychiatric disorders and independent living becomes increasingly vital. This study aims to assess living status at admission and discharge for geriatric psychiatric patients, focusing on how different diagnoses lead to differing rates of functional disability and independent living status. By identifying the disorders most likely to precipitate entry into nursing homes, we can enhance the provision of services in residential care, thereby supporting aging in place and improving longevity. Early identification and management of these conditions are critical for improving outcomes and maintaining autonomy in geriatric patients. This literature review examines how these psychiatric disorders impact the ability of geriatric patients to live independently and strategies that can be employed to mitigate these effects.</div></div><div><h3>Methods</h3><div>A literature review was conducted using databases such as PubMed and PsycINFO, focusing on studies from the past decade that focused on psychiatric disorders contributing to the loss of independent living status in elderly populations. Sources include longitudinal cohort studies, pilot trials, and research on the outcomes of psychiatric care in residential settings and home treatment. Studies were analyzed for patterns linking these conditions to loss of independent living.</div></div><div><h3>Results</h3><div>Results from the literature search yielded several studies with the following important conclusions. One study found that hospital inpatients with psychiatric disorders were 77% more likely to be discharged to a nursing home compared to those without psychiatric disorders. Another study focusing on elderly patients with depression found that depression-related cognitive decline was often associated with substantial impairment in instrumental activities of daily living (IADL). These studies emphasize the profound impact of psychiatric illness on the loss of functional ability in geriatric patients. A longitudinal cohort study on patients with recent-onset major psychiatric illness found that patients with bipolar disorder had better outcomes and were at lower risk of losing independent living status compared to those with depression and schizophrenia, indicating that functional impairment varies depending on the type of psychiatric illness. In a pilot study of 12 elderly patients with depression or delusions, a specialized psychosocial intervention program called Geriatric Psych","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"33 10","pages":"Pages S55-S56"},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613915","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}