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Purpose: To explore mental health clinicians' attitudes, experiences, and perceived barriers regarding Advance Care Planning (ACP) with older people (aged 55+) with schizophrenia/other psychotic illnesses. Methods: Qualitative analysis of focus group interviews with multidisciplinary mental health clinicians from public mental health services in Sydney, Australia. A senior external clinician facilitated online focus groups exploring clinicians' attitudes, experiences, and perceived barriers to ACP using a semi-structured interview guide. Transcripts were recorded and transcribed. N-VIVO was used to organise the data, which were subjected to reflexive thematic analysis grounded with an interpretive description framework. Results: Fifteen mental health clinicians were recruited. Two overarching themes emerged from thematic analysis of focus group transcripts: (1) It is important, and I want to do it: and (2) But I do not do it because of the complexity. Subthemes in relation to this complexity included: (i) fear of harming; (ii) families and culture; (iii) systemic barriers; (iv) capacity and legal issues; (v) timing; (vi) lack of knowledge and training; (vii) neither prioritised nor embedded in practice. Conclusion: These clinician-identified attitudes, experiences, and barriers to engagement in ACP with older people with psychotic illnesses highlight avenues of potential intervention to facilitate ACP in this cohort. Given the complexity of issues, clinicians need education and training in ACP combined with clear processes and policies to support practice. Clinician insights should be combined with the perspectives of older consumers with psychotic illnesses and their families to inform implementation of ACP. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to examine mortality for people living with dementia/mild cognitive impairment who self-harmed. Methods: We conducted a retrospective cohort study in New South Wales, Australia, using data ranging from 2001 to 2015. From people who accessed hospital services in the study period, we identified 154,811 people living with dementia/mild cognitive impairment, 28,972 who self-harmed and 1511 who had a record of both dementia/mild cognitive impairment and self-harm. We examined rates, causes and predictors of death for people with dementia/mild cognitive impairment and/or self-harm diagnoses using flexible parametric survival analyses. We explored rates of repeat self-harm in people living with dementia who self-harmed. Results: Circulatory disorders accounted for 32.0% of deaths in people with a living with dementia who self-harmed, followed by neoplasms (14.7%), and mental and behavioural disorders (9.6%). Death was more likely for someone who had self-harmed if they developed dementia/mild cognitive impairment. Predictors of death included male sex, greater physical comorbidity, a history of delirium, more previous emergency department presentations and fewer previous mental health ambulatory service days. Greater engagement with outpatient mental health services predicted a decreased likelihood of repeat self-harm. Discussion: We found that mortality increases when people who self-harm develop dementia. We argue post-diagnosis support offers a potential opportunity to reduce mortality rates in people with both dementia and self-harm diagnoses. [ABSTRACT FROM AUTHOR]

Introduction: People living with young-onset dementia and their care-partners are at risk of a range of adverse mental health outcomes and social isolation. There are few interventions aimed at supporting couples affected by young-onset dementia, which poses unique psychosocial challenges for younger people. Methodology: This pre-post interventional mixed methods pilot study aimed to assess the feasibility and acceptability of an online group program for people with young-onset dementia and their care-partners living at home in Australia. The Music And Psychology and Social connections (MAPS) program aimed to address: (1) the challenges and changes associated with young-onset dementia; and (2) coping and wellbeing. The program involved six weekly two-hour sessions co-facilitated by a psychologist and music therapist, and a private Facebook group. The primary outcomes of feasibility and acceptability were assessed through a post-program focus group, separate individual feedback sessions with each couple, and a program evaluation questionnaire. Thematic analysis was conducted on the focus group transcripts and field notes from couple feedback sessions. We also examined the preliminary utility of MAPS in improving mental health and social connectedness, using quantitative pre-post-measures. Results: Five couples completed the MAPS program. The most common dementia type was Alzheimer's Disease. Participant attendance was 87% across all sessions. Qualitative findings supported acceptability of the program with four emergent themes: being connected to others with shared experiences; reframing thoughts and feelings about dementia; music as a therapeutic tool; and benefits of MAPS. Conclusion: The high retention rate, qualitative findings and positive program evaluation suggest MAPS may be a promising, feasible and acceptable program for couples affected by young-onset dementia. [ABSTRACT FROM AUTHOR]

Objective: To describe implementation of the Pathways to Community Living Initiative (PCLI) within an Older People's Mental Health (OPMH) service. Method: A retrospective observational study was conducted. Implementation comprised partnership with a specialist Residential Aged Care Facility (RACF). Data were obtained from Clinical Advisory Committee (CAC) discussion and minutes, the PCLI database, and consumer medical records. Results: Eighteen consumers were accepted onto the program between April 2019 and March 2023. Their PCLI and rating scale outcomes alongside interventions facilitating placements are described. Interventions included OPMH case management, wide-reaching liaison, and inservices. Challenges included communication, confusion regarding roles, and differing views on capacity to accommodate complex consumers. Solutions included streamlining communication, including clinical updates in the CAC, facility appointment of a lead PCLI-nurse, and targeted RACF education. Conclusions: Considered interventions strengthened the OPMH and specialist RACF partnership over time. Clarification of professional roles and intersection with other services was crucial. Successful placement for PCLI consumers required consideration of personalised needs and existing resident mix, liaison with stakeholders, and targeted staff training. These strategies may apply to other health services implementing similar initiatives supporting community placements for OPMH consumers with complex needs. [ABSTRACT FROM AUTHOR]

The International Psychogeriatric Association (IPA) has been steadfast in its commitment towards advancing human rights of older persons since the release of its 2011 White Paper which expanded the focus of the Capacity Task Force to prioritize human rights. Through partnerships with the World Psychiatric Association Section Old Age Psychiatry (WPA-SOAP), Capacity Australia, International Longevity Centre Canada (ILC Canada), Canadian Coalition Against Ageism (CCAA), and Rights of Older Persons Australia (ROPA), IPA members have emerged as global leaders in advocating for integration of human rights-based mental health care for older persons. Advocacy efforts have spanned grassroots and global strategies. At the grassroots level, IPA has championed the seamless integration of human rights principles into clinical practice, demonstrating a commitment to action. Globally, IPA has engaged in advocacy for a United Nations (UN) convention on the rights of older persons, notably through active participation in UN Open Ended Working Group on Aging (OEWGA). This symposium showcases a diverse array of papers exemplifying these dual approaches. Papers on grassroots strategies include: (i) "Walking the Talk:20 Ways to Embed Human Rights in Everyday Clinical Practice" (Carmelle Peisah) provide practical guidance for clinicians; (ii) "The UN Decade's and our own efforts to address ageism" (Liat Ayalon); (iii) Actualizing human rights of older persons with severe mental Illness (Anne Wand). Papers highlighting global strategies include: (i) "Our role and impact with the OEWGA/OHCHR /WHO" (Kiran Rabheru) illustrating how our advocacy has urged healthcare organizations and multilateral bodies such as the UNOEWGA, World Health Organization (WHO), and Office of UN High Commissioner for Human Rights (OHCHR) to prioritize the human rights agenda for older persons; (ii) Is a new treaty critical for policy making? A lawyer's perspective (Andrew Byrnes); (iii) "The Global Alliance for Rights Based Care and Support (GARBCS)" (Carlos de Mendonça Lima) underscoring the transformative potential of collaborative efforts in fostering a rights-based approach to care. Established to address challenges faced by older individuals worldwide, GARBCS promotes optimal mental health, combats ageism, and fosters collaboration among member organizations, aligning with UN Decade of Healthy Ageing and WHO's focus areas. Founding Members include AAGP, CHeBA, ILC-Canada, IPA, WDP, WFMH, WFP, WPA, and WONCA, organisations led by many of our IPA members. Objectives: 1. To understand the challenges faced by older persons worldwide; 2. To engage clinicians in becoming human rights champions; 3. To understand current global efforts at advocacy for the human rights of older persons. Walking the Talk: 20 Ways to Embed Human Rights in Everyday Clinical Practice- Carmelle Peisah Summary: This presentation will illustrate translational significance and practical implementation of the United Nations Convention on the Rights of Persons with Disabilities (CRPD), the primary international human rights framework. Articles from the Convention most relevant to the practice of old age psychiatry include: (i) Article 12: Equal recognition before the Law including the right to equal legal capacity, the support in exercising that legal capacity, and the right to be safeguarded against undue influence and abuse; (ii) Article 14: Liberty and security of the person; (iii) Article 16: Freedom from exploitation, violence and abuse; Article 19: Living independently and being included in the community; (iv) Article 22: Respect for privacy; (v) Article 23: Respect for home and the family, and relationships on an equal basis with others; and (vi) Article 25: Equitable access to health. Clinicians will be provided with practical ways to implement each of these relevant Articles in their everyday practice. Is a new treaty on the human rights of older persons critical for effective policy making? A lawyer's perspective- Andrew Byrnes Objectives: 1. To inform participants of the latest developments relating to a new treaty on the human rights of older persons 2. To highlight the potential positive contribution of such a new treaty in terms of policymaking 3. To explore through two case studies how the absence of such a treaty has skewed policymaking in relation to older persons and their rights Summary: The development of a new United Nations treaty on the human rights of older persons or in older age has been under Discussion at the United Nations and elsewhere for more than a decade. One of the major advantages of a thematic treaty on the rights of older persons is said to be its potential contribution as a clear, comprehensive and coherent framework for policy making at the national level. Advocates argue that other thematic UN treaties – on discrimination against women, children and the rights of persons with disabhave had this effect, as have regional treaties including those that address the rights of older persons in the Inter-American and African human rights systems. This presentation will explore the potential policy contributions that a new treaty could make by considering recent examples from Australia in which the lack of a comprehensive and coherent international framework on the human rights of older persons led to flawed analysis and policy making. The examples are the Royal Commission into Aged Care Quality and Safety and the drafting of the proposed new "rights-based" Aged Care Act (2023-2024), and the proposal for a national Human Rights Act put forward by the Australian Human Rights Commission (2023) and the Australian Parliamentary Joint Committee on Human Rights (2024). The presentation will argue that, had policymakers had such a framework available to guide their deliberations, a better, more rights-complaint outcome would have resulted. Actualising human rights of older persons with severe mental illness A/Prof Anne Wand1,2,3 1. Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney 2. School of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New SouthWales 3. Older Peoples Mental Health, Sydney Local Health District People living with severe mental illness experience greater morbidity and premature mortality compared to their peers who do not have mental illness. As articulated by the Convention of the Rights of Persons with Disabilities, persons living with mental illness have an equal right to access high quality health care including towards the end of life, and the right to determine what kind of care they want. These rights sit alongside the rights to live independently and be included in the community, and respect for home and the family. Too often though, these rights are not actualised. Geriatric psychiatry has an important role in advocacy for older people living with severe mental illness to enjoy equitable rights to autonomy in decision making in areas of accommodation, consent to healthcare, and expressing wishes and preferences towards the end of life. Where capacity is lacking, clinicians may assist to maximise the older person's participation in decision making, including through supported decision making. This presentation will use examples of recent work conducted in public older persons mental health services in Sydney Australia to illustrate advocacy for older people living with severe mental illness to enjoy equal rights to autonomy of decision making and access to quality physical healthcare, including care towards the end of life (advance care planning), and supported accommodation placement (pathways to community living initiative). Conclusions: Often the only health professional engaging with an older person with severe mental illness, mental health clinicians have an opportunity and, arguably, an obligation to advocate for their consumers to actualise their human rights. The UN Decade's and our own efforts to address ageism- Liat Ayalon Ageism is defined as stereotypes, prejudices, and discrimination towards people because of their age. It can be directed towards people of any age and be either positive or negative. However, its negative impact, especially on older persons is well documented. Given its substantial impact, it is one of four pillars identified by the UN Decade as essential to tackle to achieve a world for all ages. The UN Global Report on Ageism proposed three evidence-based strategies to reduce ageism. In this presentation, I will illustrate one such strategy, which consists of a 90-minute educational workshop. The workshop was delivered to 318 Israeli adolescents (aged 11 to 15, 73.9% females) to increase their familiarity with the concept, reduce their negative ageist stereotypes, and increase their inclination to become social activists via social media. We found an improved familiarity with the concept 'ageism', while adolescents drew upon concepts such as discrimination and racism to define ageism. Following the intervention, a diverse range of age-related stereotypes emerged, signaling a shift toward more positive perceptions, with notable growth in positive age stereotypes, especially among females. Finally, about two-thirds of created memes (online visual and textual social messages) targeted ageism against older persons, 18.98% promoted an age-inclusive world, and 17.15% addressed ageism towards children and young persons. Implications for reducing ageism in adolescence and for measuring social change arediscussed. Our role and impact with the Open-Ended Working Group on Aging (OEWGA), the Office of the High Commissioner for Human Rights (OHCHR), and the World Health Organization (WHO)- Kiran Rabheru 1. Highlight the Collaborative Efforts of Key International Organizations: Illustrate the critical role of the International Psychogeriatric Association (IPA), World Psychiatric Association (WPA), and other organizations in working with UN bodies to advance the human rights of older people. 2. Emphasize the Importance of Increased Engagement and Advocacy: Discuss why deeper engagement from mental health professionals and advocacy groups is necessary to influence global policies and initiatives that protect and promote the rights of older persons. 3. Demonstrate the Impact of International Cooperation: Provide examples of how collaboration with the UN Open-Ended Working Group on Aging, the Office of the High Commissioner for Human Rights, and the World Health Organization has led to tangible improvements in the lives of older persons, particularly those with mental health conditions. Summary: In an increasingly interconnected world, the role of international organizations such as the International Psychogeriatric Association (IPA) and the World Psychiatric Association (WPA) has become vital in promoting the human rights of older people. This talk will explore how these organizations collaborate with key UN bodies, including the Open-Ended Working Group on Aging, the Office of the High Commissioner for Human Rights, and the World Health Organization, to address the unique challenges faced by older persons, especially those who live with mental health conditions. By engaging more deeply with these global efforts, we can enhance scientific advocacy, develop comprehensive policies, and implement effective interventions that safeguard the rights and well-being of older persons. This presentation will underscore the necessity of cross-sector engagement and international cooperation in fostering an inclusive world where the human rights of older people are fully actualized and protected. >The Global Alliance for Rights Based Care and Support (GARBCS)- Carlos Augusto de Mendonça Lima, Gabriel Ivbijaro, Helen Lavretsky, Kiran Rabheru Our world is rapidly aging, with scientific and medical advancements extending lifespans without necessarily enhancing the quality of those additional years. Older persons form a non- homogeneous group with varying levels of intrinsic capacity and functional abilities. Yet, universally, individuals in their later years aspire to preserve dignity, maintain control and independence, foster social inclusion, uphold justice and equality, receive respect for their identity, and pursue good health, security, engagement, and independence throughout their lives. They are entitled to timeless human rights and should receive rights-based care and support just like anyone else in society. Unfortunately, ageism, as defined by the World Health Organization, is pervasive and has a significant negative impact on the lives of older individuals. This discrimination, based on age, affects how people think, feel, and act towards older people. A human rights-based approach to health specifically aims at realizing the right to health and other health-related human rights. These rights are translated into clinical practice as social determinants of health. Their implementation is mainly dependent of fair distribution of money, power and resources at global, national and local levels. Planning health care for older persons should be guided by human rights standards and principles. The final aim of such an approach could be empowering rights-holders to effectively claim their health rights. Elimination of all forms of stigma and discrimination is at the core of a Human- Rights based care for older adults. A meeting was held during the WPA World Congress in Vienna, Austria, 2023. The attendees unanimously acknowledged that there is a significant amount of work yet to be undertaken in championing the well-being of older individuals. This includes advocating for their dignity, human rights, and health promotion. There is a shared commitment to fostering optimal brain health, resilience, and overall well-being among older adults, addressing their diverse needs encompassing mental, emotional, cognitive, physical, and spiritual dimensions. It was agreed that there is a need to bring together a stakeholder alliance that is coalesced around strengthening the human rights and dignity of older persons. The concept of a Global Alliance for Human-Rights Based Care and Support for Older Persons was born with goals: 1. Strengthen collaboration among member organizations for impactful messages, optimizing mental health, generating knowledge, and driving person-centered, evidence-based change. 2. Enhance visibility and impact across education, research, media, policy, advocating for global awareness, resources, and policies addressing mental health, prioritizing rights, combating ageism, and integrating care, education, andresearch. 3. Propose transformative changes during the UN Decade of Healthy Aging, aligned with WHO's focus areas, combating ageism, fostering age-friendly communities, ensuring person-centered integrated healthcare, and expanding access to long-term care. 4. Identify strategic opportunities for advancing Sustainable Development Goals (SDGs) across diverse age demographics, addressing how ageism hinders global Objectives. 5. Ensure a unified communication strategy for care and support for older persons, emphasizing clear terminology within global initiatives. [ABSTRACT FROM AUTHOR]

Background: Negative attitudes towards people living with mental illness (PLWMI), defined here as mentalism, are a major contribution to health care inequity, which may extend into end‐of‐life care. There is a clear need for investigation of the attitudes of doctors towards PLWMI at the end of life as doctors may lead processes of care that contribute to this inequity. Aims: The aim of this pilot study is to examine the perspectives of hospital‐based doctors regarding end‐of‐life care and medical decision‐making in PLWMI. Methods: A survey was created to explore whether mentalism is present in the perspectives of hospital doctors regarding end‐of‐life care for PLWMI. The survey included demographic characteristics of participants and questions comprising statements and vignettes that required agree/disagree responses. Descriptive statistics were used to summarise responses, and chi‐square tests examined associations with demographic variables. Results: The survey was commenced by 48 hospital‐based doctors and completed by 45. Descriptive statistics indicated that mentalism is present in the attitudes of hospital doctors regarding end‐of‐life care of PWLMI, with 47 of 48 participants (98%) endorsing at least one mentalist response. One significant association found that psychiatrists and psychiatry trainees were less likely to endorse a stereotype response in one vignette. Conclusions: This preliminary study addresses a gap within the literature on the potential contribution of mentalist attitudes in doctors to the poorer end‐of‐life care outcomes for PLWMI. The findings highlight the need for further study of this topic and suggest a role for targeted medical education in the pursuit of health care equality for PLWMI. [ABSTRACT FROM AUTHOR]

Background: Delirium is costly for patients, carers, and healthcare systems. In addition, non‐pharmacological and pharmacological management of delirium is challenging. Electroconvulsive therapy (ECT) has been proposed and used as an anecdotal treatment of delirium in clinical practice. However, the efficacy and safety of this approach are not well understood. Objective: To synthesise and review the evidence relating to the safety and efficacy of ECT as a treatment for delirium. Methods: A systematic review was completed according to PRISMA guidelines using the PubMed, CINAHL, Cochrane Library, and PsycINFO databases. Studies were eligible for inclusion if modified ECT was used to treat delirium symptoms. ECT for delirium in people with neuroleptic malignant syndrome, catatonia, or confusional states associated with acute primary psychiatric conditions were excluded. All included records were first ranked using the hierarchy of evidence‐based medicine; quality was then assessed using the Joanna Briggs critical appraisal checklists. Pooled data across the cases identified were analysed using descriptive statistics. Results: Of 1226 records screened, 10 studies met inclusion criteria: six case reports, three case series, and one quasi‐experimental study. The literature base was of mixed quality. A single quasi‐experimental study was assessed to be of 'fair' quality, the remainder of the case series and case reports were rated as 'poor' to 'fair' quality. A total of only 40 individual people with delirium who were treated with ECT were identified. In 33/40 cases, the aetiology of delirium was substance withdrawal. The number of ECT treatments administered ranged from 1 to 13. ECT was reported to positively contribute towards treatment of delirium in all cases, although objective measures of improvement were reported in only 6/13 patient cases from case reports and case series (46%). The singular quasi‐experimental study reported a statistically significant decrease in duration of delirium, time spent in physical restraint, and in benzodiazepine requirement when ECT was used as an adjunct in benzodiazepine withdrawal delirium. When adverse events were described these included mild confusion and memory deficits; all were reported as time limited and reversible. Considerable limitations in the quality of the evidence base were identified, including the risk of selection, publication and reporting bias. Much data reporting on safety and efficacy of ECT in delirium was missing. Conclusion: There is insufficient literature to support modified ECT as a clinical treatment for delirium. The few studies identified were generally of weak evidence lacking important data on safety and objective outcome measures, and not including populations with broad delirium aetiologies. Further research using more robust methodologies and broader populations (age, aetiology) of people with delirium treated with ECT is needed. [ABSTRACT FROM AUTHOR]

Objectives: Older people living with mental illness, including schizophrenia and other psychotic disorders, experience increased physical morbidity and premature mortality rates compared to the general population. However, Advance Care Plans (ACP) are rarely documented in this group, despite ability to discuss end-of-life care and express wishes. The aim of this study is to explore mental health clinicians' attitudes, experiences, and perceived barriers and facilitators to ACP with people living with psychotic illnesses, to better understand the reasons for this gap and develop a needs-responsive approach toimplementation. Methods: This qualitative study involves focus groups of multidisciplinary mental health clinicians who work with people aged 55+ with psychotic illnesses. It is being conducted in three public mental health services in Sydney, Australia. Focus groups are audio-recorded, transcribed and analysed using reflexive thematic analysis, grounded within an interpretive description framework. Results: Preliminary findings from an unsaturated sample of 12 multidisciplinary clinicians (psychiatrists, social workers, occupational therapists, psychologists) will be presented. Emerging themes regarding experiences of ACP include 'no experience', 'not a priority', 'particular relevance for nursing home residents' and 'difficult to navigate consumer choices in the context of delusions'. Emerging themes in relation to attitudes about implementing ACP with people with psychotic illnesses include: 'ACPs are needed', 'ambivalence', 'I don't know how', and 'whose responsibility are ACPs?'. Barriers to ACP include: 'misconceptions about ACP', 'misperceptions about psychotic illness', 'clinician uncertainty- capacity, emotional state, psychosis risk', 'systems issues', 'lack of knowledge and confidence', and 'interfering with therapeutic relationships'. Potential facilitators include: 'get the timing right', 'make it multidisciplinary', 'opportunity to practice', 'embed in protocol', 'upskilling clinicians- modelling and training', and 'support from an external ACP role'. Conclusions: Mental health clinicians may be the only healthcare professional in contact with an older person living with psychosis, providing unique opportunities to explore ACP. Clinicians recognise the need for ACP, the complexity of such Discussions, and importance of nuanced capacity assessment and appropriate timing. Proposed solutions to implementing ACP include combining targeted education with practical training for clinicians, embedding ACP in practice using a team approach and system change, or -alternatively-through a dedicated external ACP role. [ABSTRACT FROM AUTHOR]

Assessment and management of older people with cognitive impairment, especially those associated with psychiatric symptoms; are recognised as core capabilities of old age psychiatrists. Bi-national collections of HoNOS65+/HoNOS reveal that over 40% of older people entering public mental health services across Australia and New Zealand have a clinically significant rating on the HoNOS65+/HoNOS cognitive problem scale, with rates increasing with age, and significant regional variability. The high rates of cognitive impairment in these data reinforce the need for all mental health clinicians working with older people to have the capability to assess people with cognitive impairment. Once cognitive impairment is identified, clinicians must be equipped to incorporate the implications into individualised management plans, appropriate referral pathways and community support services. Such skills cannot be the sole responsibility of old age psychiatrists or aged care psychiatry services given the significant number of older people seen by adult mental health services. Regional variability in rates of cognitive impairment raises significant questions regarding variation in service eligibility criteria, equity of access to appropriate mental health care and the availability of a workforce and clinical environments that can meet the needs of older people with cognitive impairment. Finally, psychiatry trainees must learn about working with older people with various degrees of cognitive impairment as part of providing high-quality psychiatric care for an ageing population. [ABSTRACT FROM AUTHOR]