Petal S. Abdool’s research while affiliated with Centre for Addiction and Mental Health and other places

Current projections show that between 2000 and 2050, increasing proportions of older individuals will be cared for by a smaller number of healthcare workers, which will exacerbate the existing challenges faced by those who support this patient demographic. This review of a collection of Age and Ageing papers on the topic in the past 10 years explores (1) what best practice geriatrics education is and (2) how careers in geriatrics could be made more appealing to improve recruitment and retention. Based on these deeper understandings, we consider, as clinician educators, how to close the gap both pragmatically and theoretically. We point out paradigm shifting solutions that include innovations at the Undergraduate level, use of simulation, incorporation of learner and patient perspectives, upskilling professionals outside of Geriatrics and integration of practice across disciplines through Interprofessional Learning. We also identify an education research methodological gap. Specifically, there is an abundance of simple descriptive or justification studies but few clarification education studies; the latter are essential to develop fresh insights into how Undergraduate students can learn more effectively to meet the needs of the global ageing challenge. A case of improving understanding in delirium education is presented as an illustrative example of a new approach to exploring at greater depth education and outlines suggested directions for the future.

Objective Virtual reality (VR) simulation is changing the landscape of simulation-based medical education. Immersive VR allows users to interact with a computer-generated environment and digital avatars using a VR headset and controllers. However, current literature regarding the use of immersive VR simulation in psychiatric medical education is sparse. This study describes its use and considerations regarding tolerability.Methods At a mental health hospital in Canada, two immersive VR suicide risk assessment (SRA) case simulations were developed. These simulations have participants interview VR patients to characterize their suicide risk, offering a novel and safe way to engage healthcare providers in SRA training. Regarding user tolerability of these VR simulations, the Simulator Sickness Questionnaire (SSQ) was administered to participants after the simulation to characterize any motion sickness symptoms experienced.ResultsOf the 22 participants in this study, the overall SSQ scores demonstrated good tolerability of the VR SRA, with the majority of participants reporting no or minimal simulator sickness symptoms. Moreover, the majority of participants reported being satisfied with this training and that the VR SRA simulation enhanced their learning experience.Conclusion These study findings are novel, given the current dearth of data regarding the use of immersive VR in simulation-based psychiatric medical education. Further studies exploring the educational effectiveness of VR SRA in simulation-based psychiatric medical education are indicated.

Introduction Cognitive deficits strongly predict function in schizophrenia, including in late life. Cognitive remediation (CR) improves cognition in schizophrenia, however literature in late-life schizophrenia (LLS) is sparse. Anticholinergic medication burden (ACB) compounds age-related cognitive declines in late-life schizophrenia (LLS). This study examined the effect of CR on cognitive performance in patients with LLS. We also assessed CR tolerability, the interaction between ACB and CR on cognition. Methods We adapted CR from our pilot study to a larger group. CR was provided over 12, twice-weekly, therapist-guided group sessions. Computerized drill-and-practice exercise difficulty levels were adjusted automatically based on performance. Participants were assessed at baseline and at study completion using clinical and cognitive measures. Results Thirty-four participants were enrolled and 20 (mean (SD) age: 66.0 [5.8]) completed 92.3% (22.14 [1.98]) all CR sessions; the ITT group (N=34) attended 72.9% (17.50 [7.23]) sessions. Global cognition did not improve (completers: p=0.80, ITT: p=0.86) with negligible effect size (completers: d=0.08; ITT d=0.04). There was no significant improvement in executive function (completers: p=0.16; ITT: p=0.33). Medication ACB was inversely associated with total MoCA score, accounting for 8.9% of the variance in final MoCA score (p=0.02). Conclusions Overall, CR was well tolerated but did not improve global cognition or executive functioning in this outpatient sample with LLS. A higher ACB was associated with greater cognitive impairment and a poorer response to CR. Future studies need to better characterize potential variables serving to limit the response to CR, including the number and frequency of CR sessions and the role of ACB. This research was funded by Funding for this project was provided by the Innovation Fund of the Alternative Funding Plan for the Academic Health Sciences Centres of Ontario

Background: Older patients with schizophrenia have an elevated risk of dementia; enhancing their cognitive function holds promise for delaying dementia in this population. Cognitive deficits strongly predict function in schizophrenia. Anticholinergic medication burden (ACB) compounds age-related cognitive declines in late-life schizophrenia (LLS). Cognitive remediation (CR) improves cognition in schizophrenia, however literature in LLS is sparse. This study examined the effect of CR on cognitive performance in participants with LLS. We also assessed CR tolerability, the interaction between ACB and the effect of CR on cognition. Method: We adapted CR from our pilot study to a larger group. CR was provided over 12, twice-weekly, therapist-guided group sessions. Computerized drill-and-practice exercise difficulty levels were adjusted automatically based on performance. Participants were assessed at baseline and at study completion using clinical and cognitive measures. Result: Thirty-four participants were enrolled, 20 (mean (SD) age: 66.0 [5.8]) completed 92.3% (22.14 [1.98]) CR sessions; the ITT group (N=34) attended 72.9% (17.50 [7.23]) sessions. Global cognition did not improve (completers: p=0.80, ITT: p=0.86) with negligible effect size (completers: d=0.08; ITT d=0.04). There was no significant improvement in executive function (completers: p=0.16; ITT: p=0.33). Medication ACB was inversely associated with total MoCA score, accounting for 8.9% of the variance in final MoCA score (p=0.02). Conclusion: Overall, CR was well tolerated but did not improve global cognition or executive functioning in this outpatient sample with LLS. A higher ACB was associated with greater cognitive impairment and a poorer response to CR. Future studies need to better characterize potential variables serving to limit the response to CR, including the number and frequency of CR sessions and the role of ACB.

Objective The objective of the study was to explore the effectiveness of an immersive simulation experience using an aging simulation suit for fostering empathy towards geriatric patients with advanced mental illness.Method Psychiatry residents were recruited during their clinical rotations at a Canadian mental health hospital. The participants took on the first-person perspective of a geriatric patient with mental illness initially through written reflection, and then physically inhabited this role by wearing an aging simulation suit to perform the task of meeting with a pharmacist to review current medications and prepare a dosette. Concurrently, an audio file was played through headphones to simulate auditory hallucinations. A pre- and post-Jefferson Scale of Empathy (JSE), reflective writing exercise, debrief transcription, and evaluation questionnaire were used to evaluate the intervention. Interviews conducted 3 month post-intervention explored its impact on their clinical practice.ResultsFifteen psychiatry residents completed the study. There was a significant increase in JSE scores pre (M = 115.5, SD = 13.2) to post (M = 119.2, SD = 12.7) intervention, t(14) = 2.65, p = .02. The qualitative findings of the study demonstrated participants’ improved understanding and awareness of the patient perspective and the ability to communicate this understanding and show intentions to help through practice change.Conclusion An aging suit simulation with debriefing may be an effective educational intervention to incorporate into the medical curriculum to foster empathy for this stigmatized population.

This session will present new knowledge related to pharmacological management of older adults with LLP. The first presentation will provide an overview of the existing randomized controlled trial evidence related to the use of antipsychotics in LLP. New evidence on the patterns of antipsychotics among older adults with LLP from a population-based real world study. This study will provide an overview of the characteristics of this population including medical and psychiatric comorbidity. The patterns of antipsychotic use will be described in this population including measures of polypharmacy and dosages. The second session will then present evidence on the association between patterns of antipsychotic use and all-cause mortality among older adults with LLP. This study will describe who various prescribing patterns and subpopulations of individuals with LLP who may be at increased risk of mortality in association with antipsychotics. The third presentation will focus on the use of long-acting injectable medications (LAIs) in older adults with LLP. The frequency with which LAI are used in older adults with LLP will be described along with the characteristics of older adults who are prescribed LAI and the patterns of LAI in this population. The final presentation will provide an overview of an integrated care pathway for older adults with LLP and present evidence for the utility of care pathways for older adults with LLP. Attendees will learn new information related to the use of antipsychotics in LLP and identify strategies to optimize prescribing for this vulnerable and growing population.

OBJECTIVE: In the next 25years, the population aged 65 and older will nearly double in many countries, with few new doctors wishing to care for older adults. The authors hypothesize that early clinical exposure to elderly patient care could increase student interest in caring for older adults during their future career. METHODS: The authors conducted a pragmatic medical education randomized controlled trial (RCT) at the Jewish General Hospital and the Douglas Mental Health Institute, McGill University, in Montreal, Canada. Third-year medical students undergoing their mandatory 16-week half-time clerkship rotation in psychiatry were randomly assigned to the equivalent of 2-4 weeks of full-time exposure to clinical geriatric psychiatry (n = 84). RESULTS: Being randomly assigned to geriatric psychiatry exposure (n = 44 of 84) was associated with increased "comfort in working with geriatric patients and their families" at 16-week follow-up (59.1% versus 37.5%, χ2 (1) = 3.9; p = 0.05). However, there was no significant association found between geriatric psychiatry exposure and change "in interest in caring for older adults," or change in "interest in becoming a geriatric psychiatrist." CONCLUSION: The results of this pragmatic education RCT suggest that exposing third-year medical students to 2-4 weeks of geriatric psychiatry did not increase their interest to care for older adults or become a geriatric psychiatrist. However, it did increase their comfort level in working with older adults and their families. However, more research is necessary to identify potential interventions that could inspire and increase medical student interest in caring for older adults as part of their future careers.

Introduction We expect that in the next 25 years, the population aged older than 65 will nearly double in the Unites States and Canada and other developing countries alike. This age group will require an increased amount of health care with increasing psychiatric, cognitive and medical complexity. However, there are few new incoming doctors wishing to care for older adults as part of their general medical practice, or to specialize in geriatric psychiatry or geriatric medicine. We hypothesize that early clinical exposure to elderly patients’ care could increase students’ interest in caring for older adults during their future career. Methods We conducted a pragmatic medical education randomized controlled trial at the Jewish General Hospital and the Douglas Mental Health Institute, McGill University in Montreal, Canada. 3rd year Medical students undergoing their mandatory 16-week half-time clerkship rotation in psychiatry were randomized to the equivalent of 2-4 weeks full-time exposure to clinical geriatric psychiatry (n=84). The main outcome measured was change in “interest in caring for older adults as part of your future practice” at the end of the mandatory psychiatry clerkship rotation. The secondary outcomes were change in “interest in becoming a geriatric psychiatrist” and change in “comfort in working with geriatric patients and their families”. We compared the intervention and control groups for demographic and other potentially confounding variables using the Chi-Squared Test and we examined bivariate associations between exposure to geriatric psychiatry and interest in caring for older adults using Chi-Square and the Mann-Whitey-U tests. Results Being randomized to geriatric psychiatry exposure (n=44/84) was associated with increased “comfort in working with geriatric patients and their families” at a 16-week follow-up (χ² (1) =3.9, p=0.05) but there was no significant association found between geriatric psychiatry exposure and change “in interest in caring for older adults” (χ² (1) =0.3, p=0.6), or change in “interest in becoming a geriatric psychiatrist” (χ² (1) =0.2, p=0.7). Conclusions The results of this pragmatic geriatric psychiatry education RCT suggest that exposing 3rd year medical students to 2-4 weeks of geriatric psychiatry did not increase their interest to care for older adults in their future medical career or did not make them want to become a geriatric psychiatrist. However, it did increase their comfort level in working with older adults and their families, an important established predictor in the literature for choosing a medical career with patients 65 years and over. We believe these RCT results will help inform the design of medical school curricula in preparation for an increasingly again population in America and worldwide. However, more research is necessary to decorticate and identify potential co-synergic variables that would inspire and increase medical students’ interest in caring for older adults as part of their future careers. This research was funded by This project was supported by Charitable Donations to the Jewish General Hospital, as well as the Canadian Institutes of Health Research Fellowship Award. Dr. Rej is supported by a Fonds de Recherche Santé Québec (FRQS) Clinician-Scientist Award and has investigator-initiated grant funding from Satellite Healthcare (dialysis company) for an unrelated project.