Management Of Psychological Symptoms Research Articles

Exposure to Anticholinergic and Sedative Drugs and Healthcare Costs in Older Patients with Neurocognitive Disorders.

Literature supports an increasing number of older patients living with neurocognitive disorders alongside with their annual worldwide costs. Therapeutic management of behavioral and psychological symptoms includes the use of anticholinergic and sedative drugs for which significant exposure is negatively associated with clinical outcomes. The aim of this study was to assess the healthcare costs differences related to an increase in the exposure to anticholinergic and sedative drugs in older patients with neurocognitive disorder. A longitudinal study was conducted during 3 years on 1,604 participants of the MEMORA cohort linked with both regional public health insurance and hospital discharge databases between 2012 and 2017. Direct medical and non-medical costs were included. Exposure to anticholinergic and sedative drugs was measured by the drug burden index (DBI). Costs difference associated with a DBI≥0.5 were + 338€ (p < 0.001). After adjustment on comorbidities, NCD stage, cognitive impairment, functional limitation, polypharmacy, and sociodemographic characteristics, a DBI≥0.5 was found to be an independent predictor of an increase of total healthcare costs by 22%(p < 0.001). Anticholinergic and sedative drugs have a substantial economic burden among older patients with neurocognitive disorder. More studies are required to assess the clinical and economic impact of an efficient strategy based on the reduction of the exposure to anticholinergic and sedative drugs and the promotion of non-pharmacological interventions.

Efficacy of the Complementary and Alternative Therapies for the Management of Psychological Symptoms of Menopause: A Systematic Review of Randomized Controlled Trials.

Menopause is not a high-risk period for psychiatric illness but can cause psychological issues; the most common of which are anxiety and depression, which can impair coping and reduce women’s quality of life. Thus, many women have leaned toward complementary and alternative medicine (CAM) for the relief of menopause-related symptoms. No rigorous study exists in the literature on the effects of CAMs on the psychological symptoms of menopause despite this growing patient interest. This systematic review aimed to assess the efficacy of CAM interventions on psychological symptoms of menopause. Databases (PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar) were searched from January 2000 to May 2021 using the keywords: menopause, menopausal symptoms, psychological symptoms, and complementary and alternative medicine. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool (MMAT) for randomized clinical trials. Of the 704 articles found, 33 articles with 3,092 participants entered the final review. Aromatherapy, massage, yoga, and acupuncture, as well as some dietary and herbal supplements improved psychological symptoms during menopause based on the findings of the current study. However, the effectiveness of reflexology and exercise was debatable. However, necessary precautions should be taken when using them in clinical settings despite the positive effect of various CAM interventions on reducing psychological symptoms. More studies with a higher methodology quality are required to make better decisions about the effect of various CAM interventions on the psychological symptoms of menopause.

Room for improvement: An online survey of allied health professionals' dementia knowledge.

To evaluate the dementia knowledge of allied health professionals and identify their specific learning needs. An online survey was conducted with allied health professionals enrolled in the Understanding Dementia Massive Open Online Course, a free course open to anyone, worldwide. The primary outcome measure was the Dementia Knowledge Assessment Scale, assessed prior to course commencement. The survey was completed by 1591 participants. The mean dementia knowledge score was 35.0 (SD 8.4), with 13% (n=207) achieving a target score of 45/50 or above, indicating comprehensive dementia knowledge. Key knowledge gaps were in the areas of dementia onset and non-pharmacological management of behavioural and psychological symptoms of dementia. Allied health professionals surveyed had significant gaps in dementia knowledge. Educators planning dementia curriculum for allied health professionals could consider addressing areas of knowledge related to the identified items, with view to providing a foundation for excellence in dementia care.

Masupirdine (SUVN‐502): Novel treatment option for the management of behavioral and psychological symptoms in patients with Alzheimer’s disease

AbstractBackground5‐hydroxytryptamine‐6 (5‐HT6) receptors are G‐protein coupled receptors localized in the brain regions primarily involved in cognition and behavior i.e., cortex, dorsal hippocampus and striatum. Evidence from the studies in animal models suggests that 5‐HT6 receptor antagonist may have a potential role in controlling behavior and psychosis. Masupirdine is a pure 5‐HT6 receptor antagonist under clinical development for the management of AD and behavioral and psychological symptoms.MethodTriple therapy with masupirdine added to background dual combination treatment with donepezil and memantine was evaluated in a phase‐2 proof‐of‐concept, 26‐week, randomized, double‐blind, placebo‐controlled, multicenter, parallel groups study conducted across several sites in the United States. In this study, effects of masupirdine on the neuropsychiatric symptoms and cognition were evaluated using the Neuropsychiatric Inventory (NPI‐12) and Alzheimer's Disease Assessment Scale–Cognitive subscale (ADAS‐Cog 11), respectively in patients with moderate AD.ResultOut of 564 randomized patients, 183 patients received placebo, 184 patients received 50 mg of masupirdine and 176 patients received 100 mg of masupirdine. Masupirdine attenuated the agitation/aggression scores in the subgroup of patients who had baseline agitation/aggression. The effect observed was above the minimum clinically important difference (0.4 SD). In another subgroup of patients, masupirdine attenuated the psychotic symptoms (delusions and hallucinations) and also emergence of psychotic symptoms. Significant reduction in the cognitive decline was also noticed with masupirdine treatment in the subgroups of patients having psychotic symptoms. Masupirdine was generally safe and well tolerated in this study.ConclusionMasupirdine treatment significantly reduced the behavioral and psychological symptoms i.e., agitation/aggression and psychotic symptoms (delusions and hallucinations) with positive effect on cognition. Masupirdine could be a differentiated novel therapeutic treatment option for the management of behavioral and psychological symptoms in patients with AD.

Optimizing Practices, Use, Care and Services‐Antipsychotics (OPUS‐AP): A phase 2 scale‐up to 129 long‐term care (LTC) centers in Quebec, Canada

AbstractBackgroundAntipsychotics are often used for the first‐line management of behavioral and psychological symptoms of dementia (BPSD) despite risks and side effects, and with disregard for guidelines recommendations to prioritize non‐pharmacological interventions. OPUS‐AP builds on Canadian Foundation for Healthcare Improvement, Appropriate Use of Antipsychotic initiatives and previous work by the 4 university‐affiliated research centers on an aging population in Quebec. The OPUS‐AP strategy is supported by an evidence‐based approach, involving provincial clinical guidelines developed by Québec’s health‐technology assessment agency, the Institut national d’excellence en santé et en services sociaux (INESSS). In phase 1 of OPUS‐AP, conducted in 24 long‐term care (LTC) centers in Quebec, Canada, antipsychotic deprescribing (cessation or dose decrease) was achieved in 85,5% of residents in whom it was attempted (Cossette et al. JAMDA, 2019).MethodPhase 2 of OPUS‐AP was conducted in 129 LTC centres in Quebec, Canada, from April to December 2019. OPUS‐AP aims at improving resident care through increased staff’s knowledge and competency, resident‐centered approaches, nonpharmacologic interventions, and antipsychotic deprescribing in inappropriate indications. OPUS‐AP is implemented through integrated knowledge translation and mobilization activities. Antipsychotic, benzodiazepine, antidepressant prescriptions and BPSD were evaluated every 3 months for 6 months.ResultAt baseline, 10,601 residents were admitted on OPUS‐AP participating wards from which 74% had a diagnosis of major neurocognitive disorder (MNCD) and 47% an antipsychotic prescription. The follow‐up cohort included 4,087 residents with both MNCD and antipsychotic prescription. Among the 1216 residents in whom antipsychotic deprescribing was attempted between baseline and 6 months and still included at 6 months, successful deprescribing was achieved in 85.6% (cessation 50.0% or dose decrease 35.6%). No increase in benzodiazepine or antidepressant prescriptions nor worsening of BPSD were observed.ConclusionPhase 2 of OPUS‐AP confirmed phase 1 results of successful antipsychotic deprescribing with scale‐up to 129 LTC centers. Phase 3 of OPUS‐AP is underway in 2020 in all of Quebec’s 341 public LTC centers.

UK clinicians’ views on the use of formulations for the management of BPSD: a multidisciplinary survey

Background and objectives The process of formulating in the area of dementia care is at an early stage of development. A review published in 2016, identified 14 different types of formulation-based approaches for the management of Behavioural and Psychological Symptoms of Dementia (BPSD). The present study examines professionals’ views about the use of systematic formulations for choosing first-line non-pharmacological interventions for BPSD. Methods A 34-item online survey, with six items about formulation-based interventions for the management of BPSD, was circulated to multi-disciplinary UK dementia networks. Quantitative data were examined for the use of formulation-based frameworks in practice. Thematic analyses provided insight into the practicalities of using formulations. Results The majority of the 355 participants responding to the questions stated they used formulation-led models to inform interventions, but 24% stated they did not. Thirty-two types of formulation frameworks were named, and there was a diverse spread across the UK. The Newcastle model was the most frequently used framework, with fifty percent of the participants who formulated reporting using this framework. Four themes regarding the use of formulation emerged, relating to function, process, reported outcomes and obstacles. Conclusion Formulation-based approaches to targeting intervention are becoming popular in dementia care in the UK. More types of formulation frameworks are used in practice compared with the 2016 review. The use of formulations are seen as key to offering an alternative to pharmacological treatments. Understanding both the value of formulation-led approaches and the obstacles to their use are important to implementing NICE 2018 recommendations.

Creating a Colocation Unit for End-of-Life Care during a Pandemic.

Background: Palliative care seeks to support the physical, psycho-social and spiritual needs of patients and families who are facing life threatening diseases. Advantages of establishing a palliative care unit, or alternatively co-locating patients, include promoting optimal physical and psychological symptom management; increased family satisfaction; and facilitating resource allocation. Objective: To design a stand-alone hospital unit to provide end of life care during a pandemic. Setting: Mount Sinai Hospital (MSH), a 1,144 bed tertiary- and quaternary-care teaching facility and Brookdale Department of Geriatrics and Palliative Medicine of the Icahn School of Medicine at Mt Sinai. Method: Tracking key indicators signaling the need for conversion to a COVID-19 unit, and identifying factors to facilitate a successful conversion. Result/Implementation: Using previously identified key focused action categories as framework, we describe our successful palliative care unit (PCU) conversion into a COVID-19 care unit. Conclusion: We believe that these operational insights gained from transforming our unit during COVID-19 will be helpful to other programs and institutions during a pandemic, or public health emergencies.

The Influence of Telemedicine Care on the Management of Behavioral and Psychological Symptoms in Dementia (BPSD) Risk Factors Induced or Exacerbated During the COVID-19 Pandemic.

The number of people with dementia worldwide is expected to increase to approximately 1.3 billion in 2050. Almost 90% of patients diagnosed with dementia suffer from behavioral and psychological symptoms of dementia (BPSD). BPSD causes and risk factors are multiple and complex and can be responsible for hospitalizations in long-term institutions, psychiatric hospitalizations and search for health services. Recently, the world imposition of social distance and self-isolation as the best preventive measures for the COVID-19 pandemic has created challenges in the health care and management of this population, which may trigger or aggravate BPSD, and most caregivers are not prepared to address it. In face of this actual social distancing, telemedicine comes to be a tool for improving the management of these acute symptoms and mental care. In this article, we discuss and disseminate recommendations on this important alternative of assistance, especially considering the cases of BPSD. In this context of a pandemic, even patients with BPSD and caregivers require more frequent and updated guidance, considering the difficult context to social distance. Telemedicine can reduce the risk for the development of negative outcomes in mental health precipitated by the reduction of social contact and less access to health services, improving dementia symptom management, mainly BPSD.

An international systematic review of dementia caregiving interventions for Chinese families.

Older Asians and Chinese are among the least studied populations in the dementia caregiving literature. This review seeks to critically synthesize the literature on intervention characteristics, components and tailoring strategies for dementia family caregivers in Chinese communities globally. Five electronic databases (PsychINFO, PubMed, CINAHL, ScienceDirect and Google Scholar) were searched for articles published between 1980 and July 2018. The protocol of this review was registered with PROSPERO (CRD42019132800). Twenty-nine unique interventions across 39 papers met inclusion criteria. Results from descriptive and thematic syntheses revealed that most interventions were psychoeducational, CBT-based, multicomponent, structured, and less than a year in duration. Disease education, management of behavioral and psychological symptoms of dementia, stress coping techniques, and referral to community resources were frequently included in interventions. Community-, culture- and language-focused strategies were used to tailor interventions. The most common tailoring strategies were: (a) using community networks and media for outreach and recruitment; (b) making translations and language adaptations to the intervention materials; and (c) focusing on trust and therapeutic alliance. Most interventions produced desired outcomes, particularly reducing caregiver burden and increasing self-efficacy. To our knowledge, this is the first review to date that systematically synthesized the characteristics and tailoring of dementia caregiving interventions for Chinese families globally. Current findings suggest that most interventions are effective, although many only superficially address Chinese culture. Future research should incorporate Chinese values and cross-cultural challenges into caregiving interventions for deep-level adaptations that could potentially be more effective to engage and support Chinese caregivers.

Moving Evidence-Informed Assessment and Management of Behavioral and Psychological Symptoms of Dementia into the Real World: Training Family and Staff Caregivers in the DICE Approach

ObjectiveTo investigate the impact of a one-day training program on caregivers’ confidence and knowledge in managing aspects of dementia care. DesignOne-day caregiver training program featuring: 1) an interactive, multi-media format; 2) a companion manual; and 3) a “brain-storming” session at the end of the day that utilized attendees’ real-world cases where the use of the DICE (Describe, Investigate, Create, and Evaluate) approach was illustrated “live.” SettingThree different geographical sites in Michigan. ParticipantsFamily (n = 40) and professional (paid; n = 140) caregivers (total n = 180) for people with dementia. MeasuresPre- and post self-ratings related to confidence in aspects of dementia care management before and directly after the training. ResultsComparing self-ratings pre- and post-training, more than 50% of family caregivers showed improvement in confidence post-training on 11 of 12 items with significant improvement in 4 items. Among professionals, more than 50% of caregivers showed improved confidence on 3 of 12 items, with 4 items showing significant improvement. Family caregivers were significantly more likely than professionals to show improved confidence on 6 of 12 items. ConclusionsThe number of people with dementia and their family caregivers is large and growing every day with the aging of the population. Living well with dementia is the goal. Current care systems are inadequate and lead to multiple poor outcomes. Innovative solutions like the DICE Approach with delivery methods including a manual and interactive training can put the key components of good dementia care at the fingertips of the people who need it most.

Clinical Oncology Society of Australia: Position statement on cancer-related malnutrition and sarcopenia.

This position statement describes the recommendations of the Clinical Oncology Society of Australia (COSA) regarding management of cancer‐related malnutrition and sarcopenia. A multidisciplinary working group completed a review of the literature, focused on evidence‐based guidelines, systematic reviews and meta‐analyses, to develop recommendations for the position statement. National consultation of the position statement content was undertaken through COSA members. All people with cancer should be screened for malnutrition and sarcopenia in all health settings at diagnosis and as the clinical situation changes throughout treatment and recovery. People identified as “at risk” of malnutrition or with a high‐risk cancer diagnosis or treatment plan should have a comprehensive nutrition assessment; people identified as “at risk” of sarcopenia should have a comprehensive evaluation of muscle status using a combination of assessments for muscle mass, muscle strength and function. All people with cancer‐related malnutrition and sarcopenia should have access to the core components of treatment, including medical nutrition therapy, targeted exercise prescription and physical and psychological symptom management. Treatment for cancer‐related malnutrition and sarcopenia should be individualised, in collaboration with the multidisciplinary team (MDT), and tailored to meet needs at each stage of cancer treatment. Health services should ensure a broad range of health care professionals across the MDT have the skills and confidence to recognise malnutrition and sarcopenia to facilitate timely referrals and treatment. The position statement is expected to provide guidance at a national level to improve the multidisciplinary management of cancer‐related malnutrition and sarcopenia.

Management of spasticity and psychological symptoms through hypnosis in stroke survivors

Studies have shown that stroke survivors are associated with physical as well as psychological symptoms. Spasticity is the main physical issue associated with stroke survivors and stress, anxiety, and depression are common.&#x0D; This study was conducted to investigate any effect of hypnosis on the psychological symptoms (anxiety, stress, and depression) and on the spasticity in the stroke survivors.

Personalising Management of Behavioural and Psychological Symptoms of Dementia in Nursing Homes: Exploring the Synergy of Quantitative and Qualitative Data.

Researchers have been exploring how to manage Behavioural and Psychological Symptoms of Dementia (BPSD) in a personalised way, meanwhile, assistive technologies have been developed to collect a variety of personal data. This urges more research in investigating the combination of: data collected by the care team, which are mainly qualitative; and data collected by assistive technologies, the majority of which are quantitative. Previous studies, however, have yet to explore if and how a combination of quantitative and qualitative data could facilitate the care team to better understand each resident with dementia in the nursing home context for personalised BPSD management. Guided by a Research through Design approach, a prototype for collecting and visualising the quantitative and qualitative data towards personalised BPSD management was developed together with the care team. Via developing this prototype, knowledge was gained in what types of data could be combined for personalised BPSD management in nursing homes, what are their values, how to collect and present them, and how to introduce them in the working routine of the care team for analysis. The main findings suggest that the types of data to be collected could be unique for each resident with dementia; the quantitative and qualitative data are of value to each other during data collection and analysis; data collection should be quick and standardised yet flexible for the care team; the overview page is vital for data presentation; and user scenarios could be created to nudge the care team to analyse the data at certain points of their working routine. In general, a combination of qualitative data and quantitative data could help the care team to discover more insights about each resident with dementia and thus improve the current practice of personalised BPSD management.

Symptom clusters and quality of life in Chinese patients with heart failure

BackgroundEffective symptom assessment and management can improve quality of life in patients with heart failure. However, how psychological symptom cluster, physical symptom cluster and heart failure symptom cluster influence the quality of life of patients with heart failure remains unknown. Aims(a) To describe the symptom clusters among Chinese patients with heart failure (HF), (b) explore the relationship between symptom clusters and quality of life (QOL), and (c) detect if physical and psychological symptoms are mediators of the association between heart failure symptom and QOL. MethodsThree hundred and one patients with heart failure completed measures of symptom (MSAS), QOL and demographic and clinical characteristics. Multiple regression analysis was used to analyse the data. FindingsThe mean age of participants was 72.19 years (range 31–96 years). Each patient was approximately accompanied by an average of 11.19 symptoms (range 0–31), and the top six most common symptoms of Chinese HF patients were shortness of breath, difficulty sleeping, difficulty breathing when lying flat, lack of energy, lack of appetite and cough. Both physical symptom cluster and psychological symptom cluster were the mediators of the relationship between heart failure symptom cluster and QOL. ConclusionsThere were mediating effects of physical symptom cluster and psychological symptom cluster between heart failure symptom cluster and QOL in Chinese patients with HF. Operative assessment, management and alleviation of physical symptoms and psychological symptoms should be prioritised in symptom management strategies for the clinical caregivers.

Montessori intervention for individuals with dementia: feasibility study of a culturally adapted psychosocial intervention in Pakistan (MIRACLE).

Globally, nearly two-thirds of people with dementia reside in low- and middle-income countries (LMICs), yet research on how to support people with dementia in LMIC settings is sparse, particularly regarding the management of behavioural and psychological symptoms of dementia. Understanding how best to manage these symptoms of dementia with non-specialist approaches in LMICs is critical. One such approach is a non-pharmacological intervention based on the Montessori method. To evaluate the feasibility and acceptability of a culturally adapted, group-based Montessori intervention for care home residents with dementia and their study partners, who were paid care workers in Pakistan. This was a two-stage study: a cultural adaptation of the Montessori intervention and a single-arm, open-label, feasibility and acceptability study of 12 participant dyads. Feasibility and tolerability of the intervention and study procedures were determined through the recruitment rate, adherence to the protocol and acceptance of the intervention. Qualitative interviews were undertaken with the study partners. A pre-post exploratory analysis of ratings of behavioural and psychological symptoms of dementia, functional ability and quality of life were also conducted. The recruitment and retention rates of people with dementia were acceptable, and the intervention was well tolerated by participant dyads. Findings show a reduction in agitation levels and improvement in mood and interest for the activities. Feasibility studies of low-cost, easy-to-deliver and culturally adapted interventions are essential in laying the groundwork for subsequent definitive effectiveness and/or implementation trials for dementia in LMICs, where awareness and resources for dementia are limited.

An Integrative Review of the Role of Palliative Care in Lung Transplantation.

Lung transplant patients experience significant physical symptoms and psychological stress that affect their quality of life. Palliative care is an interdisciplinary specialty associated with improved symptom management and enhanced quality of life. Little, however, is known about the palliative care needs of lung transplant patients and the role it plays in their care. The aim of this integrative review was to synthesize the literature describing the palliative care needs, the current role, and factors influencing the integration of palliative care in the care of lung transplant patients. We searched PubMed, Scopus, CINAHL, and Embase to identify English-language, primary studies focused on palliative care in adult lung transplantation. Study quality was evaluated using Strengthening the Report of Observational studies in Epidemiology and Consolidated Criteria for Reporting Qualitative Research criteria. Seven articles were included in the review. Most were single-center, descriptive studies. Two studies used qualitative and 5 used quantitative methodologies. Collectively, these studies suggest that palliative care is typically consulted for physical and psychological symptom management, although consultation is uncommon and often occurs late in the lung transplant process. We found no studies that systematically assessed palliative needs. Misperceptions about palliative care, communication challenges, and unrealistic patient/family expectations are identified barriers to the integration. While limited, evidence suggests that palliative care can be successfully integrated into lung transplant patient management. Empirical literature about palliative care in lung transplantation is sparse. Further research is needed to define the needs and opportunities for integration into the care of these patients.

Gender differences in presentation and management of behavioral and psychological symptoms associated with dementia among nursing home residents with moderate to severe dementia

ABSTRACT Lack of identification and management of behavioral and psychological symptoms of dementia (BPSD) can negatively impact female residents. The purpose of this secondary data analysis was to explore gender differences in presentation and management of BPSD and quality of interactions between residents and staff. A total of 553 residents from 55 nursing homes were included. Males exhibited more apathy and sexually inappropriate behavior and females exhibited more anxiety and sadness. Anxiety and sexually inappropriate behavior were more likely to be addressed in care plans for males than females. There was no difference in how staff interacted with males or females.

Implementation of the Evidence Integration Triangle for the Management of Behavioral Psychological Symptoms of Dementia (EIT-4-BPSD) Intervention in a Nursing Home Setting.

Behavioral Psychological Symptoms of Dementia (BPSD) are described as symptoms of apathy, agitation, inappropriate vocalization, aggression, wandering, and resistiveness to care. Not managing BPSD appropriately can cause an increase in frustration, stress, and burnout amongst staff members, and negatively impacts the health and quality of life for residents with dementia. Psychotropic medications are often administered to residents with BPSD in long-term care facilities and can lead to adverse effects such as an increase in falls, mortality, cardiovascular events, and hospitalizations. The Centers for Medicare and Medicaid Services require facilities to use non-pharmacological person-centered interventions as first line treatment for the management of BPSD.

Sleep disturbances in HIV-HCV coinfected patients: indications for clinical management in the HCV cure era (ANRS CO13 HEPAVIH cohort).

Although common among patients coinfected with HIV and hepatitis C virus (HCV), sleep disturbances (SD) are still poorly documented in this population in the HCV cure era. This longitudinal study aimed at analysing SD in HIV-HCV coinfected patients and identifying their clinical and sociobehavioural correlates. We used 5-year annual follow-up data from 1047 participants in the French National Agency for Research on Aids and Viral Hepatitis Cohort 13 'Hépatite et VIH' (ANRS CO13 HEPAVIH) cohort of HIV-HCV coinfected patients to identify clinical (medical records) and behavioural (self-administered questionnaires) correlates of SD (mixed-effects logistic regression). SD were identified using one item documenting the occurrence of insomnia or difficulty falling asleep (ANRS 'Action Coordonnée 24' self-reported symptoms checklist), and two items documenting perceived sleep quality (Center for Epidemiologic Studies Depression and WHO Quality of Life HIV-specific brief scales). Seven hundred and sixteen (68.4%) patients with completed self-administered questionnaires reported SD at their most recent follow-up visit. In the multivariable model, hazardous alcohol consumption (Alcohol Use Disorders Identification Test-Consumption score ≥ 4 for men, ≥ 3 for women) (adjusted odds ratio = 1.61; 95% confidence interval: 1.09-2.36), depressive symptoms (6.78; 4.36-10.55) and the number of other physical and psychological self-reported symptoms (1.10; 1.07-1.13) were associated independently with SD after adjustment for sex, age and employment status. HCV cure was not associated significantly with SD. SD remain frequent in HIV-HCV coinfected patients and are associated with a series of modifiable behavioural risk factors. Independent of HCV cure, improved screening and comprehensive management of alcohol use, physical and psychological self-reported symptoms and depression are essential in this population. Closer investigation of these risk factors of SDs may both increase sleep quality and indirectly improve patients' clinical outcomes.

PREVALENCE AND CORRELATES OF SYMPTOMS OF ANXIETY AND DEPRESSION AT THE VERY END OF LIFE

Rates of psychological symptoms for patients with serious illness is high, but there has been limited research investigating psychological symptoms at the very end of life. The aim of this study was to better understand the prevalence, intensity and correlates of psychological distress at the very end of life. This cross-sectional study utilized caregiver proxy interviews. Caregivers were contacted after their loved one recently died after being on home hospice and invited to participate in a brief interview with a trained research assistant. Patient, caregiver and hospice utilization data were also abstracted from electronic medical records. N = 351 caregivers were included in the study. According to caregivers, 46.4% of patients had moderate to severe anxiety, as assessed with a score of ≥4 on the Edmonton Symptom Assessment Scale (ESAS) and 43% had moderate to severe symptoms of depression in the last week of life. Symptoms of anxiety and depression were significantly associated with caregiver burden scores and inversely associated with the age of the patient. Psychological symptom management at the very end of life is essential to providing comprehensive hospice care. Our study revealed that nearly half of patients die with moderate to severe symptoms of anxiety and/or depression. Future research is needed to improve psychological symptom management at the very end of life in order to improve the quality of life for both patients and their families.