EARLY CLINICAL EXPOSURE TO GERIATRIC PSYCHIATRY AND MEDICAL STUDENTS’ INTEREST IN CARING FOR OLDER ADULTS: A RANDOMIZED CONTROLLED TRIAL

AAGP Annual Meeting 2019 potential to facilitate early detection and pre-emptive intervention for these symptoms by enabling continuous passive monitoring in a way that in-person monitoring may not be able to. We present preliminary data for such an approach using a device called the Emerald, developed at MIT, which emits low-powered radio signals and can identify and track parameters related to human behavior (sleep, motion, spatial motion, and respiratory rate) based on how these waves reflect off the human body. Artificial Intelligence (AI) algorithms elicit behavioral markers from sensor data. The device does not require any contact or direct interaction by the person being monitored, thus representing true passive sensing. Methods: The Emerald device was installed in the rooms of two dementia patients (N=2) with behavioral symptoms residing in an assisted living facility (ALF). Motion data was gathered continuously for a period of three months and was mapped on to spatial location and time frame. Data processing and analysis occurred simultaneously during the collection period. Additionally, study staff administered weekly standardized assessments to both the participant (MMSE) and ALF staff (NPINH, CMAI, PAS) to augment data collected from the Emerald. Device data was compiled and made available to the study clinician for clinical analysis and identification of emergent behavioral complications. Results: In both participants, device data were used to identify specific behavioral patterns. The device detected variations in behavior by time of day, escalations in pacing, and moments of restlessness throughout the night for both participants. For one participant, clinical interpretation of device data led to the proposition that the participant was experiencing Periodic Limb Movement Disorder, which was unbeknownst to the participant or clinician prior to study participation. The device was able to identify periodic spasms, which occurred when the person was asleep, and localize these to the patient’s legs. The second participant showed increase pacing, wandering, and motor agitation before being hospitalized for heightened anxiety and aggression. Device data indicates the period prior to hospitalization featured increased movement episodes relative to this participant’s baseline. Conclusions: We propose that behavioral phenotyping using an AI-backed passive sensing approach is feasible and safe, and that this approach can help digitally phenotype behavior symptoms in dementia. While the device merits validation against the current standard of behavior measurement in dementia, its advantages include low cost and ongoing engagement, and continuous monitoring while giving patients the option of stopping monitoring at their discretion. Further studies evaluating sensitivity and reliability are warranted to validate the clinical utility of this device. This research was funded by: This project is supported by an Innovations grant from the Massachusetts Institute of Technology.

Poster Number: LB - 7

EARLY CLINICAL EXPOSURE TO GERIATRIC PSYCHIATRY AND MEDICAL STUDENTS’ INTEREST IN CARING FOR OLDER ADULTS: A RANDOMIZED CONTROLLED TRIAL Klara Pokrzywko1,2; Susana Gabriela Torres-Platas1; Petal Abdool3; Marouane Nassim1; Trent Semeniuk4; Yara Moussa1; Chloe Leon3; Wayne Baici3; Michael Wilkins-Ho5; Paul Blackburn5; Jess Friedland4; NP Vasavan Nair4; Karl Looper6; Marilyn. Segal6; Tricia Woo7; Marie-Andree Bruneau2; Tarek Rajji3; Soham Rej1,3 1

Geri-PARTy Research Group, Dept. of Psychiatry, Jewish General Hospital, McGill University Dept. of Psychiatry, University of Montreal 3 Div. of Geriatric Psychiatry, Center for Addiction and Mental Health, University of Toronto 4 Div. of Geriatric Psychiatry, Douglas University Mental Health Institute, McGill University 5 Division of Geriatric Psychiatry, University of British Columbia 6 Dept. of Psychiatry, Jewish General Hospital, McGill University 7 Div. of Geriatric Medicine, St. Peter’s Hospital, McMaster University 2

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”.

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Am J Geriatr Psychiatry 27:3S, March 2019

AAGP Annual Meeting 2019 We compared the intervention and control groups for demographic and other potentially confounding variables using the ChiSquared 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 (x2 (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” (x2 (1) =0.3, p=0.6), or change in “interest in becoming a geriatric psychiatrist” (x2 (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 Sante Quebec (FRQS) Clinician-Scientist Award and has investigator-initiated grant funding from Satellite Healthcare (dialysis company) for an unrelated project.

TABLE 1. Medical Students’ Baseline Characteristics (n=84)

Variable Age, y 19-25 26-30 31-35 36-40 Female Caucasian Having experience caring for older adults before medical school

Exposed Geriatric Psychiatric Rotation (n=44)

Unexposed Geriatric Psychiatric Rotation (n=40)

68.2%(n=30) 27.3%(n=12) 2.3%(n=1) 2.3%(n=1) 65.9% (n=29) 63.6%(n=28) 52.3%(n=23)

57.5%(n=23) 32.5%(n=13) 10%(n=4) 0%(n=0) 50% (n=20) 57.5%(n=23) 62.5%(n=25)

Statistics ((df), p)

c2(3) =3.6, p=0.3 c2(1) =2.2, p=0.1 c2(1) =0.3, p=0.6 c2(1) =0.9, p=0.3

TABLE 2. Effect of 3rd Year Medical School Clerkship Geriatric Psychiatry Intervention on Outcomes (n=84)

Variable Change in interest in caring for older adults (10-point scale) Increase in interest in caring for older adults (yes/no) Change in interest in becoming a Geriatric Psychiatrist (10-point scale) Increase in interest in becoming a Geriatric Psychiatrist (yes/no) Change in comfort in working with geriatric patients and their families (10-point scale)

Am J Geriatr Psychiatry 27:3S, March 2019

Exposed Geriatric Psychiatric Rotation (n=44)

Unexposed Geriatric Psychiatric Rotation (n=40)

Statistics

0.98 (+/-2.31)

0.57(+/-2.52)

U =851, p=0.8

60% (n=24)

c2(1) =0.3, p=0.6

0.33(+/-2.18)

U =837.5, p=0.7

30%(n=12)

c2(1) =0.2, p=0.7

¡0.08(+/-2.45)

U =683, p=0.08

54.5% (n=24) 0.73(+/-2.03) 34.1%(n=15) 0.70(+/-2.30)

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