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Demographic transition and changes in the population structure has contributed to global challenges related to population ageing. World Health Organization (WHO) has proposed global strategy and action plan on ageing and health to address the challenges related to population ageing. Despite the decline in intrinsic capacity, provision of appropriate environmental support can help in improving the functional ability and promoting Healthy ageing. India and Brazil are large countries with rapid population ageing with significant needs and challenges to promote Healthy Ageing. Both countries have significant differences in the cultural and socio-economic factors related to population ageing and rich history of traditional/alternative medicine interventions (such as Yoga and Ayurveda in India). Older adults have multiple comorbidities of physical and mental health issues with many of them seeking treatment from alternative systems of medicine. Holistic approach with integrated care will be helpful in older adults to promote healthy ageing. This symposium will summarize the holistic approach to healthy ageing in the global context with specific focus on the perspectives from India and Brazil.Mental health experts from India and Brazil with expertise in Geriatric Psychiatry and Integrative Medicine will be the presenters for the symposium. The symposium will have the following presentations 1.Holistic approach to Healthy ageing: Global Perspectives: Prof. Sivakumar Palanimuthu Thangaraju, Professor of Psychiatry & Head, Geriatric Psychiatry Unit, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India 2.Lifestyle interventions through Integrative medicine to promote Healthy Ageing: Indian Perspective: Prof. Shivarama Varambally, Professor, Department of Psychiatry & Former Head, Department of Integrative Medicine, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India 3.Scope for Traditional medicine and Holistic approach to Promoting Healthy Ageing in Brazil: Dr Bernardo Viana, Assistant Professor of Psychiatry, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil

Population ageing is occurring rapidly in India with the proportion of older adults (aged 60 years and above) estimated to reach 20% by the year 2050 from the existing 10%. The prevalence of mental health problems in older adults is also expected to increase significantly due to population ageing. Nearly 20% of older adults have at least one mental health condition including the subsyndromal conditions. The data from National Mental Health Survey (NMHS), Longitudinal Ageing Study of India (LASI) and the recent LASI-Diagnostic Assessment of Dementia have estimated the national prevalence of Psychiatric disorders like depression and dementia. 30.2% of older adults have significant depressive symptoms and 8.3% have major depressive disorder. The prevalence of dementia is estimated as 7.4% with an estimate of 8.8 million persons with dementia in 2016 and projected increase to 16.8 million in 2036. More than 90% of older adults with mental health problems in India remain undiagnosed and untreated. Access to non-pharmacological interventions for older adults with mental health conditions as well as their caregivers are very limited. Mental health problems in older adults are often considered as normal for ageing by older adults, family caregivers as well as health care professionals. Dedicated and specialized clinical services for geriatric mental health care is not available in most of the mental health care institutions. This symposium will present a critical review of the progress in geriatric mental health care services across India by summarizing the initiatives to promote geriatric mental health care and training. The need for comprehensive psychosocial care and psychiatric rehabilitation along with the acute geriatric mental health care will be addressed by experts involved in geriatric mental health care and training. The symposium will have the following presentations. 1.Geriatric mental health care in India- scope, challenges and innovative initiatives: Prof. Sivakumar Palanimuthu Thangaraju, Professor of Psychiatry & Head, Geriatric Psychiatry Unit, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India 2.A review of the initiatives for the training to promote the workforce for geriatric mental health care in India: Prof. Krishna Prasad Muliyala, Professor of Psychiatry & Head, Psychiatric Rehabilitation Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India 3.Psychosocial interventions for geriatric mental health care- Scope and challenges: Prof. Thirumoorthy A, Professor & Former Head, Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India

The population of older adults in India is projected to increase from the current estimate of 150 million to 350 million by the year 2050. The prevalence of older adults with mental health problems including dementia is also increasing rapidly. The socio‐cultural changes in the joint family system have necessitated the increasing requirement of formal caregivers for supporting the care of older adults in home as well as residential care institutions. Home care services providing caregiver assistance, day care, old age homes, residential care institutions for persons with mental illness or dementia are available predominantly in major cities. However, there is a huge variability in the profile of formal caregivers ranging from those with no training to qualified nurses as caregivers depending on the affordability. The need for training of formal caregivers in geriatric mental health and dementia care is acknowledged by most of the the stakeholders in the care of older adults. However, there are no minimum standards of training for the formal caregivers. The lack of trained caregivers has contributed to the increase of elder abuse, higher stress, and burnout for the caregivers with adverse impact on the quality of care of older adults. This presentation will summarize the experience and challenges related to the implementation of the training of formal caregivers in geriatric mental health and dementia care. The training initiatives for the formal caregivers conducted by the Government and Non‐Governmental organizations ranges from brief sensitization program for half a day to formal certificate course for 3 months. Most of the training programs are focused on the basic aspects of geriatric care with inadequate component of practical training. High rates of discontinuation and change of jobs, poor working conditions, lack of motivation among the caregivers and employers, lack of mandatory requirement of training are some of the important challenges limiting the progress in ensuring trained formal caregivers.

Background: Older adults are likely to experience psychological and social problems due to decline in physical strength, increased health issues, inadequate financial resources, and family dynamics. In this context, they need psychosocial care services to handle such challenges. Particularly, inmates of old-age homes are more vulnerable to experience such challenges as they are away from the family care. In this background, knowing their views on psychosocial care needs while living in old-age homes is significant to improve old-age home-based care. The aim of this study is to explore the psychosocial care needs expressed by the inmates of old-age homes. Materials and Methods: Inmates of old-age homes were selected using purposive sampling. A total of twenty residents out of four old-age homes of Bengaluru Metropolitan City were interviewed using a semi-structured interview guide. The qualitative content analysis has been carried out to identify core psychosocial care needs out of the text data. Results: Three themes, namely \"health-care needs,\" \"concerns regarding the behavior of the staff,\" and \"mental health needs,\" are emerged. Conclusion: The current study findings provide insiders' views and highlight the importance of psychosocial care services to address their needs at every old-age home.

The prevalence of mental health problems in older adults is increasing globally as well as in India due to population ageing. Mental Healthcare Act (MHCA) 2017 has a rights-based approach and came into force in India in May 2018. Its provisions have significant implications for promoting mental health care and protecting the rights of persons with mental illness (PMI). Older adults with mental health problems such as dementia have a high risk for loss of mental capacity, abuse, violation of their rights, and institutionalization. This act advocates the development of specialized clinical services for the older adults in mental health care institutions. It also recognizes the rights of PMI to access a range of services required, including rehabilitation services. Several provisions of the act, such as those related to mental capacity, advance directive, nominated representative, and responsibilities of other agencies, have specific challenges related to older adults with mental illness. In this article, we present a critical appraisal of the implications of MHCA 2017 in the context of the care of the older adults with mental illness.

Background: Dementia is a neurocognitive disorder that contributes to a high caregiver burden. This article describes caregivers' experiences in providing care at home for persons with dementia during the COVID-19 pandemic. The pandemic had brought the world to a standstill that no one alive had experienced before. Methods: Cross-sectional focus group discussion with 17 caregivers of persons living with Alzheimer's disease was conducted using video conferencing software. Results: The significant issues reported by the caregivers were changing routine, an increase in demanding behavior, an increase in the tendency of wandering behavior, increased frustration among caregivers, intolerance, and overall burden. However, some caregivers were also able to adapt to emerging situations and design a new set of daily living activities. Conclusion: Understanding caregiving experiences and guiding caregivers to build their resilience would prevent caregivers' burnout.

Alzheimer’s disease (AD), the most common cause of dementia, is a chronic illness characterized by cognitive symptoms, behavioural and psychological symptoms and difficulty in performing activities of daily living. Mild cognitive impairment (MCI) is regarded as a transitional state between healthy cognitive ageing and dementia and around 12–15% of individuals with MCI progress to dementia annually. This provides unique opportunity to initiate treatments targeted to delay or prevent the onset of AD. Based on the age at onset, AD is divided into two broad categories: early onset and late onset. Early onset AD follows the classical mendelian pattern of inheritance, whereas the late onset AD has a complex interplay of gene–environment interaction, with several lifestyle-related risk factors strongly implicated in the pathogenesis of this degenerative condition. The onset of AD pathology predates the clinical symptoms by several years. The neurodegenerative processes in AD is related to the accumulation of abnormally folded Aβ and tau proteins in amyloid plaques and neuronal tangles. Diagnosis of AD is by presence of cluster of clinical features and aided by biomarkers such as CSF Aβ42 and PET amyloid imaging, CSF tau and tau imaging, 18fluorodeoxyglucose uptake on PET and atrophy on structural magnetic resonance imaging increase the diagnostic certainty. In the absence of curative treatments, the management of AD involves pharmacological treatment to delay the onset or progression of AD and supportive care by family members. Targeting these lifestyle-related factors in young adulthood and middle age may be protective against AD. High educational achievement in early life, involvement in cognitively stimulating activity, physical activity and social engagement including rich social network have been associated with reduced risk of late-life dementia and AD.