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Eco-anxiety and climate anxiety are widely discussed in contemporary media and are subjects of growing research interest. However, there is a lack of research about the definitions and variations of these phenomena. This article analyzes various views of eco-anxiety from a wide range of disciplines. Insights from various anxiety theories are used to discuss empirical studies about forms of eco-anxiety. The article points out that uncertainty, unpredictability, and uncontrollability seem to be important factors in eco-anxiety. Most forms of eco-anxiety appear to be non-clinical, but cases of “pathological” eco-anxiety are also discussed. Other relevant terms and phenomena are scrutinized, such as ecological grief, solastalgia, and ecological trauma. The relationship between studies on eco-anxiety and research about ecological emotions and affect is probed. Eco-anxiety is found to be closely connected to fear and worry, but several disciplines include discussion of its character as existential anxiety. Psychosocial and sociological perspectives point out that social dynamics shape forms of eco-anxiety in profound ways. While paralyzing forms of eco-anxiety emerge as a problem, it is noted that eco-anxiety manifests itself also as “practical anxiety”, which leads to gathering of new information and reassessment of behavior options. This variety of forms of eco-anxiety should be taken into account in healthcare and public discussion.

IntroductionEvening-time exercise is a frequent cause of severe hypoglycemia in type 1 diabetes, fear of which deters participation in regular exercise. Recommendations for normalizing glycemia around exercise consist of prandial adjustments to bolus insulin therapy and food composition, but this carries only short-lasting protection from hypoglycemia. Therefore, this study aimed to examine the impact of a combined basal-bolus insulin dose reduction and carbohydrate feeding strategy on glycemia and metabolic parameters following evening exercise in type 1 diabetes.MethodsTen male participants (glycated hemoglobin: 52.4±2.2 mmol/mol), treated with multiple daily injections, completed two randomized study-days, whereby administration of total daily basal insulin dose was unchanged (100%), or reduced by 20% (80%). Participants attended the laboratory at ∼08:00 h for a fasted blood sample, before returning in the evening. On arrival (∼17:00 h), participants consumed a carbohydrate meal and administered a 75% reduced rapid-acting insulin dose and 60 min later performed 45 min of treadmill running. At 60 min postexercise, participants consumed a low glycemic index (LGI) meal and administered a 50% reduced rapid-acting insulin dose, before returning home. At ∼23:00 h, participants consumed a LGI bedtime snack and returned to the laboratory the following morning (∼08:00 h) for a fasted blood sample. Venous blood samples were analyzed for glucose, glucoregulatory hormones, non-esterified fatty acids, β-hydroxybutyrate, interleukin 6, and tumor necrosis factor α. Interstitial glucose was monitored for 24 h pre-exercise and postexercise.ResultsGlycemia was similar until 6 h postexercise, with no hypoglycemic episodes. Beyond 6 h glucose levels fell during 100%, and nine participants experienced nocturnal hypoglycemia. Conversely, all participants during 80% were protected from nocturnal hypoglycemia, and remained protected for 24 h postexercise. All metabolic parameters were similar.ConclusionsReducing basal insulin dose with reduced prandial bolus insulin and LGI carbohydrate feeding provides protection from hypoglycemia during and for 24 h following evening exercise. This strategy is not associated with hyperglycemia, or adverse metabolic disturbances.Clinical trials numberNCT02204839, ClinicalTrials.gov.

Background People with dementia and their care givers are provided limited guidance in medication management, potentially contributing to medication‐related harm. Importantly, there are no resources that provide comprehensive medication management guidance across care settings. To ensure that resources are co‐designed, genuine involvement of people with dementia, their care givers and the community in identifying the priorities for medication management guidance resources is needed. We explored community‐centred priorities for medication management guidance resources for people with dementia and their care givers. Methods We established a 23‐member consortium partnership with people living with dementia, care givers, healthcare professionals, and national consumer and professional organisations using a community‐based participatory research approach. A qualitative descriptive design, using four focus groups and two interviews with key informants was conducted between September to December 2023 to explore partners’ priorities for medication management resources across care settings. Content analysis was performed to generate a list of priorities. Results The key priorities for inclusion in the medication resource were to: 1) empower the person with dementia and their care givers to make informed choices, by providing pragmatic and accessible information to meet their needs and promote key questions to engage health providers in shared decision‐making; 2) inclusion of strategies to address medication challenges, and 3) suggested format and setting for the availability of information. Conclusion This is the first time a community action approach has been adopted to co‐design resources to support people with dementia and care givers in medication management challenges. The community‐centred priorities will be used to generate an inventory of consumer‐tailored communication strategies for people with dementia and their care givers.

Background Australia has a rich migration history, with one in three older people coming from a culturally and linguistically diverse (CALD) background. Patients from CALD backgrounds tend to present at later stages of their diseases but face difficulties accessing appropriate dementia care compared to English‐speaking patients. Limited literature exists on the clinical experience among CALD patients who have been historically underrepresented in dementia research. This study therefore aimed to investigate and describe the clinical characteristics and service provision for CALD patients presenting to the Memory Clinic at the Royal Melbourne Hospital, a tertiary hospital which serves a significant proportion of CALD patients. Method A retrospective analysis was conducted. All consecutive patients who presented to the Memory Clinic between September 2016 and June 2018 were included. Data collected included patient demographics, medical history, cognitive test scores, neuropsychiatric symptoms, other clinical scales, clinical diagnoses, and length of follow up. Result A total of 301 patients (mean age 78.8 ± 8.2; 55.8% female) were included and 48.5% were from a CALD background, the majority being Italian. Patients from CALD backgrounds were more likely to be living with family (73.3% vs 57.4%, OR [odds ratio] 2.1) and less likely to have attended education beyond primary level (26.7% vs 83.9%, OR 14.3). Cognitively, CALD patients had poorer performance on MMSE (median MMSE 18 vs 25) and were more likely to be diagnosed with dementia (46.6% vs 31.0%, OR 1.9) at their initial assessments. Additionally, CALD patients were less likely to be referred for neuropsychology (28.8% vs 50.3%, OR 0.40). Conclusion The study findings highlight the differences in clinical characteristics as well as inherent issue of inequality in healthcare among patients from CALD backgrounds in an Australian clinical setting. Given the recent approval of disease‐modifying anti‐amyloid therapy in mild Alzheimer’s disease, more research is warranted to help diagnose dementia at earlier stages in CALD patients and ultimately promote more equitable and culturally inclusive dementia care.

Background As the landscape of ADRD diagnoses evolves to include biomarker testing, there is a pressing need to understand the unique experiences, challenges, and support needs of families undergoing evaluations of cognitive decline, particularly in a manner that prioritizes cultural considerations from voices historically underrepresented in ADRD research. The current study aims to understand the AD biomarker disclosure journey of persons from underrepresented groups with the goal of informing culturally responsive approaches to the care of patients and their families navigating the complexities of ADRD diagnoses. Method Virtual focus groups are being conducted over a secure video conferencing platform, with a trained facilitator guiding the discussion. Participants represent a purposively selected subsample of those enrolled in Patient And family member Reactions to biomarker‐informed ADRD DiagnosEs (PARADE NIH RF1AG080591), a current add‐on to the New IDEAS study, a CMS coverage with evidence development study of amyloid PET with an explicit objective to represent diverse patients by enrolling >50% who identify as Black, African American, or Hispanic. Employing a semi‐structured interview approach, the focus group guide consists of 5 lead questions and follow‐up probes, aiming to explore participants' experiences in receiving amyloid PET results and to characterize their post‐disclosure information and support needs. Verbatim transcripts of focus group recordings will be analyzed using thematic analyses. Result Preliminary findings from initial focus groups with Black, African American and Hispanic participants and families will provide perspectives on decision‐making, expectations, and post‐disclosure experiences. This study is anticipated to yield novel insights into patient and family preferences for receiving high stakes ADRD diagnostic information and to identify potential gaps in current support mechanisms. Conclusion The results from this focus group investigation will contribute to a more comprehensive understanding of the information and support needs of culturally diverse families post‐ADRD diagnosis. Ultimately, this study seeks to inform culturally responsive care practices and will be disseminated to AD Research Centers and dementia experts, fostering the enhancement of best practices for biomarker disclosure and dementia‐related education.

Background Stress associated with caregiving for a person with Alzheimer’s Disease and Alzheimer’s Disease Related Dementias (AD/RD) has negative health implications. However, little is known about the implications of stress on non‐Hispanic Black (NHB) informal male caregivers. This study aims to examine the relationship between sleep, depression, and cognitive function in a sample of NHB informal male caregivers in the metropolitan Washington, D.C. area. Method This cross‐sectional study (n = 68) included informal caregivers and non‐caregivers who participated in self‐perceived health questionnaires and a series of cognitive assessments. Data analysis consisted of logistic regression models to understand the relationship between caregiving, cognitive health, age, education, sleep (Pittsburgh Sleep Quality Index), and depression (Center for Epidemiological Studies Depression Scale). Result Three variables were used to explore caregiving: caregiver status, caregiver tenure, and hours per week spent caregiving. Tenure was positively associated with hours per week spent caregiving (p = 0.031). Poorer sleep was associated with caregiver status (p = 0.030) and weekly time spent caregiving (p = 0.002), while depression was associated with caregiver status (p = 0.024). Additionally, there was an association between caregiver status and the Verbal Fluency Test (VFT) (p = 0.050) and the Verbal Naming Test (VNT) (p = 0.035), which became stronger when adjusting for sleep and depression (p = 0.023). Additional hours spent per week providing care was associated with poor performance on the Number Span Test (NST) (p = 0.012), which is exacerbated when adjusting for sleep and depression (p = 0.009). Caregiver tenure was associated with lower scores on the VFT (p = 0.003), unimpacted by adjusting for sleep or depression. Conclusion In this study of NHB male informal caregivers, poor sleep was associated with lexical retrieval deficits, with caregiver tenure exacerbating this. Hours spent giving care per week is also associated with decreased sleep and attentivity. The results from this pilot study indicate a need for interventions to improve sleep quality among caregivers, thus reducing cognitive burden. Given this group’s unique cultural perspectives on sleep, curating targeted cognitive behavioral sleep interventions should be examined.

Background An estimated ∼40% of dementia cases are due to modifiable risk factors which can be targeted in lifestyle interventions. Effective interventions employ face‐to‐face delivery, making them resource‐intensive and burdensome. Digital interventions offer scalability, accessibility and cost‐effectiveness. Engagement and efficacy of digital interventions are unknown, as is whether the ‘human component’ of these interventions must be retained. Method The Five Lives app is a digital health solution that combines a CE‐marked dementia risk assessment with a digital coaching programme (DC) to facilitate behaviour changes which could lead to eventual reduced dementia risk. Three groups were compared: DC‐only, DC and access to brief 1‐to‐1 virtual clinician services (DC+VC) and no intervention (control). The study spanned 12 weeks and participants (n = 154) were aged 50‐69 with normal cognition. A lifestyle score was conducted at baseline and exit, which scores participants on behaviour relating to sleep, physical activity, diet, stress & mood and mental stimulation. Engagement was measured as the total number of app activities (brain games, articles, quizzes and lifestyle log) completed during the intervention period. Result Participant engagement was high (mean participant activities = 35/week). There was a significantly greater change in lifestyle score between intervention group (DC‐only and DC+VC pooled) and control (F(1,81) = 3.10, p = 0.049), and a trend for significance for a greater change in DC‐only versus control (F(1,24) = 3.96, p = 0.058). The change in lifestyle score between DC‐only and DC+VC was not significant, nor was the difference in app engagement. Total engagement was not predictive of lifestyle score change. Conclusion Participant engagement indicates the intervention is feasible in older adults. Results suggest the Five Lives app is a promising tool to facilitate behaviour change to potentially reduce dementia risk, and the VC does not provide significant additional benefits. This study provides initial data to warrant further development of DC interventions to reduce dementia risk. Future analyses should investigate which participants respond best to the intervention, barriers to change, and how engagement interplays with sustained dementia‐targeted lifestyle change.

Background An important aspect of quality of life is engagement in meaningful and purposeful activities. For people living with dementia (PLwD), opportunities to engage in purposeful activities can be vastly diminished. Successful engagement of individuals with dementia typically hinges upon selecting engagement targets and activities that are appropriate to the individual’s level of cognitive functioning. The Pool Activity Levels (PAL) Checklist, a strength‐based, person‐centered 9‐item checklist tool for nonclinical caregivers to assess cognitive, physical, and sensory abilities in PLwD in order to guide activity planning and engagement strategies, was originally developed in British English. The increasing use of the measure in the United States necessitates a translation into American English to ensure cultural and linguistic appropriateness. Back translation (BT) is a commonly‐used methodology of questionnaire translation. However, several problems with BT have been highlighted, including its reliance on perfect equivalence and prioritization of literal translation over conceptual and cultural equivalence. Alternatives to BT include engaging professionals with expertise in translation and the subject matter to translate the assessment and to then submit the translation to a review by an expert panel and field test or using an iterative, team based approach that involves translation, review, evaluation, pretesting, and documentation. Method Adopting a multidisciplinary approach, the PAL Checklist was translated from British to U.S. English. This process involved a team of professionals, including collaboration with the original author of the PAL, from various U.S. regions with expertise in care planning and assessment. The translation methodology aligned with the ISPOR Quality of Life Special Interest Group guidelines, incorporating steps like forward translation, reconciliation, back translation, cognitive debriefing, and finalization. Result The translation retained the original checklist’s conceptual integrity while adapting linguistic differences, such as “flannel” to “washcloth/sponge” and “cupboards” to “drawers/closet.” Conclusion This preliminary translation of the PAL into U.S. English lays the groundwork for future research to assess its psychometric properties in American settings. Future research will focus on extensive validation to meet psychometric criteria (e.g., internal consistency reliability, structural validity), ensuring its efficacy and reliability in the United States.

Background Effect of dynamic lighting on sleep were studied since 1980’s. Traditional light sources were used due to lack of advancement in technology and also researchers assumed illuminance as cause of melatonin suppression. This led researchers to use high illuminance to suppress melatonin at day time. Later, it was discovered that intrinsic photoreceptor retinal ganglion cell (ipRGC), sensitive to specific wavelength, has direct impact on the level of melatonin, that shifted the attention to the actual wavelength of the stimulating light. With the invention of LEDs, having various emission profiles has allowed researcher to propose numerous LED using 5 to 8 types of LED for appropriate delivery of dynamic light to control melatonin secretion whole day. Better lighting has been shown to improve sleep, reduce anxiety/depression, and improve mood in dementia patients. Method A C‐program was developed to calculate various lighting parameters of combined spectra of LED strips. Brute force optimization was used to calculate the power to be supplied to each of the input LED strips to obtain a combined white light for dawn, day and dusk based on the required visual (e.g. CRI>90, Duv < 0.001) and non‐visual parameters for minimum power consumption and lowest material cost. Result We investigated 3 red, green, blue, ice blue, and warm white (R‐G‐B‐IB‐WW) systems from different manufactures. Only in one system, did the blue LED allow increased efficiency (<1%), demonstrating that a 4 LED system (R‐G‐IB‐WW) is sufficient i.e. blue LED is unnecessary. We added a monochromatic Cyan LED strip, its spectra overlap the action spectra of ipRGC, hoping it could help to achieve better stimulation of ipRGC cells with lower power consumption. While m‐EDI increased, but m‐EDI/W input power did not. Cyan is thus unnecessary. Conclusion We have shown that an LED system with only 4 types of LEDS (2 monochrome and 2 broadband) can generate dawn to dusk dynamic white light suitable for both visual and non‐visual needs of dementia patients (as widely accepted by researchers over the world) with high electrical to optical efficiency. This approach, using fewer LED strips and lower energy consumption, is more financially appealing.

Background Black/African American (AA) caregivers of patients with Alzheimer’s disease (AD) and related disorders can play a critical role in maintaining patient health. AD caregivers who face economic challenges may have less access to resources that may reduce caregiver burden they experience. The North Carolina Department of Commerce ranks the state’s 100 counties based on economic well‐being and assigns the most distressed counties as Tier 1, and least distressed as Tier 3. Focus groups were conducted to determine the needs of Black/AA AD caregivers in a Tier 1 and a Tier 3 county. Method The Maya Angelou Center for Health Equity Caregiver College (MC2) is an educational program that aims to improve informal caregivers’ knowledge of AD. Focus groups were conducted with community stakeholders in Wilson (Tier 1) and Mecklenburg (Tier 3) counties in North Carolina. Focus group attendees were engaged in discussion on topics including a review of local resources to support caregiving, challenges that AD caregivers face, educational needs of caregivers and preferred format of an MC2 event. Result Focus group participants (N = 15; Wilson = 8, Mecklenburg = 7) are African American (100%), with professional and community roles including clergy, caregivers, nursing, teaching, manager, community health worker, and local city officials. Findings suggest that significant needs in a Tier 1 county include lack of geriatric∖AD specialists, few caregiver support resources, and little qualified in‐home care assistance. In a Tier 3 county, structural barriers and physical access to resources were named as difficulties. Common issues for both counties included confusion by what insurance plans cover. The design for MC2 was requested as a 1‐day format in the Tier 3 County because of a large population of working caregivers, whereas in the Tier 1 County a multi‐day MC2 format was recommended due to the perception that people in the county would benefit more from a more intensive AD educational event. Conclusion Needs in Tier 1 and Tier 3 counties differed, however, both groups need help navigating medical insurance. Results will be used to customize the MC2 events to meet the expressed needs of the stakeholders in each county.