THE ASSISTED LIVING SETTING: CLINICAL CARE AND OUTCOMES

Abstract Although the description of assisted living (AL) varies by state this term generally refers to residences that provide housing and supportive services, 24-hour supervision, and at least two meals a day to meet the individual needs of residents. Approximately 37% of residents in AL need help with three or more activities of daily living (ADLs), 42% have some cognitive impairment and 39% need skilled nursing services. Approximately 15 to 50% of older adults living in AL communities experience a fall over a 6 to 24 month period. The cause of these falls involves multiple factors at the resident and facility level. In addition to a high rate of falls there is a high rate of polypharmacy, using the polypharmacy definition of taking five or more medications daily. Polypharmacy results in negative outcomes such as falls and hospitalizations among AL residents. Along with high rates of falls and polypharmacy there is also a high incidence of pain among AL residents and concerns that some pain goes unreported and untreated. Pain, polypharmacy and falls can all influence life satisfaction along with other factors such as the environment itself. The purpose of this symposium is to describe the incidence and factors that influence falls, polypharmacy, pain and pain management and the impact of these care concerns, among others, on life satisfaction drawn from 508 residents from 54 nursing homes participating in the first two cohorts of the study testing the implementation of Function Focused Care for Assisted Living (FFC-AL-EIT).

periences (ACEs) can lead to negative health effects across a lifetime. This study examines the impact of ACEs on the frequency of providing daily support (i.e., unpaid assistance, emotional support, and disability-related assistance) to family members and the moderating effects of ACEs in the association between providing daily support to family and daily negative affect. Using the National Study of Daily Experiences II, we analyzed a total of 14,912 daily interviews from 2,022 respondents aged 56 on average. Key results showed that a greater number of ACEs were associated with providing more frequent emotional support to family. We also found the significant interaction effect that adults with more ACEs showed greater negative affect on the days when they provided assistance to family members with disabilities. The findings underscore the long-term negative impact of ACEs on daily well-being in the context of family relationships. The literature documents mixed findings regarding how helping others influences individuals' mental and physical health. We assessed various types of support that older adults offered (e.g., emotional, practical, advice) and examined how helping others was associated with older adults' daily mood and physical activity. This study utilized data from the Daily Experiences and Well-being Study, where 293 participants aged 65+ reported on their helping behaviors and mood at the end of each day across 5 days. Participants also wore Actical accelerometers to track physical activity. Multilevel models revealed that older adults reported greater negative mood and less physical activity on days when they provided emotional support. Yet, giving advice was associated with increased positive mood that day. Moreover, older adults spent less time being sedentary on days when they offered practical help. This study offers insights into psychological and health consequences of helping others by examining older adults' everyday lives. Based on theory and empirical evidence linking volunteering and health, we investigated the associations between daily engagements in formal volunteering, stressors, and negative affective well-being, focusing on the stressbuffering effect of volunteering. Using eight days of daily diary data from the second wave of the National Study of Daily Experiences (participants, N = 1,320; participant-day observations, N = 8,277), we estimated a series of multilevel models to assess the within-person associations between daily volunteering, stressors, and affect. Results indicated there were no direct associations between daily volunteering and negative affect. However, we found the association between daily stressors and negative affect (but not positive affect) was weaker on days when volunteering was performed compared to days volunteering was not performed. Taken together, our findings suggested that short-term health benefits associated with daily volunteering were largely based on the stress-buffering effects of helping others, rather than through a direct effect.

THE ASSISTED LIVING SETTING: CLINICAL CARE AND OUTCOMES
Chair: Barbara Resnick 1 , 1. University of Maryland School of Nursing, Baltimore, Maryland, United States Although the description of assisted living (AL) varies by state this term generally refers to residences that provide housing and supportive services, 24-hour supervision, and at least two meals a day to meet the individual needs of residents. Approximately 37% of residents in AL need help with three or more activities of daily living (ADLs), 42% have some cognitive impairment and 39% need skilled nursing services. Approximately 15 to 50% of older adults living in AL communities experience a fall over a 6 to 24 month period. The cause of these falls involves multiple factors at the resident and facility level. In addition to a high rate of falls there is a high rate of polypharmacy, using the polypharmacy definition of taking five or more medications daily. Polypharmacy results in negative outcomes such as falls and hospitalizations among AL residents. Along with high rates of falls and polypharmacy there is also a high incidence of pain among AL residents and concerns that some pain goes unreported and untreated. Pain, polypharmacy and falls can all influence life satisfaction along with other factors such as the environment itself. The purpose of this symposium is to describe the incidence and factors that influence falls, polypharmacy, pain and pain management and the impact of these care concerns, among others, on life satisfaction drawn from 508 residents from 54 nursing homes participating in the first two cohorts of the study testing the implementation of Function Focused Care for Assisted Living (FFC-AL-EIT).

THE INCIDENCE AND IMPACT OF POLYPHARMACY IN AL RESIDENTS Elizabeth Galik 1 , 1. University of Maryland School of Nursing, Baltimore, Maryland, United States
The purpose of this study was to describe polypharmacy in AL settings. We hypothesized that: (1) age, gender, race, setting, multimorbidity and cognitive status would influence polypharmacy; and (2) polypharmacy would be associated with falls, emergency room visits and hospitalizations. This was a descriptive study using data from the first cohort of the FFC-AL-EIT Study. A total of 242 participants from 26 AL settings were included. Participants had a mean age of 86.86 (SD=7.0), the majority were women 179(74%) and white (N=232, 96%) with 5 (SD=2) comorbidities. The mean number of drugs was 7 (SD=3.56) and 51% were exposed to polypharmacy, 24% fell at least once, 9% were sent to the hospital and 13% to the emergency room. Neither hypothesis was supported. Continued research is needed to explore the factors that influence polypharmacy and to identify if there are negative outcomes associated with polypharmacy in this population.

FACTORS THAT CONTRIBUTE TO FALLS AMONG AL RESIDENTS Marie Boltz 1 , 1. Pennsylvania State University, University Park, Pennsylvania, United States
Many nurses, patients, and families continue to believe that physical activity increases the risk of falling. The purpose of this study was to test the hypothesis that residents who are exposed to Function Focused Care for Assisted Living (FFC-AL-EIT) and engage in moderate levels of physical activity would not be more likely to fall. This was a secondary data analysis using data from the first two cohorts of the FFC-AL-EIT study. The study included 508 residents the majority of whom were female (70%), white (97%), with a mean age of 87.72 (SD=7.47). Those who engaged in more moderate intensity physical activity were 1% less likely to fall (b = -.01, Wald =6.13, p =.01). There was no association between exposure to function focused care and falling (Beta =.41, Wald =2.35, p=.13). Further, engaging in moderate level physical activity was noted to be slightly protective of falling.

PAIN, PAIN MANAGEMENT, AND CONSEQUENCES OF PAIN AMONG AL RESIDENTS
Barbara Resnick 1 , 1. University of Maryland School of Nursing, Baltimore, Maryland, United States The purpose of this study was to describe the incidence, management and impact of pain on function, agitation, and resistance to care. This was a descriptive study using baseline data from 260 residents in the second cohort of the FFC-AL-EIT study. The majority of the sample was female (71%) and white (96%) with a mean age of 87 (SD=7). Fifty-two residents (20%) reported pain based on objective (PAINAD) or subjective (verbal descriptive scale, VDS) pain assessments. A total of 75 residents (29%) received pain medication and 22 (42%) individuals reporting pain were not getting pain medication. Controlling for age, gender and cognition, PAINAD was significantly associated with agitation, function, and resistance to care and the VDS was only associated with function. Pain assessments should include objective and subjective measures and management of pain should be considered as it may help to optimize function and decrease behavioral symptoms among AL residents.

FACTORS THAT INFLUENCE LIFE SATISFACTION IN AL RESIDENTS
Sarah Holmes 1 , 1. University of Maryland, Baltimore,

Maryland, United States
Life satisfaction is a multidimensional concept that addresses a personal judgment of quality from the resident's perspective. Components of life satisfaction include satisfaction related to health, the physical environment, relationships and activities. The purpose of this study was to test if there was a relationship between demographic factors, pain, falls, and use of psychotropics with life satisfaction. The sample included the first two cohorts from the FFC-AL-EIT study including 508 residents from 54 settings across Maryland, Pennsylvania, and Massachusetts. The majority of the participants were female (70%), white (97%) and the mean age was 87.72 (SD=7.47) . Based on a stepwise linear regression analysis there was a significant association between pain (r=-.20, p=.003) and psychotropic use (r=-.19, p=.003) and the model explained 11% of the variance in life satisfaction. Ongoing research is needed to consider the impact of the environment and staff-resident interactions on life satisfaction. As individuals are living longer, in many cases with chronic diseases, there is an increased focus on end-of-life