THE ASSOCIATION OF RESILIENCE AND SOCIAL NETWORKS WITH PAIN OUTCOMES AMONG OLDER ADULTS

Abstract Depression, stress and poor sleep are associated with increased pain among older adults with chronic pain. Positive resources may help buffer the impacts of negative attributes on pain. Our primary objective was to determine effects on pain outcomes (severity; interference) of positive resources (resilience; social networks) on negative attributes among older adults with pain. The sample (N=15,000) came from older adults≥65 years with AARP®Medicare Supplement and AARP®MedicareRx plans (insured by UnitedHealthcare Insurance Company) with diagnosed back pain, osteoarthritis and/or rheumatoid arthritis. Members received a survey assessing positive resources, negative attributes and outcomes of pain. Depression, stress, sleep, resilience, social networks, pain severity and interference were measured. Opioid and other medications were determined from claims. The population was propensity weighted to adjust for survey non-response; weighted to be generalizable to members with diagnosed pain. Multinomial logistic regression was used to determine associations of positive/negative attributes on pain. Among respondents (N=4,161; 29%), prevalence of pain severity and interference for no/mild, moderate and severe categories was 61%, 21% and 18% for severity and 67%, 16% and 17% for interference. In bivariate models adjusted for demographics/health status, negative attributes of depression, stress and poor sleep had stronger associations with pain severity and interference than moderating effects. In full multivariate models, the strongest associations with moderate and severe severity and interference remained depression, stress and sleep. Based on results, multidimensional pain management strategies should include management of depression, stress and poor sleep along with enhancement of positive resources and analgesics as needed for pain management.

Objectives: Occupational mobility at various stages in the life course may have a cumulative influence on health outcomes in later life.This study aims to (1) systematically review the association between occupational mobility and chronic illness in late life; and (2) identify potential mechanisms underlying this relationship.Methods: A systematic review of literature was carried out by searching two databases (PubMed and SocIndex) and reference lists.Eligible studies examined associations between occupational mobility and at least one measure of chronic illness among adults aged 50 years or above.Occupational disruptions (e.g., job loss) were reviewed as special cases of occupational mobility.Results: Downward occupational mobility and mid-life occupational disruptions have been consistently shown to predict higher risk of chronic illness in older adults.Several potential mechanisms were identified from the literature: (1) health behaviors, including dietary practices and alcohol consumption; (2) psychosocial factors, including stress, stigma, job control, job demands, and job satisfaction; (3) economic factors, including financial incentives or constraints; and (4) other individual characteristics, including personality traits and coping skills.There is also evidence that the timing of job mobility and the duration of (each) occupation modify the association between occupational mobility and health in late life.Discussion: These findings suggest that experiencing involuntary occupational mobility at various stages in the life course can increase the risk of chronic illness in late life.Health professionals and policymakers should target more resources to disadvantaged older adults who experience involuntary occupational transition.

CORESIDENCE OF OLDER PARENTS AND ADULT CHILDREN BENEFITS OLDER ADULTS'
PSYCHOLOGICAL WELL-BEING: PATH ANALYSIS Soohyoung r. Lee 1 , 1. Yeshiva University, New York, United

States
Even though the coresidence of older parents and their adult children is no longer a rare phenomenon in current society, a little is known about the benefit of living with adult children from older adults' perspectives compared to the risk of this living situation.Previous research suggests that older adults' psychological well-being is low when they live with their adult children, and this become more salient among single parents, such as widowed or divorced.The current paper utilizes the National Health Measurement Study with a sample of age 55 and over, and their SF-36 Mental Health Component score, and psychological well-being selfacceptance score was measured.Path analysis reveals while mental health and psychological well-being scores are lower among single older adults at the time of the survey (e.g., divorced, widowed) than non-single, coresidence of older adults and adult children completely mediates the negative relationship between being single and both mental health psychological well-being.A complete mediation effect of living with an adult child on older adults' mental health and psychological well-being is consistent with both white and non-white minority older adults.This suggests that living with adult child benefits older adults' mental health and psychological well-being.The current study seeks to stimulate ideas that might generate the next answer to communitybased care in our current aging society.

OLDER PEOPLE LIVING WITH HIV: THE RELATIONSHIP BETWEEN COMMUNITY-LEVEL FACTORS AND THEIR HIV HEALTH
Yookyong Lee, 1 Rick Walton, 2 Edward Jackson, 3 Lindsey Jackson, 4 and Scott Batey According to Centers for Disease Control and Prevention, older adults (aged 50 and older) accounted for 17% of new HIV diagnoses in 2016.The number of older people living with HIV (PLWH) is increasing because of antiretroviral therapy that allows a near normal life expectancy with HIV.Consequently, older PLWH are more likely to develop diseases associated with aging and be affected by polymedication.However, their lived experience and challenges that they face have been underexamined.In this study, we focused on community-level factors, which have potential health implications for older PLWH.We examined a subsample of participants who were at least 50 years-old (n=20; Mean=55; range 50-60) from a community-based participatory research study (n=40).Participants, who previously established HIV care, were recruited through word-of-mouth and flyers posted in the community.Interviews were recorded, transcribed, coded, and triangulated through an iterative process during team meetings.In this subsample (n=20), majority of participants were male (75%) and Black (80%).Older PLWH reported crime, social isolation (interacting with crime and stigma), and lack of access to resources (e.g., transportation, grocery store, pharmacy) as factors negatively associated with their physical and emotional health.A more holistic, complex approach to support older PLWH is essential.They should experience a greater quality of life along with longevity.Therefore, more attention to contextual and structural barriers associated with treatment and care is necessary to find a way for higher retention, (re)engagement, and adherence to care among older PLWH.Depression, stress and poor sleep are associated with increased pain among older adults with chronic pain.Positive resources may help buffer the impacts of negative attributes on pain.Our primary objective was to determine effects on pain outcomes (severity; interference) of positive resources (resilience; social networks) on negative attributes among older adults with pain.The sample (N=15,000) came from older adults≥65 years with AARP®Medicare Supplement and AARP®MedicareRx plans (insured by UnitedHealthcare Insurance Company) with diagnosed back pain, osteoarthritis and/or rheumatoid arthritis.Members received a survey assessing positive resources, negative attributes and outcomes of pain.Depression, stress, sleep, resilience, social networks, pain severity and interference were measured.Opioid and other medications were determined from claims.The population was propensity weighted to adjust for survey non-response; weighted to be generalizable to members with diagnosed pain.Multinomial logistic regression was used to determine associations of positive/negative attributes on pain.Among respondents (N=4,161; 29%), prevalence of pain severity and interference for no/mild, moderate and severe categories was 61%, 21% and 18% for severity and 67%, 16% and 17% for interference.In bivariate models adjusted for demographics/health status, negative attributes of depression, stress and poor sleep had stronger associations with pain severity and interference than moderating effects.In full multivariate models, the strongest associations with moderate and severe severity and interference remained depression, stress and sleep.Based on results, multidimensional pain management strategies should include management of depression, stress and poor sleep along with enhancement of positive resources and analgesics as needed for pain management.

HOME CARE SOCIAL WORKERS CLAIM MEDICARE IGNORES PATIENT NEEDS William D. Cabin 1 , 1. Temple University, Philadelphia, Pennsylvania, United States
There is significant literature on the importance of addressing social determinants of health (SDOH) in order to improve health care outcomes.In response, the Centers for Medicare and Medicaid Services (CMS) has expanded Medicare Advantage plans ability to cover SDOH-related services.Medicare home health does not cover SDOHrelated services.A literature review indicates no studies on the nature, significance, or impacts of the lack of SDOH coverage in Medicare home health.This article summarizes an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 29 home care social workers between January 2013 and May 2014 in the New York City metropolitan area.Results indicate social workers believe the lack of SDOH coverage in Medicare home health results in exacerbation of existing patient conditions; creation of new, additional patient conditions; increased home care readmissions and re-hospitalizations; increased caregiver burden; and exacerbation of patients' mental health and substance abuse needs.Policymakers are urged to consider adding coverage of SDOH to Medicare home health primarily through expanded social work coverage.

TECHNOLOGY ELECTRONIC PERSONAL HEALTH RECORD USE AMONG ELDERLY CANCER SURVIVORS AND NON-CANCER SURVIVORS
Yan Luo 1 , 1. University of Alabama, Tuscaloosa, Alabama, United States Background Electronic personal health records (ePHRs) are potential tools to improve clinical outcomes through increasing patients' self-management.Although elderly people, especially elderly cancer survivors, is a growing population who can benefit from ePHRs, little is known about its utilization among the elderly, particularly among those diagnosed with cancer.Objective By applying Anderson's Behavioral Model of Health Services Use, this study aims to examine and compare the associated factors with ePHRs use among elderly cancer survivors and noncancer survivors.Methods The data collected from the 2018 Health Information National Trends Survey (HINTS) was analyzed.The level of access to ePHRs among the elderly were assessed.Predictors of ePHRs use among elderly cancer survivors and non-cancer survivors were compared by conducting multiple linear regression.According to Anderson's Model, predisposing factors, enabling factors, and need factors were included in the statistical model.Results The overall use of ePHRs remained low among 577 participants (mean = .87,SD = 1.72, range from 0 to 4).Non-Cancer survivors reported lower ePHRs use (mean = .83,SD = 1.77, range from 0 to 4).Race/ethnicity, education, regular health care providers, health insurance, social support, and medical conditions were associated with ePHRs use among non-cancer survivors, while age, gender, social support, and self-reported health status were related to ePHRs use among cancer survivors.Conclusion This study suggests additional efforts to increase ePHRs utilization among the elderly, especially the elderly cancer survivors.The predictive findings reported in this study will contribute valuable implications to enhance the ePHRs use.

WHY DON'T ELDERS ADOPT TWO-FACTOR AUTHENTICATION? BECAUSE THEY ARE EXCLUDED BY DESIGN
Sanchari Das, 1 Joshua Streiff, 1 Lesa L. Huber, 2 and L Jean Camp 1 , 1. Indiana University Bloomington, Bloomington, Indiana, United States, 2. Indiana University School of Public Health, Bloomington, Indiana, United States Two-Factor Authentication (2FA) provides effective protection for online accounts by providing efficient and highly robust access control.Adoption and usability, however, remain challenges for such technologies.Most research on 2FA focuses on students or employees in the tech sector.For example, our research with student populations found that lack of adoption was primarily due to a lack user risk concern matched with confidence in their 'strong' password strategies.The situation for older adults (> 60 years) was quite different, as we discovered through detailed interviews and think-aloud protocols targeted at understanding the registration, after installation, and their (un)willingness to use 2FA.We focused our research on USB security hardware tokens; additionally, we asked about other 2FA strategies which the participants adopted (if any).Their lack of adoption of the devices stemmed from its shortfall of inclusive design.Most available security tokens which were compliant with tablets have very small form factors; nearly invisible in a purse, and easy to slip through a pocket.The larger security keys are device and browser (Google Chrome) dependent.The organizations which would be most invested in protecting older people --retirement management funds, the Social Security Administration, Medicare, and banking institutions 3 , 1. University of Alabama at Birmingham, Birmingham, Alabama, United States, 2. NHS CSAB, Birmingham, Alabama, United States, 3. University of Alabama at Birmingham Center for AIDS Research, Birmingham, Alabama, United States, 4.