SATISFACTION WITH OUTDOOR ACTIVITIES AMONG LONG-TERM SERVICES AND SUPPORTS RECIPIENTS

Abstract Being outdoors in nature has been associated with improved mental and physical health. There are no known studies exploring older adults’ satisfaction with outdoor activities at the start of long-term services and supports (LTSS; in nursing homes, assisted living, or at home). We examined characteristics of older adults receiving LTSS and factors associated with outdoor activities satisfaction. A secondary analysis was conducted of baseline data involving structured interviews with older adults new to LTSS (Health-Related Quality of Life: Elders in Long-Term Care; R01AG025524-05). Primary outcome was a single item on the satisfaction with outdoor activities (not at all satisfied to extremely satisfied). We conducted multivariable linear regression models controlling for the influence of the characteristics important to health-related quality of life (LTSS setting, gender, age, number of comorbidities, and sensory impairment [vision/hearing].) Among 356 people, the majority (59%) were satisfied with their outdoor activities. Of 339 participants with complete data, more depressive symptoms (higher Geriatric Depression Score; p<.001) and higher cognitive functioning (higher MMSE score; p=.038) were associated with lower ratings of satisfaction with outdoor activities. Higher self-rated physical health (p=.038) and more independence with activities of daily living (p=.017) were associated with greater satisfaction with outdoor activities. Due to the cross-sectional nature of this study it is difficult to determine causality; however, outdoor activity is important to people receiving LTSS. Interdisciplinary teams can work with older adults receiving LTSS to assess interest level with outdoor activities and create a person-centered plan to increase outdoor activity and satisfaction levels.


DEMENTIA AND COGNITIVE IMPAIRMENT BRAIN FUNCTIONAL CONNECTIVITY IN OLDER ADULTS WITH MCI: DO FALLS MATTER?
Anna R. Egbert, 1 Chun Liang Hsu, 1 Rachel Crockett, 1 and Teresa Liu-Ambrose 1 , 1. University of British Columbia, Vancouver, British Columbia, Canada Older adults with mild cognitive impairment (MCI) are at an elevated risk of falls.We conducted a pilot longitudinal observational study to examine the natural course of brain intrinsic functional connectivity (FC) and cognitive function changes in association to falling history in older adults with MCI. 15 MCI participants (mean age 75.9, range 67-86) included 10 non-fallers and 5 fallers (minimum two falls in the previous 12 months with one in the last 6 months) from Metro Vancouver, BC, Canada.At study entry and 1-year follow-up, participants completed brain scanning session of structural MRI and resting state (RS) functional MRI, the Montreal Cognitive Assessment (MoCA), and the Mini Mental State Examination (MMSE).Results indicated an interaction between time (baseline vs. follow-up) and falls history on RS-FC in individuals with MCI (p<0.001).At 1-year follow-up, MCI non-fallers showed increased FC between frontal, parietal and occipital cortex (from baseline R=0.141 to follow-up R=0.321) and lack of decline on cognitive measures.Meanwhile, MCI fallers showed weakening of FC between those brain regions (from baseline R=0.314 to follow-up R=0.201) with simultaneous cognitive deterioration.Significant relationships between FC strength and cognitive status existed only at follow-up (R=0.525,p<0.05), suggesting that the triggered functional compensatory brain mechanisms in MCI non-fallers are not successfully executed in MCI fallers.Together, our pilot data suggest that older adults with MCI who fall show more advanced brain functional degradation with adjacent cognitive decline as compared to MCI individuals who do not fall.

EVENT-SPECIFIC EMOTIONAL EXPRESSION OF PERSONS WITH DEMENTIA IN LONG-TERM CARE: PRELIMINARY RESULTS
Kyung Hee Lee, 1 Ji Yeon Lee, 2 Bora Kim, 1 and Marie Boltz 3 , 1. Yonsei University College of Nursing,Seoul,Korea,Republic of,2. Yonsei University,Seoul,Korea,Republic of,3. Pennsylvania State University,University Park,Pennsylvania,United States Although dementia-related language, comprehension, and memory deficits occur fairly early stage in dementia, persons with dementia retain the ability to express their emotion even in the late stage of disease.However, health care providers do not know how to interpret emotional expressions that could be utilized as important signals of underlying needs and care preferences in persons with dementia.The purpose of this study was to explore the event-specific emotional expressions of persons with dementia in long-term care over a 6-month period.This was a longitudinal study using repeated observations.Emotional expressions were videotaped when three specific events (personal care, meal time, and activity) occurred at baseline, month 3 and month 6.A total of nine observations was made for each participant.We enrolled 13 participants so far; ten participants were completed 6 month follow up.The mean score of MMSE at baseline was 4.38; that of ADL was 16.62.On average, persons with dementia showed 9.93 episodes of positive emotional expression (PEE) per minute and 1.81 episodes of negative emotional expression (NEE) per minute.We found between person variations for both PEE and NEE.PEE and NEE were different by three types of events.Specifically, persons with dementia showed more PEE with activity than personal care and meal time and more NEE with personal care than the other two events.This study will provide better understanding of eventspecific emotional expressions, and inform the development of emotion-oriented interventions programs to improve the psychological well-being of persons with dementia.

SATISFACTION WITH OUTDOOR ACTIVITIES AMONG LONG-TERM SERVICES AND SUPPORTS RECIPIENTS
Justine S. Sefcik, 1 Karen Hirschman, 2 Darina V. Petrovsky, 2 Nancy Hodgson, 2 and Mary Naylor 2 , 1. University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States, 2. University of Pennsylvania, Philadelphia, Pennsylvania, United States Being outdoors in nature has been associated with improved mental and physical health.There are no known studies exploring older adults' satisfaction with outdoor activities at the start of long-term services and supports (LTSS; in nursing homes, assisted living, or at home).We examined characteristics of older adults receiving LTSS and factors associated with outdoor activities satisfaction.A secondary analysis was conducted of baseline data involving structured interviews with older adults new to LTSS (Health-Related Quality of Life: Elders in Long-Term Care; R01AG025524-05).Primary outcome was a single item on the satisfaction with outdoor activities (not at all satisfied to extremely satisfied).We conducted multivariable linear regression models controlling for the influence of the characteristics important to health-related quality of life (LTSS setting, gender, age, number of comorbidities, and sensory impairment [vision/ hearing].)Among 356 people, the majority (59%) were satisfied with their outdoor activities.Of 339 participants with complete data, more depressive symptoms (higher Geriatric Depression Score; p<.001) and higher cognitive functioning (higher MMSE score; p=.038) were associated with lower ratings of satisfaction with outdoor activities.Higher selfrated physical health (p=.038) and more independence with activities of daily living (p=.017) were associated with greater satisfaction with outdoor activities.Due to the cross-sectional nature of this study it is difficult to determine causality; however, outdoor activity is important to people receiving LTSS.Interdisciplinary teams can work with older adults receiving LTSS to assess interest level with outdoor activities and create a person-centered plan to increase outdoor activity and satisfaction levels.

THE MEANINGS OF TRUST IN AFRICAN AMERICAN COMMUNITIES AND THEIR ASSOCIATION WITH PARTICIPATION IN DEMENTIA RESEARCH
Elena Portacolone, 1 Peter Lichtenberg, 2 Sahru Keiser, 3 Leah Vest, 4 Marsha Maloof, 5 and Julene Johnson 1 , 1. University of California San Francisco,San Francisco,California,United States,2. Wayne State University,Detroit,Michigan,United States,3. UCSF,San Francisco,California,United States,4. WSU,Detroit,Michigan,United States,5. Pendergrass Smith,San Francisco,California,United States African American /Black American older adults' low participation in research reduces the generalizability of research findings and hinders understanding of dementia mechanisms, further widening health disparities.Both the Alzheimer's Association and the National Institutes of Health have identified recruitment of African Americans with cognitive impairment into dementia research as an area of high priority.Distrust of research and medical institutions is often cited as a barrier to participation of African Americans in dementia research.Therefore, the goal of this study is to better understand African American community members' expectations associated with trust.We used focus groups and semi-structured interviews to examine the expectations associated with overall trust.We conducted 6 focus groups: 4 with African American older adults and 2 with caregivers of African American older adults with cognitive impairment.We also interviewed 5 African American older adults with cognitive impairment (total n=59).Data were analyzed with content analysis.Five themes emerged: 1) Importance of providing truthful help/information leading to trust; 2) Long relationships leading to trust; 3) Acting efficiently and consistently (e.g., "not fooling around") leading to trust; 4) Transference of trust (e.g., I can likely trust someone trusted by a trusted person); 5) Difficult to trust because of a harsh social environment.To conclude, trust is a complex belief associated with multiple expectations and relationships.It is critical that researchers understand these expectations related to trust in order to increase recruitment of African American older adults into dementia research.Background: Behavioral and Psychological symptoms of Dementia (BPSD) are a heterogeneous group of clinical phenomena that is subjectively experienced by the patient and/or observable by an examiner (e.g., caregiver, physician) consisting in disturbed emotions, perception, thought, motor activity, and altered personality.There are recommendations to limit antipsychotic use in patients with dementia, and the big educational effort is made to follow them.In Sweden antipsychotics use changed from 10.1% in 2007-2008 to 5.2% in 2014-2015.Aims: The aim of the study is to analyze the actors associated with treatment and mortality of dementia patients, particularly those suffering from BPSD.Particularly we focus on assessing all-cause mortality patients with dementia treated with antipsychotic drugs (APDs).Methods: We have analyzed 58,412 patients newly diagnosed with dementia.We have found that 2526 of the patients were prescribed APDs (602 typical APDs and 1833 atypical APDs)-Results In the adjusted models, use of APDs at the time of dementia diagnosis was associated with increased mortality risk in the total cohort (hazard ratio = 1.4; 95% confidence interval 1.3-1.5).We have also stratified the results.Conclusions: The risk of death in patients with dementia was increased in group that used atypical and typical APDs.Our study gives more evidence to advice caution in APD prescription for patients with dementia.

SESSION 2220 (SYMPOSIUM)
PRESIDENTIAL SYMPOSIUM: EDUCATION NETWORKS: STRENGTHENING GERONTOLOGY AND GERIATRICS THROUGH CONNECTIVITY Chair: Judith L. Howe, James J Peters VA Medical Center, GRECC, Bronx, New York, United States Discussant: Kathryn Hyer, University of South Florida, Tampa, Florida, United States The AGHE Presidential Symposium, related to the theme of the annual scientific meeting, underscores the importance of networks, collaborations and partnerships in advancing education in gerontology and geriatrics.AGHE has been