THE MEDIATING ROLE OF ADVANCE CARE PLANNING IN ACCULTURATION AND USE OF NURSING HOME AMONG KOREAN AMERICANS

Abstract The study examined attitudes towards Advance Care Planning (ACP) as a potential mediator in the association between acculturation and willingness to use nursing home in Korean American older adults (aged 60 and older). Data were driven from a cross-sectional study of 235 community-dwelling Korean American older adults (aged 60 and older) in 2013. Multivariate regression models of willingness to use nursing home were entered in the following order: (1) demographics, (2) health, (3) acculturation, and (4) attitudes towards advance care planning. The mediation effect of attitudes towards ACP in the relationship between acculturation and willingness to use nursing home was separately examined using the bootstrapping method. Higher acculturation was associated with positive attitudes towards ACP and more likelihood of using nursing home. The proposed mediation model was fully supported: positive attitudes towards ACP served as an intervening step between acculturation and willingness to use nursing home. The mediating role of attitudes towards ACP yields implications for developing culturally sensitive advance care planning education program targeting older individuals.

Data were drawn from a cross-sectional survey with 200 older KAs residing in New York. Best-subsets regressions were used to evaluate the best predictors of depression. Findings indicated that nearly 30% of older KAs reported experiencing mild or severe depressive symptoms. The best model fit for depression involved physical health, R/S coping skills, social networks, and annual household income. Social networks and R/S coping skills were found to be a protective factor against depressive symptoms and may be an effective tool for health care strategies in the management of depression and health-promoting behaviors. Careful assessment of R/S and social networks among older KAs may provide a more comprehensive approach to traditional, biomedically derived clinical practices by focusing on the whole person in early identification of risk factors, prognosis, and intervention for depression. Health education and intervention could be framed in ways that strengthen such psychosocial coping resources for older KAs. Facilitating social participation and mobilizing R/S resources in a wide range of personally meaningful activities may mitigate psychological distress and enhance life satisfaction.
feeling authentic in older adults playing pickleball may play an important role in positive psychological functioning.

PREDICTING FUNCTIONAL DECLINE IN OLDER ADULTS: MORE ACTIVITY NOW EQUALS LESS DECLINE LATER
Brenda Whitehead 1 , 1. University of Michigan-Dearborn, Dearborn, Michigan, United States According to the Function Spiral Model (Whitehead, 2017), aging attitudes influence activity engagement, which impacts functional ability via physical conditioning (or deconditioning). This study tests the activity ♢ conditioning ♢ function segment of the model using 59 older adults aged 61-92 (Mage = 76 at Time 1) who participated in 2 in-person assessments of physical health, gait, and function, spaced 3 years apart. Participants also completed mail-in questionnaires, reporting engagement in activities (walking, gardening, household chores, social clubs, etc.) at each time point. Hypotheses were 1) a lower activity level at Time 1 would predict greater decline in physical function across the 3-year span, and 2) that this effect would be mediated by changes in physical conditioning. Dependent t-tests revealed that both physical function-as indicated by the timed Get Up and Go test-and physical conditioning-as indicated by peak respiratory flow-declined during the period. The regression model testing the effect of activity engagement at Time 1 on decline in physical function (controlling for age, baseline function, and activity change) supported hypothesis 1 (-0.43, p = .003): more activity at Time 1 predicted less decline in physical function over time. Instead of supporting the mediation hypothesis, the model including both activity and conditioning demonstrated the strength of the activity at Time 1 effect, which actually increased in magnitude (-0.48, p = .001). Although the hypothesized mediation was not supported, the findings highlight current activity engagement as an important mechanism for slowing the progression of future age-related functional decline.

A PRESCRIPTION FOR WELLNESS: EXERCISE REFERRALS FOR PATIENTS AT A FEDERALLY QUALIFIED HEALTH CENTER
Gabriel Benavidez, 1 and Kelly Ylitalo 1 , 1. Baylor University, Waco, Texas, United States Physical activity improves quality of life and prevents or delays chronic disease, but most adults in the United States are inactive. Consultation and planning with a health care provider, specifically with an exercise "prescription," may increase physical activity, but utilization patterns and success of such programs are not well understood. This study assessed the initial 6 months of an exercise prescription program at a large, federally-qualified health center during 2018 whereby adult patients were referred via prescription to personalized health coaching by a fitness advisor. A census of all adults (n=512) who received an exercise prescription was combined with attendance data from the on-site exercise facility to classify patients as never attended, 1 to 3 visits, and ≥4 visits. Ordinal logistic regression was used to examine patient characteristics from the electronic health record that influenced exercise facility attendance. Only 30.2% of adults (mean age 44.7 years (SD 14.4)) completed ≥1 visit and 21.7% completed ≥4 visits. We identified no significant utilization differences by sex, race/ethnicity, body mass index, diabetes, hypertension, or coronary artery disease, but adults aged ≥60 years had almost twice the odds of ≥4 visits (OR=1.97; 95% CI: 1.18, 3.33; p=0.01) compared to younger patients. Many adult patients did not participate in the exercise prescription program, but older adults were more likely to participate. Exercise prescription programs with personalized health coaching may be useful for older adult patients receiving care at a federally-qualified health center. Future work will examine if or how exercise prescriptions impact chronic disease self-management.

EXPLORING FUNCTION OVER TIME IN OLDER ADULTS WITH ADVANCED HEART FAILURE
Theresa Floegel, 1 Alexander Schoemann, 1 and Catherine Taylor 1 , 1. East Carolina Unviersity, Greenville, North Carolina, United States Heart failure contributes to functional limitation in older adults, which is associated with rehospitalization and poorer health. However little is known about the trajectory of function after hospitalization in this population or its' association with readmission. Objective measurement over time to assess physical function trajectory in older adults with heart failure is needed. Purpose: To explore trajectory of function in older adults with heart failure who have history of hospitalization. Methods: Exploratory longitudinal design. Bi-weekly visits were conducted over 4 months with home-dwelling, ambulatory adults with heart failure (60+ years, NYHA classification III) who had a recent acute hospitalization. Function was assessed by Short Physical Performance Battery (SPPB) test and hand-grip strength (9 time-points). Descriptive analyses across time and groups comparison were performed. Results: Participants (N=10) were 75.3±4.6 years (2 female, 5 African American), with EF(%) 39±10 and 8.2±2.9 comorbidities. Half (n=5) were re-hospitalized during the study period. Those re-hospitalized scored an average 1.3 points lower on SPPB and had 2.03 kg less hand strength over time than those not re-hospitalized. An SPPB score <6 was observed across time in 51% of those re-hospitalized, compared to 31% of those remaining at home. Intra-individual function varied but did not decline over this time period. Conclusions: In a sample of older adults with heart failure, physical function ranged from some level of functional disability to functional dependence, with higher levels of disability observed in those re-hospitalized. A longer study period and larger sample may be needed to adequately assess physical function trajectory.

EXAMINING SEX DIFFERENCES WITHIN THE RELATIONSHIP BETWEEN PHYSICAL ACTIVITY AND EXECUTIVE FUNCTION IN OLDER ADULTS
Genna Losinski, 1 Hilary J. Hicks, 1 Alex Laffer, 1 and Amber Watts 1 , 1. University of Kansas, Lawrence, Kansas, United States Research has demonstrated sex-associated differences in physical activity and its benefits on cognition in older adults. The present study explored differential associations between moderate-to-vigorous physical activity (MVPA) and executive function, which is known to decline with aging. N = 53 older adults without cognitive impairment (M = 73.19 years,