Advance Care Planning Engagement and End-of-Life Preference Among Older Chinese Americans

Abstract The study aimed to examine how immigrant status and family relationships are associated with advanced care planning (ACP) engagement and end-of-life (EOL) preference over burial plan among older Chinese Americans, the largest subgroup of Asian Americans. Logistic regressions were used to analyze data from a survey of 430 older Chinese Americans aged 55 and older living in a Honolulu, Hawai’i. Results show that U.S.-born Chinese Americans were more likely to engage in ACP, including willingness thought of EOL care, and discussion about EOL care, and having preference over burial plan, than the foreign-born Chinese American. Family cohesion was not associated with ACP engagement and EOL preference over burial plan. Family conflict increased the possibility of ACP engagement, indicated by willingness thought of ACP, willingness discussion on ACP, and EOL preference over burial plan. The culturally sensitive educational intervention is needed to increase ACP engagement among older Chinese Americans.


CAREGIVING ARRANGEMENTS AND HEALTH OUTCOMES OF CHINESE OLDER ADULTS WITH DISABILITY IN CROSS-NATIONAL SETTINGS Chair: Jing Wang Co-Chair: Bei Wu
This symposium focuses on the wellbeing of older adults with disability/cognitive impairment and their family caregivers. More specifically, it aims to understand how familly support, community resources utilization, internal migration, and immigrant status impact older adults' caregiving arrangement, health outcomes and end-of-life preferences and family caregivers' caregiving burden in China and the U.S. The first study explored how perceived spousal relationships and support impact dyadic experiences of living with cognitive impairment through a person-centered care lens during a three-year period. The second presentation examined the association between adult children's support and the trajectories of depressive symptom level among Chinese older adults with disabilities. The third investigated how family relationship and immigrant status matter in advanced care planning (ACP) engagement and end-of-life preferences over burial plan among US-born and foreign-born older Chinese Americans living in Honolulu, Hawaii. The fourth study study explored family caregivers' caregiving burden for community-dwelling patients with dementia and its associated factors. The last study conducted an inventory of longitudinal aging survey datasets to stimulate research on intersection of migration and caregiving arrangement. It paved the way to use existing high-quality datasets to examine the significant impact of massive rural-to-urban migration on caregiving arrangement among Chinese older adults. This symposium presents empirical evidence of the impact of family, migration and culture-related factors on caregiving arrangement and health outcomes of Chinese older adults. The presenters emphasize the importance of providing family-centered care and design culturally sensitive interventions to improve the health outcomes of older adults.

EXISTING DATASETS TO STUDY THE IMPACT OF INTERNAL MIGRATION ON CAREGIVING ARRANGEMENTS
Hanzhang Xu, 1 Yaolin Pei, 2 Matthew Dupre, 3 and Bei Wu, 2 1. Duke University School of Medicine,Durham,North Carolina,United States,2. New York University,New York,New York,United States,3. Duke University,Durham,North Carolina,United States Massive rural-to-urban migration in China has a significant impact on caregiving arrangements among Chinese older adults. To stimulate research on the intersection of migration and caregiving, we conducted an inventory of longitudinal aging survey datasets that included older adults from mainland China. Large public available datasets that included measures related to migration and caregiving were searched and reviewed for eligibility. Key characteristics of each dataset, including study design, sample size, and measures, were extracted. Seven eligible datasets were identified, and five included national representative samples. Measures for migration varied across datasets. Some datasets included information on the migration history of older adults, whereas others focused on the migration of adult children. Similarly, caregiving was measured using different questions in each dataset. Caregiving activities were assessed with regard to their type, source, and amount. Highquality datasets exist to support research on migration and caregiving arrangements among Chinese older adults.
The study aimed to examine how immigrant status and family relationships are associated with advanced care planning (ACP) engagement and end-of-life (EOL) preference over burial plan among older Chinese Americans, the largest subgroup of Asian Americans. Logistic regressions were used to analyze data from a survey of 430 older Chinese Americans aged 55 and older living in a Honolulu, Hawai'i. Results show that U.S.-born Chinese Americans were more likely to engage in ACP, including willingness thought of EOL care, and discussion about EOL care, and having preference over burial plan, than the foreign-born Chinese American. Family cohesion was not associated with ACP engagement and EOL preference over burial plan. Family conflict increased the possibility of ACP engagement, indicated by willingness thought of ACP, willingness discussion on ACP, and EOL preference over burial plan. The culturally sensitive educational intervention is needed to increase ACP engagement among older Chinese Americans. This study aimed to examine the trajectory of depressive symptoms among Chinese older adults with disabilities and the role of adult children's support in predicting trajectory classes of depressive symptoms. Data were drawn from three waves of the China Health and Retirement Longitudinal Study (2011)(2012)(2013)(2014)(2015). The sample included 1420 disabled older adults age 60+ at the baseline and completed all three waves of the data. Growth mixture model shows two-class depressive symptoms trajectories: the higher risk group (25.49%) and the lower risk group (74.51%). Logistic regression results showed that respondents who received a longer term of adult children's instrumental support were more likely to be classified in a higher risk group after controlling the covariates (OR=1.184, p<0.05), while financial support and the frequency of contacts were not associated with the increased level of depressive symptoms. The policy implications were also discussed in this study.

DYADIC EXPERIENCES OF LIVING WITH COGNITIVE IMPAIRMENT THROUGH A 3-YEAR LONGITUDINAL QUALITATIVE STUDY
Jing Wang, 1 Bei Wu, 2 Eleanor McConnell, 3 Ding Ding, 4 and Kirsten Corazzini, 5 1. Fudan University,Nantong,Shanghai,China,2. New York University,New York,New York,United States,3. Duke University Medical Center,Durham,North Carolina,United States,4. Fudan University Affiliated Huashan Hospital,Shanghai,China,5. University of Maryland,Baltimore,Maryland,United States The fastest growth of population living with cognitive impairment takes place in China. The estimated prevalence of cognitive impairment among older adults in China is between 13% and 20%. This study focused on persons with cognitive impairment (PWCI) and their spousal care partners to explore how spousal relationships impact dyadic experiences of living with cognitive impairment through a person-centered care lens. We conducted a longitudinal qualitative study of 10 dyads of PWCI and their care partners over three years with three data collection time points. Our findings suggest that the complexity of changing experience of living with cognitive impairment is interpreted in the dynamic nature of their spousal relationship and relationship with others, patterns of communication, daily activities and care during the extended period of cognitive decline. It is crucial to help them nurture the belief that there is a significant meaning in the journey of living with cognitive impairment.

CAREGIVER BURDEN OF FAMILY CAREGIVERS OF PATIENTS WITH DEMENTIA IN A SHANGHAI COMMUNITY
Juan Li, 1 Zhijian Liu, 2 and You YIn, 3 1. Naval Medical University,Shanghai,China,2. Naval medical University,Shanghai,China,3. Changzheng Hospital,affiliated to Naval Medical University,Shanghai This study explored the level of and factors related to Chinese dementia family caregiver burden. We recruited 109 dyads of patients with dementia and their family caregivers from communities in Shanghai, China. Caregiver burden was assessed by Caregiver Burden Inventory. We used multivariate linear regression model to investigate factors associated with caregiver burden, including patients' socio-demographic information, cognitive function, ADL, neuropsychiatric symptoms, caregivers' depression, coping strategy, social support and community service utilization. The level of caregiver burden was moderate (65.92±16.74). The patients' cognitive function and social support were negatively associated with caregiver burden (β=-0.850, p＜0.01, β=-1.787, p=0.044, respectively). Caregivers' depression and community service utilization were positively associated with caregiver burden (β=2.109, p＜0.01,β=1.215, p＜0.01, respectively). These findings suggest enhancing social support and reducing depression of caregivers may have the potential of decreasing caregiver burden.

CHANGING CULTURE AROUND SERIOUS ILLNESS: THE VA LIFE-SUSTAINING TREATMENT DECISIONS INITIATIVE
Chair: Joan Carpenter Discussant: Robert Burke Discussing and documenting goals of care and lifesustaining treatment decisions with seriously ill patients is a widely endorsed practice by healthcare and professional organizations. In 2018, The Veterans Health Administration (VA) initiated a new national policy to standardize such practices, the Life Sustaining Treatment Decisions Initiative (LSTDI), which included a coordinated set of evidencebased strategies and practice standards for conducting, documenting, and supporting high-quality goals of care conversations (GoCCs); staff training to enhance skills in conducting, documenting, and supporting GoCCs; standardized, durable electronic health record tools for documenting patients' goals and preferences; and monitoring and information technology tools to support implementation and improvement. In this symposium, we will describe the first 20 months of implementing the LSTDI across the VA, the largest integrated healthcare system in the US. The first paper will focus