Creating Inclusive Advance Care Planning Tools

Abstract The cultural appropriateness of two ACP tools, My Wishes, My Care, and Conversation Starter Kit, are examined. In development by the BC Centre for Palliative Care, My Wishes, My Care was reviewed with: LGBT Non-Metropolitan Older Adults (6 focus groups, N=32); English/Chinese Speaking Older Adults (1 focus group, N=9); and English/Punjabi or Hindi Speaking South Asian Older Adults (1 focus group, N=5). The Conversation Starter Kit, developed by Ariadne Labs, was reviewed with focus groups of people whose loved one was/is in a Care Home: one LGBT group (N = 5); one South Asian group (N = 5). General feedback on both tools included: concerns over level of understanding required to use the tool; the role of family in ACP planning; cultural inclusivity (e.g., images and text) and design elements. The feedback will inform revision of these tools and assist organizations in developing inclusive ACP planning guides or educational materials.

(SA) and the absence of traditional family among LGBT older adults. These themes highlight the challenges in ACP among diverse populations and the need for targeted interventions.

INSTITUTIONAL AND CULTURAL BARRIERS TO ACP: STAFF PERSPECTIVES
Gloria Gutman, 1 Brian de Vries, 2 Helen Kwan, 3 Katrina Jang, 3 and Shimae Soheilipour, 1 1. Simon Fraser University,Vancouver,British Columbia,Canada,2. San Francisco State University,San Francisco,California,United States,3. Gerontology Research Centre,Vancouver,British Columbia,Canada This study explored staff knowledge and engagement in assisting residents/families with ACP. Focus groups were conducted at two long-term care homes, one Exclusively Chinese (EC; n = 25); one Multi-Ethnic (ME; n = 41). In each, separate focus groups were held with registered staff, care aides, and support staff who also completed brief surveys providing socio-demographic data and information about their training and experience with ACP. Perceived barriers to engagement in ACP included limited knowledge and inadequate training in facilitating ACP, cognitive impairment of residents, language barriers, lack of openness to discussing ACP, family expectations and misinformation. EC staff also considered cultural and religious beliefs as one of the main barriers to engaging in ACP both for residents and families; staff at ME focused more on timing and the role of family. Support staff and care aides did not perceive ACP as within their scope of practice, deferring to nurses.
Columbia, Canada,5. Simon Fraser University Gerontology Research Centre,Vancouver,British Columbia,Canada The cultural appropriateness of two ACP tools, My Wishes, My Care, and Conversation Starter Kit, are examined. In development by the BC Centre for Palliative Care, My Wishes, My Care was reviewed with: LGBT Non-Metropolitan Older Adults (6 focus groups, N=32); English/Chinese Speaking Older Adults (1 focus group, N=9); and English/Punjabi or Hindi Speaking South Asian Older Adults (1 focus group, N=5). The Conversation Starter Kit, developed by Ariadne Labs, was reviewed with focus groups of people whose loved one was/is in a Care Home: one LGBT group (N = 5); one South Asian group (N = 5). General feedback on both tools included: concerns over level of understanding required to use the tool; the role of family in ACP planning; cultural inclusivity (e.g., images and text) and design elements. The feedback will inform revision of these tools and assist organizations in developing inclusive ACP planning guides or educational materials.

DIGITAL INTERVENTIONS TO PROMOTE HEALTH AND WELL-BEING OF OLDER ADULTS Chair: Gloria Gutman Co-Chair: Marcia Shade
The population of older adults is on the rise and so is their adoption of technology. According to the Pew Research Center, growing numbers of older adults are using smartphones, tablets, and the internet. Technology can also be an innovative and accessible way to deliver interventions that promote positive health outcomes. But implementing and evaluating digital interventions, especially those targeted to cognitively frail or otherwise vulnerable older adults, is not easy. The first presentation in this international interdisciplinary symposium sets the stage for discussing some of the barriers encountered. Specifically, it addresses the issue of compliance of adults with Mild Cognitive Impairment (MCI) while using internet-based cognitive behavioral therapy for sleep disturbance. The second presentation described a digital tool to screen and interview older adults in a hospital emergency department who may be experiencing mistreatment. This is followed by a study of use of voice assistant reminders to help aging adults adhere to daily completion of a diary to self-monitor pain symptoms. The fourth presentation describes a feasibility study of a digital screen-based device to calm long-term care home residents exhibiting disruptive Behavioral and Psychological Symptoms of Dementia. Symposium speakers and participants will be encouraged to dialogue on how some of the implementation and evaluation barriers described might be overcome or avoided as well as to share success stories from their own research on digital interventions for older adults living at home, in congregate housing or in hospital settings.

FEASIBILITY STUDY OF A DIGITAL SCREEN-BASED CALMING DEVICE FOR MANAGING BPSD DURING CARE
Gloria Gutman, 1 Avantika Vashisht, 2 Taranjot Kaur, 2 Ryan Churchill, 2 Amir Moztarzadeh, 2 and Mojgan Karbakhsh, 2 1. Simon Fraser University, Vancouver,British Columbia,Canada,2. Simon Fraser University Gerontology Research Centre,Vancouver,British Columbia,Canada MindfulGarden (MG) is a digital device resembling a flat screen TV, with touchless sensors that react to voice and motion. In this study 13 long-term care home residents aged 74-100 exhibiting Behavioural and Psychological Symptoms of Dementia (BPSD) were randomized to treatment and control groups. On days 1-3 the treatment group received usual care plus exposure to MG during morning and evening care -events well documented to be problematic for residents and care staff; controls received usual care only. On day 4 both groups were exposed to MG with verbal cueing. A 26-item checklist was used to record frequency and types of disruptive BPSD exhibited; care duration was recorded in minutes. There was a trend toward reduction of BPSD and duration of care during morning care. Findings suggest that verbal cueing may be important for successful implementation of MG in calming residents with dementia during routine care. Diaries can be important tools to document and communicate pain symptoms. Diary-based assessments can be prone to poor adherence and limitations with biased recall. One strategy to help adherence is to use voice assistant reminders. A sample of 15 community dwelling aging adults used the Google Assistant for reminders to complete pain self-management tasks. One task was a reminder created to write daily in a pain diary. Within the diary, participants could document a change in pain, pain severity, average and worst amount of pain, and pain relief. At follow-up, it was noted that participants adhered to writing most pain characteristics in the diaries, but there were times that each question was not answered. Participant's pain characteristics varied, which could be a helpful assessment to communicate to health providers for pain management. This feasibility study is preliminary support that voice assistants may help with the daily pain diary completion. Elder Mistreatment (EM) is a global health issue that continues to be under detected and inadequately addressed in healthcare settings. In this symposium, we will describe how we built and currently use the VOICES digital health tool to screen for EM. The tool is designed exclusively with older adults in mind and runs on iPads to be used in the emergency department. VOICES screens, educates, uses motivational interviewing to facilitate self-disclosure of EM, and refers patients for in-person screening. The tool includes multimedia