Leveraging Disruptions to Create an Equitable, Age-Friendly, Learning Health System

Abstract In a learning health system, the system’s own data and the experiences of its workforce are integrated with external evidence to provide better care. In an age-friendly health system, core principles of age-friendly care are integrated into every point in the system. Disruptions caused by the COVID-19 pandemic, and the innovations that addressed them, present an opportunity to discuss how these two frameworks may be combined and leveraged to transform care for older adults. We will present examples of pandemic-related disruptions, including rapid changes in how patients and providers move within and between facilities and the significant toll on healthcare workers’ mental health. We will also highlight innovative solutions to these disruptions that could transform healthcare systems. Critical to these points is a discussion of how these disruptions have disproportionately impacted healthcare workers and patients of color and how the innovations must be implemented using an anti-racist, health equity lens.


INNOVATION DURING DISRUPTION: SUPPORTING WHAT MATTERS MOST TO OLDER ADULTS THROUGH PERSON-ENVIRONMENT FIT Sarah Szanton, Johns Hopkins University, Baltimore, Maryland, United States
The fragile and improvised systems of care for older adults have been decimated by isolation and fragmented care during the pandemic.However, innovations are increasingly being offered to older adults to improve the fit between them and their environment.This includes fit within the home, the social environment, the policy environment, and with clinicians.Advancing these "fits" requires evidence-based solutions like CAPABLE, a 4 month self-efficacy and function program that provides an occupational therapist, nurse and handyworker to assess and address older adults' functional goals.The older adult identifies what matters most and experiences a tailored program that taps into their purpose in life and supports engaging in meaningful activities.Starting in research sites, CAPABLE is now offered in 34 sites in 17 States and expanding through policy and insurers.Such efforts to leverage the strength of older adults and their families, builds capacity to evolve our communities of care.

LESSONS FROM DISRUPTION: A NEW NORMAL FOR FAMILIES AND CARE PARTNERS
Beth Fields, University of Wisconsin-Madison, Madison, Wisconsin, United States COVID-19 has forced community-dwelling older adults to rely on family members and care partners more than ever before for support.Often at the expense of their own health and well-being, family members and care partners help older adults manage physical and psychosocial needs, navigate a complex, ever-changing healthcare system, and follow public health guidelines.Given the increasing demands and poor outcomes, there is no better time than now to develop policies and practices that better recognize and support family members and care partners of older adults.To inform policy and practice development, this symposium will present findings from a literature review of peer-reviewed studies published from 2019 through 2021 that identifies and addresses challenges and opportunities related to caregiving for an older adult in a pandemic.The experiences of the past year demonstrate that the new normal needs to recognize and support family members and care partners.

RE-ENVISIONING AGING IN THE RIGHT PLACE TO DISRUPT HOMELESSNESS FOR OLDER PEOPLE
Chair: Rachel Weldrick Co-Chair: Sarah Canham Discussant: Joyce Weil Recent developments in the aging-in-place literature have recognized the significance of aging-in-the-right-place.That is, aging in a place that supports an individual's unique values, vulnerabilities, and lifestyles.This symposium will build upon existing research by critically examining the potential for older persons with experiences of homelessness (OPEH) and/or housing insecurity to age-in-the-right-place. Presenters will include interdisciplinary researchers with a diversity of perspectives stemming from gerontology, social work, and environmental design.The symposium will begin with Weldrick and Canham presenting a conceptual framework for aging-in-the-right-place that has been developed to outline indicators relevant to OPEH and housing-insecure older people.Elkes and Mahmood will then discuss findings from a study of service providers working with OPEH to consider the relative benefits and challenges of temporary housing programs.Following, Brais and colleagues will present findings from an environmental audit, developed as a novel assessment tool to evaluate the accessibility and physical design of housing programs for OPEH.A final presentation by Kaushik and Walsh will highlight findings from a photovoice study on perspectives of aging-in-the-right place among OPEH during the Covid-19 pandemic.Joyce Weil, an expert in measurement of person-place fit and life course inequalities, will discuss the implications of these papers and reflect on the potential for the aging-in-the-right-place framework to address the diverse needs of the growing population of OPEH through policy and practice.Together, the participants of the symposium will advance this emerging scholarship using a wide range of methods and perspectives.

AGING IN THE RIGHT PLACE: A CONCEPTUAL FRAMEWORK FOR HOUSING INSECURE OLDER PEOPLE
Rachel Weldrick, 1 Sarah Canham, 2 Atiya Mahmood, 1 Tamara Sussman, 3 and Christine Walsh, 4 1.Simon Fraser University, Vancouver, British Columbia, Canada, 2. University of Utah, Salt Lake City, Utah, United States,3. McGill University,Montreal,Quebec,Canada,4. University of Calgary,Calgary,Alberta,Canada Emerging research has highlighted the significance of aging in the right place (AIRP) by recognizing that secure and optimal housing should support an individual's unique vulnerabilities and lifestyles.Existing literature, however, has yet to consider what it means for older people experiencing homelessness and/or housing insecurity to age-in-the-rightplace.In order to address this knowledge gap, a review of person-environment fit models for older people and other relevant literature was conducted to determine critical identifiers of AIRP for housing insecure older people.Findings from this literature review were then refined in collaboration with interdisciplinary scholars and community partners to establish a conceptual framework.This paper presents the resulting conceptual framework and outlines the key indicators of AIRP relevant to housing insecure older people.The proposed framework provides a practical and meaningful contribution to the literature which can be used to promote housing security among individuals often excluded from existing aging-in-place models.

AGING IN THE RIGHT PLACE? PHOTOVOICE WITH OLDER ADULTS RESIDING IN SHELTERS DURING COVID-19
Vibha Kaushik, Jill Hoselton and Christine Walsh, University of Calgary, Calgary, Alberta, Canada Aging in the right place (AIRP) involves supporting older adults to live as long as possible in their homes and communities, recognizing that where an older person lives impacts their ability to age optimally and must match their unique lifestyles and vulnerabilities.Photovoice, a participatory action research strategy, allows people to document their experiences through photography, promoting critical dialogue about issues such as AIRP and rights-based housing.This presentation highlights the concept of AIRP from the perspectives of a diverse group of older adults living in promising practices shelters in Vancouver, Montreal, and Calgary, Canada using photovoice.Findings indicate that the process promoted a sense of empowerment among participants.Insights about older adults' perceptions of AIRP residing in shelters to best meet their intersectional identities, housing, and support needs will be shared.Findings inform policy initiatives that promote AIRP and the right to adequate housing for older adults experiencing homelessness.

EVALUATING SPACES FOR OLDER ADULTS EXPERIENCING HOMELESSNESS: FINDINGS FROM AN ENVIRONMENTAL AUDIT
Hannah Brais, 1 Émilie Cormier, 2 Diandra Serrano, 3 Atiya Mahmood, 4 Tamara Sussman, 3 and Valérie Bourgeois-Guerin, 2 1.Old Brewery Mission,Old Brewery Mission,Quebec,Canada,2. Université du Québec à Montréal,Montreal,Quebec,Canada,3. McGill University,Montreal,Quebec,Canada,4. Simon Fraser University,Vancouver,British Columbia,Canada Homeless populations require spaces and services that take into account their life trajectories.The Aging in the Right Place -Environmental Checklist (AIRP-ENV) is an environmental audit tool developed by our team to evaluate the accessibility and overall design features of housing targeted for aging individuals experiencing homelessness.Researchers in Vancouver, Calgary and Montreal employed this tool in 2021 to evaluate environmental features in selected promising practices to identify built environment factors that promote aging in the right place.Preliminary findings reveal the following themes across sites: access to communal and recreational spaces encourage social inclusion and meaningful recreation opportunities; barrier-free built environment features foster independence and safety; and access to services and amenities encourage community mobility.Findings demonstrate a need to employ a broader evaluative lens that incorporates psycho-social factors to gain a nuanced understanding of aging in the right place for older adults who have experienced homelessness.

TEMPORARY HOUSING FOR OLDER PEOPLE: ADDRESSING HOUSING INSECURITY TO PROMOTE AGING IN THE RIGHT PLACE
Shreemouna Gurung, 1 Shelby Elkes, 1 Atiya Mahmood, 1 Holly Lemme, 1 Gelareh Modara, 1 Emily Lam, 1 Maria Juanita Mora, 1 Sarah Canham, 2 and Rachel Weldrick, 1 1.Simon Fraser University, Vancouver, British Columbia, Canada, 2. University of Utah, Salt Lake City, Utah, United States The Aging in the Right Place (AIRP) project is a multiyear, multi-city partnership grant on aging, housing insecurity and homelessness.This paper presents findings from provider/staff interviews (N=5) at a Temporary Housing Program (THP) serving older people experiencing (or at risk of) homelessness (OPEH) in Vancouver, Canada.The researchers sought to understand the strengths and weaknesses of the program, scale-up (i.e., policies) and/or scale out impacts (i.e., on people and communities), as well as how the program promotes housing security and stability for OPEH.Narrative data reveals the program provided housing stability to OPEH by offering increased access to resources (food, pharmaceutical, transportation, social support and engagement).Additionally, through the promotion of client autonomy, privacy and security in their housing unit, the organization and staff work to support and foster AIRP among their clients and help to transform a temporary housing space into a secure home-type setting.

SOCIAL ENGAGEMENT AND WELL-BEING AMONG CHINESE OLDER ADULTS
Chair: Wei Zhang Co-Chair: Bei Wu Discussant: Yan Yan Wu Social engagement is increasingly recognized as a protective factor to promote healthy aging.This symposium provides new findings on social participation and social isolation in relation to individuals' health and well-being among the Chinese populations.Using the 2002¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬-2018 Chinese Longitudinal Healthy Longevity Survey, the first study examined the trends of leisure activity engagement among young-old adults aged 65-74 in China over a 16-year period.Findings revealed a general downward trend of