Engaging Isolated and Underserved Older Adults in 4Ms Care: Age-Friendly Care, PA

Abstract Older adults, the largest segment of the US rural population, face significant disparities in health and healthcare compared to their non-rural peers, including more chronic health conditions, financial challenges, and social isolation. They have limited access to healthcare and social services for prevention, management and treatment of chronic conditions. Age-Friendly Care-PA, a partnership between Primary Health Network and Penn State College of Nursing, aims to reduce these disparities in care and services for rural older adults through co-designing their Geriatric Workforce Enhancement Program. Age-Friendly Health Systems, an initiative of the John A Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States, equips providers, older adults, and their care partners with the support necessary to address What Matters, Medication, Mentation, and Mobility. This symposium describes how the 4Ms are integrated into clinician training and competencies, older adult education, operations, care delivery, and quality improvement. Year two outcome data will be shared. Drs. Hupcey and Fick will provide an overview of the project and its reach. Dr. Berish will describe the process of engaging stakeholders in co-developing our 4M metrics and the data generated. Jenny Knecht, CRNP, will describe a pilot study to extend the reach and acceptability of telehealth to hard-to-reach older persons. Finally, Dr. Garrow will detail a new initiative focused on equity in care. Our discussant, Dr. Terry Fulmer will lead a discussion of this work as well as next steps and policy implications.

and assessments.Twelve participants withdrew mostly citing the stress of the pandemic as their reason; 5 did not respond to multiple outreach efforts.Veterans were 66□18 y and caregivers were 58□16 y.Veterans and caregivers who completed the program rated it high on usability and acceptability.Pre-post t-tests across a psychosocial battery did not reveal significant differences; results were limited by incomplete post-intervention data.Further testing with modified retention strategies is recommended.

CAREGIVERS' LOSS OF THE DYADIC EXPERIENCE AFTER THEIR CARE PARTNER'S DEATH Harleah Buck, University of Iowa, Iowa City, Iowa, United States
One emerging dyadic concept is the experience of family caregivers when their care partner dies and their dyadic relationship comes to an end.This study qualitatively examined and characterized the loss of the dyadic experience for the caregiver after the death of their care partner.Data was accrued as part of a randomized clinical trial in 29 older hospice caregivers.Iterative thematic analysis focused on dyadic processes before, during and post death.Using two relational parameters from Relational Turbulence Theory resulted in a preliminary characterization of a new concept -dyadic dissolution as a cognitive and affective process whereby a remaining member of a dyad experiences relational uncertainty and partner interference while adapting (or not) to the death of their care partner.Findings suggest that asking several open-ended questions about the dyadic relationship will enable assessment for any continuing impact of relational uncertainty and partner interference on bereaved caregivers.

ENGAGING ISOLATED AND UNDERSERVED OLDER ADULTS IN 4MS CARE: AGE-FRIENDLY CARE, PA
Chair: Diane Berish Discussant: Terry Fulmer Older adults, the largest segment of the US rural population, face significant disparities in health and healthcare compared to their non-rural peers, including more chronic health conditions, financial challenges, and social isolation.They have limited access to healthcare and social services for prevention, management and treatment of chronic conditions.Age-Friendly Care-PA, a partnership between Primary Health Network and Penn State College of Nursing, aims to reduce these disparities in care and services for rural older adults through co-designing their Geriatric Workforce Enhancement Program.Age-Friendly Health Systems, an initiative of the John A Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States, equips providers, older adults, and their care partners with the support necessary to address What Matters, Medication, Mentation, and Mobility.This symposium describes how the 4Ms are integrated into clinician training and competencies, older adult education, operations, care delivery, and quality improvement.Year two outcome data will be shared.Drs.Hupcey and Fick will provide an overview of the project and its reach.Dr. Berish will describe the process of engaging stakeholders in co-developing our 4M metrics and the data generated.Jenny Knecht, CRNP, will describe a pilot study to extend the reach and acceptability of telehealth to hard-to-reach older persons.Finally, Dr. Garrow will detail a new initiative focused on equity in care.Our discussant, Dr. Terry Fulmer will lead a discussion of this work as well as next steps and policy implications.Moving from concept to quantitative measurement can be complex.There were several challenges in co-designing measures to assess the impact of Age-Friendly Care, PA, a geriatric workforce enhancement program.First as a FQHC, our clinical partner had not captured the metrics of interest.Second, the co-developed operational definitions for our metrics should be feasible, relevant, and useful for all project members.Third, funder reporting requirements must also be addressed.Working within this context, we co-created 11 outcome indicators structured around the 4Ms (IHI) now with 9 months of data.EMR changes to make data reportable included measuring opioid misuse mitigation, high-risk medication elimination, cognitive assessment and dementia care management, advanced care planning, care partner presence, annual wellness visit completion, pneumonia vaccination rates, colorectal screening rates, mobility goal tracking, and presence of a caregiver.Work continues around formulating themes to create a reportable mechanism for assessing What Matters.Care, PA utilizes the ECHO, all-teach-all-learn, platform to engage isolated rural providers in incorporating the 4Ms (IHI) into their practice.Age-Friendly Care, PA reaches out directly to rural older adults and their care partners to co-design education and support.We have hosted 28+ events and reached 450+ individuals.Results include tracking and improvement in quality indicators assessed including support for individuals living with dementia and their care partners (NA-66.7%),risk for opioid misuse (NA-78%), high-risk medication management (NA-47.8%),fall-risk management (NA-9.4%),and advanced care planning (NA-8.9%).We will discuss the creation, co-development, implementation, lessons learned, and future of Age-Friendly Care, PA.

REACHING OUT TO OLDER ADULTS IN RURAL COMMUNITIES BY UTILIZING COMMUNITY HEALTH WORKERS DURING A PANDEMIC Jenny Knecht, Pennsylvania State University, University Park, Pennsylvania, United States
Older adults in rural communities have access, isolation, and technology barriers to healthcare that are exacerbated by the COVID-19 pandemic.A shortage of healthcare professionals combined with limited resources and poor broadband access have limited their ability to benefit from telehealth.The pandemic has further worsened isolation in rural communities.This Age-Friendly Care, PA pilot study uses community health workers (CHW) as a bridge to connect isolated and underserved older adults with their healthcare team.The CHWs facilitate access to telehealth provided by a Federally Qualified Health Center (FQHC), and also provide "checkins' to housebound patients.The focus of the intervention is CHW delivered facilitation of telehealth and other supports to better manage their healthcare needs.We will describe the co-design of the project and discuss lessons learned in attempting to bridge the digital divide for rural older adults during and after the pandemic.

ONE POSSIBLE CONSEQUENCE OF COVID-19 VACCINE: INEQUITABLE DISTRIBUTION George Garrow, Primary Health Network, Sharon, Pennsylvania, United States
Primary Health Network (PHN) is the largest Federally Qualified Health Center (FQHC) in Pennsylvania expanding over 17 counties.Getting Pennsylvanians vaccinated is a critical step in reducing the spread and impact of COVID-19, although research suggests that the inequitable distribution of the COVID-19 vaccine may be a critical barrier.Although concerns regarding vaccine hesitancy are prevalent, experts also suggest that disparities in vaccination rates are in part due to the lack of accessible scheduling; adversely affecting underserved, such as rural communities, and minority populations.To address these obstacles, Primary Health Network is creating a COVID-19 Vaccination/Health Equity Team.Their objectives include: creating tools to provide comprehensive information on vaccine supply, identifying potential challenges and proactively planning for ways to mitigate likely disparities, identifying people who wish to be vaccinated but lack the means to do so, and connecting them in an equitable way, to vaccinations.

ENVIRONMENTAL GERONTOLOGY DURING COVID-19: AGING IN PLACE SINCE THE PANDEMIC ONSET
Chair: Melissa Cannon Co-Chair: Jessica Finlay Discussant: Graham Rowles The COVID-19 pandemic is fundamentally changing neighborhood landscapes as we shelter in place and adjust our lifestyles.To age-in-place is to live in one's home and/ or community "safely, independently, and comfortably."The ability to age-in-place is a public health priority for all, regardless of income or health status, and requires a variety of community resources to be sustainable.Since the pandemic