Patterns of Intergenerational Care Planning Among Chinese Aging Families in Hong Kong

Abstract Care planning before the onset of intensive care needs can increase families’ ability to manage caregiving crises and cope with care transitions. However, future care planning has not been substantially examined in a family context. Drawing on the model of Preparation for Future Care Needs and a family systems perspective, this study investigated patterns of intergenerational care planning across multiple planning domains (awareness, avoidance, information gathering, decision making, and concrete planning) among Chinese intergenerational pairs. Quantitative data of 213 pairs of aging parents and adult children were collected in Hong Kong. Latent Profile Analysis was conducted to examine typological structure underlying care planning patterns. Three patterns were discovered: filial-maximal, dyadic-moderate, and filial-minimal. Profile 1 contained approximately 9.9% of pairs, which demonstrated a relatively higher level of avoidance on considering the need of care preparation and engaged less in concrete planning activities. Profile 2 contained 68.5% of intergenerational pairs that had a moderate preparation level. Profile 3 contained 21.6% of intergenerational pairs that were comparatively active in care planning. The findings also indicated that although older adults across three groups demonstrated a similar level of awareness to prepare for future care, their engagement in the concrete planning activities may be driven by their children’s awareness and preparation toward future care. The findings will enhance professionals’ and service providers’ awareness of diverse care planning patterns among Asian aging families, and inform targeted policies and programmes to alleviate unpreparedness for eldercare through intergenerational care planning which can be more effective than unilateral preparation.


MEASURING DYADIC INTERACTIONS AND DINING ENVIRONMENT IN DEMENTIA MEALTIME CARE: A SYSTEMATIC REVIEW OF INSTRUMENTS
WEN LIU, 1 and Sohyun Kim, 2 1.The University of Iowa College of Nursing, Iowa City, Iowa, United States, 2. University of Iowa, Iowa City, Iowa, United States It is critical to use validated instruments to assess mealtime dyadic interactions and dining environment for people with dementia to evaluate the process and efficacy of mealtime interventions.However, the quantity and psychometric quality of such instruments are unknown.This systematic review aimed to synthesize the quantity and quality of instruments that assess dyadic interactions, physical environment, and/or social environment during dementia mealtime care.We searched Pubmed, CINAHL, AgeLine, PsychINFO, and Cochrane Library for records published between 1980-2020.Records were eligible if they included any instrument assessing concepts of interest (i.e., mealtime dyadic interactions, physical and/or social dining environment).From eligible records, eligible instruments originally developed or later modified to measure concepts of interest were identified, and instruments' characteristics were extracted: 1) development process, 2) concept/construct assessed, 3) sample/setting, 4) administration method, 5) item description, 6) scoring format/interpretation, 7) reliability, and 8) validity.A newly developed tool was used to evaluate instruments' psychometric quality.In total, 26 eligible instruments were identified.Seventeen instruments assessed dyadic interactions, 1 assessed only physical environment, and 8 assessed physical & social environment.All instruments were observational tools and scored as having low psychometric quality.Reasons for low psychometric quality included use of small sample size compared to the number of items, limited psychometric testing, and inadequate estimates.A number of instruments were developed and/or used to assess dyadic interactions, physical and/or social environment in dementia mealtime care.All instruments warrant further testing to accumulate psychometric evidence in larger diverse samples in different care settings.

PATTERNS OF INTERGENERATIONAL CARE PLANNING AMONG CHINESE AGING FAMILIES IN HONG KONG
Xue Bai, 1 Chang Liu, 2 and Tongling Xu, 2 1.The Hong Kong Polytechnic University, Hong Kong, Hong Kong, 2. The Hong Kong Polytechnic University, Hong Kong, Hong Kong Care planning before the onset of intensive care needs can increase families' ability to manage caregiving crises and cope with care transitions.However, future care planning has not been substantially examined in a family context.Drawing on the model of Preparation for Future Care Needs and a family systems perspective, this study investigated patterns of intergenerational care planning across multiple planning domains (awareness, avoidance, information gathering, decision making, and concrete planning) among Chinese intergenerational pairs.Quantitative data of 213 pairs of aging parents and adult children were collected in Hong Kong.Latent Profile Analysis was conducted to examine typological structure underlying care planning patterns.Three patterns were discovered: filial-maximal, dyadic-moderate, and filial-minimal.Profile 1 contained approximately 9.9% of pairs, which demonstrated a relatively higher level of avoidance on considering the need of care preparation and engaged less in concrete planning activities.Profile 2 contained 68.5% of intergenerational pairs that had a moderate preparation level.Profile 3 contained 21.6% of intergenerational pairs that were comparatively active in care planning.The findings also indicated that although older adults across three groups demonstrated a similar level of awareness to prepare for future care, their engagement in the concrete planning activities may be driven by their children's awareness and preparation toward future care.The findings will enhance professionals' and service providers' awareness of diverse care planning patterns among Asian aging families, and inform targeted policies and programmes to alleviate unpreparedness for eldercare through intergenerational care planning which can be more effective than unilateral preparation.

SPILLOVER EFFECTS OF RETIREMENT ON PHYSICAL AND MENTAL HEALTH OF A SPOUSE OR PARTNER: DO GENDER AND SEXUALITY MATTER?
Jingwen Liu, University of Maryland, college park, college park, Maryland, United States While the health implication of retirement on retirees has been widely discussed in social sciences, less is known about its spillover effects on one's spouse or partner.Indeed, large quantities of studies have shown that retirement is a joint decision of couples that may influence the time use of spouses and the incidence of divorce, and so leaving the cross-spouse effects unexplored may underestimate the influence of retirement and social security policies.Using ten waves of Health and Retirement Survey (HRS 1996-2014, N = 85039 observations), this research adopts fixed effects models and instrumental variable methods to examine the causal effects of a retiree's retirement on the physical and mental health outcomes of his/ her spouse or partner, with particular attention paid to the gender and sexuality differentials.Regression results suggest that transitioning into retirement is associated with enhanced self-reported health and cognitive function and decreased depressive symptoms, physical limitation, and BMI among the retirees' spouses or partners.However, the timing when retirement occurs also matters that retirement at the culturally expected retirement age leads to beneficial spillover effects, while late retirement brings about detrimental effects.Further comparison analysis indicates that retirement's spillover effects are more prominent among females and heterosexual couples than among their male and gay and lesbian counterparts.These findings inform policymakers of the cross-couple spillover effects of postponing retirement ages and the increasing physical and psychological disparities of females and gay and lesbian couples within families in middle and later life.

WE SHOULD HAVE TALKED ABOUT HOSPICE: TRANSFORMING COMMUNICATION WITH BEREAVED LGB AGING WOMEN
Korijna Valenti, 1 and Leah Janssen, 2 1.University of Denver,Colorado,United States,2. Scripps Gerontology Center,Oxford,Ohio,United States Because of historical discrimination, discomfort disclosing information, and differing definitions of family, lesbian, gay, bisexual, and transgender (LGBT) older adults with serious illness need both improved palliative and end-of-life (EOL) care communication with clinicians and recognized inclusion of spouses/partners.Communicating about palliative and EOL care may improve the care goals and emotional trajectory for patients and significant others.Using a descriptive qualitative approach, this study's aim was to analyze the communication experiences during a spouse's/partner's EOL care for bereaved LGB women (n=16) 60 and older.Drawing on queer gerontology, issues relating to access to resources and information and the systemic silencing of older LGB women illuminate areas where policy and practice may be improved.Semi-structured, one-on-one interviews were used to provide deep and meaningful information about palliative and EOL care communication between participants, their spouse or partner, and clinicians.While results reflect certain outcomes found in prior studies with non-LGBT adults, thematic analysis revealed three main findings with evidence specific to this population: 1) avoiding deep discussions about EOL; 2) lack of understanding about palliative or EOL care; and 3) limited communication with clinicians.Findings illuminate the need for better understanding among clinicians regarding palliative and EOL communication with LGBT dyads as well as communication strategies based on recognition and acceptance.Further dyadic communication research may improve care goals for LGBT older adults.Understanding couples' interactions and examining different communication behaviors may lead to improved palliative and EOL care goals for older LGBT adults with serious illness and their spouses/partners.

ENVIRONMENT STILL MATTERS: EXAMINING PERSON-PLACE-RELATIONSHIPS IN THE OLD AND THE NEW NORMAL ACROSS SETTINGS
Chair: Frank Oswald Co-Chair: Habib Chaudhury Discussant: Amanda Grenier In environmental gerontology, the home and the neighborhood have always been of particular interest for empirical research.Issues such as orientation and safety, place attachment and biographical bonding, have proven to be important for community dwellings older adults and for those living in care homes.However, with Covid-19, the seemingly stable person-place-relationships have been challenged.This symposium provides a set of applied research contributions that demonstrate the persistent salience of the environment by examining person-place-relationships in the old and the new normal in private homes and care homes.Contributions draw from ideas of "precarious ageing" (Grenier & Phillipson) and "pandemic precarity", for instance to understand housing insecurity, while concepts from environmental gerontology are used to explain processes of environmental agency and belonging.The first contribution by Mahmood and colleagues introduces an environmental audit tool for people at risk of homelessness to assess built environmental features of housing and neighborhood that support housing stability in the face of insecurity.Second, Wanka provides data from people framed as 'risk-groups' through the Covid-19 pandemic and how they dealt with contact restrictions, showing the role of intergenerational neighborhood relations to mediate risks of pandemic precariousness.Third, Elkes examined mobility and wayfinding challenges for residents in a long-term care home and subsequent environmental interventions to improve orientation.Forth, Leontowitsch and colleagues present findings from long-term care home residents during the pandemic to gain understanding of their experiences of social isolation and a biographical sense of resilience.Finally, Amanda Grenier will serve as the session's discussant.