HOME-BASED TRANSCRANIAL DIRECT CURRENT STIMULATION AND CLINICAL PAIN IN OLDER ADULTS: A RANDOMIZED CLINICAL STUDY

Abstract Knee osteoarthritis (OA) is one of the leading causes of pain in older adults. Previous studies indicated clinic-based transcranial direct current stimulation (tDCS) was effective to reduce pain in various populations, but no published studies have reported the efficacy of home-based self-administered tDCS in older adults with knee OA using randomized clinical study. Thus, the purpose of this study was to evaluate the efficacy and safety of tDCS on clinical pain intensity in adults with knee OA pain. One hundred twenty participants aged 50–85 years with knee OA pain were randomly assigned to receive fifteen daily sessions of 2 mA tDCS for 20 min (n = 60) or sham tDCS (n = 60) over 3 weeks with remote supervision via telehealth. Clinical pain intensity was measured by asking participants to rate their knee pain using a numeric rating scale from 0 (no pain) to 100 (worst pain imaginable). Participants (68% female) had a mean age of 66 years and the mean body mass index in the sample was 32.59 kg/m2. There have been no adverse events. Active tDCS significantly reduced pain intensity compared to sham tDCS after completion of the fifteen daily sessions (t = 6.57, df = 110, p < .001). We demonstrated that home-based self-administered tDCS was safe and reduced clinical pain intensity in older adults with knee OA, which can increase its accessibility. Future studies with multi-site randomized controlled trials with various populations are needed to validate our findings.

Research has shown an association between symptoms and falls and fall-related outcomes among older adults.However, this association was primarily drawn from cross-sectional studies or studies with a single symptom.Using the 2011-2018 waves of the National Health and Aging Trends Study, we examined whether 1) prior-wave common co-occurring symptoms predicted later-wave fallrelated outcomes and 2) demographics moderated the longitudinal effects of symptoms on fall-related outcomes among community-dwelling older adults.Falls and fall-related outcomes were self-reported falls, multiple falls, fear of falling (FOF), and FOF limiting activity.The number of symptoms (from 0 to 6) was calculated based on the presence of pain, insomnia, breathing difficulty, depressive symptoms, anxiety, and fatigue.Binomial logistic regression was used for data analyses.Our sample consisted of 9,060 participants who contributed 34,327 observations.These observations were aged between 65 and 79 years old (57.7%), female (58.4%), and non-Hispanic White (70.5%).Each additional symptom was associated with an increased risk of falls (Adjusted Odds Ratio [AOR]: 1.13, 95% CI: 1.11-1.15),multiple falls (AOR: 1.15, 95% CI: 1.12-1.18),FOF (AOR: 1.21, 95% CI: 1.18-1.24)and FOF limiting activity (AOR: 1.25, 95% CI: 1.21-1.29).Age, race/ethnicity, education, and living arrangement significantly moderated the relationships between symptoms and falls and fall-related outcomes.However, gender did not moderate the effects of symptoms on any outcomes.These findings suggest that symptoms longitudinally predict falls and fall-related outcomes.Common symptoms assessment and individual demographics should be incorporated into fall risk assessments and interventions.

HOME-BASED TRANSCRANIAL DIRECT CURRENT STIMULATION AND CLINICAL PAIN IN OLDER ADULTS: A RANDOMIZED CLINICAL STUDY
Hyochol Ahn 1 , Geraldine Martorella 1 , Kenneth Mathis 2 , and Hongyu Miao 1 , 1.Florida State University, Tallahassee, Florida, United States, 2. University of Texas Health Science Center at Houston, Houston, Florida, United States Knee osteoarthritis (OA) is one of the leading causes of pain in older adults.Previous studies indicated clinicbased transcranial direct current stimulation (tDCS) was effective to reduce pain in various populations, but no published studies have reported the efficacy of home-based self-administered tDCS in older adults with knee OA using randomized clinical study.Thus, the purpose of this study was to evaluate the efficacy and safety of tDCS on clinical pain intensity in adults with knee OA pain.One hundred twenty participants aged 50-85 years with knee OA pain were randomly assigned to receive fifteen daily sessions of 2 mA tDCS for 20 min (n = 60) or sham tDCS (n = 60) over 3 weeks with remote supervision via telehealth.Clinical pain intensity was measured by asking participants to rate their knee pain using a numeric rating scale from 0 (no pain) to 100 (worst pain imaginable).Participants (68% female) had a mean age of 66 years and the mean body mass index in the sample was 32.59 kg/m2.There have been no adverse events.Active tDCS significantly reduced pain intensity compared to sham tDCS after completion of the fifteen daily sessions (t = 6.57, df = 110, p < .001).We demonstrated that homebased self-administered tDCS was safe and reduced clinical pain intensity in older adults with knee OA, which can increase its accessibility.Future studies with multi-site randomized controlled trials with various populations are needed to validate our findings.

THE ASSOCIATION BETWEEN MEDITERRANEAN DIET ADHERENCE AND ALLOSTATIC LOAD IN OLDER ADULTS
Alexandra Fiocco 1 , Anik Obomsawin 2 , and Danielle D'Amico 3 , 1. Toronto Metropolitan University, Toronto, Ontario, Canada, 2. X (Ryerson) University,Toronto,Ontario,Canada,3. Toronto Metropolitan University,York,Ontario,Canada Allostatic load (AL) is a multisystemic index of biological wear and tear which is associated with poor health outcomes.In recent years, researchers have examined the association between dietary pattern intake and AL; however, no studies to date have examined the relationship between AL and consumption of a Mediterranean diet.Blood and urine samples were collected from 201 community-dwelling older adults who completed a Food Frequency Questionnaire (FFQ).A Mediterranean Diet Score (MDS) was calculated based on previous recommendations and a sex-based AL index was calculated using a count-based approach for 16 biomarkers associated with neuroendocrine, immune, cardiovascular, or metabolic function.It was hypothesized that a higher MDS would associate with lower AL, and that this association would be particularly robust the immune and metabolic subcomponents of the AL index.In support of the study hypotheses, generalized linear models revealed a significant inverse relationship between MDS and AL (ß = -0.03,P = 0.037).Furthermore, higher MDS was significantly associated with lower immune (ß = -0.06,P = 0.38) and metabolic (ß = -0.05,P = 0.039) subsystem scores, but was not associated with cardiovascular or neuroendocrine subsystem scores.Exploratory analyses further showed that the association was more robust in male than female participants.The current findings are interpreted with caution given the study design and sample characteristics.However, these findings contribute to the literature supporting the Mediterranean diet as an important lifestyle behavior that may support healthy aging.

RACIAL AND ETHNIC VARIATIONS IN DEMENTIA DIAGNOSIS, SURVIVAL, AND END-OF-LIFE CARE QUALITY
Chair: Olga Jarrín Co-Chair: Zahra Rahemi Discussant: Michael Gusmano In the United States most adults have a preference to die at home and is an indicator of good end-of-life care.In the context of dementia, family members and caregivers are decision makers and part of good and equitable care involves understanding cultural variation in attitudes and social norms related to dementia, death and dying, and the meaning of a good death.This symposium explores racial and ethnic variation in lifetime dementia diagnosis and end-of-life care quality indicators.The first presentation examines racial, ethnic, and geographic variation in the rarely discussed lifetime prevalence of dementia and survival time from dementia diagnosis to death using national Medicare data.The second presentation describes the relationship between end-of-life care planning and satisfaction with end-of-life care using data from the Health and Retirement Study.The third presentation describes variation in place of death, a key indicator of end-of-life care quality, by dementia diagnosis and race/ ethnicity using national Medicare data.The fourth presentation examines variation in hospice use, another indicator of end-of-life-care quality, and place of death by dementia diagnosis, race, and ethnicity using national Medicare data.The symposium concludes with a presentation examining the relationship between place of death and satisfaction with care received using data from the Health and Retirement Study.The Institute for Healthcare Improvement's Triple Aim (improving the experience of care, improving the health of populations, and reducing per capita costs of health care) serves as a lens for discussing policy and practice implications of the major findings from each presentation.

END-OF-LIFE CARE PLANNING AND SATISFACTION AMONG THE HEALTH AND RETIREMENT STUDY DECEDENTS
Zahra Rahemi 1 , Ayse Malatyali 2 , Tom Cidav 3 , Olga Jarrín 4 , Cheryl Dye 5 , and Christopher McMahan 5 , 1. Clemson University,Greenville,South Carolina,United States,2. University of Central Florida,Orlando,Florida,United States,3. Johns Hopkins University,Baltimore,Maryland,United States,4. Rutgers,The State University of New Jersey,New Brunswick,New Jersey,United States,5. Clemson University,Clemson,South Carolina,United States The frequency and timing of advance care planning among individuals living with cognitive impairments vary by race/ ethnicity and other sociodemographic factors.This study