EXPLORING EXPERIENCES OF PAIN MANAGEMENT AMONG FAMILY CAREGIVERS OF COMMUNITY-DWELLING OLDER ADULTS WITH DEMENTIA

Abstract Pain is often under reported and under-treated in older adults with dementia. Formal caregivers receive training and resources to develop their pain management skills; yet family caregivers (FCGs), who bear the brunt of responsibility for pain management among community-dwelling older adults with dementia have largely been omitted from research. We conducted a qualitative descriptive study to gain a deep understanding of FCGs’ experience in pain management. 25 adult FCGs of community-based older adults with dementia were living in central Virginia were interviewed. Participants were 29 to 95 years old, predominantly white, married, female, and high school graduates. Four themes emerged around exploring FCGs’ pain management experience and each theme included sub themes: 1) Values: family caregivers make values-based decisions that rely on a diverse range of beliefs towards opioids and non-pharmacological approaches. 2) Barriers: pain management was hampered by patient-related factors (comorbidity, complexity of care) and FCG-related factors (lack of training and resources). 3) Support: FCGs perceived greater competence when well supported by professional caregivers (doctors, social workers) and family members. 4) Adaptation: FCGs employed many strategies to support themselves and build a sense of self-efficacy that can either inhibit or facilitate effective pain management for their loved-ones. Adaptation and support from professional or formal caregivers greatly improved FCGs’ perception of competence in pain management, suggesting research and development of interventions targeting FCGs is warranted.

Research has shown that diverse activity engagement has positive effects on cognitive functioning in older age.However, it is unknown whether the positive effect holds within persons across days and across people.We examined daily within-person association between activity diversity and working memory in older age and effects of potential moderators therein.We examined 16-day smartphone-based ambulatory assessment data from 150 older adults (aged 65+).Participants reported their present activities and completed working memory tasks seven times per day.Within persons, higher daily activity diversity was positively associated with higher daily working memory.Moreover, the prior day's activity diversity led to that day's higher working memory, but not vice versa.We did not find any moderating effects of age, education, or fluid and crystallized intelligence.Our results strengthen the evidence on the beneficial effect of activity diversity on cognitive performance.Results are discussed in the context of cognitive reserve theory.

CAREGIVER HEALTH LITERACY AS A MODIFIABLE TARGET TO PROMOTE OLDER ADULT HEALTH
Rachel O'Conor, Morgan Eifler, Lauren Opsasnick, Laura Curtis, Julia Yoshino Benavente, Lee Lindquist, and Michael Wolf, Northwestern University, Chicago, Illinois,

United States
Many older adults receive assistance in managing chronic conditions.Yet complicating the utility of caregiver support is whether caregivers have sufficient skills to aid in a patient's self-care.Health literacy (HL) is as an important determinant of older adults' health outcomes, but few studies have examined caregiver HL and patient outcomes.We interviewed 162 patient-caregiver dyads during an ongoing cognitive aging cohort study to examine associations between caregiver HL, measured using the Newest Vital Sign, and older adults' health outcomes.Physical function and mental health symptoms were assessed using PROMIS short form assessments.Patients' also self-reported emergency department (ED) visits and hospitalizations over the past 12 months.Chi-square and t-tests were performed, as appropriate.Patients were on average 73 years old and managing 4 comorbidities.The majority were female (70%), identified as Black (35%) or White (60%).Caregivers' mean age was 64 years; half were female (56%) and had limited HL (48%).Limited caregiver HL was associated with poorer physical function (M=43.0(8.5) vs. M=46.0(9.1), p=0.05), greater comorbidities (M=4.0 (1.9) vs M=3.3 (1.8), p=0.02) and more ED visits in the past year (36.7% vs. 19.3%,p=0.01).No differences by caregiver HL were observed for patients' mental health or hospitalization.Findings suggest that caregivers with limited HL are caring for medically complex patients, and further research should examine whether limited caregiver HL leads to poorer self-management of chronic conditions.The development of HL training for caregivers may better equip them to assist older adults and improve older adult health.Pain is often under reported and under-treated in older adults with dementia.Formal caregivers receive training and resources to develop their pain management skills; yet family caregivers (FCGs), who bear the brunt of responsibility for pain management among community-dwelling older adults with dementia have largely been omitted from research.We conducted a qualitative descriptive study to gain a deep understanding of FCGs' experience in pain management.25 adult FCGs of community-based older adults with dementia were living in central Virginia were interviewed.Participants were 29 to 95 years old, predominantly white, married, female, and high school graduates.Four themes emerged around exploring FCGs' pain management experience and each theme included sub themes: 1) Values: family caregivers make values-based decisions that rely on a diverse range of beliefs towards opioids and non-pharmacological approaches.

EXPLORING EXPERIENCES OF PAIN MANAGEMENT AMONG FAMILY CAREGIVERS OF COMMUNITY-DWELLING OLDER ADULTS WITH DEMENTIA
2) Barriers: pain management was hampered by patientrelated factors (comorbidity, complexity of care) and FCGrelated factors (lack of training and resources).3) Support: FCGs perceived greater competence when well supported by professional caregivers (doctors, social workers) and family members.4) Adaptation: FCGs employed many strategies to support themselves and build a sense of self-efficacy that can either inhibit or facilitate effective pain management for their loved-ones.Adaptation and support from professional or formal caregivers greatly improved FCGs' perception of competence in pain management, suggesting research and development of interventions targeting FCGs is warranted.

FACTOR STRUCTURE OF PRE-LOSS GRIEF-12 IN CAREGIVERS OF PEOPLE LIVING WITH DEMENTIA
JuYoung Park 1 , and James Galvin 2 , 1.Florida Atlantic University College of Social Work and Criminal Justice, Boca Raton, Florida, United States, 2. University of Miami School of Medicine, Miami, Florida, United States While several studies on post-loss grief have been conducted, little research has examined assessment and treatment for pre-loss grief in family caregivers of persons living with dementia (PLWD).A total of 699 caregivers of PLWD were recruited through relevant dementia associations.The recruitment e-mail provided information about the study and instructions on how to participate by a link to the online survey.Confirmatory factor analysis (CFA) was performed to test the fit of the data from the caregivers and to assess the factor structure of the Prolonged Grief-12 (PG-12) to evaluate pre-loss grief accurately by identifying relevant items and eliminating items that are not appropriate for caregivers of PLWD to assess pre-loss grief accurately.CFA was conducted via the Full Information Maximum Likelihood estimation method to test the unidimensional model of the PG-12 in the study population.The initial model was modified to develop a better-fitting model and to detect misfitting parameters in the PG-12 by deleting irrelevant items for caregivers of PLWD.The adjusted dementia-specific 10-item version (PG-10-D) had significantly improved fit indices with RMSEA = .064,CFI = .972,and GFI = .963.An overall assessment of fit indicated that the model adequately approximated the data.Factor loadings ranged from 0.53 to 0.85.This study suggests that the dementia-specific, unidimensional PG-10-D, modifying the original PG-12, may be useful and parsimonious in assessing and quantifying preloss grief in caregivers.Further research is required to establish psychometric properties, including factorial validity and reliability, factorial invariance analysis and further factor analysis.

POSITIVE ASPECTS OF CAREGIVING AND LOWER RISK OF FRAILTY AND SLEEP DISRUPTION IN THE NATIONAL STUDY OF CAREGIVING
Alexandra Wennberg 1 , Loretta Anderson 2 , Lenis Chen-Edinboro 3 , Annachiara Cagnin 4 , and Lorenzo Pini 5 , 1. Karolinska Institutet, Stockholm, Stockholms Lan, Sweden, 2. University of Maryland,Baltimore,Reisterstown,Maryland,United States,3. University of North Carolina Wilmington,Wilmington,North Carolina,United States,4. Università degli Studi di Padova,Padua,Veneto,Italy,5. University of Padova,Padova,Veneto,Italy Older adult caregivers have compounded risk for adverse health outcomes; however, evidence investigating the association between the spectrum of the caregiving experience and frailty has been limited.In the National Study of Caregiving, we examined the cross-sectional association between caregiving experiences and both frailty and sleep disruption outcomes among caregivers.We included 621 caregivers aged 65+ who completed a phone interview, including 36 items about caregiving.Using principal component analysis, we identified three caregiving components: general burden, financial burden, and positive emotions.Frailty was assessed via low energy, shrinking, weakness, reduced activity, and poor selfrated health.Sleep disruption was assessed with two questions regarding sleep interruption and trouble falling back asleep.In age-and sex-adjusted ordinal regression models, general burden was associated with frailty (OLO=1.21,95% CI 1.12, 1.30) and trouble falling back asleep (OLO=1.08,95% CI 1.00, 1.17); financial burden (OLO=1.15,95% CI 1.02, 1.31) was associated with frailty.General (OLO=1.99,95% CI 1.38, 2.88) and financial (OLO=1.98,95% CI 1.25, 3.14) burden were associated with sleep interruption in the fully adjusted model.Positive emotions were associated with lower odds of both frailty (OLO=0.86,95% CI 0.74, 0.99) and sleep interruption (OLO=0.75,95% CI 0.58, 0.98).Caregiver burden was associated with greater risk of frailty in age-and sex-adjusted models and sleep interruption when further accounting for sociodemographic and health factors.Positive emotions of caregiving were associated with decreased risk of these outcomes.

CAREGIVER PARTICIPATION IN VIDEO VISITS: CHALLENGE OR OPPORTUNITY?
Chair: Megan Gately Co-Chair: Lauren Moo Rapid expansion of telehealth in response to COVID revealed a digital divide for many patients, particularly older adults.Given the technical complexity of video visits (which may include downloading novel software and enabling a Hui Zhao 1 , Pamela Kulbok 2 , Ishan Williams 3 , Carol Manning 2 , and Rafael Romo 4 , 1. James Madison University, Harrisonburg, Virginia, United States, 2. UVA,