Social Determinants of Health Among Those With and Without HIV Infection in NYC, the Epicenter of the U.S. Crisis

Abstract The COVID-19 pandemic in NYC, the epicenter of the US crisis, revealed indisputable evidence that social determinants of health (SDoH, e.g., racism, crowded housing, employment risks) and disparities in comorbid health risk factors produce higher burdens of disease and death among racial and ethnic populations. We conducted a needs assessment of SDoH among 1400 patients in several ambulatory care clinics to explore the impact among older adults, across different clinical populations. Among older adults with HIV (OAH), we found lower rates of food and housing insecurity compared to older adults without HIV. Despite higher levels of COVID knowledge and prevention adherence, we also found significantly higher levels of isolation, loneliness, depressive symptoms, and anxiety among OAHs compared to those without HIV. Access to Ryan White entitlements did buffer some impacts but preexisting high burdens of mental health issues were exacerbated, perhaps due to heightened perceptions of increased vulnerability to COVID-19.

older men living with HIV (OMLH).Participants were recruited through HIV Neurobehavioral Research Program at the University of California, San Diego.Our sample included 14 OMLH: average age -62 years old (range: 53 to 72), 79% white, 43% living alone, 79% men who have sex with men, 57% having college education or higher.Semi-structured interviews lasted from 43 to 114 minutes and were fully transcribed.Several themes emerged related to perceived barriers to successful aging stemming from social institutions: i.e., age discrimination and ageism, sexual and HIV-related stigma, social isolation, lack of resources, and food insecurity.Perceived institutional solutions promoting successful aging included mixed-age/inter-generational support groups, computer literacy training, health education, information and resources related to healthy lifestyle on a limited budget, and increased transparency of resources available to older adults.Advance care planning (ACP) and hospice services are underutilized by patients living with HIV (PWH).Little is known about how older PWH approach ACP; the purpose of this qualitative study was to understand barriers and facilitators to ACP within the context of the patient-clinician relationship.Data are from a larger multimethod study designed to understand social determinants of health (SDH) that shape the lives and healthcare experiences of veterans aging with HIV.The sample includes 25 veterans from the Veterans Aging Cohort Study (VACS) recruited from an urban VA medical center.Semi-structured interviews were performed and analyzed using thematic analysis.Less than half of participants reported engaging in ACP.Key barriers to ACP include: fragile social ties, distrust of the healthcare system, and fear of disclosure and discrimination.We offer several recommendations for clinicians to engage in these conversations successfully and highlight the importance of considering SDH when designing interventions.

SOCIAL DETERMINANTS OF HEALTH AMONG THOSE WITH AND WITHOUT HIV INFECTION IN NYC, THE EPICENTER OF THE U.S. CRISIS Tonya Taylor, SUNY Downstate Health Sciences University, Brooklyn, New York, United States
The COVID-19 pandemic in NYC, the epicenter of the US crisis, revealed indisputable evidence that social determinants of health (SDoH, e.g., racism, crowded housing, employment risks) and disparities in comorbid health risk factors produce higher burdens of disease and death among racial and ethnic populations.We conducted a needs assessment of SDoH among 1400 patients in several ambulatory care clinics to explore the impact among older adults, across different clinical populations.Among older adults with HIV (OAH), we found lower rates of food and housing insecurity compared to older adults without HIV.Despite higher levels of COVID knowledge and prevention adherence, we also found significantly higher levels of isolation, loneliness, depressive symptoms, and anxiety among OAHs compared to those without HIV.Access to Ryan White entitlements did buffer some impacts but preexisting high burdens of mental health issues were exacerbated, perhaps due to heightened perceptions of increased vulnerability to COVID-19.

TECHNOLOGY IS THE NEW NORMAL FOR INDIVIDUALS AGING-IN-PLACE WITH DISABILITIES Chair: Travis Kadylak Discussant: Susy Stark
Technology designers often exclude individuals aging with diverse needs, capabilities, and disabilities from engaging in the design process, which can hinder the usability and usefulness of emerging technologies.In this symposium, investigators report on research and development efforts aimed at understanding the needs of, and developing supportive technologies for, people aging with long-term disabilities.This symposium features projects from the Rehabilitation Engineering Research Center on Technologies to Support Aging-in-Place for People with Long-Term Disabilities (RERC TechSAge), which is an interdisciplinary collaboration between Georgia Tech and the University of Illinois at Urbana-Champaign.First, Bayles et al. will discuss findings from the Aging Concerns, Challenges, and Everyday Solution Strategies II study, focused on Deaf older adults' use of technologies as solution strategies for common everyday challenges.Next, Mitzner et al. will highlight the development of an evidence-based group exercise intervention (Tellewellness Tai Chi for Arthritis) aimed at promoting both physical exercise and social interaction for older adults with long-term mobility disabilities.Kadylak et al. will describe how voiceactivated digital assistants can support older adults aging with mobility disabilities by reporting on findings from a longitudinal demonstration project with older adults in assisted and independent living communities.Exploring the potential for smartbathroom technology to promote aging in place, Sanford et al. will discuss how smartbathroom sensor data can be analyzed and vizualized to identify ways to communicate insight from sensor data to improve training of occupational therapy practitioners.Susy Stark from Washington University will serve as the discussant for the symposium.

TECHNOLOGY SOLUTIONS FOR EVERYDAY BARRIERS AMONG DEAF OLDER ADULTS
Lyndsie Koon, 1 Shraddha Shende, 2 Wendy Rogers, 2 Jenny Singleton, 3 and Megan Bayles, 2 , 1. University of Kansas, Lawrence, Kansas, United States, 2. University of Illinois Urbana-Champaign, Champaign, Illinois, United States, 3. University of Texas at Austin, Austin, Texas, United States American Sign Language (ASL) is the primary form of communication for approximately 250,000 people in the U.S. (Mitchell et al., 2006).As these individuals age, they may experience challenges in their everyday activities.For example, ASL users rely on visual cues, but have age-related change in vision.Moreover, ASL users may need to utilize technology to communicate with non-ASL users, but the technology may not be suitable/usable for older adults.We explored these issues in the Aging Concerns, Challenges, and Everyday Solution Strategies (ACCESS) study, wherein we interviewed Deaf older adults (N=60) in ASL, who provided insights into unique, everyday challenges they encounter.We will focus on the technology solution strategies they incorporate to address and overcome challenges with daily activities.Understanding how participants think about, adapt, and utilize different technologies can inform future technology design to successfully support diverse, aging populations.

DELIVERING A TAI CHI INTERVENTION TO ADULTS AGING WITH MOBILITY DISABILITIES USING ZOOM
Elena Remillard, 1 Kara Cohen, 2 Lelah Cochran, 2 and Tracy Mitzner, 3 , 1. Georgia Institute Of Technology,  Atlanta, Georgia, United States, 2. Georgia Institute of  Technology, Atlanta, Georgia, United States, 3. Georgia  Institute of technology, Atlanta, Georgia, United States  Many individuals aging with mobility disabilities experience barriers to participating in physical activity, including transportation challenges and the need for specialized instruction.Since the COVID-19 pandemic began, these participation barriers have been amplified due to lockdowns and restrictions.Tele-technologies, including videoconferencing platforms like Zoom, can facilitate access to exercise classes from one's home.Virtual group exercise classes that incorporate social interaction have particular potential to support the physical and mental health of this population.This session will highlight lessons learned from launching the 'Tele Tai Chi' study, in which we are delivering an evidence-based Tai Chi program (Tai Chi for Arthritis) via Zoom to small group classes of older adults with long-term mobility disabilities.We will describe adaptations made in translating the in-person program to an interactive, online class, and provide an overview of a 'Telewellness' Tool that provides guidelines for using Zoom to deliver exercise classes to older adults.

EXPLORING USE OF DIGITAL HOME ASSISTANTS FOR OLDER ADULTS: A DEMONSTRATION PROJECT
Maya Malecki, 1 Leonardo Galoso, 1 Saahithya Gowrishankar, 2 Amy Brown, 3 Ramavarapu Sreenivas, 2 Wendy Rogers, 1 and Travis Kadylak, 4 , 1. University of Illinois Champaign,Illinois,United States,2.University of Illinois at Champaign,Illinois,United States,3. CRIS Healthy Aging Center,Danville,Illinois,United States,4. University of Illinois Urbana Champaign,Champaign,Illinois,United States Emerging digital home assistant technology has potential to support older adults in their homes.Voice-activated assistants can be used for entertainment, environmental control, physical activities, health management, and social engagement.However, many older adults have limited experience with these devices, which are not designed with them in mind.We conducted a demonstration project to explore how Sean Halpin, 1 Vincent Marconi, 2 Amy Justice, 3 Theodore Johnson II, 4 D. Keith McInnes, 5 Molly Perkins, 6 and Emily Pinto Taylor, 4 , 1. University of Georgia, Decatur,