USING RESEARCH TO ADVANCE THE DEMENTIA-FRIENDLY COMMUNITY MOVEMENT AT THE LOCAL, NATIONAL, AND INTERNATIONAL LEVEL

Abstract It is estimated that more than 55 million people worldwide are living with dementia. To address the social and health needs of individuals living with dementia and their care partners, researchers, policymakers and advocates have championed dementia-friendly communities (DFCs) as a population-level response. DFCs promote the well-being of those living with dementia, empower all members of the community to celebrate the capabilities of persons with dementia, and encourage individuals living with dementia to engage in their communities. The objective of this symposium is to describe the ways in which research can help to advance the dementia-friendly movement at the local, national, and international levels. First, Scher & Greenfield will describe the dimensions of implementation of DFCs in Massachusetts with implications for program monitoring and process evaluation. Second, Epps & colleagues will discuss the process of developing a person-centered tool to evaluate the impact of dementia-friendly programs in faith-based communities. Third, Somerville & colleagues will present findings from a study of community and organizational factors related to dementia-friendly readiness in community-based senior centers. Finally, Sun & colleagues will discuss the barriers and facilitators to implementation of DFCs in the USA during the COVID-19 pandemic. Taken together, these studies demonstrate the utility of quantitative and qualitative research methodologies to elucidate how and to what extent DFCs are implemented. Findings have implications for examining the population health impact of DFC efforts, as well as for attending to issues of health disparities and aging equity in the uptake, implementation, and sustainability of DFC initiatives.

The transition from home to a nursing home is a complex and emotional process, especially for older persons with dementia. The informal caregiver usually plays a central role in this care process, which is often fragmented. Therefore, this study aims to analyze the experiences of informal caregivers of older persons with dementia during this transition.An interpretative phenomenological design was used to analyze secondary data. In-depth interviews were conducted with informal caregivers, in the Netherlands, between February 2018 and July 2018. The study identified three, interwoven paradoxes influenced by the healthcare system and the healthcare professionals providing care. The first paradox described the initial negative emotions related to a nursing home move. Those emotions are a paradox to the feelings of relief and acceptance later in the transition process. The second paradox was related to a prospective need to postpone the transition for as long as possible and a retrospective need for a timely transition plan. The third paradox defines an internal struggle for the informal caregivers of wanting to remain involved while simultaneously experiencing a need for distance from care responsibilities. This study identifies a fine line between optimal and fragmented transitional care. The results can motivate informal caregivers to start planning the move. Similarly, it allows healthcare professionals to provide tailored support. Future research should focus on defining these paradoxes and their link with the healthcare system to determine if the transition from home to a nursing home can be optimized.

THE ROLE OF SUBJECTIVE AGE IN PREDICTING POST-HOSPITALIZATION OUTCOMES
Anna Zisberg 1 , Nurit Gur-Yaish 2 , Efrat Shadmi 3 , Ksenya Shulyaev 3 , Juliana Smichenko 3 , and Yuval Palgi 3 , 1. University of Haifa,Israel,Haifa,Hefa,Israel,2. Oranim Academic College of Education,Tivon,Hefa,Israel,3. University of Haifa,Haifa,Hefa,Israel Subjective age contributes to a range of health and functional outcomes in older adults. Most of the evidence comes from studies in community dwelling older adults. The current study explores whether younger subjective age serves as a protective factor against hospital associated physical, cognitive, and emotional decline. This paper is a secondary analysis of a subsample (N=250) from the HoPE-MOR (Hospitalization Process Effects on Mobility Outcomes and Recovery) study for which subjective age was assessed at the time of hospital admission and outcomes were measured one-month post-discharge. Psychological and physiological subjective age was measured as a person's report on the degree to which they feel older or younger compared to their chronological age on a 5-point Likert-type scale. Measures of independency in Activities of Daily Living, Lifespace mobility, cognitive function and depressive symptoms, were based on participants' assessment at admission and one-month post-discharge. In a sample of acutely ill participants, age 77.5±6.6, those with younger psychological subjective age had a significantly lower odds for poorer mental (OR=0.66, 95%CI 0.45-0.97), functional (OR=0.62, 95%CI 0.43-0.90) and cognitive state (OR=0.60, 95%CI 0.36-0.98), and better life-space mobility (OR=0.67, 95%CI 0.47-0.95). Findings were significant after controlling for numerous demographic, functional, cognitive, emotional and chronic and acute health predictors. Physiological subjective age was not significantly related to post hospitalization outcomes. Psychological subjective age could serve as a relatively simple parameter to identify older adults who are at risk for poor hospitalization outcomes for consideration of inclusion in preventive in-hospital and post discharge interventions.

USING RESEARCH TO ADVANCE THE DEMENTIA-FRIENDLY COMMUNITY MOVEMENT AT THE LOCAL, NATIONAL, AND INTERNATIONAL LEVEL
Chair: Clara Scher Co-Chair: Emily Greenfield Discussant: Joseph Gaugler It is estimated that more than 55 million people worldwide are living with dementia. To address the social and health needs of individuals living with dementia and their care partners, researchers, policymakers and advocates have championed dementia-friendly communities (DFCs) as a population-level response. DFCs promote the well-being of those living with dementia, empower all members of the community to celebrate the capabilities of persons with dementia, and encourage individuals living with dementia to engage in their communities. The objective of this symposium is to describe the ways in which research can help to advance the dementia-friendly movement at the local, national, and international levels. First, Scher & Greenfield will describe the dimensions of implementation of DFCs in Massachusetts with implications for program monitoring and process evaluation. Second, Epps & colleagues will discuss the process of developing a person-centered tool to evaluate the impact of dementia-friendly programs in faith-based communities. Third, Somerville & colleagues will present findings from a study of community and organizational factors related to dementia-friendly readiness in community-based senior centers. Finally, Sun & colleagues will discuss the barriers and facilitators to implementation of DFCs in the USA during the COVID-19 pandemic. Taken together, these studies demonstrate the utility of quantitative and qualitative research methodologies to elucidate how and to what extent DFCs are implemented. Findings have implications for examining the population health impact of DFC efforts, as well as for attending to issues of health disparities and aging equity in the uptake, implementation, and sustainability of DFC initiatives.

DIMENSIONS OF IMPLEMENTATION FOR DEMENTIA-FRIENDLY COMMUNITY INITIATIVES Clara Scher, and Emily Greenfield, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, United States
Dementia-friendly community (DFC) initiatives are a community-level approach to support individuals living with dementia and their care partners. DFC initiatives engage in a range of activities including raising awareness about dementia, enhancing local services, and advocating for inclusive public facilities and spaces. There is significant variation in the implementation of DFC initiatives worldwide which creates challenges for both process and outcomes evaluation. We used data from qualitative interviews with DFC leaders in Massachusetts to develop a framework to assess the implementation of DFC initiatives. Qualitative descriptive analysis yielded distinct dimensions such as robustness of multisectoral action teams, diversity of strategies for outreach to older adults, and degree of focus on coordinating care. Building on the tradition of using radar charts to evaluate DFC initiatives, we visualized the shape of implementation across the various dimensions. This framework can help to advance research, practice, and policy as part of the DFC movement.

Emory University, Fairburn, Georgia, United States, 2. Emory University, Atlanta, Georgia, United States
As the prevalence of dementia rises, modifying built and social environments of persons living with dementia (PLWD) becomes increasingly essential. Although there is a call to rigorously evaluate dementia-friendly community initiatives, no known comprehensive evaluation tools exist to assess small communities (churches and community centers). Therefore, we are developing a person-centered Dementia-Friendly Community Assessment tool. This tool will consist of new and validated scales to assess the level of dementiafriendliness among churches enrolled in a dementia-friendly congregation program based in African American communities. A draft of a theory-informed survey instrument is being shared with stakeholders (church leaders, caregivers, and PLWD) during focus groups who will provide feedback on their understanding and relevance of questions on the instrument. The tool will then be modified based on feedback and the final instrument will be piloted with broad church membership. Our aim is to enable programs to quantify their dementia-friendly community initiative's impact.

PERCEPTIONS OF DEMENTIA FRIENDLY COMMUNITY STAKEHOLDERS IN THE US: CHALLENGES AND STRATEGIES DURING COVID-19
Fei Sun 1 , Ha-Neul Kim 1 , Opur Fredrika 1 , and Christian Conyers 2 , 1. Michigan State University,East Lansing,Michigan,United States,2. University of Michigan,Ann Arbor,Michigan,United States This study examines the challenges faced by Dementia Friendly Communities (DFC) during COVID-19 pandemic and the strategies used to address these challenges from the perspectives of DFC stakeholders in the U.S. Data were collected in 2020 through an online survey of 183 stakeholders (Mage =35.3, SD=8.8, 43.6% being female) involved who were in DFC design, implementation, or evaluation. Three challenges rated most critical by participants included limited funding (40.4%), difficulties to provide services due to policies to contain COVID-19 (35.7%), and lack of staffing (29.3%). Three rated most important strategies included seeking funding and government support (31.1%), developing partnerships and relationships with multiple sectors (29.1%), and recruiting persons with dementia and family caregivers as advocates (27.5%). Communities demonstrated resilience during the COVID-19 pandemic to implement DFC-related activities. To sustain DFC, enhancing national awareness, acquiring additional funding, and firm cogency from staff members, local/state government, and local communities are needed. As local hubs for aging services, senior centers are wellpositioned to engage in dementia-friendly community (DFC) work. Yet centers vary in their engagement, especially as the DFC concept has been introduced only recently in the US. Using a mixed-methods approach, we drew on data from a survey of senior centers in Massachusetts, the US Census, and qualitative interviews with senior center staff to examine factors associated with DFC engagement. Centers that reported greater engagement were in municipalities with higher proportions of older residents from vulnerable groups (e.g., adults ages 80+, limited English proficiency, with a disability, living alone). They also reported greater programmatic, social service, funding, and staff capacity. Qualitative findings elucidated how senior center leaders drew on intrapersonal, interpersonal, organizational, and community assets to support local DFC efforts. We discuss implications for policies and practices to cultivate senior centers and other