A BIOPSYCHOSOCIAL-ECOLOGICAL, FAMILY-FRAMED APPROACH TO DEMENTIA CARE

Abstract An individual’s experience of cognitive impairment is shaped by biopsychosocial factors, including their own perceptions of illness as well as interactions with family members, healthcare providers, and the communities in which they live. With advancing illness an individual’s dementia care requires the involvement and commitment of others, usually family. Hence, the quality of a person’s illness experience is shaped largely by relationships with family members and others throughout their respective communities. Current models of dementia care recognize family members as an important part of the care team, but fail to consider a patient’s family system and relationships as social determinants that affect care outcomes. This presentation will introduce a biopsychosocial-ecological, family-framed approach to dementia care that addresses factors that influence care considerations at both the individual and relational levels of the social ecological networks that the patient and their family members occupy.

is characterized by impairment in socioemotional functioning. Spouses caring for individuals with bvFTD often experience profound health/well-being declines, compared to Alzheimer's disease (AD) caregivers and non-caregiving older adults. We hypothesized that disrupted positive emotional connections between spousal caregivers and individuals with bvFTD contribute to caregivers' lower emotional well-being. 23 bvFTD-caregiver, 23 AD-caregiver, and 17 control dyads had a 10-minute conflict conversation in the laboratory. Positive emotional connections were measured as the covariation of partners' positive emotional behaviors during the conversation. Caregiver emotional well-being was assessed via questionnaire . We found that bvFTD caregivers had lower emotional well-being than AD caregivers and controls (who did not differ from each other, t=.80, p=.43), c=-.70, p<.01. Importantly, this effect was fully mediated by bvFTD caregivers' lower positive emotional connections, c'=-.38, n.s. We speculate that lower positive emotional connections can cause social isolation and contribute to bvFTD caregivers' health/well-being declines.

PRECLINICAL DEMENTIA CARE AND PREVENTION IN CONTEXT: FROM INSIGHTS TO ACTION
Chair: Daniel Rong Yao Gan Co-Chair: Patricia Heyn Discussant: Emily Greenfield Dementia affects people with lower socioeconomic statuses disproportionately. People with undiagnosed Alzheimer's disease may or may not express dementia symptoms depending on their brain reserve, cognitive reserve, and their ability to compensate for brain pathology. Much of these depend on their childhood education, but late-life social engagement may also play a role. As lifespan increases globally, preclinical dementia care and prevention in community settings will be increasingly important. The characteristics of everyday environments that are kind to various changes amid declining cognition may enhance the quality of life of older adults with and without dementia. Such environments may be available or unavailable in diverse communities of varying socioeconomic statuses. This collaborative symposium between the ADRD and CEnR interest groups brings together multidisciplinary scholars to imagine psychosocial interventions that could mitigate place-based disparities in cognitive health. The first presentation frames the importance of relational perspectives in a biopsychosocialecological model of care amid cognitive decline. The second presentation shows the cognitive impact of networks among kinless older adults across Europe. The third presentation explores community perspectives on preventive brain health programs in various neighborhoods. The fourth presentation centers the voice and action of people with dementia to improve their neighborhood social environments. The final presentation identifies policy implications for communitybased care and prevention from network perspectives. Discussions will distil the significance of community for persons living with and without dementia diagnosis to generate place-based interventions that may better support care and prevention in diverse settings, and identify structural barriers to these efforts.

A BIOPSYCHOSOCIAL-ECOLOGICAL, FAMILY-FRAMED APPROACH TO DEMENTIA CARE Carol Podgorski, University of Rochester, Rochester, New York, United States
An individual's experience of cognitive impairment is shaped by biopsychosocial factors, including their own perceptions of illness as well as interactions with family members, healthcare providers, and the communities in which they live. With advancing illness an individual's dementia care requires the involvement and commitment of others, usually family. Hence, the quality of a person's illness experience is shaped largely by relationships with family members and others throughout their respective communities. Current models of dementia care recognize family members as an important part of the care team, but fail to consider a patient's family system and relationships as social determinants that Innovation in Aging, 2022, Vol. 6, No. S1 affect care outcomes. This presentation will introduce a biopsychosocial-ecological, family-framed approach to dementia care that addresses factors that influence care considerations at both the individual and relational levels of the social ecological networks that the patient and their family members occupy. So-called "kinless" older adults (unpartnered and childless) are a growing population across the globe who may be at higher risk for social isolation and cognitive decline. Yet, this group of older adults is understudied in dementiarelated research and their risk of cognitive decline likely varies by country context. We analyze data from the Survey of Health, Ageing & Retirement in Europe (SHARE) to explore cognitive decline by family structure and country. We assess cognitive decline along a gradient of "kinlessness" by comparing older adults with a) partner and child, b) partner and no child, c) no partner and child, and d) no partner and no child across 20 European countries. Results of this study will outline the dementia risks faced by the growing population of older adults with non-traditional family structures and highlight characteristics of country context that might enhance or reduce risk of cognitive decline for "kinless" older adults.

"PEOPLE DON'T LIVE IN A VACUUM": CO-DEVELOPING A BRAIN HEALTH PILOT PROGRAM IN THE COMMUNITY THROUGH CITIZEN SCIENCE
Claire Wang 1 , Daniel Rong Yao Gan 2 , Eireann O'Dea 3 , and Brain Health in the Community (BHIC) Steering Committee 2 , 1. Johns Hopkins University , Baltimore City, Maryland,United States,2. Simon Fraser University,Vancouver,British Columbia,Canada,3. Simon Fraser University,North Vancouver,British Columbia,Canada The Psychosocial Model of Everyday Cognitive Resilience identifies social identity as an important determinant of older adults' wellbeing as they experience cognitive decline in community settings. We engaged community-dwelling older adults to assess the model and co-develop programs that address existing gaps through twelve focus groups. N=55 older adults were recruited from various community organizations. Two 1-hour sessions discussed (1) variables that were important to older adults, namely neighbourhood friendship and social experiences, and (2) how these mediated the effects of self-expression, time outdoors, and communal provisions on mental wellbeing. Many participants highlighted the importance of strong friendship for deeper needs such as grief support, whereas others pointed out the relevance of meaningful activities or volunteering opportunities for a sense of purpose. Overall, a speed-friending program with an emphasis on listening was desirable for connecting and contributing socioemotionally to develop "happy medium" friendships, while piloting evidence-based interventions for brain health.

FLIPPING STIGMA ON ITS EAR: A TOOLKIT FROM PARTICIPATORY ACTION RESEARCH
Mariko Sakamoto 1 , Jim Mann 1 , Deborah O'Connor 2 , and Alison Phinney 1 , 1. University of British Columbia,Vancouver,British Columbia,Canada,Vancouver,British Columbia,Canada People living with dementia face persistent stigma, discrimination and social exclusion, with significant emotional, physical and social consequences. Addressing this requires changing attitudes and fostering actions for communities to include people with dementia as citizens with agency and self-determination. This presentation highlights the work of an Action Group (AG) of people living with dementia. As part of a four-year Participatory Action Research study aimed at addressing the stigma, discrimination and social exclusion that is so common to the dementia experience, members of the AG in partnership with the research team developed the Flipping Stigma on its Ear Toolkit. Focus will be on the action-oriented nature of this research project, an overview of the toolkit, and exploration of the communal space that was created by AG members in the process of working together, learning from one another, and making a collective contribution towards addressing stigma, discrimination and social exclusion. This presentation will describe a series of research projects using Social Network Analysis (SNA) to measure the personal social networks of community-dwelling older adults at-risk for or currently experiencing dementia. The first part of the presentation will provide a brief overview of SNA methods, including advantages of SNA compared to more traditional social activity scales. The second part of the presentation will present evidence from multiple studies to identify distinct pathways linking upstream social network characteristics to downstream pathophysiological processes in the aging brain. In particular, we will distinguish between cognitive stimulation experienced in expansive social networks and neuroendocrine benefits derived from cohesive social networks. The third part of the presentation will present implications for psychosocial interventions to reduce health disparities in dementia care and prevention. We recommend leveraging the multidimensional functionality of social networks across the lifecourse to influence multiple cognitive health pathways simultaneously.