ADVANCE CARE PLANNING MOTIVATED BY THE COVID-19 PANDEMIC

Abstract The COVID-19 pandemic has exposed older adults to complex healthcare situations, via personal experience or media stories about serious illness. Hearing about lengthy intubation, sedation, rapid decline, and distress at the end of life has the potential to prompt people to reevaluate their perspective on their own end-of-life care. This study explored advance care planning (ACP) among older adults and whether COVID-19 experiences altered their healthcare preferences and planning. One hundred and fifty-one respondents (M age = 71.2 yrs, range = 55–93) completed an online survey about ACP completion, ACP conversations, and life-prolonging interventions. Respondents were mainly female (78%), White (71%), and well educated (77% with at least a bachelor’s degree). A substantial proportion had not completed an advance directive (31%) or chosen a medical power of attorney (33%), and 78% of them intended to complete them in the next year or had initiated ACP. Among those who had completed ACP, a quarter intended to make changes, with 13% less open to life-prolonging medical treatments and 13% more open to them. Despite these intentions, a small proportion of people had ACP conversations since the start of the pandemic with their spouse/partner (37%), children (25%), siblings, (19%), friends (27%), primary care physician (16%), or other healthcare provider (12%). Results of this study suggest that now may be a critical moment to encourage older adults to have ACP conversations, in light of how their experience during the pandemic has motivated a reconsideration of treatment preferences.

this project investigates infertility and testicular cancer, misregulation of the endocrine system, problems with germ and Sertoli cell maintenance, and ultimately gene expression changes that alter cellular proliferation and death.Infertility affects 4.5-6% of North American males and up to 15% of couples worldwide.Infertility may be caused by unknown genetic factors, as up to 2,300 genes are pertinent to male fertility.This research project aims to create the molecular toolbox needed to evaluate gene function in cultured male germ cells.We will use mouse primary spermatogonial stem cells and a human testicular cancer cell line to knock out the functions of genes Phosphoprotein 1 (Spp1) and Inhibitor of DNA Binding 4 (Id4) in the testis to determine the effect of the knockouts on male germ cell proliferation and cell death.We designed single guide RNAs (gRNAs) using online bioinformatic tools and amplified the genes from human and mouse genomic DNA to demonstrate the effectiveness of our gRNAs in vitro.These gRNAs and Cas9 compose the beginnings of the molecular toolbox used to electroporate cultured cells.This research will contribute to the greater scientific community by providing insight into the function of Spp1 and Id4 relating to male fertility and providing a methodology for future research in aging-related fertility diseases and testicular cancer.

P16-EXPRESSING SENESCENT CELLS ARE A DOUBLE-EDGED SWORD IN SHAPING IMMUNE RESPONSES WITH AGE
Blake Torrance, Hunter Panier, Andreia Cadar, Dominique Martin, Erica Lorenzo, Jenna Bartley, and Laura Haynes, UConn Health, Farmington, Connecticut, United States Aging results in the accumulation of senescent cells which can cause dysfunction in many contexts but the effects on immune responses remain unclear.Here, we aimed to probe the effects of clearing senescent cells in aged mice on the immune response to influenza infection.We utilized a powerful p16 trimodality reporter mouse model (p16-3MR): under the control of the p16 promoter, these mice express cassettes encoding luciferase, RFP, and herpesvirus thymidine kinase (HSV-TK).p16 is commonly upregulated in senescent cells so this model allows us to selectively delete those cells by treating with ganciclovir (GCV), which will induce apoptosis in cells expressing HSV-TK.We hypothesized that while p16-expressing senescent cells may exacerbate dysfunctional responses to a primary infection, they may play a protective role in resolving inflammation and fostering memory cell generation.We found that deletion of p16-expressing cells enhanced viral clearance and decreased infiltration of pro-inflammatory flu-specific CD8 T cells during the primary response to infection.Conversely, at 30 days post infection, there were fewer flu-specific CD8 memory T cells and lower amounts of anti-viral antibodies in the lungs of GCV treated mice.We also observed perturbations in memory T cell trafficking in GCV treated mice.Furthermore, GCV treated mice were unable to mount an effective memory response and were unable to control viral load following a heterosubtypic challenge.This suggests that targeting senescent cells may potentiate primary responses while limiting the ability to form durable and protective immune memory with age.

ARE WE GOING TO FEEL COMFORTABLE THERE?: EMERGENT FINDINGS FROM THE DIVERSITY IN LIFE PLAN COMMUNITIES STUDY
Mushira Khan, 1 Pankaja Desai, 2 and Catherine O'Brien 3 , 1. Mather Institute,Evanston,Illinois,United States,2. Rush University Medical Center,Chicago,Illinois,United States,3. Mather,Evanston,Illinois,United States Life Plan Communities (LPCs), formerly known as Continuing Care Retirement Communities, offer an array of amenities as well as a continuum of care where residents may live independently or access assisted living or skilled care if needed.Racial/ethnic minority older adults are under-represented among LPC residents.One likely contributor to this lack of diversity is that racial/ethnic minorities make up a relatively small proportion of higher income groups.However, there may be additional reasons for their relative absence in most LPCs.The purpose of the 'Diversity in Life Plan Communities' study is to (1) identify barriers that impact the decision to move into an LPC for racial/ ethnic minorities, and (2) identify strategies to increase resident diversity in LPCs.In this presentation we share preliminary findings from in-depth, semi-structured, qualitative interviews with community-dwelling Black, Latinx, and South Asian adults (n=10) living in Chicagoland and case study interviews with current LPC 'resident champions' (n=3) who are actively involved in efforts to increase resident diversity at their respective LPCs.Thematic analysis of the data showed that lack of awareness about LPCs, concerns about racism, desire to age-in-place among loved ones, and perceived non-availability of culturally-congruent activities were key barriers to moving into an LPC.These findings suggest that in order to increase resident diversity within their communities, LPC operators, staff, and current residents may consider targeted outreach efforts in racial/ethnic communities, take steps to create a welcoming environment and engage in more culturally congruent activities, and involve adult children/grandchildren in the decision-making process.The COVID-19 pandemic has exposed older adults to complex healthcare situations, via personal experience or media stories about serious illness.Hearing about lengthy intubation, sedation, rapid decline, and distress at the end of life has the potential to prompt people to reevaluate their perspective on their own end-of-life care.This study explored advance care planning (ACP) among older adults and whether COVID-19 experiences altered their healthcare preferences and planning.One hundred and fifty-one respondents (M age = 71.2yrs, range = 55-93) completed an online survey about ACP completion, ACP conversations, and life-prolonging interventions.Respondents were mainly female (78%), White (71%), and well educated (77% with at least a bachelor's degree).A substantial proportion had not completed an advance directive (31%) or chosen a medical power of attorney (33%), and 78% of them intended to complete them in the next year or had initiated ACP.Among those who had completed ACP, a quarter intended to make changes, with 13% less open to life-prolonging medical treatments and 13% more open to them.Despite these intentions, a small proportion of people had ACP conversations since the start of the pandemic with their spouse/partner (37%), children (25%), siblings, (19%), friends (27%), primary care physician (16%), or other healthcare provider (12%).Results of this study suggest that now may be a critical moment to encourage older adults to have ACP conversations, in light of how their experience during the pandemic has motivated a reconsideration of treatment preferences.

VIEWS OF OLDER ADULTS ON SUPPORT OPTIONS TO RELIEVE THEIR WORKING INFORMAL CAREGIVERS: A STORY COMPLETION STUDY
Eline Vos, 1 Simone de Bruin, 2 Suzanne Pees, 1 Allard van der Beek, 3 and Karin Proper 1 , 1. National Institute for Public Health and the Environment, Bilthoven, Utrecht, Netherlands, 2. Windesheim University of Applied Sciences, Zwolle, Overijssel, Netherlands, 3. Amsterdam Public Health research institute, Amsterdam UMC, Amsterdam, Noord-Holland, Netherlands Older care recipients living at home increasingly rely on support from informal caregivers, who often combine their caregiving tasks with a paid job.Because of this combination of tasks, working caregivers may become overloaded.Different caregiver support options are available, that also affect older care recipients' lives, such as respite care, technology, or home care.The aim of this qualitative study was to obtain insight into the perceptions, concerns and preferences of older informal care recipients about the use of support to relieve their working informal caregivers.We performed a story completion writing task among 23 informal care recipients aged 65 years or older, using hypothetical situations to let participants reflect on different caregiver relief support options.The task was followed-up by a story-mediated interview.We used thematic analysis to inductively analyze story completions and interviews.We found that older adults were often willing to use support to relieve their caregivers, to ensure their wellbeing.However, they were also concerned about how the use of such support may conflict with their interests, preferences and values (e.g.respect for their autonomy, privacy, having a trusting relationship with caretakers, paying attention to human aspects in care).Older adults were most hesitant to use adult day care facilities and technological support options.While these areas of tension cannot always be completely resolved, it is important to jointly identify and discuss these, and work towards solutions to balance the respective interests, values and needs of older adults and caregivers.

USING SOCIAL MEDIA TO UNDERSTAND FAMILY CAREGIVER PERSPECTIVES ON ASSISTIVE TECHNOLOGY FOR PERSONS WITH ALS
Yong K Choi and Salhah Alomairi, University of California Davis School of Medicine, Sacramento, California, United States ALS Forum (alsforums.com) is an online support group for those who have motor neuron disease or amyotrophic lateral sclerosis (ALS).It provides information, advice, connection, care, and assistance to persons living with ALS and their family caregivers.This study aimed to analyze the online discussion posts by caregivers of persons with ALS and assess their perceptions, experiences, and challenges of using assistive technologies (AT).Posts were extracted from the ALS caregiver discussion forum via web scraping using Python in March 2022.The extracted posts are dated between June 2005 and January 2022.The total number of posts and replies generated during this period was 52,292 by 2,397 unique users.Additional searches were conducted using assistive technology-related keywords to create the text dataset.A total of 263 posts by 137 unique users were identified.After the initial review, 186 posts were included in the final analysis.Thematic analysis revealed six major themes: (1) Uses of AT (automation/control, communication, mobility); 2) Barriers and Facilitators (cost, effort to learn new technology, rejection, interoperability, customer service); 3) Usability (hardware and software-related); 4) Sharing Experience on AT; 5) Giving Advice; 6) Seeking Information on AT.The findings are consistent with previous literature that online health discussion forums provide access to rich data that contains lived experiences of patients and caregivers.The findings may inform the design of future assistive technology that incorporates the patients' and caregivers' perspectives to increase the adoption and long-term sustainability of the technology for people living with ALS and their caregivers.

OLDER ADULTS INFLUENCING THE CIVIC ENGAGEMENT OF VOLUNTEER CAREGIVERS DURING THE COVID-19 PANDEMIC Kathleen Gale, Eras Senior Network Inc., Waukesha, Wisconsin, United States
Older adults who do not qualify for government entitlement programs but lack sufficient financial or other personal resources help them to age in place rely on community organizations to assist them with social determinants of health.However, these organizations struggle with high rates of volunteer caregiver turnover, a looming crisis spotlighted during the COVID-19 pandemic.At least one group of volunteer caregivers continued to serve during this period.This phenomenological study investigated the experiences of eight volunteer caregivers who served older adults through a Faith in Action model volunteer driver program during the first year of the pandemic.Findings indicate that a volunteer's commitment to older adults, awareness of the needs of older adults, and established relationships with older adults were more important than concerns about COVID-19.Study participants were alert to the needs of older adults during and between service activities, making personal sacrifices of time, money, and physical exertion to accommodate needs.Participants approached service caring for the older adult and expected reciprocal care in the form of appreciation and respect.They considered discontinuing service if efforts weren't appreciated or if deeply held values were violated.The volunteer service organization was key in mitigating conflict within the relationship of the volunteer and older