BACKGROUND:Older adults with HIV (OAWH) face elevated dementia risk, yet dementia remains under-addressed in HIV care. Given the multidisciplinary nature of HIV clinics, there is unique opportunity to expand dementia care capacity by training HIV clinic staff. METHODS:In this feasibility study we adapted Scotland's National Dementia Champions Programme for use in HIV clinics, creating the 'HIV Dementia Champion Program.' Implementation strategies focused on stakeholder engagement, local relevance, and sustainability. A community advisory board of OAWH guided program development. Training involved ten sessions with local dementia experts. Educational outcomes and implementation outcomes were measured via surveys. Assessments of program sustainability and cost were also conducted. RESULTS:Four trainees completed the program. Educational performance was high at baseline with minimal change following training. Implementation outcomes indicated high acceptability, appropriateness, and feasibility. Sustainability scores were favorable, noting funding challenges. Community advisory board feedback was positive and highlighted interest in cognitive health. CONCLUSIONS:The HIV Dementia Champion Program is a feasible intervention for expanding dementia care capacity. Educational outcomes were modest but the program enhanced resource awareness and trainee confidence. This initiative demonstrates the potential of adapting geriatric training models to meet the needs of OAWH.

Background: The Cultivating Health and Aging Researchers by Integrating Science, Medicine, and Aging (CHARISMA) program at the University of Chicago (UC), is an NIA-funded longitudinal clinical research training program for undergraduate students from groups underrepresented in the sciences and medicine. CHARISMA students participate in an aging-focused: 1) realistic research career experience, 2) didactic curriculum, and 3) multi-tiered mentorship program. This manuscript describes CHARISMA and early quantitative data demonstrating its success. Methods: Students apply for and are accepted into CHARISMA in year-long intervals, with programming lasting from June to May. Short-term outcomes are measured using student surveys, including an adapted 23-question version of the critical research appraisal inventory (CRAI), the Geriatrics Attitude Scale for Primary Care Residents, and questions rating the overall program, mentor, importance of aging research, and career interests. Results: Twenty-two students have completed CHARISMA. After completing CHARISMA, student aggregate CRAI scores increased (6.8 to 7.5, p = 0.04). Additionally, the substantial majority of students completing CHARISMA were definitely, very or somewhat Additionally, 87% (19/22), 73% (16/22), and 82% (18/22) of students were definitely, very, or somewhat interested in pursuing a career in medicine that serves older adults, pursuing a career in clinical research, or pursuing a career focused on aging-related research. Conclusion: Early data demonstrates that CHARISMA increases undergraduate student knowledge of and interest in aging-related clinical research.

Abstract As the U.S. populations ages, medical students need primary geriatric skills yet continue to lack interest in geriatric care and hold negative attitudes towards caring for older adults (OA). The Geriatrics and Aging Through Transitional Environments (GATE) Curriculum for first year Pritzker medical students provides experiential learning conducting a functional history interview and assessing frailty and home safety risks. Students attended a 1-hour lecture on geriatric functional history taking, frailty (fatigue, resistance, weight loss, gait, hospitalization) and home safety assessments. Student pairs conducted an in-home structured interview with an OA “trained patient” (TP) or untrained OA family/acquaintance. OA residents at a local retirement community were recruited and trained as TP through a 1-hour training session on-site. Training addressed students’ learning objectives, interview questions, and techniques for delivering feedback to students. Learner evaluation included a pre/post survey assessing self-confidence interviewing OA using a Likert scale (5=Extremely confident, 1=Not at all) and attitudes towards OA using open-ended word association. From 2021-23, 178 Pritzker medical students (100%) completed 96 interviews (86% with TP, 14% with family/acquaintances) with 55 OA. Confidence interviewing changed significantly pre-GATE (M=1.73, SD=.720) to post-GATE (M=3.43, SD=.814); t(168)=-23.88, p<.001. Students’ attitudes towards OA shifted post-GATE with an increased usage of word associations “wise/knowledgeable” and “storytellers” and decreased associations as “frail, slow, diseased.” A medical student curriculum incorporating in-home functional history taking interviews with OA TP may increase students’ confidence interviewing and instill positive attitudes towards OA that are foundational for building empathic doctor-patient relationships across medical specialties.

Abstract Dementia caregivers have well-documented needs including dementia education, resources, and emotional support. Our prior work demonstrated the efficacy of a novel dementia education program designed to transform urban faith-community leaders into “Dementia Resource Champions” equipped to start their own support groups. We adapted this program to be delivered virtually. A 6-week curriculum of presentations, resources, and video interviews with caregivers was created by an interprofessional team of geriatrics specialists. Recruitment for “DRC: Online” utilized email blasts and online sign-up forms. While registration for the course was open to all, recruitment emphasized that this program was originally developed for local faith-based communities. Each week, participants received an email with a pre-recorded video didactic presentation, a caregiver interview video, and a link for the weekly videoconference discussion. Fourteen participants completed the pre-training survey, and seven went on to complete the 6-week course and post-training survey. Participants’ reported self-confidence in dementia knowledge increased significantly from pre- to post-training (5-Likert Scale, Paired t-test: Pre (M = 2.1 , SD = 1.1); Post (M = 4, SD = 0.6), t(6) = 7.1, p < .001). Self-reported ability to use the internet to find dementia resources also increased significantly (Pre: (M = 3.9, SD = 1.1); Post: (M = 4.7, SD = 0.5), t(6) = 2.5, p = .045.) Participants’ average rating of the program was 4.7 (5-Point Likert, 5=Excellent). Results indicate that this relatively low-tech approach to virtual dementia education is a feasible way to train community leaders to become resources for dementia caregivers.

rapidly expanding array of billing revenue opportunities.Seeking to continue a 4-year run at the Annual Assembly, two PC physicians responsible for the financial health of their teams will elevate clinicians' knowledge of billing and clinical revenue to the next level.The session will open with a brief review of commonly used billing codes: Evaluation and Management, Advance Care Planning, Face-to-Face and Non-Faceto-Face Prolonged Service Codes, and Chronic and Complex Chronic Care Management Codes.Presenters will unpack at length the updated 2022 Medicare documentation guidelines, which offer real opportunities to save time and increase revenue.The session will then transition to lively case-based learning with extensive audience interaction.Inpatient, outpatient, and home care scenarios will be described and dissected, and when different codes or combinations of billing codes could be compliantly chosen, relative value unit differences will be highlighted to show which billing codes might be selected to optimize revenue.The time has ended when PC programs' costs were nothing more than an organization's financial rounding error.It is critical for all clinicians to understand billing at a deeper level, and this session will help attendees feel comfortable with more complex billing topics.

BACKGROUND:African Americans in the general population have been shown to be less likely than White ethnic groups to participate in advance care planning; however, advance care planning in the population receiving dialysis has not been well explored.OBJECTIVE:We examined the prevalence of African American patients receiving haemodialysis' advance care planning discussions, and whether advance care planning impacts end-of-life care preferences.DESIGN:In-person interviewer-administered surveys of African American patients receiving in-centre haemodialysis.SETTING/PARTICIPANTS:About 101 participants at three large dialysis organisation units in Chicago.OUTCOMES:Self-reported advance care planning and preferences for life-extending treatments at end-of-life.RESULTS:Most patients (69%) report no advance care planning discussions with their healthcare providers. Nearly all patients (92%) without prior advance care planning reported their healthcare providers approached them about advance care planning. While the majority of patients indicated preference for aggressive life-extending care, prior conversations about end-of-life care wishes either with family members or a healthcare provider significantly decreased patients' likelihood of choosing aggressive life-extending care across three scenarios (all p < 0.05). Significantly more patients reported that common end-of-life scenarios related to increased dependence/disability were "not worth living through" compared with those associated with increased burden on family, decreased cognitive function, and severe pain/discomfort.CONCLUSION:African Americans with end-stage renal disease need more frequent, culturally-sensitive advance care planning discussions. Despite a preference for aggressive life-sustaining treatments, individuals with prior advance care planning discussions were significantly less likely to support aggressive end-of-life care. End-of-life care discussions that focus on the impact of life-extending care on patients' independence could be more concordant with the values and priorities of the African American patients.

Purpose: Explore if and how American Samoan cultural norms influence caregivers' knowledge, attitudes, and care choices for person's living with Alzheimer's Dementia (AD).Design: This pilot study used mixed methods.Methods: 1) Quantitative survey: measuring knowledge/attitudes towards AD (n = 80); 2) Qualitative techniques: a) Focus groups (n= 54) with caregivers; b) Semi-structured interviews (n=26) with health professionals; and c) In-depth interviews (n=3) with key informants. Emergent themes were created using data from all methods.Findings: Quantitative analyses revealed 50% of participants identified AD as normal aging, 83% as mental illness. The majority of participants believed elders with AD do not experience pain (70%) and should be cared for solely at home (74%). Qualitative evidence showed dissonance between cultural norms of respect for elders, familial caregiving duty, shame in others observing elders' dementia-related behaviours, and the current language used to describe AD.Conclusions: Our findings show a need for developing and disseminating culturally sensitive terminology for AD to destigmatize and transmute attitudes, knowledge and care choices for elders living with AD.Clinical Evidence: American Samoan terminology for dementia is discordant with its cultural norms, thus shaping caregivers' perceptions of AD and influencing care choices for managing AD symptoms.

Abstract African Americans (AA) are twice as likely to develop Alzheimer’s Disease as Caucasians. Historically, houses of faith have been a center of the AA community and a trusted source of information and support. Based on these facts, as well as community needs, the SHARE Network (a Geriatrics Workforce Enhancement Program on the South Side of Chicago) in partnership with faith-based community leaders, created an opportunity for community members to train to become resource experts on Alzheimer’s Disease & Related Dementias (ADRD) and create sustainable caregiver support groups (CSGs). The resulting initiative, Dementia Resource Champions, is a train-the-trainer style health education initiative piloted in 2018, and subsequently expanded and modified due to COVID. Participants receive instruction on stress reduction, ADRD, and community resources. They discuss how to structure CSGs to meet community needs. Results of this initiative include development of five brand-new CSGs with faith communities on Chicago’s South Side.

•Describe the structure/function/content of the APPI.•Propose assessment measures utilized that include individualized goal setting and identification of learning needs.•Analyze the strengths and limitations of the longitudinal format of this mixed methods curriculum. With physician shortages, many healthcare systems rely on APPs to provide clinical care for their PC programs. However, access to comprehensive PC training can be challenging for these clinicians. PC and hospice leaders across Chicagoland implemented the APPI, an intensive mix of didactics, interactive webinars, standardized patient (SP) training, and clinical shadowing experiences conducted over a 3-month period. •Describe the structure/function/content of the APPI.•Explore assessment measures utilized that include individualized goal setting and identification of learning needs.•Analyze the strengths and limitations of the longitudinal format of this mixed methods curriculum. Mixed educational methods include 2 full-day conferences (symptom management and communication skills role plays); six live 1-hour interactive case-based webinars delivered on a learning management system; mindfulness/resilience; and summative standardized patient (SP) experiences. Trainees completed 16 hours of clinical shadowing at academic and community sites offering inpatient, outpatient, home based, and hospice care experiences. Evaluation methods included quantitative and qualitative data on: self-assessment of PC skills pre/post training, identification of new skills learned, individual goal setting associated with each webinar subject and shadowing encounter, and overall program evaluation. A total of 29 APPs from 14 healthcare organizations participated in two APPI cohorts (2018, 2019). Trainees reported a significant increase in confidence and frequency performing all 25 targeted skills pre/post APPI. The majority (96%) rated the skill level of webinars, SP training, and shadowing experience as “a very good to excellent fit” and the APPI overall “very to extremely valuable” (97%). The analysis of qualitative results is on-going and will be described. This regional APPI training program utilizes a mixed methods educational format, including in-person didactics and remote learning, shadowing, SP training, and mindfulness skills. Preliminary data show positive quantitative and qualitative results.

•Recognize potential pitfalls and missed opportunities in responding to family members’ communication about their belief that God will perform a miracle and heal their loved one despite medical team’s belief that patient is at the end of life. Gain understanding of both sides of an interaction in which the clinician encounters a terminally ill African-American patient and family who are expecting a miracle; the clinician who feels frustrated and manipulated by the patient/family who are not facing the reality of impending death; the patient and family who feel their beliefs and culture are being entirely disregarded.•Describe the ongoing challenges and historical context which inform a belief in miracles and emphasis on hope for African Americans across the lifespan, including at the end of life. Gain insight into the concept of “hope and miracles” in the African-American community, from (1) A historical and cultural context and (2) In terms of how it plays out in serious illness.•Describe communication strategies which demonstrate respect, build trust, and reduce conflict in responding to family’s expression of a belief in miracles in the face of a patient’s poor prognosis. Gain insight into a communication method in which the patient and family’s values of hope and a miracle are respected by the clinician; and the resulting feelings of (a) the patient/family and (b) the clinician. End of life care in the U.S. has been rooted in values that represent the cultural and religious values of the white middle class. Yet what is perceived and promoted as beneficial for one group may not hold the same value for another groups, with a different frame of reference, value system and life experience. Lack of understanding of, and respect for, the cultural values of others often results in negative consequences for the patient and family. Patients and families whose beliefs and values are not understood or addressed, understandably feel disrespected and devalued, and have to make additional efforts to ensure that the goals of care they wish for themselves/ their loved ones, are followed. Palliative care clinicians often feel frustration when they see a terminally ill patient undergoing “needless” interventions/treatments. In the African-American community the importance of faith, spiritual beliefs and church are key components in understanding and coping with illness, and provide a framework within which treatment decisions are made. African-American families’ deep faith in God’s healing power, and the belief in hope, both of which directly impact goals of care and treatment preferences, are often misunderstood by clinicians. In this session, participants will gain an understanding into the central relevance of “hope and miracles” in the African-American community, from both a historical and cultural context, as well as how it plays out in serious illness. Illustrations will be provided of ineffective clinician-patient/family communication (resulting in the patient/family feeling disrespected and a frustrated clinical team), as well as positive communication. Take-home lessons for effective culturally-based communication and best practices are provided.

Background: Advance care planning (ACP) is a critical component of end-of-life (EoL) care, yet infrequently taught in medical training. Objective: We designed a novel curriculum that affords third-year medical students (MS3s) the opportunity to practice EoL care discussions with a trained older adult in the patient's home. Design: Volunteers were instructed as trained patients (TPs) to evaluate MS3s interviewing and communication skills. The MS3s received a didactic lecture and supplemental material about ACP. Pairs of MS3s conducted ACP interviews with TPs who gave verbal and written feedback to students. Student evaluations included reflective essays and pre/postsurveys in ACP skills. Settings and Participants: A total of 223 US MS3s participated in the curriculum. Results: Qualitative analysis of reflective essays revealed 4 themes: (1) students' personal feelings, attitudes, and observations about conducting ACP interviews; (2) observations about the process of relationship building; (3) learning about and respecting patients' values and choices; and (4) the importance of practicing the ACP skills in medical school. Students' confidence in skills significantly improved in all 7 domains (P < .001): (1) introduce subject of EoL; (2) define advance directives; (3) assess values, goals, and priorities; (4) discuss prior experience with death; (5) assess expectations about treatment and hospitalization; (6) explain cardiopulmonary resuscitation and outcomes; and (7) deal with own feelings about EoL and providers' limitations. Conclusions: The use of older adults as TPs in an ACP curriculum provides students an opportunity to practice skills and receive feedback in the nonmedical setting, thereby improving comfort and confidence in approaching these conversations for future patients.

•Make attendees aware of the impact of American Samoan (AS) culture on caregivers attitudes and knowledge about AD.•Increase understanding of the importance of developing resources for dementia education in the American Samoan culture. Despite modernization, AS culture has retained norms/practices, including respect toward elders, familial protection and shame of elders’ behavioral symptoms, and caregiving as solely a family responsibility. Such ties to their cultural identity can impact the care AS healthcare providers give elders with AD. There is a dearth of research on AS culture and its relationship to caregiving for AD elders. The present research seeks a fuller understanding of how AS cultural practices shape caregivers’ awareness, attitudes/knowledge about AD in AS. Understand impact of American Samoan (AS) culture on caregivers’ attitudes/knowledge about Advanced Dementia (AD). Determine resources for dementia education and care supports for AS culture. 1) Focus Groups, (n=54): Four, 1-hour sessions conducted with community-based caregivers/advocates, using a semi-structured Moderator Guide. 2) Semi-structured Interviews (n=26) conducted with physicians. 3) Key Informant interviews (n= 3). 4) Ten-item Survey asking about knowledge/attitudes towards AD, administered to all participants prior to focus groups/interviews (n=80). Emergent themes were analyzed using Dedoose web-based qualitative software. Survey indicates 50% of sample conceptualized AD as a normal part of aging and a terminal illness, and 83% conceived it as mental illness. Further, 70% believed it was not painful, and people with AD should be cared for at home (74%). Focus groups/interviews corroborated these findings, showing AS lack knowledge about AD that is based in: 1) nuances of AS language, conceptualizing AD as a mental and terminal illness; 2) respect for elders, making it shameful for others to see their elders' behavioral symptoms, and, 3) caring for elders with AD as responsibility of family. AS cultural norms embedded in language play a role in shaping attitudes/ knowledge of healthcare providers about AD.