S56. ADVANCE CARE PLANNING DURING CRISIS: TRENDS IN OLDER ADULTS WITH ALZHEIMER’S DISEASE AND RELATED DEMENTIAS POST COVID-19

Introduction To examine trends in ACP engagement before and after the COVID-19 pandemic and to identify factors associated with ACP engagement among older adults with ADRD. Methods We analyzed a longitudinal study from 1,854 older respondents who their doctor said they have Alzheimer's disease or related Dementia in the Health and Retirement Study (HRS) data base across three periods we classified as: pre-COVID (2014–2018), COVID (2020), and post-COVID (2022). ACP engagement was assessed through four components: Medical care discussion with anyone, presence of a documented living will, limited care clauses in the living will, and assignment of a durable power of attorney (DPOA). Weighted proportions and multivariable regressions were used to examine trends and associations with demographic, socioeconomic and clinical factors. Results The Period was divided using the five wave cycles into pre-covid (2014, 2016, and 2018), Covid (2020), and Post-covid (2022). ACP was assessed by measuring participants’ ability to participate in all four measures of ACP analyzed: whether they discussed care with anyone, have a written living will, if the living will dictate clauses to limit care, and whether they have an assigned durable power of Attorney (DPOA). Logistic regression adjusted for demographic, Socioeconomic, Medicare resources, and health-related factors. Most respondents were aged 75–89 (42.9%), female (58.2%), and non-Hispanic White (77.5%); 90% were insured by Medicare. ACP discussions increased significantly from 54.2% pre-COVID to 67.9% post-COVID (p for trend = 0.05). In contrast, other ACP components showed no significant changes: documented living will (68.3% to 63.7%, p = 0.57), DPOA assignment (79.5% to 74.3%, p = 0.80), and limited care clauses in a living will (92.3% to 89.9%, p = 0.60). Post Covid, ACP engagement was higher among college-educated individuals (OR: 2.49; 95% CI: 1.41–4.41) and those without severe functional limitations, while being Black (OR: 0.49; 95% CI: 0.28–0.87) and having Medicare (OR: 0.18; 95% CI: 0.05–0.64) were associated with lower likelihood of engagement. Conclusions COVID-19 was associated with increased ACP discussions among older adults with ADRD, but disparities and gaps in legal documentation persist. While conversations rose, formal planning lagged, particularly among underserved Black communities. Targeted, culturally appropriate interventions are needed to translate ACP discussions into actionable and legally recognized EOL care plans, especially for vulnerable geriatric populations.