Adult Day Research Articles

Changes in long-term care insurance revenue among service providers during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic has impacted peoples’ health-related behaviors, especially those of older adults, who have restricted their activities in order to avoid contact with others. Moreover, the pandemic has caused concerns in long-term care insurance (LTCI) providers regarding management and financial issues. This study aimed to examine the changes in revenues among LTCI service providers in Japan during the pandemic and analyze its impact on different types of services.MethodsIn this study, we used anonymized data from “Kaipoke,” a management support platform for older adult care operators provided by SMS Co., Ltd. Kaipoke provides management support services to more than 27,400 care service offices nationwide and has been introduced in many home-care support offices. The data used in this study were extracted from care plans created by care managers on the Kaipoke platform. To examine the impact of the pandemic, an interrupted time-series analysis was conducted in which the date of the beginning of the pandemic was set as the prior independent variable.ResultsThe participating providers were care management providers (n = 5,767), home-visit care providers (n = 3,506), home-visit nursing providers (n = 971), and adult day care providers (n = 4,650). The results revealed that LTCI revenues decreased significantly for care management providers, home-visit nursing providers, and adult day care providers after the COVID-19 pandemic began. The largest decrease was an average base of USD − 1668.8 in adult day care.ConclusionThe decrease in revenue among adult day care providers was particularly concerning in terms of the sustainability of their business. This decrease in revenue may have made it difficult to retain personnel, and staff may have needed to be laid off as a result. Although this study has limitations, it may provide useful suggestions for countermeasures in such scenarios, in addition to support conducted measures.

The PELI-D II Study: Development and Preliminary Validation of the Preferences for Leisure Activities Inventory (P-LAI) for Adult Day Services

ABSTRACT Objectives The current study aimed to develop and preliminarily validate an initial version of an instrument to assess the leisure activity preferences of people receiving adult day services (ADS). Methods Based on previously conducted concept mapping steps, we identified 12 clusters of preferences for leisure activities. We adopted the structure of the Preferences for Everyday Living Inventory and phrased our cluster labels as questions to develop a first draft of the Preferences for Leisure Activities Inventory (P-LAI). We conducted cognitive interviews (n = 8) to revise, preliminarily validate, and preliminarily finalize the P-LAI. Results The draft of the P-LAI included 25 questions. Based on the results of the cognitive interviews, the number of questions was reduced to 21, three questions were rephrased, and evidence to support the preliminary validity of the P-LAI based on the response processes was provided. Conclusions The P-LAI is the first instrument to assess preferences for leisure activities in the ADS environment. Clinical implications The preliminary results of the P-LAI allow ADS providers and healthcare professionals to assess the preferences for leisure activities of people who receive ADS in a structured way. Based on these results, preference-based services can be designed and planned, and the person-centered philosophy of care can be further operationalized in the ADS environment.

Dementia-Related Disparities in Adult Day Centers: Results of a Bivariate Analysis.

Adult day services (ADS) are a valuable resource for people living with Alzheimer's disease and Alzheimer's disease and related dementias (AD/ADRD) and serve a large population of late-life immigrants, often with limited English proficiency (LEP). This secondary data analysis examined potential disparities in diagnosis, dementia severity, medical complexity, and dementia-related behavioral problems in persons with AD/ADRD with LEP within the ADS setting. The current study used data from TurboTAR, the electronic health record for ADS in California. Bivariate analyses were conducted to examine differences in clinical management for those with and without LEP. Of 3,053 participants included in the study, 42.3% had LEP. Participants with LEP had higher rates of emergency department use and medication mismanagement. However, due to non-standard data collection, there was a significant amount of missing data on language preference (38.1%) and race/ethnicity (46.5%). Although these findings suggest LEP may play a role in the clinical management of persons with AD/ADRD in ADS, missing data caused by lack of standardized collection compromise the results. It is essential to improve data collection practices in ADS on language, race, and ethnicity to help identify health disparities and promote equitable care for marginalized older adults. [Journal of Gerontological Nursing, 50(4), 42-47.].

The potential habitat and environmental fitness change of Aedes albopictus in Western Eurasia for 2081-2100.

The range of Aedes albopictus, the most important vector mosquito in Western Eurasia is growing due to climate change. However, it is not known how it will influence the habitats occupied by the species and its environmental fitness within its future range. To study this question, the habitat characteristic of the mosquito was investigated for 2081-2100. The models suggest a notable future spread of the mosquito in the direction of Northern Europe and the parallel northward and westward shift of the southern and eastern potential occurrences of the mosquito. The models suggest a notable increase in generation numbers in the warmest quarter, which can reach 4-5 generations in the peri-Mediterranean region. However, both the joint survival rate of larvae and pupae and the number of survival days of adults in the warmest quarter exhibit decreasing values, as does the potential disappearance of the mosquito in the southern regions of Europe and Asia Minor, along with the growing atmospheric CO2 concentration-based scenarios. While in 1970-2000 Aedes albopictus mainly occupied the hot and warm summer temperate regions of Europe, the species will inhabit dominantly the cool summer temperate (oceanic) and the humid continental climate territories of North and North-Eastern Europe in 2081-2100.

268 Steps per Day and Time Spent Standing in Adults with CKD in a Sedentary-Reducing Intervention

268 Steps per Day and Time Spent Standing in Adults with CKD in a Sedentary-Reducing Intervention

성인 장애인 가족의 가족탄력성과 가족 외부의 사회적 지지가 비장애 형제자매의 자존감에 미치는 영향

This study was conducted in order to identify the factors that influence the self-esteem of the non-disabled siblings of adult family members with disabilities. A total of 223 non-disabled siblings were interviewed in cooperation with institutions for adults with disabilities, such as welfare centres for the disabled, adult day care centres and workshops for the disabled, located in Seoul and Gyeonggi Province, and the results were analysed using t and F tests and multiple regression analysis. The results of the study showed that family resilience and social support had a significant impact on self-esteem. Their explanatory power was higher than that of demographic variables. The significance of this study is that it examines how family resilience and social support outside the family can have a positive impact on the self-esteem of adult siblings of people with disabilities and explores the implications.

Qualitative Analysis of Implementation Factors of an Embedded Caregiver Support Intervention into Adult Day Services.

Adult day services (ADS) are an important and often underutilized support resource for older adults. For persons living with dementia (PLWD), ADS is an optimal access point to not only receive therapeutic and rehabilitative activities, but as a vehicle for respite/relief for dementia caregivers. Yet, there is currently a lack of research on integrating caregiver interventions into home and community-based services such as ADS. This paper reports on qualitative findings from the Improving Outcomes for Family Caregivers of Older Adults with Complex Conditions: The Adult Day Plus (ADS Plus) Program Trial. Drawing from semi-structured interviews conducted with family caregivers and ADS site staff, we conducted a thematic analysis to examine the implementation process of ADS Plus. Themes address the relational nature of the intervention, learning, influence of the administrative infrastructure, and receptivity of ADS Plus. Our analysis determined that implementation of ADS Plus was feasible and accepted by site staff and dementia caregivers but also calls for additional evaluation of embedded caregiver support interventions across different contexts (e.g., staff size, limited technology environments) to further identify and test implementation mechanisms across settings.

Thiamethoxam-Induced Intergenerational Sublethal Effects on the Life History and Feeding Behavior of Rhopalosiphum padi

Thiamethoxam, a second-generation neonicotinoid insecticide is widely used for controlling sap-sucking insect pests including Rhopalosiphum padi. The current study aimed to investigate the life-history parameters and feeding behavior of R. padi following treatments with sublethal concentrations of thiamethoxam. The lethal concentration 50 (LC50) value of thiamethoxam against adult R. padi was 11.458 mg L−1 after 48 h exposure. The sublethal concentrations of thiamethoxam (LC5 and LC10) significantly decreased the adult longevity, fecundity, and reproductive days in the directly exposed aphids (F0 generation). In the progeny R. padi (F1), the developmental durations and total prereproductive period (TPRP) were decreased while the adult longevity, fecundity, and reproductive days (RPd) were increased at both thiamethoxam concentrations. The demographic parameters including the net reproductive rate (R0), intrinsic rate of increase (r), and finite rate of increase (λ) were prolonged only at the LC5 of thiamethoxam. The EPG results indicated that the sublethal concentrations of thiamethoxam increases the total duration of non-probing (Np) while reducing the total duration of E2 in directly exposed aphids (F0). Interestingly, the E2 were significantly increased in the progeny generation (F1) descending from previously exposed parental aphids (F0). Overall, this study showed that thiamethoxam exhibited high toxicity against directly exposed individuals (F0), while inducing intergenerational hormetic effects on the progeny generation (F1) of R. padi. These findings provided crucial details about thiamethoxam-induced hormetic effects that might be useful in managing resurgences of this key pest.

Dose-response relationship between sleep duration and cardiovascular metabolic multimorbidity among older adults in China: A nationwide survey

Aims and objectivesThe purpose of this study was to explore the relationship between the duration of sleep per day and cardiovascular metabolic multimorbidity (CMM) in older adults and to identify how many hours of sleep per day can lead to a lower risk of CMM in older adults. BackgroundCMM are a common syndrome in the older adults. There may be an association between sleep duration and CMM in older adults, with both insomnia and sleep deprivation having an impact on the health of older adults. Therefore, it is important to explore the possibility that older adults who sleep for a few hours per day may have a lower prevalence of CMM. MethodsThe study included 9710 older adults. The sleep duration in this study was assessed by the question "How many hours of sleep do you currently get in a day? ". Older adults were defined as having CMM when they had two or more of the five categories of hypertension, diabetes, heart disease, stroke or cardiovascular disease, dyslipidemia. We used multivariate logistic regression analysis to explore the association among sleep duration and CMM. Restrictive cubic splines were used to examine the shape of the association among sleep duration and the CMM. The STROBE checklist was used for this cross-sectional study. ResultsThe mean age was 84.78 ± 11.73 years, with 55.5 % being female. Of the total sample, 21.3 % were CMM. When all covariates were adjusted, there was dose–response relationship between sleep duration and CMM. The dose-response relationship between CMM and sleep duration showed that older adults had a lower risk of cardiovascular and metabolic multimorbidity when they slept 9 h and 10 h per day. ConclusionWith the increasing population of older adults, the number of older adults suffering from CMM continues to rise, and adequate sleep time can effectively prevent the occurrence of CMM. We should pay attention to the sleep problem of the older adults. Relevance to clinical practiceThis study provided information for healthcare providers to identify circumstances that increase cardiovascular metabolic multimorbidity and suggest the appropriate sleep duration per day to reduce the risk of disease in older adults. Patient or public contributionBecause of the public database data used in this study, all data were collected by survey agency personnel, so this section is not applicable to this study.

Hormetic effects of thiamethoxam on Schizaphis graminum: demographics and feeding behavior

In agroecosystems, insects contend with chemical insecticides often encountered at sublethal concentrations. Insects’ exposure to these mild stresses may induce hormetic effects, which has consequences for managing insect pests. In this study, we used an electrical penetration graph (EPG) technique to investigate the feeding behavior and an age-stage, two-sex life table approach to estimate the sublethal effects of thiamethoxam on greenbug, Schizaphis graminum. The LC5 and LC10 of thiamethoxam significantly decreased longevity and fecundity of directly exposed adult aphids (F0). However, the adult longevity, fecundity, and reproductive days (RPd)—indicating the number of days in which the females produce offspring – in the progeny generation (F1) exhibited significant increase when parental aphids (F0) were treated with LC5 of the active ingredient. Subsequently, key demographic parameters such as intrinsic rate of increase (r) and net reproductive rate (R0) significantly increased at LC5 treatment. EPG recordings showed that total durations of non-probing (Np), intercellular stylet pathway (C), and salivary secretion into the sieve element (E1) were significantly increased, while mean duration of probing (Pr) and total duration of phloem sap ingestion and concurrent salivation (E2) were decreased in F0 adults exposed to LC5 and LC10. Interestingly, in the F1 generation, total duration of Np was significantly decreased while total duration of E2 was increased in LC5 treatment. Taken together, our results showed that an LC5 of thiamethoxam induces intergenerational hormetic effects on the demographic parameters and feeding behavior of F1 individuals of S. graminum. These findings have important implications on chemical control against S. graminum and highlight the need for a deeper understanding of the ecological consequences of such exposures within pest management strategies across the agricultural landscapes.

Comparison of the clinical characteristics in parents and their children in a series of family clustered Mycoplasma pneumoniae infections

BackgroundMycoplasma pneumoniae infections have increased in China recently, causing some evidence of familial clustering. The purpose of this study was to compare the clinical features of parents and children in cases of familial clustering of Mycoplasma pneumoniae infection.MethodsA retrospective analysis was performed on the cases of familial clustering of Mycoplasma pneumoniae infection, and the clinical characteristics of parents and children were compared.ResultsWe identified 63 families, of these, 57 (65.5%) adults and 65 (94.2%) children required hospitalization. Fifty-seven adults (mean age 35.1 ± 4.6 years, 80.7% female) and 55 children (mean age 6.3 ± 3.9 years, 54.5% female) were included in the analysis. The incidence of mycoplasma infection in adults had increased gradually over the past year, while the rate in children had spiked sharply since June 2023. The clinical symptoms were similar in the two groups, mainly fever and cough. The peak temperature of children was higher than that of adults (39.1 ± 0.7℃ vs 38.6 ± 0.7℃, p = 0.004). Elevated lactate dehydrogenase was more common in children than in adults (77.8% vs 11.3%, p < 0.001). Bronchial pneumonia and bilateral involvement were more common in children, while adults usually had unilateral involvement. Three (60%) adults and 21 (52.5%) children were macrolide-resistant Mycoplasma pneumoniae infected. Children were more likely to be co-infected (65.5% vs 22.8%, p < .001). Macrolides were used in most children and quinolones were used in most adults. Ten (18.2%) children were diagnosed with severe Mycoplasma pneumoniae pneumonia, whereas all adults had mild disease. Children had a significantly longer fever duration than adults ((5.6 ± 2.2) days vs (4.1 ± 2.2) days, p = 0.002). No patient required mechanical ventilation or died.ConclusionsMycoplasma pneumoniae infection shows a familial clustering epidemic trend at the turn of summer and autumn, with different clinical characteristics between parents and children.

Using mHealth to Improve Communication in Adult Day Services Around the Needs of People With Dementia: Mixed Methods Assessment of Acceptability and Feasibility.

Adult day services (ADS) provide community-based health care for older adults with complex chronic conditions but rely on outdated methods for communicating users' health information with providers. CareMOBI, a novel mobile health (mHealth) app, was developed to address the need for a technological platform to improve bidirectional information exchange and communication between the ADS setting and providers. This study aims to examine the feasibility and acceptability of CareMOBI in the ADS setting. A concurrent-triangulation mixed methods design was used, and participants were client-facing ADS staff members, including direct care workers (paid caregivers), nurses, and social workers. Interviews were conducted to describe barriers and facilitators to the adoption of the CareMOBI app. The acceptability of the app was measured using an adapted version of the Technology Acceptance Model questionnaire. Data were integrated into 4 themes as anchors of an informational matrix: ease of use, clinical value, fit within workflow, and likelihood of adoption. A mix of ADS staff (N=22) participated in the study. Participants reported high levels of acceptability across the 4 domains. Qualitative findings corroborated the questionnaire results; participants viewed the app as useful and were likely to implement CareMOBI in their practice. However, participants expressed a need for proper training and technical support throughout the implementation process. The CareMOBI app has the potential to improve care management in the ADS setting by promoting effective communication through an easy-to-use and portable method. While the integration of CareMOBI is acceptable and feasible, developing role-specific training modules and technical assistance programs is imperative for successful implementation within the ADS setting.

IDF23-0156 How much should insulin be reduced on dialysis days for Adults with Diabetes receiving Hemodialysis? A Systematic Review

IDF23-0156 How much should insulin be reduced on dialysis days for Adults with Diabetes receiving Hemodialysis? A Systematic Review

Low physical activity is a risk factor for sarcopenia: a cross-sectional analysis of two exercise trials on community-dwelling older adults

BackgroundPhysical inactivity is an important factor in the development of sarcopenia. This cross-sectional study explores the prevalence of sarcopenia and associations of physical activity (PA) with sarcopenia in two exercise trial populations. These study groups are clinically meaningful community-dwelling populations at increased risk for sarcopenia: older adults not meeting the PA guidelines and those with a recent hip fracture (HF).MethodsData from 313 older adults who did not meet the PA guidelines (60% women; age 74.5 ± 3.8, body mass index 27.9 ± 4.7) and 77 individuals with HF diagnosed on average 70 ± 28 days earlier (75% women; age 79.3 ± 7.1, body mass index 25.3 ± 3.6) were included in this study. Grip strength and muscle mass (Dual-energy X-ray absorptiometry [DXA] in older adults not meeting the PA guidelines and bioimpedance analysis in participants with HF) were used to assess sarcopenia according to the European Working Group in Older People 2019 (EWGSOP2) criteria. The current level of PA was self-reported using a question with seven response options in both study groups and was measured with a hip-worn accelerometer for seven consecutive days in older adults not meeting the PA guidelines.ResultsThe prevalence of sarcopenia and probable sarcopenia was 3% (n = 8) and 13% (n = 41) in the older adults not meeting the PA guidelines and 3% (n = 2) and 40% (n = 31) in the HF group, respectively. In the age- and sex-adjusted logistic regression model, the lowest levels of self-reported PA were associated with increased probable sarcopenia and sarcopenia risk in older adults not meeting the PA guidelines (OR 2.8, 95% CI, 1.3–6.1, p = 0.009) and in the HF group (OR 3.9, 95% CI, 1.4–11.3, p = 0.012). No significant associations between accelerometer-measured PA and probable sarcopenia or sarcopenia were found.ConclusionsProbable sarcopenia is common among community-dwelling older adults not meeting the PA guidelines and very common among individuals recovering from HF who are able to be involved in exercise interventions. In addition, since low PA is associated with higher probable sarcopenia and sarcopenia risk, it is recommended to screen for sarcopenia and promote regular physical activity to prevent sarcopenia in these populations.

Sedentary activity, sedentary bouts, and patterns of total daily sedentary activity, and their relationship with stress and well-being in individuals with diabetes and prediabetes: The Lolland-Falster Health Study

AimsThis study aimed to investigate the cross-sectional associations of stress and well-being with the total amount of sedentary activity and sedentary bouts in adults with diabetes and prediabetes. A secondary aim was to explore the sedentary activity pattern during a day in adults with diabetes and prediabetes. MethodsThis cross-sectional study from the Danish Lolland-Falster Health Study categorized participants into diabetes (including both type 1 and type 2 diabetes) and prediabetes based on their HbA1c level and self-reported use of diabetes medication. Exposures were Perceived Stress Scale (scores ≥18 = moderate to high stress) and WHO-5 Well-Being Index (scores ≤50 = low well-being). Outcomes were total daily sedentary activity and sedentary bouts assessed with thigh-worn and back-worn accelerometers. ResultsAmong the 562 included adult participants, 15 % had low well-being and 65 % had moderate to high stress. Higher well-being was associated with lower total sedentary activity in participants with diabetes (−1.1 min/day, 95 % CI -2.0; −0.2, for every 1-point increase in WHO-score) and participants with prediabetes (−0.6 min/day, 95 % CI -1.1; −0.05, for every 1-point increase in WHO-score). No association was found between stress and sedentary activity. During a day, participants with diabetes were more sedentary with a mean difference of −0.7 h/day (95 % CI -1.1; −0.4) when compared with participants with prediabetes. ConclusionsThis study found that higher well-being is associated with lower total daily sedentary activity in individuals with diabetes and prediabetes, while no association between stress and sedentary activity was found. These findings imply that individuals with diabetes and prediabetes and low well-being may need additional support to reduce time spent on daily sedentary activity.

Healthy at Home: an integrated health and social care initiative for vulnerable and marginalized older adults in Toronto

PurposeThe Healthy at Home (H@H) is an older adult day program that is in Toronto in Ontario, Canada. This is an integrated health and social care (IHSC) program that seeks to address the social isolation and health needs of a highly vulnerable older adult population living in the north Toronto communities. These are Russian-speaking Jewish older adult immigrants. The case provides a detailed description of the factors that enabled a diverse group of health and social care organizations to integrate their respective services to address the health and social care needs of their clients using a culturally appropriate and trauma-informed lens.Design/methodology/approachA case description comprised of key informant interviews, and a focus group was undertaken of representatives from health and social care organizations serving clients in the north Toronto area.FindingsThis case description identified eleven integration factors that enabled organizations to provide integrated care using a culturally appropriate and trauma-informed lens, and they include developing an aligned vision and goals, communications, an inter-organization culture of inter-dependence, champions, pre-existing relationships, and champions. In addition, operating in the not-for-profit sector, sector differences, enabling public policies and a strong sense of community have influenced integration of services across the organizational partners to serve its high-risk client group.Originality/valueThis case description lends insights into how IHSC can be leveraged to provide culturally appropriate and trauma-informed care for highly vulnerable client/patient populations. A lesson learnt is that social care partners can engage in successful integration leadership in joint health and social care integration efforts.

Advanced prescription of injectable anticancer drugs: Safety assessment in a European Comprehensive Cancer Centre using the risk matrix approach.

The purpose of this work was to assess failures in the advanced prescription of parenteral anticancer agents in an adult day oncology care unit with more than 100 patients per day. An a priori descriptive analysis was carried out by using the risk matrix approach. After defining the scope in a multidisciplinary meeting, we determined at each step the failure modes (FMs), their effects (E) and their associated causes (C). A severity score (S) was assigned to all effects and a probability of occurrence (O) to all causes. These S and O indicators, were used to obtain a criticality index (CI) matrix. We assessed the risk control (RC) of each failure in order to define a residual criticality index (rCI) matrix. During risk analysis, 14 FMs were detected, and 61 scenarios were identified considering all possible effects and causes. Nine situations (15%) were highlighted with the maximum CI, 18 (30%) with a medium CI, and 34 (55%) with a negligible CI. Nevertheless, among all these critical situations, only three (5%) had an rCI to process (i.e., missed dose adjustment, multiple prescriptions and abnormal biology data); the others required monitoring only. Clinicians' and pharmacists' knowledge of these critical situations enables them to manage the associated risks. Advanced prescription of injectable anticancer drugs appears to be a safe practice for patients when combined with risk management. The major risks identified concerned missed dose adjustment, prescription duplication and lack of consideration for abnormal biology data.

Comparison of the efficiency of initial dental alignment with Invisalign® aligners changed every 7 or 14 days in mature adults: Randomized clinical trial.

To compare the anterior crowding correction after sequential use of the first 5 aligners between two aligner exchange protocols (7 and 14 days) in mature adult patients. Thirty-six patients over 35 years who received orthodontic treatment with Invisalign® were randomly allocated to two different aligner replacement sequence protocols: Group 1: exchange every 7 days (n = 18); and Group 2: exchange every 14 days (n = 18). All patients were scanned with iTero Element 5D® (Align Technology) in two treatment times: at pre-treatment (T1) and after using the first five aligners (T2). Little's Irregularity Index (LII) and arch widths were evaluated with OrthoCAD software. Intra and intergroup comparisons were performed with the dependent and independent t-tests. The results were considered significant for P < .05. Thirty-five patients completed the study. Both groups' maxillary and mandibular Irregularity Indexesi were significantly lower at T2. There was no significant difference in inter-canine, inter-premolar, and intermolar distances.G2 (14 days) presented a greater decrease in mandibular irregularity than G1 (7 days). Both exchange protocols (7 and 14 days) effectively correct anterior crowding in the initial phase of orthodontic treatment with aligners in mature adult patients. However, the 14-day exchange protocol provided a greater correction in mandibular anterior crowding in the evaluated period than the 7-day exchange protocol.

Adult Day Care Service: Who Uses it and Who Wants to Use it? Multivariable Analysis of Current and Future Use of Adult Day Care Service by Elderly Persons in Long-Term Care

Background Adult day care serves to ease the burden on informal caregivers and to provide adequate care and support for care recipients. Across Bavaria and Germany, adult day care is attended by 4% of all care recipients. The aim of the secondary analysis was to identify variables linked to the current or desired future use of adult day care services. Methodology For the cross-sectional study Benefits of Being a Caregiver ("Zugewinne durch die Pflege"), informal caregivers of geriatric care receiver were surveyed in Bavaria from October 2019 to March 2020 (age>65; n=958). Data regarding caregiving situation, characteristics of informal caregivers and care recipients, and sociodemographic information were collected. Two binary logistic regression analyses were conducted to identify predictors of current or desired adult day care service use. Results Adult day care was used by 7.3% (n=70) of informal caregivers. Utilization was associated with dementia and high care degree requirements of the care recipient(Nagelkerke's R2 = 0.200). Of the 888 informal caregivers not using adult day care services, 223 (25.1%) expressed a desire to use them. This was associated with care recipients suffering from dementia, a poor previous relationship, and a high subjective burden on the informal caregiver (Nagelkerke's R²=0.083). Conclusion The utilization rate of adult day care was found to be higher than reported in Bavarian or German care statistics. Dementia and an increased need for care of the care recipient were associated with utilization, but contrary to reports in literature, no association with everyday limitations, sex, education, or duration of care was found. More than two-thirds of Bavarian informal caregivers do not want to use adult day care services either now or in the future.

The potential habitat and environmental fitness change of Aedes albopictus in Western Eurasia for 2081-2100.

The range of Aedes albopictus, the most important vector mosquito in Western Eurasia is growing due to climate change. However, it is not known how it will influence the habitats occupied by the species and its environmental fitness within its future range. To study this question, the habitat characteristic of the mosquito was investigated for 2081-2100. The models suggest a notable future spread of the mosquito in the direction of Northern Europe and the parallel northward and westward shift of the southern and eastern potential occurrences of the mosquito. The models suggest a notable increase in generation numbers in the warmest quarter, which can reach 4-5 generations in the peri-Mediterranean region. However, both the joint survival rate of larvae and pupae and the number of survival days of adults in the warmest quarter exhibit decreasing values, as does the potential disappearance of the mosquito in the southern regions of Europe and Asia Minor, along with the growing atmospheric CO2 concentration-based scenarios. While in 1970-2000 Aedes albopictus mainly occupied the hot and warm summer temperate regions of Europe, the species will inhabit dominantly the cool summer temperate (oceanic) and the humid continental climate territories of North and North-Eastern Europe in 2081-2100.