Adult Day Care Research Articles

Barriers and Facilitators to the Applicability of Adult Daycare Centers in Saudi Arabia: A Qualitative Study.

Adult daycare centers (ADCs) enable older adults to socialize and enjoy planned group activities while receiving healthcare services. These centers also assist caregivers by empowering them to remain in the workforce. This study aims to explore the challenges in establishing ADCs in Saudi Arabia (SA) from the perspectives of healthcare professionals, healthcare policymakers, older adults, and caregivers. Additionally, this study's objective is to identify the barriers, facilitators, and applicability of ADCs in SA. A qualitative study was conducted using semi-structured individual interviews. Inductive and deductive thematic analyses were employed to identify common themes regarding the barriers and facilitators to the applicability of ADCs in SA. Five researchers independently examined the transcripts using inductive analysis. Deductive analysis mapped the themes to Campinha-Bacote's cultural competence model. Data were collected from 46 participants, including caregivers, older adults, healthcare professionals, and healthcare policymakers. The findings highlight that the main facilitators to establishing ADCs in SA are the expected positive impact on the psychological and physical well-being of older adults and their caregivers. Conversely, cost and transportation, in addition to cultural considerations are possible barriers. This study identified the perceived benefits of ADCs for older adults and caregivers from a Saudi societal perspective. Thematic analysis showed that ADC's applicability in SA is possible, with some modifications to fit within the Saudi context. Additional efforts are necessary to promote the concepts and services that ADCs provide for older adults and to encourage support for these centers by non-profit organizations and the government.

Characteristics of survivors enrolled in the World Trade Center Health Program

The World Trade Center (WTC) Health Program is a limited federal health care program that provides medical monitoring and treatment for WTC-related health conditions to responders and survivors impacted by the terrorist attacks on September 11, 2001.This study described the characteristics of the Program survivor members (who lived, worked, went to school, daycare or adult daycare or present in the New York City Disaster Area of 9/11/2001) to stimulate innovative ideas for improving healthcare services, generate new research interest, and serve as a reference for future research on this population. Administrative and medical claims data collected from the Program start date (07/01/2011) through 2022 were used. As of 12/31/2022, there were 37,384 enrolled survivors: 5.0% were aged ≤21 years on 9/11/2001, 45.9% females, and 31.2% non-Hispanic Whites. A total of 24,148 (64.6%) were certified for at least one WTC-related condition, including neoplasms (36.0%), aerodigestive disorders (35.6%) and mental health conditions (18.6%); 22.9% were certified for more than one category. Certification rates of some WTC-related conditions differed by sex, age and race/ethnicity. WTC survivor population is diverse in sex, age and race/ethnicity, with a high proportion certified for certain WTC-related health conditions, providing great opportunities for research in various areas.

Effect of adult day care centre attendance on hypertension management.

Hypertension (HT) silently threatens one in three adults, especially older adults, who struggle with blood pressure (BP) control because of limited health access, poor adherence to medication and failure to make lifestyle changes. This increases their risk for heart disease, kidney failure and dementia. Fortunately, adult day care centres (ADCCs) offer hope. These community facilities provide daytime care, including health support services, social activities and exercise. This study investigated the perceived effect of adult daycare centre attendance on BP control and treatment adherence. A mainly descriptive study at MUCPP Community Health Centre (CHC) in Bloemfontein, South Africa, between July 2020 and September 2020, used questionnaires researchers completed during interviews. The researchers approached 372 hypertensive patients of a minimum of 60 years old and at least 2 years since being diagnosed. Of the 90 who attended ADCCs, 71.1% had controlled hypertension compared to 51.4% of those who did not. While treatment adherence showed no difference, a positive association between ADCC attendance and BP control is evident. The findings suggest a promising link between ADCC attendance and improved BP control in older adults with hypertension. Adult Day Care Centres warrant further exploration as it seems to be an encouraging support intervention for this vulnerable population.Contribution:This study highlights the positive impact ADCCs have on hypertension management in older adults, urging increased physician awareness and patient referrals.

ASSOCIATIONS BETWEEN DISABILITY, CHRONIC DISEASES, AND DEPRESSIVE SYMPTOMS IN VIETNAMESE OLDER ADULTS

Abstract After the fall of Saigon in 1975, several waves of Vietnamese immigrants/refugees migrated to the U.S. currently comprising 2.2 million individuals, the 4th-largest Asian-origin subgroup in the U.S. Despite the large number and their traumatic, adverse lifelong experiences, health research on this population is scarce. To fill this gap, we developed the Vietnamese Aging and Care Survey and collected health data on older Vietnamese in Houston, Texas, the 2nd-largest Vietnamese-populated metropolitan area in the nation. The purpose of this study was to examine the associations between their physical disability, chronic diseases, and depressive symptoms. Respondents (N=210) were 76 years old (mean), married (63%), and female (56%) with 8 years of education. They lived in the U.S. for 25 years (mean) and spoke Vietnamese only (88%) in multi-generation (80%) low-income households (91%, ≤$25K). They self-rated their health as fair/poor (80%) with ≥1 chronic condition (76%). Those with higher depressive symptoms were less likely to be married (p=0.004) and have more chronic diseases (p=0.004) compared to those without depressive symptoms. Regression analyses showed significant associations between arthritis (β=2.73), liver disease (β=6.24), ADL disability (β=0.72), and higher depressive symptoms. Limited control over their basic function (ADL disability) would restrict their daily lives, and mobility issues and pain (arthritis and liver disease) might impact them psychologically. While older Vietnamese may leverage their multi-generation living condition, and receive tangible support with ADL disability within their families, healthcare professionals should connect them with culturally and linguistically relevant adult daycare centers that provide social and exercise opportunities.

A Patchwork Quilt

Abstract: This paper presents a qualitative case study of a drama-therapy group for older adults at an adult daycare center in Israel. It explores the therapeutic processes in the group in terms of drama therapy and positive aging theory. The group included 12 participants between the ages of 70 and 90, who met for 10 months for 2-hour weekly sessions with a drama therapist (the first author). We used the therapist’s records as data and qualitatively analyzed them. The analysis revealed three main themes: (a) movement arousing memories inherent in the body; (b) the contribution of music to autobiographical memory; (c) transformation and change in the life story through dramatic resonances. These findings shed light on the contribution of drama therapy to support older adults at varied functioning and cognitive levels, and to promote positive aging.

Partnering with hospital providers to facilitate handoff for persons with dementia in the acute care setting

AbstractObjectivesIndividuals with Alzheimer’s disease and related dementias cannot verbalize their care needs during transitions of care (TOC) and rely on their home caregivers (HCs) for advocacy. The lack of communication between clinicians in one setting and HCs can lead to detrimental health outcomes for the length of stay. With the assistance of Family Nurse Consultants (FNCs), a standardized care needs communication tool (SCNCT) for support persons of persons with dementia (PWD) was implemented to enhance the ability of the support person to communicate care needs during TOC.MethodParticipants of the project included FNCs who assessed the needs of the PWD enrolled in a specialized adult daycare center. After obtaining IRB approval, pre‐ and post‐educational 5‐point Likert scale surveys were administered to capture if a gap exists in communication care needs for cognitively impaired individuals and if the tool can help bridge that gap. A PowerPoint presentation was utilized for training the FNCs on the SCNCT. Participants were informed to anticipate another survey within thirty days of follow‐up training.ResultsDescriptive statistics were utilized to analyze the Likert scale questions for all surveys. Only the last question of the 30‐day post‐implementation survey yielded scale data. Eight FNCs completed the pre‐survey and another survey post‐presentation. Seven of them responded to the survey 30‐day post‐project implementation. The tool was new to the FNCs, and the output generated a utilization rate of 43%. Moreover, HCs who were offered the tool benefited from that time of preparation for their loved ones. There was also a statistically significant improvement in FNCs' perception of the value and usefulness of the tool after they were introduced to it. The results of the two‐tailed Wilcoxon signed‐rank test conducted to investigate the pre‐ and post‐survey scores were significant based on p = .039.ConclusionThe project did not demonstrate the HCs' involvement with the tool due to limitations associated with the COVID 19 pandemic, yet the results showed promising due to the champions' perceived value. Nonetheless, the project findings revealed that HCs could be crucial members to strengthen TOC for the cognitively impaired individual using the SCNCT.

Experiences of Disabled Older Adults in Urban Area Adult Day Care Centers: A Multisite Case Study.

This study described clients' experiences within adult day care (ADC) and its related impacts. A multisite case study was conducted with 26 older adults from six ADCs in Tokyo, with interviews and field observations conducted between November 2020 and July 2022. The transcribed interviews and field notes were analyzed qualitatively. Three categories pertaining to context ("guilt and resignation to the current living conditions," "desire for social connection despite frustrating limitations," and "supported life based on weekly ADC routine") and four categories about the experiences within ADC ("savoring disability- and age-friendly conversations," "feeling happy about something new and positive," "challenges for changes in self-image," and "discomfort with others and the waste of time") were extracted. Clients' increased vulnerability due to disabilities and COVID-19 affected their experiences. ADCs provide a safe place for interaction, and their use must be encouraged to develop a disability- and age-friendly society.

A web-based care assistant for caregivers of the elderly: Development and pilot study.

The aging population in Korea has driven a surge in demand for elderly care services, leading to significant growth in elderly welfare facilities, particularly Adult Daycare Centers (ADCs). However, despite advancements in care facilities, caregivers continue to face challenges in providing suitable elderly care due to difficulties arising from gaps in the latest information on the elderly and their coping abilities. The objective of this study is to develop and evaluate the effectiveness of the elderly care assistant system, which facilitates the sharing of information and knowledge necessary for elderly care among caregivers. The ECA system was designed to support knowledge sharing through a knowledge management system based on an ontological knowledge model, with a web-based user interface for improved accessibility. A field trial was conducted at ADC in Seoul from August 17 to September 21, with eight caregivers participating. A mixed-methods approach, involving both surveys and interviews, was employed to gauge the ECA system's effectiveness. The study found that the use of the ECA was beneficial in promoting knowledge sharing among caregivers. Additionally, caregivers noted the potential benefits of using the ECA in conjunction with family caregivers, who can offer additional information and perspectives on elderly care. This study presents preliminary evidence of the potential benefits of a care knowledge sharing system among various caregivers in elderly care. Although the elderly care assistant effectively promotes knowledge sharing, more research is needed to fully understand its impact on elderly care outcomes.

CHANGING TALK (CHAT) ONLINE COMMUNICATION EDUCATION FOR ADULT DAY CARE STAFF: EVALUATION AND FUTURE DIRECTIONS

Abstract Communication education has been effective in reducing elderspeak use for nursing home staff and subsequently reduces resistiveness to care and inappropriate antipsychotic medication use in residents living with dementia. Communication is fundamental for dementia care and educating staff in other long-term service and support settings such as Adult Day Care (ADC) is needed. Tailoring education to the specific setting is indicated to optimize acceptability and effectiveness. ADC staff (N=22) from 3 ADC centers participated in the Changing Talk: Online Training (CHATO). Results for the 19 staff who completed the education program were analyzed. A focus group was conducted with a subset of participants to evaluate feasibility, applicability, and directions for tailoring for ADC settings. Knowledge gain was demonstrated by score increases 15.0 percentage points (p<.001) from pre- to post-education on the Changing Talk Scale (CHATS). Confidence in Dementia Care (CODE) scores significantly increased after CHATO (p=.05), indicating an increase in confidence in caring for clients with dementia. The mean Modified Diffusion of Innovation scale score was 2.2 (1=intend to use skills in practice to 5=don’t intend to use), indicating intent to use with clients. Program evaluation ratings were positive indicating satisfaction. Focus group participants reported that the CHATO was valuable and recommended ADC specific scenarios. The results support the value of CHATO for ADC staff as well as specific directions to better tailor the education to increase applicability in this LTSS setting.

THE ROLE OF WORKPLACE POLICY ON EMPLOYED FEMALE CAREGIVERS DURING THE CORONAVIRUS PANDEMIC

Abstract The coronavirus pandemic has indelibly impacted society over the past two years. This qualitative study explores how working female caregivers, in particular, experienced the pandemic and how the workplace supported them during this time. Findings from interviews with 29 working female caregivers revealed that many caregivers were unable to set boundaries around caregiving during the pandemic. Caregivers frequently found themselves on their own in providing care. This meant that caregivers had little time to themselves to rest and recharge. Whereas prior to the pandemic, caregivers may have had help with caregiving through services like respite and adult daycare, these services were no longer options. This reduced level of external support and care influenced caregivers’ socioemotional wellbeing. Workplace policies, such as the ability to work remotely and working flexible hours, helped to ease caregiver burden. These findings have implications for both caregivers and workplaces during future crises and disasters.

The Elderly’s Thoughts and Attitudes about Polypharmacy and Deprescribing: A Qualitative Pilot Study in Portugal

The high prevalence of polypharmacy and potentially inappropriate medications in the elderly makes them a vulnerable group to adverse drug events. Deprescribing is the medication review plus cessation of potentially inappropriate medications with a health professional’s help. Several barriers and enablers influence it, and its knowledge can help health professionals. The objective of the study is to understand the Portuguese elderly’s attitudes and ideas about polypharmacy and deprescription. We made a qualitative approach through a focus group with elderly patients from an adult daycare center with transcription and codification into themes and subthemes based on previous frameworks. Eleven elderly patients participated in the focus group. The identified elderly’s ideas and attitudes could be clustered into five main barriers: appropriateness, process, influences, fear, and habit, and five main enablers: appropriateness, process, influences, dislike, and cost. Although the elderly’s strong beliefs regarding medication benefits and necessity prevail, contrary opinions regarding lack of benefit/necessity, drug interaction/side effects, and medication complexity/number may influence their willingness to deprescribe positively. The health professional’s influence and the patient’s trust in their doctors were perceived essential for decision-making as either a barrier or an enabler. The medication benefit was a big barrier, and side effects/drug interaction experiences are an important enabler.

Effect of Group Physical Games on Life Quality of Older Adults at Adult Daycare Centers

Introduction: Physical activity is a predictor of the health outcomes of the older adults, and many approaches have been introduced for its implementation. The present study aimed to investigate the effect of group physical games on life quality (QOL) of older adults at an adult day care center.
 
 Methods: This quasi-experimental study was conducted using pre-test and post-test. Using convenience sampling, a total of 50 senior citizens above 60 years of age from two adult daycare centers of Babol and Amol in 2017 was placed in an intervention (25) and a control (25) group, respectively. The intervention group received physical games program twice a week for 6 weeks. The SF12 questionnaire was used to assess the QOL. The statistical analysis of the variables was carried out using t-tests, Wilcoxon, and Mann-Whitney tests at a significant level (P < 0.05) with SPSS software.
 
 Results: The QOL scores of the participants in the intervention group, compared to the control group have significantly improved (p < 0.001). The calculated difference for the quality of life of the intervention group was (d = 4.40± 2.36) being (d = 1.68± 1.74) and (d = 2.72± 1.51) in the physical and mental aspects, respectively.
 
 Conclusion: Physical exercise program (especially stationary physical game) can improve the quality of life of the older adults both physically and mentally. Therefore, such activities can be used to improve the quality of life of the older adults.

Use of tangible, educational and psychological support services among Chinese American dementia caregivers.

Though many studies have examined the service utilization of dementia caregivers, there is limited empirical evidence from Asian Americans in this field. Guided by Andersen's behavioral model of health services use, we aimed to understand what factors were associated with utilizing multiple types of services among Chinese American dementia caregivers. We collected survey data from 134 Chinese dementia caregivers in New York City. Logistic regression models were conducted to test the associations between predisposing, enabling, and need factors and the likelihood of using tangible (home health aide, adult daycare, respite care), educational (lectures and workshops), and psychological (peer support groups and psychological counseling) support services. Several variables conceptualized by Andersen's model, including caregiver's knowledge about services, caring tasks, length of care and burden, and care recipient's physical and cognitive deteriorations, were significantly associated with higher possibilities of using multiple types of services. Three sociocultural factors-residing in Chinatown, availability of alternative family caregivers, and diagnosis of cognitive deterioration-were also associated with higher likelihood of using educational or psychological services. The findings extend the existing literature on service utilization of caregivers by highlighting the importance of distinguishing types of services and considering sociocultural factors in future research and practice.

Experiences of Disabled Older Adults in Tokyo's Adult Day Care Centers during COVID-19-A Case Study.

The COVID-19 pandemic resulted in social isolation among elderly people with disabilities. Adult daycare (ADC) is an important community care option for socialization among people with disabilities. However, their experiences with ADC remain underexplored. Thus, this study investigated the experiences of community-dwelling disabled elderly with ADC from the perspective of socialization. Four older women from Tokyo with disabilities, availing of one ADC service, were interviewed across two sessions between November 2020 and January 2021. The transcribed interviews and field notes were analyzed qualitatively. This yielded eight categories: two pertaining to context (“restricted social interaction outside of ADC”, “feeling simultaneously grateful and ashamed of oneself as a recipient of care services”), and six pertaining to experience with ADC (“take a catastrophic defensive posture in situations where one’s perception of value is shaken”, “express oneself positively to justify one’s daily life”, “have trouble knowing what to do”, “put oneself in a shaded exchange relationship”, “examine the value of elderly people in need of care in society”, and “savor regular contact with others”). Ensuring the use of ADC as a safe place for interaction while considering pandemic-related needs is important to develop policy and practical responses to restricted socialization during COVID-19.

Improving older adults’ accessibility to the web using real-time online interactive guides

Internet use by older adults is increasing and has the potential to improve their mental and social wellbeing, however it is still low compared to other age groups for various online activities. The objective of this study was to develop and evaluate a computerized expert system, GoldNet, which functions as a human expert and guides the user, step-by-step and in real time, when performing online operations. A user study was conducted on 30 older adults (over 65 years old) that attend an adult daycare center. The participants were all novice users with no prior experience using the Internet. A stratified randomized between participants experimental design was used to evaluate users' performance and satisfaction before and after receiving guidance, after practice, and after a two-week period without controlled practice. Participants were assigned to one of three study groups according to the guidance they received: GoldNet guides, video guidance, or guidance from a personal human tutor. During the experiment participants’ eye movements were monitored. The results indicate that by using GoldNet's automated guides, older adults can perform online tasks with high effectiveness, efficiency, and user satisfaction, performing comparably to users trained by a personal human tutor and significantly better than users relying on video guidance. GoldNet was also found beneficial as a refresher tool after a period without controlled training.

通所リハビリテーション利用者の入浴状況と心身機能およびADLとの関連

通所リハビリテーション利用者の入浴状況と心身機能およびADLとの関連

COVID-19-Related Lifestyle Changes among Community-Dwelling Older Adult Day-Care Users: A Qualitative Study.

In Japan, the community-based comprehensive care system is an important initiative. The purpose of this study was to understand COVID-19-related lifestyle changes experienced by older adults who lived in communities and used day-care services. Using a qualitative inductive research method, semi-structured interviews were conducted with 13 older adults who used day-care services in Kyoto City, which assessed lifestyle changes before and after the spread of COVID-19 during March–April 2021. The extracted lifestyle change codes were classified into six categories and 16 subcategories. The data revealed that older adults felt socially isolated and experienced multiple changes in their lives, including limited leisure activities, changes in roles, decreased interpersonal interaction with family and acquaintances, poor diet and sleep quality, and reduced attention to personal appearance and grooming. The findings suggest that during COVID-19, older adults had difficulty adapting to the various changes in their lives and showed a decline in physical and mental functioning. Thus, it is important for day-care facilities to create sustainable spaces in response to the various care needs of community-dwelling older adults whose lifestyles have changed as a result of the COVID-19 situation.

Use of Tangible, Educational, and Psychological Supportive Services Among Chinese American Dementia Caregivers

Background and Objectives: Though many studies have examined the service utilization of dementia caregivers, there is limited empirical evidence from Asian Americans and the lack of incorporating community resources and sociocultural factors in this field. Guided by the Andersen's Behavioral Model of Health Services Use (ABM), we aimed to understand whether and how predisposing, enabling and need factors were associated with utilizing multiple types of services among Chinese Americans dementia caregivers. Research Design and Methods: We collected survey data from 134 Chinese dementia caregivers in New York City. Logistic regression models were conducted to test the associations between predisposing, enabling and need factors and the likelihoods of using tangible (home health aide, adult daycare, respite care), educational (lectures and workshops), and psychological (peer support groups and psychological counseling) services. Results: Consistent with prior literature, caregiver’s knowledge about services, caring tasks, length of care and burden and care recipient’s physical and cognitive deteriorations, were significantly associated with higher possibilities of using multiple types of services among these Chinese American dementia caregivers. Three sociocultural factors, including residing in Chinatowns, availability of alternative family caregivers and diagnosis of cognitive deterioration, were also associated with higher likelihoods of using educational or psychological services. Discussion and Implications: The findings extended the existing literature on service utilization of caregivers by highlighting the importance of distinguishing types of services and the necessity of considering sociocultural factors in future research and practice.

Telephone support for dementia family caregivers during the COVID‐19 pandemic: Experiential differences in spouse and adult‐child caregivers

BackgroundDue to the COVID‐19 pandemic, family caregivers stayed home with their person with dementia (PWD) continuously for 24/7. They faced limited social activity with lack of essential services such as adult daycare and in‐home services. Social restrictions can worsen cognitive deterioration and increase behavioral problems of PWD, causing increased caregiver burden, distress, and loneliness. Caregiver research team developed a telephone support intervention with trained university students who provided emotional support, and COVID‐19 information. The objective of the study is to identify the different needs in caring between spousal caregivers and adult‐child caregivers for community‐dwelling PWD during this pandemic.MethodsFamily caregivers were recruited through our previous home‐visit family caregiver study. Trained bilingual university students conducted telephone support calls in English, Spanish, Korean or Vietnamese as preferred by caregiver participants, once a week during the 3 month of the early pandemic period. Students summarized each conversation in a call log for debriefing by a gerontology faculty. Thematic analysis using call logs was conducted and coded by two independent raters by using Dedoose, a qualitative data analysis tool. Similarities and differences between spousal caregivers and adult‐child caregivers were identified.Results14 spousal caregivers (11 were wives and 3 were husbands, mean age 67.4) and 11 adult‐child caregivers (daughters, mean age 49) participated in the study. Three themes were identified: (1) spousal caregivers had high sense of being left alone and isolated while adult‐child caregivers felt a greater responsibility for the family including PWD care, (2) both groups showed increased stress but for spouse caregivers it was due to worsening PWD behaviors, for adult‐child caregivers it was the restriction on social interaction and concerns about losing jobs, (3) similarities in adapting to the COVID‐19 safety recommendations and incorporating it into everyday life.ConclusionThe findings showed an increase in stress and anxiety in both groups but the differences were: for spouse high level of loneness, difficulty with PWD behaviors; for adult‐child caregivers greater burden due to family and reduced social life. Both groups followed COVID‐19 safety protocol and highly appreciated the telephone‐based emotional support during the pandemic.

Effects of Community-Based Physical-Cognitive Training, Health Education, and Reablement among Rural Community-Dwelling Older Adults with Mobility Deficits.

Reablement services are approaches for maintaining and improving the functional independence of older adults. Previous reablement studies were conducted in a home environment. Due to the limited evidence on the effects of multicomponent interventions and reablement in a community-based context, this study aimed to develop and evaluate the effect of community-based physical–cognitive training, health education, and reablement (PCHER) among rural community-dwelling older adults with mobility deficits. The trial was conducted in rural areas of New Taipei City, Taiwan. Older adults with mild to moderate mobility deficits were recruited from six adult daycare centers, and a cluster assignment was applied in a counterbalanced order. The experimental group (n = 16) received a PCHER intervention, comprising 1.5 h of group courses and 1 h of individualized reablement training, while the control group (n = 12) underwent PCHE intervention, comprising 1.5 h of group courses and 1 h of placebo treatment. A 2.5-h training session was completed weekly for 10 weeks. The outcome measures contained the de Morton Mobility Index (DEMMI), the Saint Louis University Mental Status (SLUMS) Examination, the Barthel Index (BI), the Short Physical Performance Battery (SPPB), and the Canadian Occupational Performance Measure (COPM). The PCHER significantly improved the DEMMI, SLUMS, BI, SPPB, and COPM (all p < 0.05), with medium-to-large effect sizes. PCHER also showed an advantage over PCHE in terms of the SPPB (p = 0.02). This study verified that combining individualized reablement with group-based multicomponent training was superior to group courses alone in enhancing the functional abilities of community-dwelling older adults with mobility deficits.