Adult Day Care Research Articles

The effect of a subsidy policy on the utilization of community care services under a public long-term care insurance program in rural Japan

This cross-sectional study investigated the effect of an interim subsidy policy for low-income beneficiaries to buy home help services under Japanese long-term care insurance (LTCI) for the service utilization of home help and other community care services. Claims records during the period from October to December 2001 were reviewed to compare the monthly amounts for each service and out-of-pocket copayment for subsidized ( n = 137) and non-subsidized ( n = 124) beneficiaries. A multivariable linear regression analysis was conducted to control for age, gender, household size, length of care, and care eligibility level. Compared with the non-subsidized beneficiaries, the subsidized beneficiaries used 1.53 times as much home help service ( p < 0.001), and spent 0.70 times as much on out-of-pocket copayments ( p < 0.001), while they used fewer adult daycare services (0.71 times as much as the non-subsidized did, p = 0.063). The results strongly indicated that the interim subsidy for low-income beneficiaries alleviated the economic burden, but also resulted in service overuse and the substitution of home help services for other community care services. The policy implications of these findings were discussed.

Can neuromuscular strength and function in people with dementia be rehabilitated using resistance-exercise training? Results from a preliminary intervention study.

Neuromuscular weakness is a prominent symptom among people with central nervous system disorders, such as dementia, typically leading to disability in activities of daily life. We sought to evaluate the potential of resistance exercise to improve neuromuscular strength and function in the lower extremities among community-dwelling people with dementia. Twenty-eight subjects, aged 70-88 years and with an average Mini-Mental State Examination score of 17.8 +/- 7.2, were recruited from a population of adult daycare facility users. Subjects underwent pre- and postintervention assessment of strength and physical function consisting of determination of bilateral maximum strength of the knee extensor, hip flexor, dorsiflexor muscles, and handgrip; and evaluation of lower-extremity function based on repeated chair stands and gait speed. The intervention consisted of moderate-intensity progressive resistance training of the hip extensors, abductors, knee extensors and flexors, and dorsiflexors using the Theraband resistance system for up to 3 days weekly over a 6-week period. Subjects completed an average of 11.4 +/- 2.5 exercise sessions. Among those who exercised at least twice per week (> or = 12), they improved an average of 15.6% in quadriceps strength, 10.1% in handgrip strength, 22.2% in sit-to-stand (STS) time, 9.9% in usual gait time, 5.4% in fast gait time (p =.03), and 14.0% in the timed-up-and-go (TUG) test. Subjects demonstrated improvements in some areas of muscular capacity (quadriceps and handgrip) and most tests of lower-extremity function (STS, gait, TUG), yet declines in other areas (dorsiflexion and iliopsoas strength). Although strength or functional deficits in all domains were not remediable, these results suggest the potential of a resistance-exercise intervention of longer duration and/or greater intensity to produce beneficial effects on the neuromuscular functioning of people with dementia.

Refractive errors and visual impairment in 900 adults with intellectual disabilities in the Netherlands.

To collect data on refractive errors and visual impairment in adults with an intellectual disability (ID) in the Netherlands. A randomized sample of 2100 participants was drawn from a base population of 9000 adults with intellectual disabilities in the Netherlands. This article reports on the first 900 participants. All participants underwent a protocol-based on-site ophthalmological assessment carried out by skilled investigators. Co-operation was classified according to the number of tests that could be carried out reliably and was good or excellent in 80% of subjects, average in 13% and poor in 7%. Refraction could be reliably assessed in 505/900 (56%) subjects. There was an increased risk of visual impairment in all subgroups compared to the general Dutch population. Visual acuity (VA) was related to the level of ID, but refractive errors were not. New spectacles were prescribed in 106 cases (12%). Of 374 people in whom both monocular VA and the refractive error of the right eye could be reliably assessed, 153 (41%) had a pretest prescription, 16 (10%) of which we found to be inadequate. Of the 221 participants without a pretest prescription, 41 (19%) benefited from correction. Only 38/84 (45%) subjects aged 50 years or older, who could benefit from correction for near vision, had near spectacles. New correction increased the mean distant VA significantly from 0.44 to 0.65 (p < 0.0005). With some adaptations, visual screening is feasible in a majority of adults with ID. Visual impairment and refractive errors are much more prevalent in adults with ID than in the normal population. Accurate spectacle correction resulted in significant improvement in distant VA.

Adult day care: northern perspectives.

This qualitative study explores older adults', caregivers', and nurses' perceptions regarding adult day care (ADC). The study took place in two small towns and one small city in the northern interior region of British Columbia, Canada, with the intent to develop ADC programs that reflect the needs of older persons and their caregivers. The 32 participants contributed their perceptions in focus groups and individual interviews. The interviews, in this descriptive/exploratory study, were audiotaped, transcribed verbatim, and analyzed using inductive, qualitative techniques. The participants acknowledged ADC services as essential to the health and well-being of older adults and their caregivers. The major themes that emerged were need for respite; aging in place; ADC programming; program characteristics; staff knowledge, skills, and attitudes; and northern perspectives. The study participants identified a number of possible reasons for underuse of ADC programming in the north. This study provides information that can facilitate the grounding of ADC policy within the clients' perspectives and a northern context. The participants' thoughts also highlight areas of policy that have broad applicability to the provision of services to the elderly in any setting.

A Case for Community and Hospital-Based Long-Term Care Facilities in Saudi Arabia

A Case for Community and Hospital-Based Long-Term Care Facilities in Saudi Arabia

Montessori Improved Cognitive Domains in Adults with Alzheimer's Disease

Montessori materials were used in two adult day-care centers to slow cognitive decline in adults with Alzheimer's disease. Using a within-subject design, participants in one adult day care received three months of the Montessori materials, then standard intervention later. Participants were administered a battery of cognitive measures at baseline, three months, and six months. Favorable scores for the Montessori condition were significant with the subscales of the Ordinal Scale of Psychological Development-Modified (total, object permanence, means-ends), Dementia Rating Scale (total, attention, concept, memory), Parachek Geriatric Behavior Rating Scale (social behavior), and the Wechsler Memory Scale (digit forward). Montessori materials appeared instrumental in positively influencing basic cognitive abilities of attention, object permanence, and social behavior.

Chapter 1 A Comparison of Four Person-Environment Fit Models Applied to Older Adults

Inthispaper, we comparefour Person-Environment(P-E) Fit models in terms of their ability to predict well-being among older adults. The models tested include: Lawton and Nahemow's (1973) competence model (model 1); Carp and Carp's (1984) congruence model (model 2); and two models based on Kahana's (1982) proposition that subjective prioritizing of multi-level environmental needs is a required element of P-E fit measures. The first priority model (model 3) represents unmet needs in the environmental domain with the highest subjective priority. The weighted priority model (model 4) scales P-E scores according to the prioritization of all environmentaldomains under study. A total sample of 174 seniors dwelling in the Vancouver community were used in this research; divided into a vulnerablesub-sample of Adult Day Care (ADC) clients (n = 115) and a non-frail community sub-sample (n = 59). Lawton's (1997) Valuation of Lifescale (VOL)was used as a measure of well-being. Model 4 was found to predict the largest amount of variance in VOL for the total sample and both sub-samples, after controlling for several covariates. Model 3 was the second best model in predicting VOL for the ADC sample, whereas model 2 wasthe second best predictor of VOL for the non-frail sample. The findings are discussed in terms of their implications for theory development, for explaining research showing that frail and non-frail older persons exhibit similar levels of well-being, and for client-centered service program-ming.

An Interest Inventory of Games for Older Adults

Objectives. The objectives of the study were to (1) develop an interest inventory of games for use with older adults and (2) identify older adults' preferences for specific games.Method. Focus groups identified games popular among older adults, and those games comprised a preliminary interest inventory given to 92 respondents, aged 60-95. Respondents included well-elders living independently, assisted-living residents, adult daycare clients, and nursing home residents. Forty-eight games of interest to at least 5% of respondents comprise the final interest inventory.Results. Eleven games were of interest to at least one-third of all respondents, with dominoes, checkers, and bingo of interest to more than half. Well-elders slightly favored sedentary games to physically active games, while other groups greatly favored sedentary games. Well-elders demonstrated the greatest breadth of interest in games.Conclusion. Games are a purposeful activity that hold high interest for older adults and consequently have significant value as therapeutic tools for occupational therapists.

An Interest Inventory of Games for Older Adults

Objectives. The objectives of the study were to (1) develop an interest inventory of games for use with older adults and (2) identify older adults' preferences for specific games.Method. Focus groups identified games popular among older adults, and those games comprised a preliminary interest inventory given to 92 respondents, aged 60-95. Respondents included well-elders living independently, assisted-living residents, adult daycare clients, and nursing home residents. Forty-eight games of interest to at least 5% of respondents comprise the final interest inventory.Results. Eleven games were of interest to at least one-third of all respondents, with dominoes, checkers, and bingo of interest to more than half. Well-elders slightly favored sedentary games to physically active games, while other groups greatly favored sedentary games. Well-elders demonstrated the greatest breadth of interest in games.Conclusion. Games are a purposeful activity that hold high interest for older adults and consequently have significant value as therapeutic tools for occupational therapists.

Effects of a staff implemented therapeutic group activity for adult day care clients

The growing popularity of therapeutic Adult Day Care (ADC) services for older adults has created a tremendous need for effective activity programming for older adults experiencing cognitive declines. This study evaluated a staff implemented, group activity that is highly structured and supplemented with external cognitive supports-Question Asking Reading (QAR). Four staff members and 17 clients of two adult day care centers participated in the study. Results indicate a significant increase in the rate of Total Verbalizations produced by group members as well as a significant increase in the rate of verbalizations coded as On-Topic Elaborations. This study provides support for the feasibility and practicality of staff implemented therapeutic activities.

The provision of staff development programs in adult day care centers.

Little is known about staff development activities in adult day care (ADC) programs. Therefore, this descriptive study was used to compare existing center programs with research- and practice-derived "model staff development program" for orientation, inservice education, and continuing education opportunities. A multi-step mail survey design was used to study licensed adult day care programs in Virginia (n = 38). The design produced a 92% (n = 35) response rate among eligible respondents. Thirty-seven percent (n = 13) of the responding administrators described staff development activities that met the criteria for a model program. Despite limited financial support, Virginia centers are making an effort to provide comprehensive staff development opportunities for their staff. Centralized or regionalized programming may be two viable solutions for addressing unmet staff training issues for these community-based agencies. Moreover, because their staff tend to be interdisciplinary in nature, educational programming for an interdisciplinary audience will be in order.

ATTITUDES TOWARD INTERGENERATIONAL EXCHANGES AMONG ADMINISTRATORS IN CHILD AND ADULT DAY CARE CENTERS

Previous attitudinal research regarding age has focused solely on adults’ attitudes toward children or, more commonly, societal attitudes toward older adults. This study examines a new area of attitudinal research, factors that affect attitudes toward intergenerational exchanges (events) involving young children and older adults. Child and adult daycare professionals were selected as the study group because their practice settings are increasingly popular, contemporary environments for intergenerational exchanges between these two intergenerational partners. The results of regression analyses demonstrate that administrators’ attitudes are positively affected by contact with existing intergenerational programming and suggest that future administrators’ attitudes may be positively influenced by exposure to intergenerational programs while in graduate and undergraduate programs.

Family Caregiver Perceptions of Benefits and Barriers to the Use of Adult Day Care for Individuals with Alzheimer's Disease

To determine the perceived benefits and barriers to the use of adult day care (ADC) by family caregivers of individuals with Alzheimer's disease (AD), 104 family caregivers (52 users of ADC and 52 nonusers) were interviewed by telephone using a semistructured interview protocol. Comparisons were made between users and nonusers of ADC. Analysis of the qualitative data identified seven categories of barriers to ADC and seven categories of benefits to ADC. Both quantitative and qualitative analyses revealed no significant differences in reported barriers to ADC use by users and nonusers. Both users and nonusers reported barriers; more users overcame the barriers to use the service. Both users and nonusers saw benefits to the caregiver from using ADC; only users saw ADC as primarily benefiting the patient. ADC users also used other respite services more than nonusers.

National survey of hospital-based pharmacokinetic services.

The status of pharmacokinetic services in the nation's hospitals was studied. A questionnaire was mailed in February 1995 to all 252 respondents to ASHP's 1994 national survey of hospital-based pharmaceutical services who indicated the provision of pharmacokinetic services in their institution. Ninety-eight completed questionnaires were returned (40.2% response rate). The pharmacokinetic services provided required an average of 19.1 person-hours per week, tended to be provided by staff pharmacists, were managed by the pharmacy department, tended to be most focused on aminoglycosides and vancomycin, required an average of 60 notes in patient charts per month, and relied on both computers and calculators for deriving values. There was little contact with patients during the consultation process. Drug concentration measurements tended to be scheduled by service providers, but confidence in the accuracy of the timing of dose administration and blood sampling was limited. Respondents believed that the services tended to be supported by other hospital personnel and that they were successful. There was very little expectation that the workload for providing pharmacokinetic services would increase in the near future. A national survey of hospital-based pharmacokinetic services showed that it took 19 hours per week on average to provide the services, that the focus was on aminoglycosides and vancomycin, and that the services were perceived to be supported by other departments.

Finding Satisfaction in Adult Day Care: Analysis of a National Demonstration of Dementia Care and Respite Services

The effects of adult day care (ADC) operational choices on the satisfaction of informal caregivers were examined for 312 pairs of caregivers and care receivers from 10 case study sites that participated in the Robert Wood Johnson Foundation's national demonstration of Dementia Care and Respite Services. Cognitive, behavioral, and affective components of satisfaction were examined. Satisfaction was represented by measures of perceived affordability, length of stay, intensity of use, and caregiver well-being. Multivariate analyses indicated that controlling for other factors, program operational choices about nursing approaches, respite services, and activities programming had direct and interactive effects on satisfaction. The study concluded that dementia status is not a strong predictor of satisfaction with ADC, and the operational choices made by ADC programs can influence consumer outcomes, but no single choice accounts for all aspects of consumer satisfaction.

Agitation among elderly persons at adult day-care centers: the experiences of relatives and staff members.

Two hundred participants (mean age = 80 years) from five senior day-care centers were included in a study of agitation. Staff members at the centers and participants' relatives rated the frequency with which participants displayed agitated behaviors, via an expanded version of the Cohen-Mansfield Agitation Inventory. The most frequent behaviors noted were general restlessness, repetitious sentences, verbal interruptions, and pacing. A three-factor solution for staff members' ratings included (a) physically nonaggressive behaviors, including general restlessness and pacing; (b) verbally agitated behaviors, including complaining and constant requests for attention; and (c) aggressive verbal behaviors, including cursing and temper outbursts. A three-factor solution for relatives' ratings included (a) physically nonaggressive behaviors, including general restlessness and pacing; (b) verbally agitated behaviors, including constant requests for attention and related interruptions; and (c) aggressive behaviors, including cursing, grabbing, kicking, and pushing. The syndromes of both models showed similarity to the factors found in a nursing home population, although differences were also apparent.

Factors Influencing the Utilization of Results: A Case Study of an Evaluation of an Adult Day Care Program

Abstract: With increasing emphasis on outcome research in health care, there is concern about the poor utilization of evaluative research findings at the organizational level. This article examines the factors that influence utilization of results at a local agency and program level. The selected findings of an evaluation of one small adult day-care program will be used as a case study to illustrate the issues associated with these utilization factors. Three broad categories will be addressed in the discussion: structural factors, factors associated with the research process itself, and factors related to the organizational climate of the agency.

Prevalence and Predictors of Burnout Among Adult Day Care Providers

Over the past decade, an extensive research literature has focused on stress, burden, and coping among family caregivers to improve the quality of care to dependent elders. Although a better understanding of the prevalence and predictors of burnout among formal service providers could be expected to produce similar benefits, little is known about stress and burnout among paid caregivers. The purpose of this study was to examine the extent to which paid care providers in adult day care (ADC) experience burnout and to examine the relationship between employees' perceptions of their work environment and burnout. Participants (N = 102) were staff from a random sample of ADC centers in California. Using the Maslach Burnout Inventory, burnout was found to be low for the depersonalization and personal achievement aspects and moderate for emotional exhaustion. Hierarchical regression indicated that after controlling for demographic differences and daily hassles, work environment measures were significant correlates of each of the three aspects of burnout. Findings are discussed in terms of their implications for organizational-level work design issues and macrolevel policy decisions.

Rural/Urban Differences in Adult Day Care

A review of the literature indicated that rural areas tended to be disadvantaged relative to urban areas in community-based health services, but no studies had been done on adult day care (ADC). Using data from a national survey of 822 ADC centers, this study found significant differences between urban and rural ADC centers on 23 of 42 structure, process, and client measures. Rural ADC centers tended to have lower enrollments, with a client population that was significantly less impaired. These findings were further reflected in services and activities provided in rural centers that were less clinical, a finding that is consistent with a less impaired clientele. Rural centers also reported less involvement of the family and community in activities. Rural ADC was clearly different from urban and deserves further study as a distinct entity.

Parallel Service Delivery in Community Long-Term Care

Using data collected in a state-wide study of adult day care (ADC) in Pennsylvania and indices of technicality, routinization and service provision, this study examined the interventive relationship between ADC program staff (n = 59) and participant caregivers, (n = 67). The analysis found the relationship between formal and informal networks to be one of parallel service delivery rather than complementary roles with caregivers providing a wider range of services more frequently than program staff (t = 6.91, p < 601).