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Westmore MR, Anderson KA. Adult Day Services for People With Intellectual and Developmental Disabilities: A Scoping Review. FAMILY & COMMUNITY HEALTH 2024; 47:209-218. [PMID: 38713756 DOI: 10.1097/fch.0000000000000406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
BACKGROUND Adult day services (ADS) are therapeutic, social, and health-related activities that keep people in their homes, rather than institutional settings. While there is a growing body of literature on ADS for older adults, there is far less information available about ADS for younger adults with intellectual and/or developmental disabilities (IDDs). METHOD Researchers conducted a scoping review of 6 databases (892 total articles). RESULTS After applying inclusion and exclusion criteria, 74 full articles were reviewed, with 10 articles meeting study requirements. The research team found the literature is limited to simple descriptive reports or interventions that use ADS as a platform. CONCLUSIONS Simply put, we know very little about the services provided to younger adults with IDD in ADS. Implications for future research are discussed, including the need to catalog the services offered in ADS for younger adults with IDD and to evaluate their impact on participant well-being.
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Affiliation(s)
- Megan R Westmore
- Author Affiliations: The School of Social Work University of Texas at Arlington, Arlington, Texas (Ms Westmore); and Department of Social Work, University of Mississippi, Oxford, Mississippi (Dr Anderson)
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Du S, Tan H, Gao H. Multi-dimensional impact of COVID-19 on active mobility in urban China: a scoping review of empirical knowledge. Front Public Health 2024; 12:1398340. [PMID: 38799676 PMCID: PMC11119323 DOI: 10.3389/fpubh.2024.1398340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Active mobility, such as cycling and walking, is assuming a growing significance in the daily lives of urban residents in China due to its positive impact on health and the environment. The impact of the COVID-19 epidemic has elicited significant changes in behaviors, perceptions, and intellectual viewpoints in this domain, potentially altering residents' physical activities in the long-term. This scoping review seeks to delve into the multi-dimensional influence of the epidemic on active mobility in urban China. A thorough investigation of English and Chinese studies up to January 2024 was conducted, drawing from articles in Web of Science and the Chinese National Knowledge Infrastructure. Only empirical studies providing knowledge into this subject were selected in the review, which comprised 20 studies in total. This review indicates that the influence of COVID-19 on active urban mobility in China has exhibited contradictory outcomes in terms of behavior. Besides, the experiences during the epidemic have significantly shaped citizens' attitudes and understanding of active mobility. The repercussions of the epidemic and the ensuing restrictions exacerbate the existing challenges faced by women, particularly those who are married, the older adult, and individuals with low incomes. The results exhibit both resemblances and idiosyncrasies when juxtaposed with prior research conducted in different nations. This analysis also offers valuable insights for improving active mobility across individual, organizational, and socio-political realms. The current state of empirical understanding in this field underscores the need for further research endeavors employing diverse methodological approaches and increased emphasis on the transformations anticipated in the post-epidemic era.
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Affiliation(s)
- Shengchen Du
- Department of Sociology, Tianjin University of Technology, Tianjin, China
| | - Hongze Tan
- Department of Sociology, Nankai University, Tianjin, China
| | - Hua Gao
- Beijing Federation of Trade Unions Cadre College, Beijing, China
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Batista-Malat E, Yan M, Wilber KH, Jacobson M. Exploring Staffing Levels in Adult Day Services: Does Profit Status Matter? J Am Med Dir Assoc 2024; 25:826-829.e1. [PMID: 38253319 DOI: 10.1016/j.jamda.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE For more than 4 decades, adult day service centers (ADSCs) have provided long-term care services and socialization to hundreds of thousands of people in the United States. An important part of the long-term care continuum, ADSCs serve older adults and adults with disabilities, many of whom have low incomes and are racial and ethnic minorities. Yet, little is known about the quality of ADSCs. To better understand ADSC quality, we examined staffing levels, a key aspect of organizational structure. Staffing levels are an established quality measure associated with resident outcomes in nursing homes. Our study compares ADSC staffing levels between for-profit and nonprofit or government-operated ADSCs. DESIGN Cross-sectional secondary data analysis using a nationally representative survey of ADSCs. SETTING AND PARTICIPANTS Adult day service center (n = 573) directors completed a survey as part of the 2018 National Study of Long-Term Care Providers. METHODS Bivariate comparisons and multivariate linear regression were used to compare staffing, measured as hours per participant day in nonprofit and for-profit ADSCs. RESULTS Approximately 60% of ADSCs in the sample were nonprofit or government-operated and the remainder were for-profit. For-profit ADSC staffing averaged 1.5 hours per participant day and nonprofit or government-operated ADSC staffing averaged 1.9 hours per participant day. For-profit ADSCs had 15.8% (P = .047) lower hours per participant day compared with nonprofit ADSCs after controlling for center characteristics, such as Medicaid use, participant acuity, and ADSC size. CONCLUSION AND IMPLICATIONS We found that for-profit ADSCs have lower staffing levels compared with nonprofit and government-operated ADSCs. Future research is needed to understand how staffing levels relates to the quality of care in for-profit and nonprofit ADSCs and how these relationships vary by participant characteristics, such as income, race/ethnicity, and acuity.
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Affiliation(s)
- Eleanor Batista-Malat
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA.
| | - Mengzhao Yan
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Kathleen H Wilber
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Mireille Jacobson
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA; Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
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Monahan Z, Shores D, Mack A, Bray N, Ford A, Hartwell M. Prevalence of depression among caregivers based on the condition and relationship of care recipient. J Affect Disord 2023; 340:442-447. [PMID: 37582463 DOI: 10.1016/j.jad.2023.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Caregiver distress is the strain experienced by individuals providing care for people with chronic conditions which limit their self-sufficiency for tasks of daily living. Over 1 in 5 Americans are caregivers-a number expected to increase with an aging population. METHODS We performed a cross-sectional analysis using the 2021 Behavioral Risk Factor Surveillance System (BRFSS) conducted by the Centers for Disease Control and Prevention (CDC) to determine rates of depressive disorders among caregivers and associations between demographic and relational aspects of the care recipient. RESULTS The included sample size for analysis was 32,676, representing 17,274,935 US caregivers. We found that caregivers who were female, American Indian/Alaskan Native, race-not-listed, earning less than $15,000 a year, or did not complete high school, had higher rates of depression diagnosis. The rates of depression were higher among caregivers if the recipient had a mental or chronic respiratory condition, or if the recipient was their live-in partner. Rates of depression were lower for caregivers of their mother-in-law or spouse. LIMITATIONS Results were based on self-reported survey data, which are susceptible to social desirability bias. Diagnoses of depression may also be over or under reported across several demographic variables, which may confound results. CONCLUSION Our findings add to previous research showing that specific groups of caregivers are at higher risk for caregiver stress. Future qualitative research may elucidate underlying causes of depression among caregivers. Analysis into the risk factors for depression among caregivers is vital in providing effective therapeutic options for the caregiver.
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Affiliation(s)
- Zach Monahan
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, OK, United States of America; Oklahoma State University Center for Health Sciences, Department of Healthcare Administration, Master of Science in Global Health Program, Tulsa, OK, United States of America.
| | - Dyani Shores
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, OK, United States of America
| | - Alyson Mack
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, OK, United States of America
| | - Natasha Bray
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, OK, United States of America
| | - Alicia Ford
- Oklahoma State University Center for Health Sciences, Department of Psychiatry and Behavioral Sciences, Tulsa, OK, United States of America
| | - Micah Hartwell
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, OK, United States of America; Oklahoma State University Center for Health Sciences, Department of Psychiatry and Behavioral Sciences, Tulsa, OK, United States of America
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5
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Williams K, Coleman CK, Maria H, Shaw C, Perkhounkova Y, Beachy T. Promoting Elderspeak Awareness: Adapting Changing Talk Online Communication Education for Adult Day Services Staff. Res Gerontol Nurs 2023; 16:85-94. [PMID: 36944174 PMCID: PMC10037668 DOI: 10.3928/19404921-20230220-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Communication is fundamental for dementia care across long-term services and support (LTSS) settings. Education increasing nursing home (NH) staff awareness of person-centered communication has reduced staff elderspeak communication and reduced resistiveness to care of residents with dementia. The current study tested the Changing Talk Online (CHATO) education with adult day services (ADS) staff to identify strategies for adaptation for other LTSS settings. Three dementia-specific ADS sites participated in the CHATO education program. Participants completed knowledge assessment, communication ratings, and confidence ratings on providing care pre- and post-CHATO; a program evaluation; and rated their intention to use skills in practice. Findings were compared to an earlier study of CHATO in NHs. Focus groups evaluated feasibility, applicability, and directions for tailoring. Mean scores on the Changing Talk Scale knowledge test increased by 15 percentage points (p < 0.001). Confidence in providing dementia care scores also increased (p = 0.037). The mean Modified Diffusion of Innovation scale score was 2.2, similar to that in NHs, indicating intent to use skills; and program evaluation was positive. Focus group participants reported CHATO was valuable and recommended incorporating scenarios specific to ADS care. [Research in Gerontological Nursing, 16(2), 85-94.].
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Affiliation(s)
- Kristine Williams
- University of Kansas Medical Center, School of Nursing, Kansas City, Kansas
| | - Carissa K. Coleman
- University of Kansas Medical Center, School of Nursing, Kansas City, Kansas
| | - Hein Maria
- University of Iowa College of Nursing, Iowa City, Iowa
| | - Clarissa Shaw
- University of Iowa College of Nursing, Iowa City, Iowa
| | | | - Tim Beachy
- University of Iowa College of Public Health, Iowa City, Iowa
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Naruse T, Hatsushi M, Tsuchiya-Ito R, Kobayashi M, Kato J. Experiences of Disabled Older Adults in Urban Area Adult Day Care Centers: A Multisite Case Study. Gerontol Geriatr Med 2023; 9:23337214231156304. [PMID: 36814693 PMCID: PMC9940214 DOI: 10.1177/23337214231156304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/10/2023] [Accepted: 01/21/2023] [Indexed: 02/20/2023] Open
Abstract
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.
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Affiliation(s)
- Takashi Naruse
- Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Japan,Takashi Naruse, Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | | | - Rumiko Tsuchiya-Ito
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
| | | | - Junichi Kato
- Long-Term Care Health Facility, Peace Plaza, Seishinkai Medical Corporation, Tokyo, Japan
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Van Cleve R, Cole E, Degenholtz HB. Risk of hospitalization associated with different constellations of home & community based services. BMC Geriatr 2023; 23:36. [PMID: 36670350 PMCID: PMC9862558 DOI: 10.1186/s12877-022-03676-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/05/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Identify the association between specific combinations of home and community-based services (HCBS) and risk of acute hospitalization. METHODS Data for this study came from Pennsylvania Medicaid claims and Medicare records. This was a retrospective, observational cohort study that examined hospitalization, HCBS service use and patient characteristics between July, 2014 and December, 2016. This analysis compared risk of inpatient hospitalization risk for community dwelling disabled older adults using a range of Medicaid financed HCBS. Twelve constellations of HCBS were identified representing different combinations of common services (personal assistive services [PAS], delivered meals, and adult day care). Since HCBS users are not randomly assigned to different combinations of services, we used logistic regression to estimate the predicted probability of experiencing hospitalization conditional on the constellation of services, and adjusting for demographics, health and level of disability. RESULTS The most common constellation was people who used under four hours of PAS per person per day. This group experienced a hospitalization rate of 13.7%. however, those individuals receiving more than 4 h per person per day experienced only a 10.2% hospitalization rate. Similar trends were seen for people who used PAS in combination with home delivered meals. However, those who used adult day care experienced higher hospitalization rates as the number of hours of personal assistive service increased: increasing from 6.8% among those with under 4 h, to 8.6% among those with 8 or more hours per person per day. CONCLUSION Using medium and high levels of PAS was associated with lower hospitalization risk for people who PAS alone or in combination with delivered meals. By contrast, higher levels of PAS was associated with increased hospitalization for adult day users (both alone or in combination). Policy makers should consider offering higher levels of PAS to offset potential risk of hospitalization. Future research is needed to explain the association between adult day care and risk.
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Affiliation(s)
- Raymond Van Cleve
- grid.280747.e0000 0004 0419 2556Big Data Science Training Enhancement Program Fellow, Center for Innovation to Implementation , VA Palo Alto Health Care System, CA Palo Alto, USA ,grid.168010.e0000000419368956Post Doctoral, Stanford University, CA 94305 California, USA
| | - Evan Cole
- grid.21925.3d0000 0004 1936 9000Department of Health Policy and Management, Medicaid Research Center, University of Pittsburgh, Pittsburgh, USA
| | - Howard B. Degenholtz
- grid.21925.3d0000 0004 1936 9000Department of Health Policy and Management, Medicaid Research Center, University of Pittsburgh, Pittsburgh, USA
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Spetz J, Flatt JD. Alzheimer's Disease Services, Staffing, and Outcomes in Adult Day Health Centers. J Am Med Dir Assoc 2023; 24:645-652. [PMID: 36623809 DOI: 10.1016/j.jamda.2022.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 11/11/2022] [Accepted: 11/24/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Increasing rates of Alzheimer disease and related dementia (ADRD) has resulted in greater reliance on adult day health centers (ADHCs) and their skilled workforce. Little is known about staffing in ADHCs that provide ADRD services compared with ADHCs that do not. This study examines whether there are differences in staffing between ADHCs that offer ADRD services versus those that do not, and whether the percentage of ADHC participants with ADRD is associated with staffing levels. It also examines whether staffing levels and provision of ADRD services are associated with participant outcomes. DESIGN Cross-sectional analysis of secondary survey data. SETTING AND PARTICIPANTS We used facility-level data from the 2014 National Post-acute and Long-term Care Study Adult Day Services Center module. This survey is completed by administrators of ADHCs, who provide information about their ADHC's organization, services, participants, sources of payment, staffing, and participant outcomes. METHODS Bivariate comparisons and multivariate regressions were used to compare scope of services, staffing, and participant outcomes for ADHCs that offered ADRD programs compared with those that did not. RESULTS ADHCs with ADRD programs had similar average daily attendance, less revenue from Medicaid and self-payment, and greater proportions of Black and female participants. ADHCs with ADRD programs had similar staff hours per participant day for all staff categories; licensed nurse staffing increased and social worker staffing decreased with the proportion of participants with ADRD. Staffing had significant associations with participant outcomes. CONCLUSIONS AND IMPLICATIONS ADHCs that have more participants with ADRD have greater staffing of licensed nurses but fewer social workers. Participant outcomes are associated with staffing, but the results suggest that there are unmeasured dimensions of participant risk that confound the relationship.
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Affiliation(s)
- Joanne Spetz
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.
| | - Jason D Flatt
- School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV, USA
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Omeally-Soto S, Zhong J, Boafo J, Wu B, Brody AA, Riffin C, Sadarangani TR. Warning Signs of Acute Infectious Disease-Related Illness in Persons Living With Dementia: Perspectives of Primary Care Providers, Adult Day Service Center Staff, and Family Care Partners. J Psychosoc Nurs Ment Health Serv 2022; 61:35-43. [PMID: 36198122 PMCID: PMC10079777 DOI: 10.3928/02793695-20220929-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
In the current study, we conducted one-on-one interviews with primary care providers (PCPs) and family care partners (FCPs) and held focus groups with interdisciplinary adult day service center (ADSC) staff to understand the perspectives of care providers across community settings regarding early warning signs of acute illnesses in persons living with dementia (PLWD). We used content analysis to analyze qualitative data. Warning signs of acute illnesses in PLWD fell into one of five categories, including new onset changes in (a) physical functions, (b) moods or behaviors (psychological), (c) social interactions, (d) speech, or (e) appearance. FCPs (n = 11) focused on physical changes, whereas ADSC staff (n = 33) emphasized changes in speech and social interactions in addition to the other categories. Although ADSC staff and PCPs (n = 22) focused on changes in functions and moods, each group described these changes differently. ADSC staff possess rich information that can be used to identify acute changes in PLWD and describe a broader range of warning signs compared to PCPs and FCPs. FCPs may benefit from further training in distinguishing between normal disease progression and acute illness. Future research should focus on the implementation of standardized tools across community-based care providers to simplify the identification and reporting of early warning signs in PLWD. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].
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Impact of Daycare Service Interruption during COVID-19 Pandemic on Physical and Mental Functions and Nutrition in Older People with Dementia. Healthcare (Basel) 2022; 10:healthcare10091744. [PMID: 36141355 PMCID: PMC9498727 DOI: 10.3390/healthcare10091744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 11/18/2022] Open
Abstract
This study evaluated changes of cognitive, physical, and nutritional status before and after the interruption and resumption of daycare services during the COVID-19 pandemic in older dementia people in a daycare center. Comprehensive geriatric assessment data were analyzed before and after the lockdown of daycare center services, including mini-mental state examination, activities of daily living (ADL) scores, mini-nutritional assessment-short forms (MNA-SF), and timed up-and-go (TUG) tests. Among 19 dementia people participating in daycare services, 17 participants were enrolled in the study with, finally, two excluded because of incomplete follow-ups. They had a median age of 81 years; their MNA-SF scores and TUG values deteriorated significantly after a 3-month closure of daycare services (p < 0.05), and after resumption of daycare services the MNA-SF scores and TUG values recovered to near the pre-lockdown levels (p < 0.05). Besides, baseline ADL scores predicted a decline and recovery of TUG and MNA-SF values. Our findings suggest that planning continuous support for older dementia adults is important for daycare facilities during COVID-19 pandemic confinement.
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Siette J, Knaggs G, Nguyen AD, Brett L, Jorgensen M, Gow E, Georgiou A. 'I go home with a happy heart'. Enhancing community aged care services to sustain togetherness: Perspectives from Australian staff and clients. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1746-e1755. [PMID: 34633727 DOI: 10.1111/hsc.13602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 08/20/2021] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
Social participation is critical to the health and well-being of older adults, however, participation often declines with age. Research has identified that personal and environmental factors such as high socioeconomic status and accessible transportation are associated with higher levels of social participation. However, the barriers and facilitators to social participation experienced by older adults receiving community aged care services remains largely unexplored. This qualitative study aimed to generate context-rich data and identify the barriers and facilitators to effective community care services that can support older adults' participation in the community and contribute to individual well-being. Semi-structured focus groups were conducted with 40 community aged care clients and 21 staff members between January to July 2018 and thematic analysis was undertaken. Environmental factors, such as availability and accessibility of transportation services emerged as the most important factors influencing participation. Older age, self-attitude towards one's own functional ability and limited social networks were important personal factors affecting participation. Proactive aged care services (e.g., engaged staff, tailored activities) were reported to assist with continual engagement in aged care services. In contrast, the type, location and accessibility of the activity, associated costs and limited options for accessible transportation were key barriers to older adults' social participation. Pathways contributing to positive engagement were complex and variable, but personal well-being and local community resources emerged as important factors encouraging higher social participation. These findings are discussed in the context of the ongoing pandemic and implications for future aged care services are provided.
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Affiliation(s)
- Joyce Siette
- Australian Institute of Health Innovation, Macquarie University, Macquarie, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Macquarie, NSW, Australia
| | - Gilbert Knaggs
- Australian Institute of Health Innovation, Macquarie University, Macquarie, New South Wales, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, Macquarie, NSW, Australia
| | - Amy D Nguyen
- Australian Institute of Health Innovation, Macquarie University, Macquarie, New South Wales, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Lindsey Brett
- Department of Health Professions, Macquarie University, Macquarie, NSW, Australia
| | - Mikaela Jorgensen
- Australian Institute of Health Innovation, Macquarie University, Macquarie, New South Wales, Australia
| | - Edwina Gow
- UnitingCare Australia, Canberra, NSW, Australia
| | - Andrew Georgiou
- Australian Institute of Health Innovation, Macquarie University, Macquarie, New South Wales, Australia
- Centre for Ageing, Cognition and Wellbeing, Macquarie University, Macquarie, NSW, Australia
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Larsson Ranada Å, Österholm J. Promoting Active and Healthy Ageing at Day Centers for Older People. ACTIVITIES, ADAPTATION & AGING 2022. [DOI: 10.1080/01924788.2022.2028050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Åsa Larsson Ranada
- Department of Health, Medicine and Caring Science, Division of Prevention, Rehabilitation and Community Medicine, Unit of Occupational Therapy. Linköping University, Norrköping, Sweden
| | - Johannes Österholm
- Department of Health, Medicine and Caring Science, Division of Prevention, Rehabilitation and Community Medicine, Unit of Occupational Therapy. Linköping University, Norrköping, Sweden
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13
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Li Y, Liu J, Sun F, Xu L. Adult Day Service Use Among Minority Older Adults: Facilitators, Barriers, and Outcomes From an Updated Integrative Literature Review Between 2010 to 2021. J Appl Gerontol 2022; 41:2253-2263. [PMID: 35652698 DOI: 10.1177/07334648221106772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Adult day services (ADS) are one of the more popular long-term care options for racial and ethnic minority older Americans. Focusing on minority older adults, this study aims to (a) identify both the individual and structural/organizational levels factors associated with ADS use and to (b) examine ADS' effect on health and well-being. Using the integrative review approach of Whittemore and Knafl, we found 14 studies published between 2010 to 2021. Findings concluded that individual-level needs and enabling factors were associated with ADS use and outcomes among minority older adults centered mostly on quality of life. Organizational/structural characteristics of ADS were never empirically examined in relation to service use or health outcomes. Future research should move beyond the individual level to identify and address the impact of the institutional structure, culture and practice on access, quality, and use.
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Affiliation(s)
- Yawen Li
- School of Social Work, 14672California State University San Bernardino, San Bernardino, CA, USA
| | - Jinyu Liu
- School of Social Work, 139058Columbia University, New York City, NY, USA
| | - Fei Sun
- School of Social Work, 3078Michigan State University, East Lansing, MI, USA
| | - Ling Xu
- School of Social Work, University of Texas Arlington, Arlington, TX, USA
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14
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Van Cleve R, Degenholtz HB. Patterns of Home and Community Based Service Use by Beneficiaries Enrolled in the Pennsylvania Medicaid Aging Waiver. J Appl Gerontol 2022; 41:1870-1877. [PMID: 35593519 DOI: 10.1177/07334648221094578] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND This study examines multiple services are used across a population and the association between type and amount of services use with level of disability and living arrangement. METHODS This is a descriptive cross-sectional analysis examining HCBS use among older Pennsylvanians from 2014 to 2016 enrolled in Pennsylvania's 1915(c) waiver program. Data were derived from Medicaid claims. Logistic regression and OLS regression were used to examine the association between service use and level of disability, controlling for age, gender, race, and other covariates. RESULTS People with Alzheimer's or a related dementia were more likely to use adult day care. People with higher ADL and IADL limitations were more likely to use higher amounts of PAS and less likely to have delivered meals. CONCLUSIONS These findings demonstrate HCBS is a complex package of services that are allocated regarding the level of need and resources available to individual program participants.
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Affiliation(s)
- Raymond Van Cleve
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA, USA
| | - Howard B Degenholtz
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA, USA
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Naruse T, Hatsushi M, Kato J. Experiences of Disabled Older Adults in Tokyo's Adult Day Care Centers during COVID-19-A Case Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095356. [PMID: 35564750 PMCID: PMC9104431 DOI: 10.3390/ijerph19095356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/11/2022] [Accepted: 04/24/2022] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Takashi Naruse
- Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
- Correspondence:
| | - Masakazu Hatsushi
- Hakononakanohako, General Incorporated Association, Tokyo 140-0001, Japan;
| | - Junichi Kato
- Long-Term Care Health Facility, Peace Plaza, Seishinkai Medical Corporation, Tokyo 183-0021, Japan;
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16
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Yamamoto T, Goda A, Maki Y, Tone A, Kousaka T, Arita K, Ogawa Y, Katsura J, Yanagibashi K. Factors related to suspension of day-care services: an effective program for older users with declined ambulation to reduce care burden. Eur Geriatr Med 2022; 13:951-957. [PMID: 35217981 DOI: 10.1007/s41999-022-00621-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/01/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Day-care services contribute to maintaining the daily living ability of older people cared for at home. This study aimed to detect factors that could impede the continuation of day-care services. METHODS We collected clinical data of 132 older users (age = 82.8 ± 7.5 years; male:female = 49:83) utilizing our day-care center from April 2019 to March 2020. We evaluated age, sex, underlying disease, medication, family background, care level, food texture, physical ability, reasons for frequenting day-care centers, and combined medical/nursing care plans. Participants were divided into two groups: continuation (n = 51) and suspension (n = 81). The collected items were evaluated statistically using the chi-square test, Mann-Whitney test, and unpaired t test. Multivariate logistic analysis (forward-backward stepwise selection method) was added to the statistically significant items. Statistical significance was defined as p < 0.05. RESULTS The comparison test detected statistical significance in Parkinson disease/Parkinsonism, pain complaints, day-service use, short-stay service use, day-care center use to reduce care burden, physical ability including ambulation, and availability of the major caregiver (p < 0.05). Day-care service use to reduce care burden (odds ratio 5.646, p < 0.05), use of short-stay and day-care services (odds ratio 4.798, p < 0.05), and low independent ambulation (odds ratio 0.585, p < 0.05) were the likely factors for suspended use (percentage of correct classification = 68.5%). CONCLUSION An unreplaceable and effective program for day-service and short-stay services to improve the activities of daily living of older users and reduce care burden is required in day-care centers.
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Affiliation(s)
- Tomoe Yamamoto
- Department of Rehabilitation, Hikari Hospital, Shiga, Japan
| | - Akio Goda
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, Japan.
| | - Yoshinori Maki
- Department of Rehabilitation, Hikari Hospital, Shiga, Japan
| | - Akira Tone
- Department of Rehabilitation, Hikari Hospital, Shiga, Japan
| | | | - Kouyou Arita
- Department of Rehabilitation, Hikari Hospital, Shiga, Japan
| | - Youhei Ogawa
- Department of Rehabilitation, Hikari Hospital, Shiga, Japan
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17
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Vervaecke D, Owaisi RB, Meisner BA. Adult Day Program Directors' Experiences Managing the COVID-19 Pandemic. Can J Aging 2021; 40:1-12. [PMID: 34676814 DOI: 10.1017/s0714980821000490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Adult day programs (ADPs) provide community-based supervised recreational services to older adults living with chronic conditions and their caregivers. Most ADPs continued operating during the pandemic, tasking directors with the responsibility of managing the complexities of the coronavirus disease (COVID-19) pandemic. This study explored how ADP directors managed and experienced the COVID-19 pandemic. Semi-structured interviews were conducted with 18 ADP directors from a large health care region in Ontario. Thematic analysis resulted in four themes that detailed how participants: 1) responded to the pandemic with adapted services; 2) navigated the pandemic responses within systems and organizations, and with each other, clients, and caregivers; 3) felt personally during the pandemic; and 4) gained new insights on their clients and the importance of ADPs in the health care system due to the pandemic. Findings highlight pre-existing and emerging gaps and opportunities within ADP service provision for clients and caregivers, as well as service providers and directors.
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Affiliation(s)
- Deanna Vervaecke
- School of Kinesiology & Health Science, York University, Toronto, ON, Canada
| | - Rumia B Owaisi
- School of Global Health, York University, Toronto, ON, Canada
| | - Brad A Meisner
- School of Kinesiology & Health Science, York University, Toronto, ON, Canada
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18
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Unger ES, Grabowski DC, Chen JT, Berkman LF. Association Between New-Onset Medicaid Home Care and Family Caregivers' Health. JAMA HEALTH FORUM 2021; 2:e212671. [PMID: 35977187 PMCID: PMC8796991 DOI: 10.1001/jamahealthforum.2021.2671] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/23/2021] [Indexed: 12/22/2022] Open
Abstract
Importance More than 17 million people in the US provide uncompensated care for adults with physical or cognitive limitations. Such caregiving is associated with worse mental and physical health, yet little research has investigated how publicly funded home care might ameliorate these harms. Objective To investigate the association between Medicaid home care services and family caregivers' health. Design Setting and Participants This longitudinal cohort study used data from the 1996 to 2017 Medical Expenditures Panel Survey. Data on all household members were collected in 5 interviews over 2 years. Person-level difference-in-difference models were used to isolate within-person changes associated with new onset of Medicaid home care. The Medical Expenditures Panel Survey longitudinal data sets included 331 202 individuals (approximately 10% excluded owing to loss to follow-up). Adult (age ≥21 years) members of households that contained at least 1 person with limited activities of daily living were included in our study. The analysis itself was performed from March to August of 2020. Exposures New onset of regular (≥1 time per month) Medicaid home care in the household. Main Outcomes and Measures Self-rated mental and physical health (planned prior to beginning the study). Results The study population was 14 013 adults; 7232 were "likely caregivers," or nondisabled adult coresidents of someone with activities of daily living limitations. Overall, 962 likely caregivers were ever exposed to Medicaid home care in the household; for 563, we observed the onset. Of likely caregivers exposed to Medicaid home care, 479 (50%) were women; 296 (31%) were White non-Hispanic, 309 (31%) were Hispanic or Latinx, and 279 (29%) were Black non-Hispanic individuals, respectively; 326 (34%) had less than a high school education; and 300 (31%) were in or near poverty. Median age of participants was 51 (interquartile range, 39-62) years. New-onset Medicaid home care was associated with a 0.08 standard deviation improvement in likely caregivers' self-rated mental health (95% CI, 0.01-0.14; P = .02) measured 1 to 6 months after onset, equivalent to a 3.39% improvement (95% CI, 0.05%-6.33%) over their average preonset mental health. No association with self-rated physical health was found (<0.001 standard deviations; 95% CI, -0.06 to 0.06; P = .99). Conclusions and Relevance In this cohort study, Medicaid home care was associated with improvement in caregiver self-rated mental health, but not with any short-term change in self-rated physical health. When evaluating the social value of home care programs, policy makers should consider spillover benefits to caregivers.
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Affiliation(s)
- Emily S Unger
- Harvard Medical School, Boston, Massachusetts
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Jarvis T Chen
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Lisa F Berkman
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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19
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Naruse T, Yamamoto-Mitani N. Service Use Objectives among Older Adult Day Care Clients with Disability in Japan. NURSING REPORTS 2021; 11:608-614. [PMID: 34968336 PMCID: PMC8608051 DOI: 10.3390/nursrep11030058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 11/29/2022] Open
Abstract
Quality assurance in long-term care settings requires outcome evaluation reflecting client-specific needs of service use. This study aimed to explore the clients’ needs of adult day care (ADC). Data of 360 clients from 11 ADC agencies in Japan were analyzed. Clients’ needs for ADC use were evaluated by their respective ADC staff using 17 items of four domains: “social participation,” “hygiene and health,” “exercise and eating habits,” and “family support.” The prevalence of four domain needs was calculated and the relationship between physical independency and the presence of needs in the four domains was examined by the chi-squared test. A total of 291 (80.8%) clients had one or more needs while 69 (19.2%) clients had none. The social participation need was most prevalent (270, 75.0%) and 249 clients (69.1%) had combination needs, including social participation, along with another domain. “Feeling like revisiting the ADC” was the most common need (60.6%); it was more frequently needed by those with a higher level of independence (p = 0.003). The study findings suggest that an outcome measure relevant to social participation can be considered as the most common benefits of ADC use. However, ADCs with clients who are more dependent should consider hygiene, nursing, and family support needs.
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Affiliation(s)
- Takashi Naruse
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
- Correspondence:
| | - Noriko Yamamoto-Mitani
- Department of Gerontological Home Care and Long-Term Care Nursing/Palliative Care Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan;
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20
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Lin CF, Wu JJ, Huang YH, Ju LY, Lin SY, Chou YC, Lin CS. Impact of day care services on physical and cognitive functions in old people with dementia in a medical center in central Taiwan. Health Qual Life Outcomes 2021; 19:170. [PMID: 34167529 PMCID: PMC8223263 DOI: 10.1186/s12955-021-01806-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 06/14/2021] [Indexed: 02/26/2023] Open
Abstract
Background Day care service (DCS) provides various activities in a professional environment to meet the old people with functional limitations. However, relatively little is known about the effects of DCS on physical and mental functions. Methods This was a retrospective study that we used a comprehensive geriatric assessment to evaluate the changes before and after DCS among participants in a hospital-affiliated geriatric day care center in Taiwan. The burden of the participants’ families was also assessed. Results The 18 participants with a median age of 80.9 (interquartile range (IQR) 75.2–86.6 y/o) were enrolled and followed up for 6 months. Based on the clinical dementia rating (CDR), disease stage was very mild in 3 participants, mild in 10, moderate in 3, and severe in 2. The activities of daily living (ADL) scores of the participants improved significantly from 75 (IQR 60.0–80.0) at baseline to 77.5 (IQR 65.0–90.0) at the 6 month (p < 0.001), and mini-mental state examination (MMSE) scores from 15 (IQR 11.5–20.0) to 18 (IQR 15.8–24.0) (p = 0.026). There was a positive correlation of baseline mini-nutritional assessment-short form score and the 3-level version of the European Quality of Life-5 dimensions utility index with both ADL and MMSE scores at the 6-month follow-up. In addition, the family burden scale was reduced from 22 to 15 (p = 0.002). Conclusions The physical and cognitive functions in old people with dementia who received DCS were maintained or partially improved, and their families’ stress burden was alleviated.
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Affiliation(s)
- Cheng-Fu Lin
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan, ROC.,Division of Occupational Medicine, Department of Emergency, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Jia-Jyun Wu
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan, ROC.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Yu-Hui Huang
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan, ROC.,Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Li-Ying Ju
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.,School of Nursing, Chung Shan Medical University, Taichung, Taiwan, ROC
| | - Shih-Yi Lin
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan, ROC
| | - Ying-Chyi Chou
- Department of Business Administration, Center for Healing Environment Administration and Research (HEAR), Tunghai University, No. 1727, Sec. 4, Taiwan Boulevard, Xitun District, Taichung, 40704, Taiwan, ROC.
| | - Chu-Sheng Lin
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan, ROC.
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21
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Angel JL, Vega WA, Gutiérrez Robledo LM, López-Ortega M, Andrade FCD, Grasso SM, Rote SM. Optimizing Dementia Care for Mexicans and Mexican-Origin U.S. Residents. THE GERONTOLOGIST 2021; 62:483-492. [PMID: 34160610 DOI: 10.1093/geront/gnab075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Indexed: 11/13/2022] Open
Abstract
In this article, we report on the recommendations of a bi-national conference that examined the institutional capacities and future ability of Mexico and the United States to address the need for affordable and sustainable dementia care that results from growing older adult populations. These recommendations reflect the large difference in resources between the two nations and each country's political and institutional capacity. Progress in both countries will require an expansion of programs or generation of new ones, to meet the needs of older adults, including improving access to services and actively managing the dementia care burden. A comprehensive federal health care safety net will be required in both nations, but economic realities will constrain its implementation. Both nations suffer from a persistent shortage of geriatric primary care physicians and geriatricians, especially in rural areas. Advances in diagnosis, treatment and care management require additional knowledge and skills of general and specialized staff in the healthcare workforce to deliver evidence-based, culturally and linguistically appropriate long-term care, and human rights-oriented services. We conclude with a discussion of recommendations for bi-national dementia care policy and practice.
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Affiliation(s)
- Jacqueline L Angel
- Lyndon B. Johnson School of Public Affairs and The Center on Aging and Population Sciences, The University of Texas at Austin, Austin, Texas, USA
| | - William A Vega
- Stempel School of Public Health and Social Work, Florida International University, University Park, Florida, USA
| | | | | | | | - Stephanie M Grasso
- Department of Speech, Language and Hearing Sciences, The University of Texas at Austin, Austin, Texas, USA
| | - Sunshine M Rote
- Kent School of Social Work, University of Louisville, Louisville, Kentucky, USA
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22
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Keisari S. Expanding the Role Repertoire While Aging: A Drama Therapy Model. Front Psychol 2021; 12:635975. [PMID: 33746854 PMCID: PMC7973357 DOI: 10.3389/fpsyg.2021.635975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/09/2021] [Indexed: 11/13/2022] Open
Abstract
Drama therapy has been found to improve various facets of mental health while aging. It provides opportunities for personal growth and creative expression and enhances group relationships. Drama therapy is a widely acknowledged way to explore the life stories in late life. However, only a handful of studies have empirically explored the value of drama therapy for the aging population. This conceptual analysis was designed to address this need by developing a new integrative model of drama therapy. The analysis is based on the review of the results of four studies that explored the integration of life-review and playback theater as a drama therapy approach for older adults. The therapeutic process focused on the exploration of life-crossroads stories, a short unique technique which enables the participants to craft a harmonious view of their life stories in a short-term dramatic creative group process. Combining the four results yielded a multidimensional model which points to three potential transformative routes: the evolution of the life story, the evolution of improvised dramatic expression, and the expansion of social engagement. The transformative routes are described through the lens of role theory in drama therapy.
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Affiliation(s)
- Shoshi Keisari
- Department of Gerontology, University of Haifa, Haifa, Israel.,Department of Philosophy, Sociology, Education, and Applied Psychology (FISPPA), University of Padua, Padua, Italy
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23
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Bangerter LR, Liu Y, Kim K, Zarit SH. Adult day services and dementia caregivers' daily affect: the role of distress response to behavioral and psychological symptoms of dementia. Aging Ment Health 2021; 25:46-52. [PMID: 31668091 PMCID: PMC7190408 DOI: 10.1080/13607863.2019.1681934] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Adult day services (ADS) provide respite for dementia caregivers and directly reduce exposure to behavioral and psychological symptoms of dementia (BPSD). This study examines the psycho-behavioral mechanism on how daily ADS use may benefit caregivers' daily affect through its impact on the distress associated with BPSD stressor exposure. The sample consists of dementia caregivers (N = 173) who participated in an ADS intervention across 8 days. Multilevel structural equation modeling was conducted to examine the within- and between-person mediating effects of BPSD distress on the direct associations between daily ADS use and daily negative and positive affect. ADS days were associated with lower daily negative affect and higher daily positive affect; the significant within-person effect of ADS use on daily affect was mediated by daily BPSD distress. Findings highlight the association between daily ADS use and caregiver affective well-being. This understanding is important for designing respite and other interventions to help dementia caregivers manage the daily stress of caregiving.
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24
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Chen LY, Hsu TJ, Ke LJ, Tsai HT, Lee WT, Peng LN, Lin MH, Chen LK. Care for older adults with dementia: PACE day care or residential dementia care units? Arch Gerontol Geriatr 2020; 93:104310. [PMID: 33316639 DOI: 10.1016/j.archger.2020.104310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 11/26/2020] [Accepted: 11/26/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Persons with dementia (PwD) are at greater risk for various adverse health outcomes, and the best care model remains to be determined. This study aimed to compare the physical and neurocognitive performance of PwD in the Program of All-inclusive Care for the Elderly (PACE) and residential dementia care units. METHODS This was a case-control study comparing outcomes between care recipients of PACE services (PC group) and residential dementia care (RC group). Demographic characteristics, underlying diseases, physical function, cognitive function, mood status, and behavioral and psychotic symptoms of dementia (BPSDs) were assessed every 3-6 months in both groups, while frailty status and Timed Up-and-Go Test (TUGT) performance were assessed every 6 months in the PC group only. RESULTS Overall, 96 participants (PC group: 25, RC group: 71; mean age: 86.4 ± 6.8 years) were enrolled with the median follow-up period of 43.6 weeks. Lower incidence of hospital admissions was noted in the PC group (0.52 ± 1.12 vs 1.38 ± 2.49 admissions/1,000 person-days, p=0.023), even though the PC group had higher multimorbidity and more severe BPSDs. During the study period, the PC group showed a significant improvement in body mass index, less physical dependence, better cognitive performance and reduced depressive mood. In addition, the PC group showed improvement in frailty, leisure hour activities, and TUGT results. However, participants in the PC group were more likely to experience BPSD deterioration (β coeff.: 0.193, 95% CI: 0.121- 0.265). CONCLUSION The PACE services significantly reduced unexpected hospital admissions of PwD, facilitated the maintenance of physical independence, and improved cognitive performance and mood status. Further randomized controlled studies are needed to determine the most appropriate care model for PwD.
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Affiliation(s)
- Liang-Yu Chen
- Aging and Health Research Center, Taiwan; Institute of Public Health, National Yang-Ming University, No. 155, Sec. 2, Li-Nong St., Taipei 11221, Taiwan; Center for Geriatrics and Gerontology, Taiwan
| | | | - Li-Ju Ke
- uAge Day Care Center, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Rd., Taipei 11217, Taiwan
| | - Hui-Te Tsai
- Center for Geriatrics and Gerontology, Taiwan
| | | | - Li-Ning Peng
- Aging and Health Research Center, Taiwan; Center for Geriatrics and Gerontology, Taiwan
| | - Ming-Hsien Lin
- Aging and Health Research Center, Taiwan; Center for Geriatrics and Gerontology, Taiwan.
| | - Liang-Kung Chen
- Aging and Health Research Center, Taiwan; Center for Geriatrics and Gerontology, Taiwan
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25
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Dharmakulaseelan L, Berall A, Santiago AT, Gardner S, Aleong R, Edelstein B, Karuza J, Blake C, Crawford S, Naglie G. Using Standardized Tools to Characterize Adult Day Program Populations: Implications for Future Research and Clinical Practice. J Am Med Dir Assoc 2020; 22:1096-1100.e1. [PMID: 33082097 DOI: 10.1016/j.jamda.2020.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/17/2020] [Accepted: 08/27/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To demonstrate the usefulness of primary data collection using clinician-rated and self-rated standardized measures to describe adult day program (ADP) populations and address programming issues such as identifying members at risk of dropping out. SETTING AND PARTICIPANTS One ADP in London, Ontario, and 2 ADPs in Toronto, Ontario, Canada. A total of 223 community-dwelling older adults were recruited across the 3 different programs. METHODS The interRAI Community Health or Home Care Assessment and self-rated psychosocial assessments were collected on program enrollment. Data analyses included descriptive statistics, comparison of the populations between ADPs, and multinomial regression models to assess reasons for program withdrawal. RESULTS Mean ages across the 3 programs ranged from 78.3 to 83.8 years and the proportion of women ranged from 49.3% to 56.6%. Compared with one of the ADPs, members from 2 other ADPs exhibited higher use of mobility aids (P < .001), higher levels of cognitive impairment (P < .05), increased risk for institutionalization (P < .001), lower levels of depression (P < .01), and greater need for supervision for basic and instrumental activities of daily living (P < .01). Members assessed to be at higher risk for institutionalization and have increased medical complexity showed possible association with program withdrawal at one ADP. CONCLUSIONS AND IMPLICATIONS The tools were useful in identifying differences in physical and psychosocial characteristics of members across the 3 ADPs. Information collected from interRAI and self-rated psychosocial assessments may be helpful in the development of individualized care plans, program services, and recommendations that target transitional care. By understanding member profiles and reasons for withdrawal, ADPs may be able to develop strategies to help members stay in the program and live in the community longer.
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Affiliation(s)
| | - Anna Berall
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | | | - Sandra Gardner
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rosanne Aleong
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | - Beatrise Edelstein
- Allied Health and Ambulatory Services, Humber River Hospital, Toronto, ON, Canada
| | - Jurgis Karuza
- Department of Psychology, Buffalo State University, Buffalo, NY, USA
| | | | | | - Gary Naglie
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada; Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Medicine, Baycrest Health Sciences, Toronto, ON, Canada.
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26
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Keisari S, Gesser-Edelsburg A, Yaniv D, Palgi Y. Playback theatre in adult day centers: A creative group intervention for community-dwelling older adults. PLoS One 2020; 15:e0239812. [PMID: 33002024 PMCID: PMC7529427 DOI: 10.1371/journal.pone.0239812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/14/2020] [Indexed: 11/19/2022] Open
Abstract
The literature indicates that theatre and drama-based interventions have the potential to improve older adults' well-being and health. The goal of the current study was to characterize the process of a creative group intervention in adult day centers (ADCs), which integrates playback theatre and life-review principles. Our objective was to provide an evidence-informed framework for drama therapy interventions, which would allow older adults to bring up and explore their life-stories in a dramatic creative process in their own community. A total of 27 participants ranging in age from 63 to 91, took part in one of three playback theatre groups. The playback theatre group intervention comprised 12 weekly sessions. All sessions were videotaped to capture the lived experience of the creative process and were analyzed in post-intervention interviews. In addition, focus group meetings were conducted with 13 ADC staff members to decipher further the effects of the participation as perceived by people outside the groups. Three types of potential transformation were identified in the qualitative analysis: the evolution of life stories, evolution of playfulness, and expansion of social engagement. The results indicate the potential of the integrative framework to serve as a creative intervention in ADC communities, as well as its potential to bring about a personal transformation and expand it to enable a person's social engagement in the community. The findings imply the potential benefits of using playback theatre groups to supplement the routine care provided in ADCs.
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Affiliation(s)
- Shoshi Keisari
- Department of Gerontology, University of Haifa, Haifa, Israel
| | - Anat Gesser-Edelsburg
- School of Public Health and The Health and Risk Communication Research Centre, University of Haifa, Haifa, Israel
| | - Dani Yaniv
- School of Creative Arts Therapies, The Emili Sagol Creative Arts Therapies Research Centre, University of Haifa, Haifa, Israel
| | - Yuval Palgi
- Department of Gerontology, University of Haifa, Haifa, Israel
- The Centre for Research and Study of Aging, University of Haifa, Haifa, Israel
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27
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Measurement Development for Japanese Clients' Experiences during Adult Day Care Service Use (The J-AdaCa Tool). Healthcare (Basel) 2020; 8:healthcare8040363. [PMID: 32987870 PMCID: PMC7711524 DOI: 10.3390/healthcare8040363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 11/20/2022] Open
Abstract
Adult day care (ADC) is among the most common services in the Japanese long-term care context, but information on how such care is offered remains scarce. This study aimed to develop a measurement tool to assess the richness of clients’ experiences regarding their ADC service use. Through a collaboration with ADC administrators and staff, semi-structured interviews were conducted with three ADC clients (in one ADC agency), and a questionnaire survey (17 items about clients’ and their families’ experiences within ADC) was applied to 360 ADC clients (in 11 ADC agencies). Principle component analysis showed four factors regarding experience of ADC use: “Social participation”, “Hygiene and health”, “Exercise and eating habits”, and “Family support”. These positive experiences might be effectively provided if stakeholders refer to clients’ needs during ADC experiences, and their effective provision may relate to better care outcomes.
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Mazurek J, Szcześniak D, Trypka E, Lion KM, Wallner R, Rymaszewska J. Needs of Older People Attending Day Care Centres in Poland. Healthcare (Basel) 2020; 8:healthcare8030310. [PMID: 32872520 PMCID: PMC7551148 DOI: 10.3390/healthcare8030310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/19/2020] [Accepted: 08/27/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction: Day care centres (DCC) aim to support older adults living in their own homes by providing a variety of activities to promote the independence of those people and reduce the caregiver’s burden. In Poland, there are no standards for providing this form of care. The provided care is delivered by different organisations, and there is a lack of quality control in the majority of places. Regrettably, in Poland, there is a paucity of research on the holistic needs of the elderly attending DCC. Aim of this study: This is the first study which has aimed to identify the Polish day care centres attendees’ needs to ensure that the increasing number of older people receive the best possible care, and as a part of the quality improvement process for recommendation development of the new day care services model in Poland within the ‘Homely Marina’ project. Methods and Materials: A representative sample (n = 269) was randomly selected from day care centres attendees (estimated as 10,688) in Poland. An anonymous survey for the assessment of needs was developed by the authors. Results: The respondents assessed the level of provided services as very good or good. Best rated services included meals, supportive and welfare services (occupational therapy, music therapy, art therapy, cognitive training). Almost half of the participants indicated the need for company as the main reason to attend a DCC. This research reveals a lack of support with regard to additional staff: e.g., a nurse. Conclusions: In Poland, the services offered in DCC should focus on social isolation and sense of loneliness prevention, and maintenance of social activity of the elderly. The presented analysis of needs in Polish day care centres suggests a need for changes which may improve the quality of services. There is a great need to find a balance between home-based care and in-patient care, using better integration of available services and strengthening support for informal caregivers. Robust research with a collection of meaningful outcomes is required to ensure that in Poland, the increasing number of older people is enabled to access high-quality day care service provision.
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Affiliation(s)
- Justyna Mazurek
- Department and Division of Medical Rehabilitation, Wroclaw Medical University, 50-367 Wroclaw, Poland
- Correspondence:
| | - Dorota Szcześniak
- Department of Psychiatry, Wroclaw Medical University, 50-367 Wroclaw, Poland; (D.S.); (E.T.); (K.M.L.); (R.W.); (J.R.)
| | - Elżbieta Trypka
- Department of Psychiatry, Wroclaw Medical University, 50-367 Wroclaw, Poland; (D.S.); (E.T.); (K.M.L.); (R.W.); (J.R.)
| | - Katarzyna Małgorzata Lion
- Department of Psychiatry, Wroclaw Medical University, 50-367 Wroclaw, Poland; (D.S.); (E.T.); (K.M.L.); (R.W.); (J.R.)
- Menzies Health Institute Queensland, Griffith University, Brisbane 4111, Australia
| | - Renata Wallner
- Department of Psychiatry, Wroclaw Medical University, 50-367 Wroclaw, Poland; (D.S.); (E.T.); (K.M.L.); (R.W.); (J.R.)
| | - Joanna Rymaszewska
- Department of Psychiatry, Wroclaw Medical University, 50-367 Wroclaw, Poland; (D.S.); (E.T.); (K.M.L.); (R.W.); (J.R.)
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Steinbeisser K, Schwarzkopf L, Graessel E, Seidl H. Cost-effectiveness of a non-pharmacological treatment vs. "care as usual" in day care centers for community-dwelling older people with cognitive impairment: results from the German randomized controlled DeTaMAKS-trial. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:825-844. [PMID: 32219623 PMCID: PMC7366591 DOI: 10.1007/s10198-020-01175-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 02/11/2020] [Indexed: 05/06/2023]
Abstract
BACKGROUND Cognitive impairment in older adults causes a high economic and societal burden. This study assesses the cost-effectiveness of the multicomponent, non-pharmacological MAKS treatment vs. "care as usual" in German day care centers (DCCs) for community-dwelling people with mild cognitive impairment (MCI) or mild to moderate dementia over 6 months. METHODS The analysis was conducted from the societal perspective alongside the cluster-randomized controlled, multicenter, prospective DeTaMAKS-trial with waitlist group design. Outcomes were Mini-Mental Status Examination (MMSE) and Erlangen Test of Activities of Daily Living in Persons with Mild Dementia or Mild Cognitive Impairment (ETAM) of 433 individuals in 32 DCCs. Incremental differences in MMSE and ETAM were calculated via a Gaussian-distributed and incremental cost difference via a Gamma-distributed Generalized Linear Model. Cost-effectiveness was assessed via cost-effectiveness planes and cost-effectiveness acceptability curves (CEAC). RESULTS At 6 months, MMSE (adjusted mean difference = 0.92; 95% confidence interval (CI): 0.17 to 1.67; p = 0.02) and ETAM (adjusted mean difference = 1.00; CI: 0.14 to 1.85; p = 0.02) were significantly better in the intervention group. The adjusted cost difference was - €938.50 (CI: - 2733.65 to 763.13; p = 0.31). Given the CEAC, MAKS was cost-effective for 78.0% of MMSE and 77.4% for ETAM without a need for additional costs to payers. CONCLUSIONS MAKS is a cost-effective treatment to stabilize the ability to perform activities of daily living and cognitive abilities of people with MCI or mild to moderate dementia in German DCCs. Thus, MAKS should be implemented in DCCs.
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Affiliation(s)
- Kathrin Steinbeisser
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Larissa Schwarzkopf
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
- IFT Institut für Therapieforschung, Leopoldstr. 175, 80804 Munich, Germany
| | - Elmar Graessel
- Department of Psychiatry and Psychotherapy, Center for Health Service Research in Medicine, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany
| | - Hildegard Seidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
- Quality Management and Gender Medicine, München Klinik gGmbH, München Klinik Schwabing, Kölner Platz 1, 80804 Munich, Germany
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Duan-Porter W, Ullman K, Rosebush C, McKenzie L, Ensrud KE, Ratner E, Greer N, Shippee T, Gaugler JE, Wilt TJ. Interventions to Prevent or Delay Long-Term Nursing Home Placement for Adults with Impairments-a Systematic Review of Reviews. J Gen Intern Med 2020; 35:2118-2129. [PMID: 31898134 PMCID: PMC7352002 DOI: 10.1007/s11606-019-05568-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 11/05/2019] [Accepted: 11/20/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND With continued growth in the older adult population, US federal and state costs for long-term care services are projected to increase. Recent policy changes have shifted funding to home and community-based services (HCBS), but it remains unclear whether HCBS can prevent or delay long-term nursing home placement (NHP). METHODS We searched MEDLINE (OVID), Sociological Abstracts, PsycINFO, CINAHL, and Embase (from inception through September 2018); and Cochrane Database of Systematic Reviews, Joanna Briggs Institute Database, AHRQ Evidence-based Practice Center, and VA Evidence Synthesis Program reports (from inception through November 2018) for English-language systematic reviews. We also sought expert referrals. Eligible reviews addressed HCBS for community-dwelling adults with, or at risk of developing, physical and/or cognitive impairments. Two individuals rated quality (using modified AMSTAR 2) and abstracted review characteristics, including definition of NHP and interventions. From a prioritized subset of the highest-quality and most recent reviews, we abstracted intervention effects and strength of evidence (as reported by review authors). RESULTS Of 47 eligible reviews, most focused on caregiver support (n = 10), respite care and adult day programs (n = 9), case management (n = 8), and preventive home visits (n = 6). Among 20 prioritized reviews, 12 exclusively included randomized controlled trials, while the rest also included observational studies. Prioritized reviews found no overall benefit or inconsistent effects for caregiver support (n = 2), respite care and adult day programs (n = 3), case management (n = 4), and preventive home visits (n = 2). For caregiver support, case management, and preventive home visits, some reviews highlighted that a few studies of higher-intensity models reduced NHP. Reviews on other interventions (n = 9) generally found a lack of evidence examining NHP. DISCUSSION Evidence indicated no benefit or inconsistent effects of HCBS in preventing or delaying NHP. Demonstration of substantial impacts on NHP may require longer-term studies of higher-intensity interventions that can be adapted for a variety of settings. Registration PROSPERO # CRD42018116198.
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Affiliation(s)
- Wei Duan-Porter
- Center for Care Delivery and Outcomes Research, VAHSRD Minneapolis VA Health Care System, Minneapolis, MN, USA.
- University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Kristen Ullman
- Center for Care Delivery and Outcomes Research, VAHSRD Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Christina Rosebush
- Center for Care Delivery and Outcomes Research, VAHSRD Minneapolis VA Health Care System, Minneapolis, MN, USA
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Lauren McKenzie
- Center for Care Delivery and Outcomes Research, VAHSRD Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Kristine E Ensrud
- Center for Care Delivery and Outcomes Research, VAHSRD Minneapolis VA Health Care System, Minneapolis, MN, USA
- University of Minnesota Medical School, Minneapolis, MN, USA
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Edward Ratner
- University of Minnesota Medical School, Minneapolis, MN, USA
- Geriatric Research Education & Clinical Center, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Nancy Greer
- Center for Care Delivery and Outcomes Research, VAHSRD Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Tetyana Shippee
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Joseph E Gaugler
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Timothy J Wilt
- Center for Care Delivery and Outcomes Research, VAHSRD Minneapolis VA Health Care System, Minneapolis, MN, USA
- University of Minnesota Medical School, Minneapolis, MN, USA
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Randomized Controlled Trial of the Caregiver Orientation for Mobilizing Personal Assets and Strengths for Self-Care (COMPASS) for Caregiving Journey: A National Family Caregiver Support Program in a Long-Term Care Insurance System. J Am Med Dir Assoc 2020; 21:1906-1913.e3. [PMID: 32620359 DOI: 10.1016/j.jamda.2020.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/30/2020] [Accepted: 05/06/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To investigate the effects of a national support program on family caregivers for long-term care (LTC) recipients. DESIGN A single-blinded randomized controlled trial compared the 8-week Caregiver Orientation for Mobilizing Personal Assets and Strengths for Self-Care (COMPASS) program consisting of 6 individual in-home, 3 group support, and 2 telephone sessions with a multicomponent intervention, and a control group. SETTING AND PARTICIPANTS In total, 969 caregivers who were living with LTC recipients assessed as having a high caregiving burden in 12 Korean cities. MEASURES The primary outcomes were depression, burden, and stress levels of caregivers, the secondary outcomes were caregiver self-efficacy, positive aspects of caregiving, social support, social activities, and health risk behaviors. These outcomes were measured at baseline and after the 8-week program, analyzed using modified intention-to-treat, per-protocol (PP), and non-PP analyses. RESULTS The modified intention-to-treat analysis revealed significant improvements in burden (effect size, = 0.010, P = .008), depression (ηp2 = 0.012, P = .003), and health risk behaviors (ηp2 = 0.010, P = .012) for the experimental group compared with the control group. However, there were no significant differences between the 2 groups in improving stress (P = .997), social support (P = .234), or social activities (P = .816). The PP analysis indicated that the COMPASS program was successful in increasing positive aspects of caregiving (ηp2 = 0.013, P = .004) and self-efficacy (ηp2 = 0.010, P = .032) compared with the control group. CONCLUSIONS AND IMPLICATIONS The COMPASS program was effective in family caregivers of LTC recipients in critical aspects of physical and psychological outcomes, especially in demonstrating the important role of participating in group support sessions. It is feasible for the program to become a formal national support program as part of the national insurance system in Republic of Korea.
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Orellana K, Manthorpe J, Tinker A. Day centres for older people - attender characteristics, access routes and outcomes of regular attendance: findings of exploratory mixed methods case study research. BMC Geriatr 2020; 20:158. [PMID: 32366223 PMCID: PMC7197165 DOI: 10.1186/s12877-020-01529-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 03/23/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Social prescribing is encouraged to promote well-being, reduce isolation and loneliness. Traditional, generalist day centres for older people could be suggested by social prescribing, but little is known about their clientele or their outcomes. As part of a larger study of the role, outcomes and commissioning of generalist English day centres for older people, the characteristics of attenders at 4 day centres, their reasons for attendance and outcomes were explored. METHODS This mixed-methods study used qualitative interviews and standardised tools within an embedded multiple-case study design. Semi-structured interviews with older day centre attenders (n = 23, 62% of eligible attenders) of 4 day centres in south-east England, recruited purposively to reflect organisational differences, were analysed. RESULTS Participants reported non-elective withdrawal from socialisation following health or mobility decline, or losses. Apart from living arrangements and marital status, attenders' profiles differed between centres. Access had been mostly facilitated by others. Day centre attendance enhanced quality of life for this group of socially isolated people with mobility restrictions and at risk of declining independence and wellbeing. The positive impact on attenders' social participation and involvement and on meaningful occupation was significant (p-value < 0.001, 99% CI), with an average ASCOT gain score of 0.18. Ten outcome themes were identified. CONCLUSION Outcomes of day centre attendance are those targeted by social care and health policy. Centres were communities that 'enabled' and offset loss or isolation, thus supporting ageing in place through wellbeing and contributed something unique to their attenders' lives. By monitoring attenders' health and wellbeing and providing practical support, information and facilitating access to other services, centres offered added value. Attendance needs to be set in the context of other social engagement and care provision which may not overlap or duplicate centre support. Professionals may wish to explore the benefits of social prescriptions to day centres but should map local centres' provision, engage with their organisers, and seek information on attenders, who may differ from those in this study.
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Affiliation(s)
- Katharine Orellana
- NIHR Policy Research Unit on Health and Social Care Research, The Policy Institute, King’s College London, Strand Campus, London, WC2R 2LS UK
| | - Jill Manthorpe
- NIHR Policy Research Unit on Health and Social Care Research, The Policy Institute, King’s College London, Strand Campus, London, WC2R 2LS UK
| | - Anthea Tinker
- Institute of Gerontology, King’s College London, Strand Campus, Strand Campus, London, WC2R 2LS UK
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Naruse T, Kitano A, Matsumoto H, Nagata S. A Logic Model for Evaluation and Planning in an Adult Day Care for Disabled Japanese Old People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062061. [PMID: 32244980 PMCID: PMC7143420 DOI: 10.3390/ijerph17062061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/14/2020] [Accepted: 03/17/2020] [Indexed: 11/16/2022]
Abstract
Adult day care (ADC) provides various services for meeting clients' needs. Based on the mini-Delphi method with 46 ADC staff and the discussions with eight ADC administrators, this study developed and finalized a comprehensive logic model to represent the elements of ADC. For the three basic structures of a logic model-inputs/activities, outputs, and outcomes-the model contained seven core categories and 23 sub-categories. The ADC inputs/activities consisted of two core categories: "Place to stay" and "Intervention from staff". These inputs/activities caused two kinds of outputs: "Clients' experiences" and "Families' experiences". "Accumulating experiences" with repeated ADC visits was established as the link between the ADC outputs and outcomes, which were "Clients' change" and "Families' change". ADC centers provide various experiences for their clients and their caregivers, ranging from the fulfillment of needs for fundamental care to psychiatric care and self-actualization. Improving various model-related inputs/interventions can produce better experiences and outcomes. The model can guide ADC administrators, policymakers, and researchers in the evaluation of a heterogeneous ADC service program that is community-based, thereby ensuring optimal care for clients with an efficient use of resources.
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Affiliation(s)
- Takashi Naruse
- Department of Community Health Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan;
- School of Nursing, Midwifery & Social Work, The University of Queensland, At Lucia, QLD 4072, Australia
- Correspondence:
| | - Ayaka Kitano
- Analytics & Innovation Department, Business Development Division, SMS Co., Ltd., 2-11-1 Shibakouen, Minato-ku, Tokyo 105-0011, Japan;
| | - Hiroshige Matsumoto
- Department of Community Health Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan;
| | - Satoko Nagata
- Faculty of Nursing and Medical Care, Keio University, 4411 Endo, Fujisawa, Kanagawa 252-0883, Japan;
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Marrow J, Roeser A, Gasper J, LaRocca NG, Frankel D. Benefits of Multiple Sclerosis Adult Day Program Participation for People with Multiple Sclerosis: A Qualitative Study. Int J MS Care 2019; 22:201-207. [PMID: 33177955 DOI: 10.7224/1537-2073.2019-019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Multiple sclerosis adult day programs (MSADPs) are nonmedical service programs that provide care and support to people with multiple sclerosis (MS) experiencing levels of impairment that interfere with employment and activities of daily living. The purpose of this study was to identify how program participants think MSADPs benefit them. Methods We conducted in-depth interviews with 95 people with MS who were MSADP participants. Interviews occurred as part of site visits to ten programs across the country. We supplemented participant interviews with interviews of program staff and ethnographic observation of activities at each site over 1 to 3 days. Results Participants reported several benefits from participating in an MSADP. Almost universally, participants explained that receiving and giving social support were the most important benefits. Other positive outcomes described included increased emotional well-being, better understanding and acceptance of MS, practical know-how for accomplishing ordinary tasks, and increased mobility and improved motor functioning. Conclusions Participants believe that MSADPs have a profound influence on their psychosocial health, much of which they attribute to membership in a socially cohesive community. Clinicians and policy makers should consider recommending these programs for people with MS who have unmet psychosocial needs and experience functional impairments.
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Symonds-Brown H, Ceci C, Duggleby W, Purkis ME. Re-thinking the nature of day programs for people with dementia: Implications for research. DEMENTIA 2019; 20:326-347. [PMID: 31696730 DOI: 10.1177/1471301219884429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Day programs are commonly identified in dementia strategies as a solution for keeping people with dementia home for as long as possible. Limited research evidence is available to support these policy approaches, and much of what exists demonstrates equivocal results. While key day program researchers have called for improvements in methodological and theoretical efforts, we argue that basic assumptions concerning what a day program is, and how the effects of day programs should be studied, also require reconsideration. Problematization is a systematic review strategy used to identify and critique assumptions guiding research practices and knowledge development in a field of study. The approach entails a broad overview of a field of research alongside a close reading of key texts to identify prevailing assumptions about the object of study and how it can be known. The intent is to discern how these assumptions are influencing research practices and thus knowledge development. A review of historical texts and research literature reviews was used (1) to identify trends in day program research between 1990 and 2018 and (2) to support identification of influential and typical studies for closer analysis (n = 36). The outcome of our analysis of the research literature suggests three sets of assumptions that guide much of the day program research literature: dementia is mainly treated as a problem of the individual; day programs are treated as stand-alone units of substitute care; and the space of day programs is seen as a simple background to care. We argue that the assumptions regarding care and space have narrowed the field of research and contributed to the production of equivocal findings. We suggest alternative framings of notions of care and space, informed by a Science and Technology Studies' approach to care practices, to generate knowledge about day programs that can usefully inform policy and practice.
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Chiriboga DA, Park NS, Gilbert K, Molinari VA, Barnes M. Cognitive and Functional Status of Persons Newly Enrolled at Dementia-Specific Adult Day Centers and Burden of Their Caregivers. Innov Aging 2019; 3:igz013. [PMID: 31263789 PMCID: PMC6592638 DOI: 10.1093/geroni/igz013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives Recognizing the important role that dementia-specific adult day centers have in maintaining persons with a neurocognitive disorder in their home, this article examines three critical indicators at the time when people first enroll in such a center: cognitive and functional impairment of the enrollee, and burden reported by their family caregivers. We also considered variations in these 3 indicators by race/ethnicity and by the relationship of caregiver to the new enrollee. Research Design and Methods We conducted a secondary analysis of data collected by a nonprofit organization operating 11 dementia-specific adult day centers located on the east coast of Florida. Nursing staff conducted intake interviews with enrollees and their caregivers, and assessed functional status within one month of admission. Instruments included the Zarit Burden Scale and components of the Minimum Data Set: the Brief Interview for Mental Status (BIMS) and 4 measures of functional status. Results On average the cognitive scores of newly enrollees were well-within the range indicated for severe impairment, and these levels did not differ by race/ethnicity. Burden reported by caregivers however differed significantly, with Latinx caregivers reporting the greatest burden and African American/Black caregivers reporting the least. Further, while daughters generally reported higher levels of burden than other family caregivers, Black daughters reported the least. Discussion and Implications Results suggest a need for greater dissemination efforts about adult day programs to the Latinx community, as well as attention to the disparate burden placed upon differing family relationships of caregivers to enrollees.
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Affiliation(s)
- David A Chiriboga
- Department of Child & Family Studies, University of South Florida, Tampa
| | - Nan S Park
- School of Social Work, College of Behavioral and Community Sciences, University of South Florida, Tampa
| | - Karen Gilbert
- Alzheimer's Community Care, West Palm Beach, Florida
| | - Victor A Molinari
- School of Aging Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa
| | - Mary Barnes
- Alzheimer's Community Care, West Palm Beach, Florida
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Ibsen TL, Eriksen S, Patil GG. Farm-based day care in Norway - a complementary service for people with dementia. J Multidiscip Healthc 2018; 11:349-358. [PMID: 30100730 PMCID: PMC6067609 DOI: 10.2147/jmdh.s167135] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Day care services provide meaningful activities and coping experiences in a safe environment for people with dementia, as well as improve quality of life. Such services vary in types and settings. Farm-based day care (FDC) services are described as services that have been adapted from the farm setting, using farm resources to promote health. There is limited knowledge on the service offered in both FDC and regular day care services for people with dementia. The present study aims to investigate FDC in Norway and describe the services and the participants’ care environment. Materials and methods We mapped the existing farms offering day care in Norway by the spring 2017 (N=33) and collected information through two cross-sectional surveys (N=32) answered by the service providers at the farms. Results The farms included in this survey provided day care services to 227 people with dementia, located in most regions of Norway. The services varied in terms of group size and half of the services had young people with dementia (≤65 years) and people with dementia at an early stage as their primary target group. About half of the staff had health care education (47.5%), and there were staff with agricultural competence available in most FDCs. All farms reported that the participants spent time outdoors every day, and all services, except two, had animals. The providers highlighted the opportunity to choose activities that were individually tailored for each participant, as the diversity of resources in the farm made it possible to organize different activities. Conclusion FDC services have similarities in organization, daily structure, and number of health education personnel to other day care services, but differ in type of care environment with a wide range of activities and available resources like farm buildings, gardens, animals, and outdoor areas.
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Affiliation(s)
- Tanja Louise Ibsen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway,
| | - Siren Eriksen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway,
| | - Grete Grindal Patil
- Department of Public Health Science, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway
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