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Bofao J, Bergh M, Zheng A, Sadarangani T. Dementia-Related Disparities in Adult Day Centers: Results of a Bivariate Analysis. J Gerontol Nurs 2024; 50:42-47. [PMID: 38569103 DOI: 10.3928/00989134-20240313-01] [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: 04/05/2024]
Abstract
PURPOSE Adult day services (ADS) are a valuable resource for people living with Alzheimer's disease and Alzheimer's disease and related dementias (AD/ADRD) and serve a large population of late-life immigrants, often with limited English proficiency (LEP). This secondary data analysis examined potential disparities in diagnosis, dementia severity, medical complexity, and dementia-related behavioral problems in persons with AD/ADRD with LEP within the ADS setting. METHOD The current study used data from TurboTAR, the electronic health record for ADS in California. Bivariate analyses were conducted to examine differences in clinical management for those with and without LEP. RESULTS Of 3,053 participants included in the study, 42.3% had LEP. Participants with LEP had higher rates of emergency department use and medication mismanagement. However, due to non-standard data collection, there was a significant amount of missing data on language preference (38.1%) and race/ethnicity (46.5%). Although these findings suggest LEP may play a role in the clinical management of persons with AD/ADRD in ADS, missing data caused by lack of standardized collection compromise the results. CONCLUSION It is essential to improve data collection practices in ADS on language, race, and ethnicity to help identify health disparities and promote equitable care for marginalized older adults. [Journal of Gerontological Nursing, 50(4), 42-47.].
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Cotton QD, Albers E, Ingvalson S, Skalla E, Bailey D, Marx K, Anderson K, Dabelko-Schoeny H, Parker L, Gitlin LN, Gaugler JE. Qualitative Analysis of Implementation Factors of an Embedded Caregiver Support Intervention into Adult Day Services. J Alzheimers Dis 2024; 98:445-463. [PMID: 38461501 DOI: 10.3233/jad-230787] [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] [Indexed: 03/12/2024]
Abstract
Background Adult day services (ADS) are an important and often underutilized support resource for older adults. For persons living with dementia (PLWD), ADS is an optimal access point to not only receive therapeutic and rehabilitative activities, but as a vehicle for respite/relief for dementia caregivers. Yet, there is currently a lack of research on integrating caregiver interventions into home and community-based services such as ADS. Objective This paper reports on qualitative findings from the Improving Outcomes for Family Caregivers of Older Adults with Complex Conditions: The Adult Day Plus (ADS Plus) Program Trial. Methods Drawing from semi-structured interviews conducted with family caregivers and ADS site staff, we conducted a thematic analysis to examine the implementation process of ADS Plus. Results Themes address the relational nature of the intervention, learning, influence of the administrative infrastructure, and receptivity of ADS Plus. Conclusions Our analysis determined that implementation of ADS Plus was feasible and accepted by site staff and dementia caregivers but also calls for additional evaluation of embedded caregiver support interventions across different contexts (e.g., staff size, limited technology environments) to further identify and test implementation mechanisms across settings.
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Affiliation(s)
- Quinton D Cotton
- University of Minnesota School of Public Health, Minneapolis, MN, USA
- Center for Healthy Aging and Innovation at the University of Minnesota, Minneapolis, MN, USA
| | - Elle Albers
- University of Minnesota School of Public Health, Minneapolis, MN, USA
- Center for Healthy Aging and Innovation at the University of Minnesota, Minneapolis, MN, USA
| | - Steph Ingvalson
- University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Emily Skalla
- University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Dionne Bailey
- University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Katie Marx
- Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | - Laura N Gitlin
- Drexel University College of Nursing and Health Professions, Philadelphia, PA, USA
| | - Joseph E Gaugler
- University of Minnesota School of Public Health, Minneapolis, MN, USA
- Center for Healthy Aging and Innovation at the University of Minnesota, Minneapolis, MN, USA
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Sadarangani TR, Gaugler JE, Dabelko-Schoeny H, Marx KA. Adult Day Services, Health Equity for Older Adults With Complex Needs, and the COVID-19 Pandemic. Am J Public Health 2022; 112:1421-1428. [PMID: 36103694 PMCID: PMC9480461 DOI: 10.2105/ajph.2022.306968] [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] [Accepted: 05/31/2022] [Indexed: 11/04/2022]
Abstract
Morbidity and mortality from COVID-19 have unduly affected older adults from racial and ethnic minority groups. In this article, we highlight the experiences and vulnerabilities of diverse older adults with complex health and social needs when their access to vital, but overlooked, community-based adult day service centers (ADSCs) was abruptly cut off during a pandemic. Pandemic-related ADSC closures left vulnerable older adults and their care partners without essential daily support and services, such as health monitoring and socialization. However, the magnitude of the impact of ADSC closures on well-being, particularly among members of racial/ethnic minority groups, has yet to be measured with any form of "big data" because large-scale, nationally representative data sets consisting of participant-level information and outcomes associated with ADSC participation do not yet exist. Unmet needs of older adults resulting from pandemic-related ADSC closures are underrecognized because of a lack of systematic data collection, undermining efforts to achieve health equity. We call on ADSCs to link rigorous collection of racial and ethnic data to quality measures of access to equitable "age-friendly" care as a means of better supporting diverse community-dwelling older adults beyond the COVID-19 pandemic. (Am J Public Health. 2022;112(10):1421-1428. https://doi.org/10.2105/AJPH.2022.306968).
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Affiliation(s)
- Tina R Sadarangani
- Tina R. Sadarangani is with the Rory Meyers College of Nursing, New York University, New York. Joseph E. Gaugler is with the School of Public Health, Division of Health Policy and Management, University of Minnesota, Minneapolis. Holly Dabelko-Schoeny is with the College of Social Work, Age-Friendly Innovation Center, Ohio State University, Columbus. Katherine A. Marx is with the School of Nursing, Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD
| | - Joseph E Gaugler
- Tina R. Sadarangani is with the Rory Meyers College of Nursing, New York University, New York. Joseph E. Gaugler is with the School of Public Health, Division of Health Policy and Management, University of Minnesota, Minneapolis. Holly Dabelko-Schoeny is with the College of Social Work, Age-Friendly Innovation Center, Ohio State University, Columbus. Katherine A. Marx is with the School of Nursing, Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD
| | - Holly Dabelko-Schoeny
- Tina R. Sadarangani is with the Rory Meyers College of Nursing, New York University, New York. Joseph E. Gaugler is with the School of Public Health, Division of Health Policy and Management, University of Minnesota, Minneapolis. Holly Dabelko-Schoeny is with the College of Social Work, Age-Friendly Innovation Center, Ohio State University, Columbus. Katherine A. Marx is with the School of Nursing, Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD
| | - Katherine A Marx
- Tina R. Sadarangani is with the Rory Meyers College of Nursing, New York University, New York. Joseph E. Gaugler is with the School of Public Health, Division of Health Policy and Management, University of Minnesota, Minneapolis. Holly Dabelko-Schoeny is with the College of Social Work, Age-Friendly Innovation Center, Ohio State University, Columbus. Katherine A. Marx is with the School of Nursing, Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD
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Sadarangani T, Anderson K, Westmore MR, Zhong J. Dementia patient and caregiver relevant outcomes currently being reported by adult day service centers in the United States. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12310. [PMID: 35783452 PMCID: PMC9237299 DOI: 10.1002/trc2.12310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/02/2022] [Accepted: 05/02/2022] [Indexed: 11/23/2022]
Abstract
Background Approximately one third of adults in adult day services (ADS) centers have Alzheimer's disease (AD) and AD-related dementias (ADRD). Understanding of the impact and effectiveness of ADS on persons living with dementia (PLWD) is limited by a lack of patient and caregiver relevant outcomes (PCRO) data. We identified PCROs collected at ADS sites in states that mandate serial data collection and examined the degree to which these data align with established Dementia Care Practice Recommendations (DCPR) and PCROs used in other areas of long-term care. Methods We conducted an item analysis of regulatory forms used by ADS. Consistent with the methodology used by the Imbedded Pragmatic AD/ADRD Clinical Trials (IMPACT) Collaboratory for PCROs collected in other long-term care settings, we created a matrix informed by DCPR. We matched each item in regulatory forms reflecting a PCRO to one of the seven DCPR domains as well as to the 53 PCROs from other long-term care sectors. Results Ten states routinely collect outcome data in ADS. Among these, 80% assess cognitive function. All 10 states capture PLWD's ability to complete activities of daily living. Presence and frequency of behavioral symptoms were collected by 80% of states. Very few or, in some cases, none of the 10 states, collected PCROs related to care planning and coordination, education, social support, and/or family caregiver burden and support. Discussion Lack of standardized collection of PCROs hampers researchers' understanding of ADS. The vast majority of PCROs collected center on participants' physical health; conversely, data on socialization, social support, and caregiver well-being, which are purportedly the most impactful services offered by ADS centers, are rarely collected. ADS would be well served to focus on these outcome domains as the resulting data could paint a more complete picture of the holistic impact of ADS on PLWD and their caregivers.
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Affiliation(s)
- Tina Sadarangani
- New York University Rory Meyers College of NursingNew YorkNew YorkUSA
| | - Keith Anderson
- The University of Texas at Arlington School of Social WorkArlingtonTexasUSA
| | | | - Jie Zhong
- New York University Rory Meyers College of NursingNew YorkNew YorkUSA
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Lunt C, Shiels C, Dowrick C, Lloyd-Williams M. Outcomes for older people with long-term conditions attending day care services delivered by paid staff or volunteers: a comparative study. Palliat Care Soc Pract 2021; 15:26323524211030283. [PMID: 34291206 PMCID: PMC8274090 DOI: 10.1177/26323524211030283] [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: 01/06/2021] [Accepted: 06/16/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Day care services support older people living with long-term conditions (LTC’s). Aims: The aims of the study were to determine outcomes in terms of loneliness and health-related quality of life for older people with LTCs attending day care services in the United Kingdom. Methods: Newly referred older people with LTCs to day care services in North West of England and Wales were invited to participate. The EQ-5D-3L and De Jong Loneliness questionnaires were completed at recruitment, 6 and 12 weeks. Results: Ninty-four older people (64% female), age range 65–99 years; mean number of LTCs 4.3 (range: 2–9) were recruited. About 52% lived alone and 36% lived in one of the 20% most deprived local authorities in England and Wales. Outcomes over 12 weeks were comparable for paid, blended, and for volunteer-led services. Conclusion: Following the Covid-19 pandemic, it is increasingly urgent to support older people with LTCs who may have lost physical and cognitive function during lockdown and to support their recovery. Our study suggests that volunteers can provide services and complement the care provided by paid staff, freeing up resources and enabling increasing numbers of older people to be supported.
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Affiliation(s)
- Catherine Lunt
- Academic Palliative and Supportive Care Studies Group and Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Chris Shiels
- Statistician, University of Liverpool, Liverpool, UK
| | - Christopher Dowrick
- Primary Care, Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Mari Lloyd-Williams
- Professor of Palliative Medicine, Academic Palliative and Supportive Care Studies Group and Department of Primary Care and Mental Health, University of Liverpool, Brownlow Hill, Liverpool L69 3GB, UK
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Sadarangani T, Anderson K, Vora P, Missaelides L, Zagorski W. A National Survey of Data Currently being Collected by Adult Day Service Centers Across the United States. J Appl Gerontol 2021; 41:729-735. [PMID: 33985380 DOI: 10.1177/07334648211013974] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
An understanding of adult day service centers' (ADC) impacts on clients' health and well-being has been hampered by a lack of large-scale data. Standardizing data collection is critical to strengthening ADC programs, demonstrating their effectiveness, and enabling them to leverage additional funding streams beyond Medicaid. We distributed an electronic survey on current data collection efforts to ADCs nationally to determine categories of data ADCs are collecting related to clients' health. In our sample (N = 248), only 32% of ADCs collected patient-level data for research and analysis-most commonly on activities of daily living, cognition, nutrition, and caregiver strain. However, validated assessment tools were used in less than 50% of the cases. ADCs are willing to collect data: More than 70% reported a willingness to participate in future studies. National studies piloting data collection protocols with uniform outcome measures are needed to advance the understanding of ADCs' capabilities and impacts.
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Affiliation(s)
| | - Keith Anderson
- University of Texas at Arlington School of Social Work, USA
| | - Paayal Vora
- Northeast Ohio Medical University, Rootstown, USA
| | - Lydia Missaelides
- Alliance for Leadership and Education/California Association of Adult Day Services, Sacramento, USA
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Gaugler JE, Dykes K. Assessing mechanisms of benefit in adult day programs: the adult day services process and use measures. Aging Ment Health 2019; 23:1180-1191. [PMID: 30303402 PMCID: PMC6458102 DOI: 10.1080/13607863.2018.1481931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objectives: A limitation of adult day service (ADS) research is that there remains little understanding of how these community-based long-term care programs operate to benefit clients or family caregivers (i.e. the process of ADS use). The purpose of this study was to validate the 'ADS Process and Use Measures' (APUM) which were developed to assess such mechanisms. Method: Participant observation and semi-structured interviews in two ADS settings resulted in qualitative data to inform a conceptual model, subscales, and Likert-scale items. Three experts in ADS research reviewed the initial 129-item version of the APUM to establish content validity, and 27 family caregivers of current or prior ADS clients provided feedback on face validity of a subsequent 58-item version. Results: Principal components and confirmatory factor analyses on a sample of 269 family members of ADS clients recruited from 90 programs throughout the U.S. established a measure featuring 5 domains, 12 reliable subscales, and 49 items. Analysis of discriminant and convergent validity found that various subscales from four of the domains (Why ADS is Used, Events Prior to Use, Why ADS Does Not Work, and Pathways to Benefits) were significantly associated (p < 0.05) with family caregiver distress and ADS client quality of life variables. Conclusion: The ADS Process and Use Measures effectively assess mechanisms of program benefit and could help to enhance the overall quality of these critical community-based long-term care options for older persons and their families.
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Affiliation(s)
- Joseph E. Gaugler
- Center on Aging, School of Nursing, University of Minnesota, 6-153 Weaver-Densford Hall, 308 Harvard Street S.E., Minneapolis, MN 55455-1331, USA, Phone: 612-626-2485, Fax: 612-625-7180, LinkedIn URL: www.linkedin.com/in/jegaugler,Correspondence regarding this article should be addressed to Joseph E. Gaugler, PhD, Long-Term Care Professor in Nursing, University of Minnesota, 6-153 Weaver-Densford Hall, 308 Harvard Street S.E., Minneapolis, MN 55455-1331, , Phone: 612-626-2485, Fax: 612-625-7180
| | - Kaitlyn Dykes
- Families and LTC Projects, School of Nursing, University of Minnesota and Sidney Kimmel Medical College, Thomas Jefferson University, 701 9th Street NW, Byron MN 55920, USA, , Phone: 507-696-0406, Facebook URL: https://m.facebook.com/profile.php?id=1310216623, LinkedIn URL: https://www.linkedin.com/in/kaitlyn-dykes-5bb82968
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