Factors influencing the use of adult day care by individuals with Alzheimer's disease: a multivariate examination of the California Alzheimer's Disease Diagnostic and Treatment Center Program

Influences on the access to and use of formal community care by people with dementia and their informal caregivers: a scoping review

BACKGROUND

The literature describes the obstacles to sufficient care faced by people with dementia and their informal caregivers. Although factors influencing access and utilisation are frequently studied, the body of knowledge lacks an overview of aspects related to influence. The frequently used Behavioural Model of Health Care Use (BM) could be used to structure and explain these aspects. An adaptation of the BM emphasises psychosocial influences and appears to enrich the understanding of the use of long-term care for dementia.

METHODS

We conducted a scoping review with the aim of providing an overview of the aspects influencing the access to and utilisation of formal community care in dementia. Our search covered the PubMed, CINAHL, Social Science Citation Index and PsychInfo databases, as well as grey literature. Two researchers assessed the full texts for eligibility. A data extraction form was developed and tested. We analysed the main topics investigated by the studies and mapped and described the investigated psychosocial aspects according to the BM after narratively summarising the findings. We used the Mixed Method Appraisal Tool (MMAT) to critically appraise the included studies.

RESULTS

A total of 94 studies were included: n = 55 with quantitative designs, 35 with qualitative designs and four with mixed methods. The studies investigated different services, mainly focusing on health care services. One third of the studies provided information regarding the severity of dementia. The most frequently investigated main topics were ethnicity and attitudes towards services. Psychosocial aspects were frequently investigated, although few studies considered the perspectives of people with dementia. Approximately half of the studies reported a theoretical framework. The adapted BM facilitated the structuring and description of psychosocial aspects. However, this instrument did not address topics beyond the scope of psychosocial aspects, such as sociodemographic characteristics.

CONCLUSIONS

The access to and utilisation of formal community care for dementia can only be partly explained by individual influencing aspects. Therefore, a theoretical framework would likely help to describe this complex subject. Our findings indicate that the psychosocial categories of the adapted BM enriched the original BM, and that people with dementia should more often be included in healthcare service research to ensure a better understanding of the barriers to accessing formal community care.

Knowledge, help-seeking and efficacy to find respite services: an exploratory study in help-seeking carers of people with dementia in the context of aged care reforms

BACKGROUND

Research highlights the need for carers of people with dementia to acquire relevant and timely information to assist them to access appropriate respite services. Unfortunately, negative experiences of information-seeking can create additional stress for carers and contribute to delays in up-take, or not using respite services at all.

METHODS

Cross-sectional survey data was collected from a convenience sample of n = 84 carers of older people with dementia living in the Illawarra-Shoalhaven region of NSW, Australia. We assessed knowledge, attitudes, information seeking behaviours, and unmet need for respite services in 2016, following national aged care reforms.

RESULTS

Over the previous 12 months, 86% of carers sought respite service information. The majority (73%) of all carers reported an unmet need for respite services, and were relying on personal networks to provide support for respite information. Few utilised the new government gateway 'My Aged Care' phone line (11%) or website (25%). However, 35% used a pre-existing helpline to access short term or emergency respite. We found a preference for interpersonal information sources, including local doctor (65%), professionally and volunteer led carer support groups (49%), and family and friends (46%). Those using four or more information sources showed higher capacity to name local respite services. Respite service information seekers were more likely to be caring for someone with behavioural problems, to have received assistance to access services, and to have used respite services in the past 3 to 6 months.

CONCLUSIONS

New reforms in the Australian aged care sector have not adequately responded to the needs of carers of people with dementia for respite service information and support. Wider, community-based messaging promoting positive service options and the provision of active personal support is required to address the unmet need for respite in carers of people with dementia.

The unmet support needs of carers of older Australians: prevalence and mental health

ABSTRACTBackground:Population aging places greater demands on the supply of informal carers. The aims of this study were to examine (1) the types of unmet support needs of carers of older Australians and (2) the association of unmet needs with mental health.

METHODS

Utilizing new data from the 2015 Australian Bureau of Statistics (ABS) Survey of Disability, Ageing and Carers, we calculated the prevalence of carers experiencing specific and multiple unmet needs for support, using single and multiple item measures. Logistic regression models were fitted to examine the association between unmet needs and psychological distress (using the Kessler psychological distress scale), once demographic and health factors were controlled for.

RESULTS

In 2015, 35% of carers of older Australians cited at least one unmet need for support. Among this group, almost two-thirds cited multiple unmet support needs (64.7%). The most prevalent types of unmet needs included financial (18%), physical (13%), and emotional support (12%), as well as additional respite care and support to improve carer health (12%). After controlling for demographic and health characteristics of the carer, having any unmet need for support increased the odds of psychological distress by twofold (OR = 2.20, 95% CI = 1.65, 2.94). With each successive unmet need for support, the odds of psychological distress increased 1.37 times (OR = 1.36, 95% CI = 1.22, 1.54). Those who had received assistance with care, but required further support were 1.95 times more likely (OR = 1.95, 95% CI = 1.17, 3.24) to be in distress and those who had not received care assistance were about 2.4 times more likely (OR = 2.38 95% OR = 1.56, 3.62) to be in distress relative to those with no unmet need.

CONCLUSIONS

Addressing unmet support needs of carers is important, not only for the planning of services for carers in an aging population, but also because of the association between unmet support needs and carers mental health.

Correlates of service delivery and social environment in adult day service programs

The objectives of this study were to better describe adult day service (ADS) programs and determine how various structural and case mix characteristics of ADS were empirically associated with the services provided in and the social environments of adult day programs. All directors of ADS programs in Minnesota (United States) were contacted from 2011 to 2012 to complete a detailed online survey that collected information on ADS structure, client case mix, services and activities, and social environment (n = 83; 67.5% response rate). Several structural characteristics and case mix indicators (e.g., number of clients attending) were significantly associated (p < .05) with specific types of ADS service provision, such as health monitoring. Programs that were adequately staffed and perceived as pleasant appeared to also have a more vibrant social environment. The results suggest the potential need for bolstering staffing and enhancing the physical environment of ADS programs.

Risk Factors of High Burden Caregivers of Dementia Patients Institutionalized at Day-Care Centres

We examined which variables are associated with day care centres utilization among caregivers of dementia patients. A cross-sectional analysis of socio-demographic variables, relationship with caring and psychological aspects was conducted in 58 informal caregivers with intense burden. 58.6 % used day care assistance and 41.4 % did not. The results showed the importance of the commitment between the caregiver and their family and friends. The use of day care services is independent of the age, gender, educational level, marital status, occupation and relationship with the patient. However, in the multivariate analysis the provision of help by families and friends predicted the use of day care assistance. The bivariate analysis showed a significant relationship between depressive symptoms and self-rated health with day care attendance. Screening the help provision from families and friends in caregivers of dementia patients with intense burden would be relevant to design interventions which delay their institutionalization and reduce costs.

A review of the factors associated with the non-use of respite services by carers of people with dementia: implications for policy and practice

The use of respite services by carers has been shown to extend the length of time people with dementia can remain living in the community with family support. However, the use of respite services by informal carers of people with dementia is often low and does not appear to match carer need. To better understand how to address carers' unmet need for respite, the factors that impede respite service use must be identified. To achieve this, a narrative synthesis of published academic literature (1990-2011) was undertaken regarding factors associated with not utilising different types of respite services utilising Anderson's Behavioural Model of Service Use. The review reinforces the importance of the assessment and matching of services to the needs of individual carers and care recipients at the local level. It also highlights the need to move beyond care pathways for individuals. To support respite use there is a need for local action to be augmented at a community or population level by strategies to address attitudinal and resource barriers that influence sub-groups of the carer population who may be more vulnerable to service non-use.

Use of adult day care service centers in an ethnically diverse sample of older adults

Our nation is aging and unprepared to meet the needs of community-dwelling seniors and their caregivers. This study explored the perceived need for and use of adult day care services (ADS) in a low-income population. A random sample of 537 patient-caregiver dyads were recruited in home care agencies, and separate in-home surveys were conducted. Patients and caregivers were primarily women and 50.2% were of Hispanic origin. Although half (n = 267/537, 49.7%) of the caregivers had a perceived need for using ADS, only 19.1% of these caregivers used these services, mostly in the context of severe patient cognitive impairment. There were no racial or ethnic differences among ADS users and nonusers. The overall low use of ADS in a growing ethnically diverse senior population with a perceived need for services warrants further investigation and action as states seek to decrease nursing home placement and find solutions for our looming caregiving crisis.

Day care for dementia patients from a family caregiver's point of view: a questionnaire study on expected quality and predictors of utilisation - Part II

Background

The investigation of the predictive variables for utilisation of day care and the views of family caregivers of dementia patients about quality of day care are the goals of this work.

Methods

The cross-sectional study was carried out as an anonymous written survey of family caregivers of dementia patients in Germany. Participants were 404 family caregivers of dementia patients, of these 128 were users of day care, 269 were non-users and 7 gave no details about utilisation. Qualitative and quantitative data were analysed using qualitative content analysis and binary logistic regression analysis.

Results

The assessment of how helpful day care is for the individual care situation and the age of the family caregiver are significant predictors for utilisation of day care. Caregivers most frequently cited a programme of activities suited to the abilities of the dementia patients as quality criterion.

Conclusions

In order to reduce the number of those caregivers who think they don't need day care compared with the number who really don't need it, caregivers should be transparently informed of the relevant advantages and quality principles of using day care. According to caregivers' wishes, the organisation of day care centres must include activities suited for dementia patients.

Determinants of Adult Day Center Attendance Among Older Adults With Functional Limitations

Objective: To examine factors related to regularity of adult day center (ADC) attendance among seniors with functional limitations. Methods: Using data collected as part of a larger study, we identified the proportion of scheduled days attended among 101 ADC users in Montréal and identified determinants of this attendance. Results: More regular attendance was associated with previous profession of ADC participant or spouse in a sector other than health care, receiving formal help for activities of daily living or instrumental activities of daily living on days of expected ADC participation, participating for the whole day rather than half a day, lower participation in prevention and health-promotion activities, and lower caregiver burden among persons with cognitive impairments and higher caregiver burden among persons without cognitive impairments. Discussion: To enhance ADC intervention effects, levels of participation should be maximized. Study findings suggest ways to promote more regular attendance.

[Utilization of day care services by frail seniors]

This study consists of a secondary analysis of data collected during the SIPA demonstration project. Its purpose is to identify the proportion of Adult Day Care (ADC) users as well as the determinants of use in this group of persons 65 years old and over receiving home care services in Montreal. Results show that 18.8% of the sample have at least one ADC presence during a 6 months study period. The following factors increase the probability of ADC use: being younger; not having a university degree; being born outside of Canada or for persons born in Canada, living with a caregiver; receiving help from the CLSC for daily life activities more than once a week; being in the catchment population of an ADC which fees are lower; and for men only, having had a stroke or presenting functional incapacity.

Adult day care: northern perspectives

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