Feasibility of predicting functional decline in the elderly through key posture information during sit-to-stand movement

BACKGROUND

Early detection of functional decline in the elderly in day care centres facilitates timely implementation of preventive and treatment measures.

RESEARCH QUESTION

Whether or not a predictive model can be developed by applying image recognition to analyze elderly individuals' posture during the sit-to-stand (STS) manoeuvre.

METHODS

We enrolled sixty-six participants (24 males and 42 females) in an observational study design. To estimate posture key point information, we employed a region-based convolutional neural network model and utilized nine key points and their coordinates to calculate seven eigenvalues (X1-X7) that represented the motion curve features during the STS manoeuvre. One-way analysis of variance was performed to evaluate four STS strategies and four types of compensation strategies for three groups with different capacities (college students, community-dwelling elderly, and day care center elderly). Finally, a machine learning predictive model was established.

RESULTS

Significant differences (p < 0.05) were observed in all eigenvalues except X2 (momentum transfer phase, p = 0.168) between participant groups; significant differences (p < 0.05) were observed in all eigenvalues except X2 (p = 0.219) and X3 (hip-rising phase, p = 0.286) between STS patterns; significant differences (p < 0.05) were observed in all eigenvalues except X2 (p = 0.842) and X3 (p = 0.074) between compensation strategies. The motion curve eigenvalues of the seven posture key points were used to build a machine learning model with 85% accuracy in capacity detection, 70% accuracy in pattern detection, and 85% accuracy in compensation strategy detection.

SIGNIFICANCE

This study preliminarily demonstrates that eigenvalues can be used to detect STS patterns and compensation strategies adopted by individuals with different capacities. Our machine learning model has excellent predictive accuracy and may be used to develop inexpensive and effective systems to help caregivers to continuously monitor STS patterns and compensation strategies of elderly individuals as warning signs of functional decline.

The day program multiple: Noncoherence and ontological politics

Globally, day programs are increasingly proposed in policy as one way to address the support needs of people living at home with dementia and their families. Day programs represent a kind of space that can meet multiple interests and ideologies concerned with sustaining care at home for people living with dementia. In this paper, we draw on findings from an ethnographic study of how day programs work as care in the community for people living with dementia to argue that day programs' ontological status in research as a "simple location" of care contributes to the ambiguous outcomes and limited evidence available for improving their design and delivery. Using one program as an illustrative case, we demonstrate the multiplicity of a day program and the ontological politics through which the potentialities for care emerge. Robert Cooper's proximal analysis of organizing's and Annemarie Mol's work on ontological politics inform this analysis. Of note in this analysis are the different enactments of a day program and their modes of coordination. We show when these enactments hang together well and when they do not and consider the effects of these politics for care. Of particular concern is how some versions of a day program are easily displaced by the interests of administrative versions and managerial logics. We argue for approaches to research and planning that acknowledge the "day program multiple" and precarious nature of care.

A scoping review on the psychosocial interventions used in day care service for people living with dementia

BACKGROUND

Adult Day care centres provide an important aspect of care provision through all phases of the dementia illness from diagnosis to the end of life (Dabelko HI 2008) supporting the well-being of both older people living with dementia and their care partners. Services within adult day care settings are designed to provide biopsychosocial health benefits to participants as well as care partner respite.

OBJECTIVE

To examine research studies, literature reviews and grey literature and identify and map the literature on psychosocial interventions used in day care services for older people living with dementia and chart their use, evaluation and outcomes. The research review question is "what are the psychosocial interventions used in day care service for older people living with dementia?" Psychosocial interventions are important non-pharmacological interventions which support people's wellbeing.

METHODS

Inclusion/Exclusion criteria were identified and guided the search strategy. Participants were people aged 60 years and over living with dementia attending day care services. The use of psychosocial interventions for this cohort was the focus of the review. Databases were searched (Cochrane Reviews, CINAHL, Embase, Medline EBSCO, Medline Ovid, Medline PubMed, PsycINFO, Scopus, Open Grey, Lenus and WHO Global Index Medicus databases) using keywords/terms with Boolean operators from 2011 to 2023. Rayyan was used to extract and manage the data.

RESULTS

The findings present a narrative and charting of the data from the 45 papers that met the review criteria, and this data is mapped onto the five objectives. Within this review, interventions were grouped into five broad types: nature (n = 6 papers), memory/cognitive (n = 11 papers), social (n = 17 papers), animal (n = 4 papers), or physical/sensory (n = 7 papers) based interventions.

CONCLUSIONS

This review has illustrated the wide variety in the types, range and facilitation of psychosocial interventions within adult day care services. This review highlights the potential benefits of these interventions. However, findings must be considered in the context that many were provided as brief intervention studies with little evidence of continuation after the study and further research is required given the complex and diverse range of interventions. Results will be of interest to practitioners planning to implement or evaluate psychosocial interventions used in day care services for older people living with dementia.

Older Adults Who Meditate Regularly Perform Better on Neuropsychological Functioning and Visual Working Memory Tests: A Three-month Waitlist Control Design Study with a Cohort of Seniors in Assisted Living Facilities

Background: Neuropsychological functioning and visual working memory are vulnerable to age-related decline. This investigation examines the impact of meditation on the said outcomes for older adults in assisted living facilities. Older adults (N = 136) from four assisted living facilities in Mumbai and Pretoria were randomized into intervention and waitlist control groups.Method: The Repeatable Battery for Assessment of Neuropsychological Status (RBANS) was used as a screening instrument for recruitment (cutoff total index score = 86 ± 4). RBANS, the Simple Object Span Test (SOST), and the Picture Span Test (PST) were used to assess the outcomes. The intervention group underwent a 90-day meditation training complemented with self-practice.Results: Posttest scores of the intervention group were higher. Older adult men, with college degree, middle class, widowed, in fair health, with no diagnosed psychiatric conditions, who attended at least 70 (out of 90) meditation lessons and who self-practiced at least 70 times, gained more from the meditation intervention. Intervention compliance had the strongest effect on posttest outcomes as well as sex and psychiatric morbidities.Conclusion: Meditation intervention needs some refinements for older adult women, with high school education, upper class, currently married, in poor health, with diagnosed anxiety/depression/drug dependence, who attended fewer meditation lessons and self-practiced infrequently.

Re-thinking the nature of day programs for people with dementia: Implications for research

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.

Assessing mechanisms of benefit in adult day programs: the adult day services process and use measures

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.

The Effect of Adult Day Program Attendance on Emergency Room Registrations, Hospital Admissions, and Days in Hospital: A Propensity-Matching Study

Purpose of the Study

This study is an investigation of the effect of adult day program attendance by home care clients 65 years of age and older on numbers and rates of emergency room registrations, hospital admissions, and days in hospital.

Design and Methods

Each adult day program attendee was matched to a single unique nonattendee (n = 812) on the basis of similar propensity scores which had been estimated from 19 demographic, psychosocial, clinical, and functional covariates. Evaluation of the propensity-matching procedure indicated that balance had been achieved on the covariates.

Results

Subsequent analyses revealed significantly lower mean 100-day rates of emergency room registrations, hospital admissions, and days in hospitals for attendees, compared to matched nonattendees. Although lower rates were largely attributable to longer stays in the home care program for attendees, attendees' mean number of days in hospital was still significantly lower compared to nonattendees.

Implications

Findings replicate and extend results from previous research that reported a decreased reliance on costly health care services by seniors who attend adult day programs.

Feasibility of an electronic participant information system for adult day services: A qualitative study of staff perspectives

Adult day services (ADS) professionals have begun to explore assessment systems focused on participants. Barriers include inadequate technology, software costs, and personnel requirements. We present data from staff interviews at an ADS with an electronic participant information system. Contrary to reports about difficulties learning to use electronic systems, staff found the system manageable and data meaningful. We identify ways that community-based centers can build partnerships and utilize software to integrate assessment and electronic records to improve center performance and participant outcomes. ADS programs should explore how outcome data systems can be used to improve care, promote family caregiver engagement, optimize staff workload, and promote fiscal stability.

Exploring the benefits of respite services to family caregivers: methodological issues and current findings

OBJECTIVES

There is growing emphasis on empirical validation of the efficacy of community-based services for older people and their families, but research on services such as respite care faces methodological challenges that have limited the growth of outcome studies. We identify problems associated with the usual research approaches for studying respite care, with the goal of stimulating use of novel and more appropriate research designs that can lead to improved studies of community-based services.

METHOD

Using the concept of research validity, we evaluate the methodological approaches in the current literature on respite services, including adult day services, in-home respite and overnight respite.

RESULTS

Although randomized control trials (RCTs) are possible in community settings, validity is compromised by practical limitations of randomization and other problems. Quasi-experimental and interrupted time series designs offer comparable validity to RCTs and can be implemented effectively in community settings.

CONCLUSION

An emphasis on RCTs by funders and researchers is not supported by scientific evidence. Alternative designs can lead to development of a valid body of research on community services such as respite.

Community-based dementia day programmes: Common elements and outcome measures

Dementia Day programmes are considered important in supporting the well-being of both people living with dementia and their caregivers. There is, however, limited evidence on the effectiveness of these programmes. This article reports on a study undertaken in New Zealand on the effectiveness of community-based dementia day programmes. The small-scale pilot study was aimed at investigating the elements that make up an effective client-focused dementia day programme and the methods employed by organisations to measure the outcomes of these programmes. A mixed methods approach was employed with multiple stakeholders. The research revealed that effective day programmes comprised five core elements, and that surveys, reporting and auditing processes are routinely used to measure the quality of outcomes of day programmes. Although these findings are reflective of a specific context, it raises concerns about the nature and availability of evidence informing decisions regarding the design and implementation of day programmes internationally.

The process of adult day service use

The objective of this study was to examine why and how families and older adults utilize adult day services. The current study included three months of participant observation in one rural and one suburban adult day service program in an upper-Midwestern region of the United States as well as semi-structured interviews with 14 family members of clients and 12 staff members from these programs. Several key constructs emerged that organized the multiple sources of qualitative data including programmatic philosophy, positioning, and environment of ADS; clients' and family members' reasons for use; the process of ADS use by families and clients; and pathways to family/client psychosocial and client functional outcomes. A number of inter-related themes emerged within each construct. The constructs identified and their potential associations among each other were used to expand upon and refine prior conceptualizations of ADS to frame future clinical and research efforts.

Quality of life among disabled older adults without cognitive impairment and its relation to attendance in day care centres

Day care centres intend to improve the quality of life of disabled older adults. The aims of the paper are to: (a) examine the extent to which users of day care centres experience higher levels of quality of life compared to their peers who are non-users; and (b) to explore the relationships between the length of use and frequency of weekly attendance at day care centres and quality of life. This is a case-control study with a sample of 817 respondents, of whom 417 were users of day care centres and 400 were non-users, matched by age, gender and family physician. The study was conducted in 12 day care centres in the southern region of Israel. Data collection included face-to-face interviews using a structured questionnaire. Quality of life was found to be significantly related to the use of day care centres, but length and frequency of attendance were insignificant in explaining quality of life among users of day care centres. The study demonstrated that users of day care centres have a higher quality of life, but in a cross-sectional study we cannot prove causality. Therefore, more research using quasi-experimental and longitudinal research designs is necessary to assess causality between use and attendance at day care centres on users' quality of life.

Attendance in adult day care centers of cognitively intact older persons: reasons for use and nonuse

The article aims to (a) examine the reasons for nonuse of ADCC, and (b) explore the reasons for use of adult day care centers (ADCCs) among users. The sample includes 819 respondents of whom 417 are users of 13 day care centers and 402 are nonusers, matched by age, gender, and family physician in the southern region of Israel. Data collection includes interviews that used a structured questionnaire. The most frequent reasons for nonuse of ADCCs are accessibility barriers, characteristics of participants and of the ADCCs, "no need for this service," and personal difficulties. Those who use this service report that it improved their well-being, met their needs, enabled them to establish social relationships, and alleviated their family caregivers' burden. ADCCs should be more responsive to the needs of various constituencies of frail older adults and be more accessible to those who do not use this type of service.

Use of adult day care centers: do they offset utilization of health care services?

PURPOSE

Based on the medical offset effect, the goal of the study was to examine the extent to which users and nonusers of adult day care centers (ADCC) differ in frequency of use of out-patient health services (visits to specialists) and in-patient health services (number of hospital admissions, length of hospitalizations, and visits to emergency departments).

DESIGN AND METHODS

A case-control study was used with a sample of 800 respondents, of whom 400 were users of 13 day care centers in the southern region of Israel and 400 were nonusers, matched by age, gender, and active family physician. Data collection included face-to-face interviews using a structured questionnaire. Data on health care service utilization were drawn from the central computerized data of one of the health care organizations in Israel.

RESULTS

Although users of ADCC significantly differed from nonusers in socioeconomic characteristics, they did not significantly differ from nonusers in the magnitude of health care services' utilization. Utilization of health care services was rather connected with morbidity rather than with use of ADCC. Therefore, no offset effect was found.

IMPLICATIONS

The current form of ADCC in Israel focuses mainly on meeting social needs of the participants and therefore do not meet the their actual health needs. Therefore, inclusion of health services within ADCC may have an offset effect, but this necessitates further examination.

Attendance in adult day care centers and its relation to loneliness among frail older adults

BACKGROUND

Loneliness is widespread among older adults, in particular among those who are chronically ill and functionally limited. The aims of the paper are: (i) to examine the extent to which users of day care centers experience loneliness compared to their peers who are non-users; and (ii) to explore the relationships between length of use and frequency of weekly attendance at day care centers and loneliness among users of day care centers.

METHODS

A case-control study was used with a sample of 817 respondents of whom 417 were users of 13 day care centers and 400 were non-users, matched by age, gender, and family physician in the southern region of Israel. Data collection included face-to-face interviews using a structured questionnaire.

RESULTS

The vast majority in both groups (79.3% and 76.3%, respectively) reported moderate to severe levels of loneliness. Perceived economic status and self-rated health were the most significant variables in explaining loneliness. No significant differences were found between users and non-users of day care centers in the level of loneliness. Attendance at day care centers, as well as length and frequency of use, had no significant association with loneliness.

CONCLUSION

More research, which will include quasi-experimental and longitudinal research designs, is necessary to examine the causal relationships between attendance at day care centers and loneliness. This can provide information on the effectiveness of day care centers in reducing loneliness among frail older adults.

A Constellation of Concerns

While adult day services (ADS) continues to grow within the home and community-based services sector, questions remain as to the challenges that the industry faces and anticipates facing in the future. In this study, a national sample of ADS centers ( N = 557) responded to open-ended questions regarding current and future challenges. Qualitative and quantitative analyses revealed that funding was a central concern around which a complex and interconnected constellation of challenges revolved, such as adequate staffing, marketing their services, physical space, and complicated care needs.Given the challenging economic times, these findings suggest that the continued evolution of the ADS industry depends largely on the implementation of changes in policy and funding mechanisms.

Beneficial care approaches in specialized daycare units for persons with dementia

BACKGROUND

Daycare services are seen as a valuable means of helping old people to continue living in their own homes. Relatively little is known about care approaches in daycare units and how they benefit the clients themselves. This work attempts to show the way in which the care approaches in daycare units are constituted.

METHODS

Participant observation that was concluded with individual interviews with the directors of the units.

RESULTS

The findings show that beneficial care approaches in these daycare units establish practices and habits that give a particular structure to the course of everyday life of the patient with dementia, enhance the person's sense of normality, and allow him/her to enjoy being among others, while being appreciated as the person he or she is.

CONCLUSION

Well-organized and knowledgeable daycare service not only provides relief from care for the relatives, but also supports and enriches the lives of the individuals with dementia.

Nurses' perceptions and experiences at daycare for elderly with stroke

PURPOSE

While adult daycare (ADC) is considered a culturally acceptable model of long-term care in countries with a tradition of family-oriented caregiving, Korea is struggling as soaring needs for ADC outpace qualified staff and regulatory systems. This study aimed to describe Korean daycare nurses' perceptions of key daycare services and their working experiences with stroke patients and their families.

DESIGN

A mixed-method design was used. First, we conducted a cross-sectional descriptive survey to assess Korean nurses' perceptions about the importance of daycare services. Then focus group interviews were performed to explore the nurses' experiences at ADC.

METHODS

Seventy of a total of 96 nurses at ADC that specialized in the care of stroke patients responded to the survey (response rate 72.9%) and rated the importance of 11 key daycare service items on a visual analogue scale (0-10). Using a purposive sampling design, 16 eligible nurses were interviewed as a group. The qualitative data from focus group interviews were analyzed using thematic analysis to classify common themes into larger categories.

FINDINGS

Survey data revealed that the nurses perceived "skilled nursing services,""functional recovery," and "general health counseling" as the most important daycare service areas. Focus group data resulted in five themes: "Providing the same, standard care,""Lack of partnership with family caregivers,""Conflict with other staff: ambiguity of the roles and tasks,""Lack of proper education and training," and "Need for quality control and monitoring."

CONCLUSIONS

Daycare nurses fully recognized the importance of direct nursing care services that are keys to adequate recovery and rehabilitation of older patients with stroke. However, they experienced substantial barriers to carrying out these services due to role confusion, insufficient number of qualified nursing staff, and lack of partnership with family caregivers.

CLINICAL RELEVANCE

The results provide insight into changing healthcare policy to support daycare nurses in a country with limited resources and regulations. Strategies such as better quality control and monitoring of daycare services, provision of continuing education, and prioritizing key services should be considered as a way to address challenges experienced by daycare nurses.

In their own words: participants' perceptions of the impact of adult day services

Despite the growth in the number of adult day services programs providing long-term care in the United States, researchers have struggled to consistently identify the benefits of the services to older adult participants. Instead of identifying participant outcomes driven by administrative databases, funding requirements or accreditation expectations, this study attempted to identify outcomes through the lived experiences of the older adult participants through one-on-one interviews after 3 months of attendance. The purpose of this qualitative study was to gain an understanding of the experiences of older adult participants and to build theoretical understandings that connect experiences with outcomes. Twenty-eight semistructured interviews were conducted with older adults attending 4 day health programs administered by 1 organization in a large mid-west City. Three main program experiences were identified: social connections with participants, empowering relationships with staff, and participation and enjoyment of activities and services. These experiences seemed to be associated with perceived improvements in psychosocial well-being and a perceived decrease in burden or dependence on the caregiver. The findings provide theoretical connections that are helpful for exploring the impact of adult day services based on participant perspectives. Results suggest a need for further examination of the role social workers play in supporting psychosocial services within adult day programs.

Adult day health center participation and health-related quality of life

PURPOSE

The purpose of this study was to assess the association between Adult Day Health Center (ADHC) participation and health-related quality of life.

DESIGN AND METHODS

Case-controlled prospective study utilizing the Medical Outcomes Survey Form 36 (SF-36) to compare newly enrolled participants from 16 ADHC programs with comparable community-dwelling older adults who did not attend an ADHC. Assessments were conducted at study enrollment, 6 and 12 months.

RESULTS

ADHC participants (n = 57) and comparison group subjects (n = 67) were similar at baseline in age, ethnic diversity, medical conditions, depression, cognition, immigration history, education, income, and marital status. Significantly more comparison group subjects lived alone (p = .002). One year after enrollment, the SF-36 domains role physical and role emotional improved significantly. Adjusted role physical scores for ADHC participants improved (23 vs. 36) but declined for the comparison group (38 vs. 26, time by group interaction p = .01), and role emotional scores improved for ADHC participants (62 vs.70) but declined for the comparison group (65 vs. 48, time by group interaction p = .02). Secondary analyses revealed that changes in daily physical functioning, depressed affect, or cognitive functioning did not explain the improvements found in role physical and role emotional scores for ADHC participants. No significant differences in trends for the 2 groups occurred for the SF-36 domains physical functioning, social functioning, and mental health.

IMPLICATIONS

ADHC participation may enhance older adults' quality of life. Quality of life may be a key measure to inform care planning, program improvement, and policy development of ADHC.

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.