Factors influencing adult day care center utilization among older adults

¶ … Attendance in Adult Day Care Centers of Cognitively Intact Older Persons

Reasons for Use and Nonuse" by Iecovich and Biderman (2012), attempts to determine the factors as to why patients and families don't use centers like these for older adults and to determine the more compelling reasons for their use. Iecovich and Biderman gathered a sample of just over 800 participants, half of which were users, and the other half which were not users of such center, all originating from the same part of Israel. The researchers gathered data via a structured questionnaire given in interview form: this questionnaire revealed that one of the biggest reasons for the non-use of these centers was because of perceived accessibility barriers which were seen to be traits of participants and the centers there, and the view that there was not a need for their service, along with other challenges. Iecovich and Biderman did discover however, that many of the users felt that these centers contributed to a bolstered sense of peace, happiness, and helped their needs be met more profoundly, helping them to build friendships, and relieve the care burden placed on family members.

Ultimately the researchers concluded that the bulk of these centers need to be more open to the act of responding to the needs of these mature members of society, and work hard to be more communicative and attractive to families who would not ordinarily be open to such a service (Iecovich & Biderman, 2012). Basically, one can conclude that these centers have real power and real ability to improve the quality of life for seniors and their families by reducing stress: this is done for the caregivers by the relief in the burden of care, and for seniors by giving them a more enhanced and meaningful quality of life.

Article Two

The article, "Intrinsic and extrinsic barriers to mental health care among community-dwelling younger and older adults" by Pepin and colleagues sought to determine the exact barriers to mental health care which persisted among both younger and older adults. Pepin and associated collected data by using a 56 item self-report measure, known as the Barriers to Mental Health Services Scale (BMHSS). This particular scale was used because of its ability to zero in on 10 of the major obstacles which exist in terms of mental health services -- such as stigma, fear, incorrect beliefs, payment worries and other perceived barriers. The findings of the researchers found strikingly that older adults simply did not have the same concerns about insurance, fear of mental health therapy, and beliefs about issues in finding a good doctor. Interestingly enough, genders also deviated consistently in their answers with men finding stigma a bigger obstacle to overcome and women finding the perceived difficult in finding a mental health care physician a bigger obstacle (2009). Thus, the researchers in this case were able to conclude that stigma simply wasn't as big a barrier as they had thought and thus should not be given the attention that it generally is.

However, the limitations of the study were discussed, as the bulk of the sample included many psychologically happy and well adjusted mature adults which most likely influenced the findings in a significant manner. Another limitation was that the sample of older adults were all taken from those living in an urban setting in the western United States, another factor which no doubt influenced the sample. However, the study ultimately demonstrated that the stress of caring for older adults could be alleviated if they were in the appropriate program for mental health and if the relevant barrier to mental health care was pinpointed and overcome in an appropriate fashion.

Article Three

The study, "Adult day service use and reductions in caregiving hours: effects on stress and psychological well-being for dementia caregivers" by Gaugler and colleagues sought to assess whether the use of adult day care services really had an impact on patients and families in a positive manner. The researchers were trying to see if when older adults engaged in these programs it helped the standard caregivers by relieving their stress and by alleviating the bulk of their caregiver duties. The data was collected over three months with a participant sample number of 400, and findings which all pointed to general success. The study demonstrated that there were marked, "Decreases in memory problem hours among adult day service users were associated with reduced feelings of role overload; decreases in ADL hours among non-users were associated with decreases in worry and strain over a three-month period" (Gaugler et al., 2003). This means that essentially the researchers felt confident in concluding that such services were successful in relieving the burden of care for all parties involved, and offering a certain level of repose to standard caregivers, such as family members.

Given the success of these findings and the promise of adult care centers for mature adults, one can conclude that they have very real stress-reducing powers and quality-of-life enhancing capabilities. However, they're not perect and this was reflected in the limitations of the study: the study took place only within one state in the nation (New Jersey) and this can make it difficult to accurately apply these findings with a greater level of universality. However, the study did occur over a three-month period and had a heightened focus available to it, with a desire to determine the exact psychological impacts on both parties.

Article Five

The article, "Enhancing Quality of Life of Families Who Use Adult Day Services: Short- and Long-Term Effects of the Adult Day Services Plus Program" by Gitlin and colleagues (2006) looked all the consequences, both immediate and eventual of adults day care centers, with the factors of "family caregiver well-being, increase service utilization, and decrease nursing home placement of impaired older adults enrolled in adult day care" (Gitlin et al., 2006). The study was structured so that caregivers from different day centers were recruited which offered different services, providing care and support to family caregivers through different avenues of contact, and offering services from counseling, learning and referrals for one year (Gitlin et al., 2006).

After twelve weeks, the participants exhibited the following: "(n = 106) reported less depression (p =.016), improved confidence managing behaviors (p =.013) and enhanced well-being (p =.001) compared with controls. Long-term effects analyses (n = 69) showed that, compared with controls, ADS Plus participants continued to report less depression (p=.005) and enhanced confidence managing behaviors (p =.007)" (Gitlin et al., 2006). Such participants also harnessed these services on average of 37 days longer than the controls and with less nursing home placements or needed placements (Gitlin et al., 2006). This allowed the researchers to determine that this particular program, ADS Plus is more cost efficient and better to implement within adult centers, offering pivotal clinical and public health benefits (Gitlin et al., 2006). While there wasn't a tremendous amount of discussion regarding the potential of stress reduction and quality of life improvements, these benefits were all there and intensive (Gitlin et al., 2006).

Article Six

The article, "Respite for Dementia Caregivers: The Effects of Adult Day Service Use on Caregiving Hours and Care Demands" by Gaugler and colleagues sought to accurately assess how well adult day care services could actually make a forseeable difference in minimizing the levels of primary caregiving, such as how long the caregivers were able to spend on activities of daily-living and other such issues (2005). "Three-month longitudinal data from the Adult Day Care Collaborative Study (N = 400) were used. Adult day service users reported greater decreases in hours spent on behavior problems when compared to nonusers, even after controlling for baseline differences between the two groups" (Gaugler et al., 2005).

Furthermore, these users found that they had a lower likelihood of behavior issues in the patients that they had checked into the programs (Gaugler et al., 2005). The researchers found that these results strongly suggested the clear capabilities of such services in helping and empowering caregivers to use their time differently: to restructure it fully, offering benefits not only to the family caregivers but to community residing adults who also have issues like dementia (Gaugler et al., 2005). Because this study was so focused on the tangible benefits of adult day care and how those benefits could impact both the caregivers and the mature adults, there was a strong construct of cause and effect, creating greater confidence in all results.

Article Seven

The article, "Adult Day Care for the Frail Elderly Outcomes, Satisfaction, and Cost" by Baumgarten and colleagues (2002), looks at how happy and content actual elderly clients were when they were in adult day care. The article sought to assess goals and satisfaction levels as well among the caregivers of these elderly people along with the exact influences that such care centers had on the financials of the professional health industry at large. Thus, the researchers gathered a sample of just over 100 participants to both the control and experiments group, ultimately finding that both the mature adults and their family caregivers had positive opinions and impressions of these day centers at large. However, what the researchers would readily admit was that they weren't able to gather any data which demonstrated lasting and meaningful impacts on the anxiety, depression or other such status in engaging in day-to-day life (Baumgarten et al., 2002).

In fact, there was no data which pointed to a relief of caregiver burden or a relief on the fiscal demands of health care services (Baumgarten et al., 2002). This led the researchers to acknowledge that while such programs did have clear positivie benefits as relayed by all who were virtually involved in the study, these benefits didn't manifest in such a tangible manner. Of course, this doesn't indicate that there weren't tangible benefits, just that they may have been more elusive. "In future studies, maintenance of high levels of participation should be incorporated as an explicit program goal" (Baumgarten et al., 2002).