Exploring the Intersection of Chronic Disease, Function, and Social Care in Adult Day Care Clients With Dementia

The interrelationships among dementia, concomitant disease, and social determinants of health are poorly understood and have critical implications for disease course, treatments, and caregiving needs. The aim of this study was to identify patterns of co-occurring chronic conditions among persons with dementia and the relationship of these patterns with clinical characteristics, demographic predictors and functional status. A latent class analysis (LCA) was conducted using data from 53 California adult day centers (n=3,053). Four distinct groups emerged: “dementia only”; “dementia +: > 2; + > 3; + >5 chronic conditions. Having dementia + >5 was associated (p <.001) with greater risk of falls, isolation, medication mismanagement, and reduced likelihood of using an adaptive device. Dementia in day center clients is complicated by clinical conditions, functional decline, and a need for supports that may be lacking. Center staff must be trained and resourced to manage the complex needs of persons with dementia.

Testing a Preference Tool in Different Care Settings in Germany: Descriptive Results

Background The tool “Preferences for Everyday Living Inventory” (PELI) for Nursing Homes (NH) was developed in the USA. In our project PELI-D, the PELI was translated from English into German and piloted in three care settings: Nursing Home (NH), Home Care (HC) and Adult Day Care (AD). Objective The objective is to provide insights in preferences of importance of older adults in need of care in Germany. Methods Data collection was carried out in 2019 on multiple measurement points: n=48 baseline (T0) and n=41 two-week follow-up (T1). Results The results indicate that the importance of certain preferences distinguishes between the care settings: In NH preferences for body care and aspects of professional care are important. Additionally, in HC the aspects of social contact and eating/drinking are perceived as important. Comparing T0 and T1, importance of the item’s daily routines, social contact and aspects of privacy seem to be reliable.

Variety of Identifying and Assessing Preferences of Everyday Living of Older Adults

Identifying preference of older adults supports person-centred care. The most sophisticated instrument is the preference for everyday living inventory (PELI). The PELI has been translated into German language and tested in different care settings. For people who experience difficulties communicating their preference the PELI has been combined with photographs. The voice of older immigrants could lead to an enhancement of the PELI as well other preference tools. Thus, our symposium title: Variety of identifying and assessing preferences of everyday living of older adults. Our symposium includes four presentations: Dr. Bergmann will present data from a preference study in three different care settings (long-term care, nursing homes, adult day care) in Germany. The results indicate that the importance of certain preferences distinguishes between the care settings. Dr. Vanessa Burshnic will present data from her content validity study of photographs used to supplement the Preferences for Everyday Living Inventory-Nursing Home (PELI-NH) from the perspective of older adults. Content analysis revealed thematic codes describing participants’ photograph preferences including image quality, context, subject diversity, and relevance to long-term care. Mike Rommerskirch-Manietta will present results from a review to identify Instruments which can be used to assess preferences for everyday living of older adults. Interestingly instruments either represent multiple or only one domain. The study from Viktoria Peters-Nehrenheim does focus on preferences of older immigrants. She will present results how older immigrants (first generation) define preferences and how they can be assessed. Prof. Van Haitsma will be our discussant.

Effect of buddy-style intervention on exercise adherence in community-dwelling disabled older adults: A pilot randomized controlled trial

Objective To assess the preliminary effects of a buddy-style intervention to improve exercise adherence. Design A parallel-group, open-label, pilot randomized controlled trial. Setting Adult day-care centers. Participants Sixty-five disabled older adults. Interventions All participants underwent a 12-week home exercise program, and the intervention group received a 5–10 min buddy-style intervention between older adults in the intervention group once weekly at an adult day-care center. Main measures Based on the exercise log calendar, the number of days of exercise was assessed for each of the three phases: 1–4 weeks, 5–8 weeks, and 9–12 weeks. Short physical performance battery was measured at baseline and after 12 weeks. Results Of the 590 screened older adults, 65 were recruited and 33 were assigned to the intervention group. One participant in each group withdrew before the program began, and four and five patients in the intervention and control groups, respectively, dropped out by the 12-week assessment. Analysis of covariance of the 28 and 26 patients in the intervention and control groups, respectively, for whom exercise log calendars could be retrieved, showed that the intervention group (24.4/28 days) exercised significantly more days than the control group (20.6/28 days) at 9–12 weeks ( P = 0.009). In the between-group effect of the intention-to-treat analysis of short physical performance battery, walking and standing test ( P = 0.790, P = 0.829) were not significantly different, and balance test ( P = 0.049) was significantly better in the control group. Conclusions There was a preliminary effect of the buddy-style intervention to improve exercise adherence.

Recognizing Caregiving Fatigue in the Pandemic: Notes on Aging, Burden and Social Isolation in Emilia-Romagna, Italy

In Italy, the COVID-19 pandemic and its associated lockdowns have provoked potentially serious short and long-term consequences for older people with serious health conditions as well as their family caregivers. With the closure of adult day-care centres and the suspension of private homecare services, families have needed to rearrange care activities and many are concerned about the situation of their relatives in residential homes. This article examines interpretations of aging and caregiving fatigue during the first period of national lockdown in Emilia-Romagna, Italy. The relation between old age, lockdown, and social isolation, with respect to global ideas and rhetoric, focuses on vulnerability, individual autonomy, and caregiving fatigue. I examine how the representation of the ‘burden’ of caregiving in late age shaped the media depictions, and I analyze it in relation to the meanings of fatigue attached to narrations from family caregivers and the members of a local Alzheimer’s Café. I also focus on the life story of one family caregiver to critique the idealized vision of family care that was reproduced during the pandemic. I argue that the recognition of aging and caregiving fatigue during the lockdown reflected pre-existing normative models and structural inequalities of family care rather than radically altering them.

Risk of Hospitalization Associated With Different Constellations of Home & Community Based Services

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, enrollment files, enrollee evaluations, and Medicare and Medicaid hospitalization records. This analysis compared risk of inpatient hospitalization across an entire state Medicaid population of community dwelling elderly individuals receiving HCBS. Twelve constellations of HCBS were identified, each composed of different services. Using logistic regression, we derived predicted probabilities of experiencing hospitalization for people in each constellation. This was secondary data analysis conducted outside of a hospital. This study used observational data. There was no randomization.Results:The highest risk of hospitalization, 15.1%, was associated with use of home delivered meals and low levels of PAS. The lowest risk of hospitalization, 7.5% was associated with use of adult day care and low levels of PAS. An 11.6% risk of hospitalization was associated with people who had applied to receive HCBS but were deemed ineligible. This risk was higher than all other constellations of HCBS except for the risk associated with using only low levels of PAS (13.9%) and using low levels of PAS and home delivered meals (15.1%). Conclusions: Using medium and high levels of PAS was associated with lower hospitalization risk compared to only low levels of PAS. Offering a higher initial level of PAS upon enrollment in Medicaid could potentially reduce hospitalization risk. People receiving home delivered meals had an elevated hospitalization risk.

Service Use Objectives among Older Adult Day Care Clients with Disability in Japan

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.