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.

Inequity in Health Among People Living With Alzheimer's Disease and Related Dementias in Adult Day Centers

In adult day centers (ADCs), 58% of clients identify as racial/ethnic minorities, and at least 30% have Alzheimer’s Disease and related dementias (ADRD). ADCs offer culturally and linguistically congruent care to clients, making them well-positioned to address potential health disparities affecting persons with ADRD. We used data from 53 California ADCs (n=3,053) to identify differences in clinical characteristics among ADC clients’ with ADRD based on demographics such as race and English proficiency. We found that, when compared to their respective counterparts, a significantly greater proportion of racial/ethnic minorities and non-English speakers (p<.001) had 5 or more chronic conditions in addition to ADRD. We noted considerable missing data on race, likely because ADCs in California are not mandated to report data on race/ethnicity. In order to identify inequities in care within this complex population, social determinants of health, including race, must be a standard component of client assessment.

Impact of iN2L Tablets on Loneliness and Well-Being: Findings of an Innovative Industry-AAA Program

Area Agency on Aging (AAA) senior and adult day centers closed due to COVID-19, causing many older adults to lose an important source of connection and engagement, leading to social isolation. To combat negative consequences, iN2L and a Florida AAA partnered on an innovative program providing iN2L tablets to AAA-supported older adults to use at home. The tablets have a simple interface, content specifically designed for older adults (e.g., games; music; movies), and video call capability. Participants included 51 independent older adults (mean age 77) and 39 family caregivers (mean age 59) of people with dementia. Participants completed phone surveys with AAA case managers at baseline and 3 months, including UCLA Loneliness Scale (3 item) and questions about their tablet experiences. Findings show positive trends for loneliness and well-being in both groups. At 3 months, lonely participants decreased from baseline by 25% for independent older adults and 18% for family caregivers. Over 80% of independent older adults agreed the tablet engages them in meaningful activities, provides daily enjoyment, and helps with relaxation. For family caregivers, 79% agreed the tablet is another tool in their caregiver toolkit and about 70% agreed the tablet adds daily enjoyment, helps with relaxation, and provides engagement in meaningful activities for their family member. Approximately 50% of caregivers felt happier, less stressed, and less irritable since using the tablets. This work has implications for the utility of technology in promoting engagement and connection, alleviating negative effects of social isolation, and the effectiveness of industry-AAA partnerships.

Inequities in Palliative and Dementia Care and Health in Long-Term Supportive Services Settings

Most older adults with serious illness, including Alzheimer’s Disease and Related Dementias (ADRD) reside in community-based settings. These individuals and their care partners rely on Long Term Supportive Services (LTSS) including nursing home, home health, hospice, and adult day centers to provide support. LTSS are often under-resourced and reimbursed however, with significant regulatory restrictions on the care they can provide. These issues combined with other systemic factors in our healthcare system and society, including racism and poverty, lead to substantial inequities. Even preceding the use of LTSS, ADRD is diagnosed later in non-white individuals and access to high-quality services, including palliative care is severely limited. Moreover, few palliative care interventions address ADRD and even fewer have been specifically tailored to address the needs of our multi-cultural, racially and ethnically diverse society. This symposium will therefore utilize data from several nationwide data sets collected as part of routine care for clinical, billing, and/or regulatory purposes to assess inequities that exist across LTSS sites related to ADRD and palliative care. The individual abstracts show a clear pattern of inequities that stem from endemic systems failures towards people of color in the United States that must be addressed through a multipronged approach. This research shows that policies must be changed to require adequate collection of social determinants of health, to target policies that allow sub-standard or limited access to care, and research and clinical reform to produce a more culturally sensitive approach to care for those with ADRD and other serious illnesses.

Home and Community Based Service Use Among Veterans With Dementia Living in Rural Virginia

Despite the overall expansion of rural Veteran health care facilities, older Veterans in these areas are still underserved and face challenges and barriers to access services. Using data from 60 family caregivers of persons with dementia (PwD; Mean Age = 67 years, Range = 39-84; 92% White; 71% Spouse) we examined the types of home-based and community services they utilized. We also examined reasons that family caregivers provided for not using these services. Next, we applied Andersen's Behavioral Model of Health Services to examine how predisposing factors such as demographics, available resources, and PwD’s needs were associated with the use of services. We found that Veterans living in rural counties had lower access to caregiver support groups, homemaker services, adult day centers, and home-based respite services. The top three reasons for not using services were that the family caregiver chose to do it themselves, the PwD did not want the service or the service provider to help, or it was too far from the caregiver’s home. Regression analysis further showed that caregivers caring for PwDs with greater ADL challenges and memory and behavior problems were more likely to need and utilize paid services. Disparities based on gender, age, and race were also explored. Findings suggest the need to develop effective service promotion strategies and destigmatizing the use of paid services among Veteran families to reduce health disparities in rural regions.

Unpacking Data From Adult Day Centers in Order to Realize Their Untapped Potential in Dementia Care

Adult day centers (ADCs) in the United States represent a vital, but commonly overlooked, resource for dementia care among community-dwelling older adults. However, the severity of dementia in ADC users, their medical complexity, the supports offered to them, and health outcomes associated with adult day services among persons living with dementia is poorly understood. This is in part due to a lack of standardized data collection in this industry. In this symposium, we present the most current research on these issues, as well as strategies to improve data collection across ADCs to strengthen care. The symposium begins with analysis of data from the state of California that identifies patterns of chronic conditions in ADC users with dementia that are associated with emergency department visits and hospitalizations. We then examine data from the Centers for Disease Control, comparing dementia specialized ADCs and their participants to non-specializing ADCs. We compare the extent to which states with ADC programs require collection of patient centered reported outcomes on persons with dementia. Finally, we explore an innovative collaboration between researchers and community partners to simplify data collection in these centers. Our findings suggest that persons with dementia in ADCs are an extremely complex population and that some ADCs are better suited than others to meet their extensive needs. Additional patient-centered data collection can be supported with widely available software, and has the potential to demonstrate the effectiveness of ADCs, aid in program development, and help leverage funding opportunities.

Evidence for the Need to Standardize Data Collection on Patient Outcomes Across Adult Day Centers in the United States

Researchers’ ability to measure the impact of adult day centers (ADCs) on participants’ health has been hampered by a lack of large-scale data. We examined categories of data ADCs across the United States are collecting related to patients’ health and health outcomes with the idea of developing a future national cohort of centers. We distributed an electronic survey to ADCs in 50-states on current data collection efforts. Forty states were represented (N=250). Only 32% of ADCs collect patient level data for research and analysis. Vital signs, nutritional risk, falls, and activities of daily living data were most commonly collected. However, validated assessment tools were used in less than 50% of cases. Researchers’ ability to pool data on clinical outcomes among ADC users is limited by lack of data collection and use of uniform outcome measures across ADCs. Standardizing data collection is critical to strengthening ADC programs and demonstrating their effectiveness.

Services That Matter for Aging in Place: Research on the Impact and Promise of Adult Day Centers

Adult day service centers (ADCs) in the United States are increasingly recognized as an important source of community-based long-term care for older adults. However, awareness, widespread utilization, reimbursements, and access to ADCs have been limited by a lack of evidence on ADCs’ impact. In this interdisciplinary symposium, we explore current research taking place in the realm of adult day services to understand the reach and impact of ADCs. We begin by examining the most current center-level and user-level data from the National Center for Health Statistics, and demonstrate how these data can be used to inform research and policy. We subsequently evaluate survey data from the National Adult Day Services Association that captures clinical data being collected in ADCs (N=250) surrounding users’ clinical outcomes. We then explore the effectiveness of four interventions on ADC users’ health and functional status: board games, cognitive behavioral therapy, aromatherapy and dance. Finally, we examine the association between adult day services use by African American persons with dementia and depressive symptoms in their caregivers. Our findings suggest that ADCs serve a complex population with high rates of poverty and chronic conditions, but ADCs can have a meaningful impact on users’ health and well-being by leveraging innovative programming. We conclude by discussing how standardization of data collection efforts could enable researchers and policymakers to evaluate ADCs’ impact and target funding towards services that maximizes users’ health and well-being.

Physical Activity Programming and Physical Function of Older Adults in Adult Day Centers: A Mixed-Methods Approach

With increased prevalence of Alzheimer’s disease, there is a need for long-term care services (e.g., Adult Day Centers (ADCs)) to provide physical activity (PA) programs to maintain physical function of older adults. ADCs report offering PA programs; however, information on PA programs and physical function of participants attending ADCs is limited. The study aims to a) explore perspectives of ADC directors on PA programming; b) examine physical function in older adults attending ADCs. A cross-sectional mixed-methods study was conducted among ADC directors and attending participants. Interviews were conducted with ADC directors to assess barriers and facilitators of PA programming. Physical function was assessed among ADC participants via the Short Physical Performance Battery (SPPB) and Timed Up and Go (TUG). Five director interviews were conducted and three major themes emerged; 1) current PA programming limited by fear of falls, 2) staff training and retention, and 3) diversifying PA programming. Twenty-nine ADC participants enrolled in the study, Mage= 74.5±8.2 years; BMI= 29.2 ±7.4 kg/m2; MMSE= 25.6 ±3.3; 51.7% (n=15) African American; 79.3% (n=23) males. ADC participants scored 6.7±3.1 on the SPPB and 15.4±5.3 seconds on the TUG. Directors expressed the importance of PA; however, mentioned current programming was limited due to risk of falls and untrained staff in PA. Findings indicate that older adults attending ADCs have physical function scores indicative of high fall risk. Future PA programming may consider including alternative forms of PA while embedding falls prevention strategies to reduce risk of falls and improve physical function among ADC participants.