Estado actual de la Enfermería en los Centros de Día Gerontológicos de Huelva / Estado atual da enfermagem nos Centros de Dia Gerontológicos de Huelva / Current state of Nursing in Gerontological Day Centers of Huelva

Introducción: El envejecimiento poblacional ha desplegadoun nuevo y amplio campo de estudio para la ciencia sanitariaen el que la enfermería debe investigar para garantizar laautonomía en salud de las personas mayores.Objetivo: Visibilizar los Centros de Día Gerontológicos(CDG) y las actividades de los profesionales de enfermeríaen dichos centros en Huelva.Metodología: Se ha realizado una investigación cualitativa apartir de cuestionarios y entrevistas dirigidas al personal dedirección y enfermería de varios Centros de Día de Huelvay provincia.Resultados: Los CDG son un recurso intermedio con múltiplesobjetivos y funciones, que ofrecen calidad de vida tantopara los mayores como para sus familiares. Se componende un equipo básico de profesionales que trabaja de formano permanente. La figura de la enfermería es esencial, perocuenta con una situación laboral muy deficiente.Conclusión: Estos centros proporcionan cuidados profesionalesy permiten la permanencia en los domicilios habitualesfavoreciendo la calidad de vida y autonomía de esta poblaciónmayor. La bibliografía sobre este tema es escasa, por lo quese considera necesario profundizar en su investigación juntocon la puesta en marcha de programas y propuestas de mejoraque den a conocer estos centros sociosanitarios.(AU)

Introduction: Population aging has opened up a newand broad field of study for health science in whichnursing must investigate to guarantee the healthautonomy of older people.Objective: To make visible the Gerontological DayCenters (CDG) and the activities of nursing professionalsin these centers in Huelva.Methodology: A qualitative investigation has beencarried out using questionnaires and interviews directedat the management and nursing staff of several DayCenters in Huelva and the province.Results: The CDG are an intermediate resource withmultiple objectives and functions, which offer qualityof life for both the elderly and their families. They aremade up of a basic team of professionals who workon a non-permanent basis. The role of nursing isessential, but it has a very poor employment situation.Conclusion: These centers provide professional careand allow them to remain in their usual homes,favoring the quality of life and autonomy of thisolder population. The bibliography on this topic isscarce, so it is considered necessary to deepen itsresearch along with the implementation of programsand improvement proposals that make these socio-health centers known.(AU)

Introdução: O envelhecimento populacional abriuum novo e amplo campo de estudo para as ciênciasda saúde no qual a enfermagem deve investigar paragarantir a autonomia de saúde dos idosos.Objectivo: Dar visibilidade aos Centros de DiaGerontológicos (CDG) e à actividade dos profissionaisde enfermagem destes centros de Huelva.Metodologia: Foi realizada uma investigação qualitativaatravés de questionários e entrevistas dirigidas aosdirigentes e pessoal de enfermagem de vários Centrosde Dia de Huelva e da província.Resultados: Os CDG são um recurso intermediáriocom múltiplos objetivos e funções, que oferecemqualidade de vida tanto para os idosos quanto paraseus familiares. São formados por uma equipe básicade profissionais que atuam de forma não permanente.O papel da enfermagem é essencial, mas tem umasituação laboral muito precária.Conclusão: Estes centros prestam cuidados profissionaise permitem a permanência nos seus domicílios habituais,favorecendo a qualidade de vida e a autonomia destapopulação idosa. A bibliografia sobre este tema éescassa, pelo que considera-se necessário aprofundara sua investigação juntamente com a implementaçãode programas e propostas de melhoria que dêem aconhecer estes centros sócio-sanitários.(AU)

La salud y los cuidados: un análisis interseccional de género y vejeces a partir del trabajo realizado en CEPRAM (2022) / Health and care: an intersectional analysis of gender and old age from the work done at CEPRAM (2022)

INTRODUCCION: Nuestra región, y Argentina, se encuentra atravesando un momento de rápido envejecimiento demográfico. Se trata de un proceso contextualizado social e históricamente de representaciones, estereotipos y significados particulares. El presente trabajo tiene por objetivo describir y analizar las posibles articulaciones entre la perspectiva de salud integral, redes en salud y los cuidados a y entre personas adultas mayores a partir de la experiencia de trabajo en el CEPRAM (Centro de Promoción del Adulto Mayor) en el que las mujeres ocupan un rol central. MÉTODOS: Investigación cualitativa interaccionista con entrevistas sobre experiencias y significados. RESULTADOS: Refieren mejoras en su autoestima, flexibilidad, apertura y escucha como reconocimiento del otro/a. La cantidad y la calidad de cobertura en servicios de cuidados recae mayoritariamente sobre las familias y especialmente, sobre las mujeres y disidencias, perpetuando la desigualdad de género en la distribución de tareas, las condiciones en que se llega y transita la vejez. Ellas vieron este espacio como uno de cuidados, dando sustento a formas más integrales de entenderlos como eje de la salud. CONCLUSIONES: CEPRAM logró captar y solucionar necesidades ­socioafectivas­ de mujeres mayores, insatisfechas y no atendidas por el Estado. Promueve la autonomía relacional donde la participación y la construcción de redes basadas en los vínculos, fundamentales para su salud integral. Los entornos extrahospitalarios como oportunidad de acercamiento al sistema de salud, deben resolver necesidades de cuidado con perspectiva de envejecimiento saludable, fomentando la habilidad funcional, así como los atributos relacionados con el proceso diferenciado por género y salud que permiten a la persona ser y hacer (AU)

INTRODUCTION: Our region, and Argentina, is going through a period of rapid demographic aging. It is a socially and historically contextualized process of representations, stereotypes and particular meanings. The aim of this paper is to describe and analyze the possible articulations between the integral health perspective, health networks and care for and among older adults based on the experience of working in the CEPRAM (Center for the Promotion of Older Adults) in which women play a central role. METHODS: Qualitative interactionist research with interviews on experiences and meanings. RESULTS: They report improvements in their self-esteem, flexibility, openness and listening as recognition of the other. The quantity and quality of coverage in care services falls mostly on families and especially on women and dissidents, perpetuating gender inequality in the distribution of tasks, the conditions in which old age arrives and passes. Women saw this space as one of care, giving support to more comprehensive ways of understanding it as the axis of health. CONCLUSIONS: CEPRAM was able to capture and solve the social and emotional needs of older women, unsatisfied and unmet by the State. It promotes relational autonomy where participation and the construction of networks based on bonds are fundamental for their integral health. The out-of-hospital environments as an opportunity to approach the health system, should solve care needs with a healthy aging perspective, promoting functional ability, as well as the attributes related to the process differentiated by gender and health that allow the person to be and to do (AU)

Shared Site Intergenerational Programs: A National Profile.

Shared site intergenerational programs deliver ongoing services and shared programming to youth and older adults in a single setting. With the potential to benefit youth, older adults, families, and communities, they attract growing attention from practitioners, researchers, funders, and policy makers. Using national survey data we profile characteristics of 95 shared sites. Responding programs connected over 25,000 youth and older persons in 2017. The most common models consisted of adult day services and early childhood programs (i.e., preschool or childcare), though unique models offered diverse opportunities. Current priorities and challenges can be addressed with systematic data collection and access to resources, including incentives in the 2020 reauthorized Older Americans Act.

Americans prefer to receive care where multiple generations are served.Shared site intergenerational models vary; child and adult day programs are common.Practitioners need access to evaluation, interprofessional, and programming resources.The reauthorized Older Americans Act can help address the needs of shared site programs.

"The Sun Came Up Because You Got Here ": A Qualitative Exploration of Person-Centered Care Strategies Used by Adult Day Care Centers to Manage Behavioral and Psychological Symptoms of Dementia.

In order to reduce care partner strain and support aging in place for people living with Alzheimer's Disease and Alzheimer's Disease Related Dementias (AD/ADRD), adult day centers (ADCs) must manage behavioral and psychological symptoms of dementia (BPSD). The purpose of this paper is to identify person-centered care strategies used by center staff to manage BPSD. Six focus groups with center staff (n = 31) were conducted. Data were analyzed using directed content analysis guided by Kitwood's conceptual approach to cultivating personhood in dementia care. Themes were identified and organized within Kitwood's framework. The results demonstrate that staff incorporate evidence-based person-centered approaches to AD/ADRD care that align with Kitwood's principles of comfort, attachment, inclusion, and identity. Staff individualize their approach to people with AD/ADRD within a group setting. They monitor, engage, socially stimulate, and, when needed, de-stimulate them. Centers are flexible social environments with underrecognized expertise managing BPSD using person-centered approaches.

Evaluación de la calidad de vida de personas mayores participantes de un centro diurno / Evaluation of quality of life of older people participating in an adult day care center

Objetivos: Evaluar los cambios en la calidad de vida de un grupo de personas mayores participantes de un centro de adultos mayores en Santiago, Chile. Metodología: Estudio longitudinal prospectivo con 2 aplicaciones, una al ingreso y otra al término de la participación en un centro de adultos mayores con 35 personas mayores de 60 años. La calidad de vida se midió con el instrumento de la Organización Mundial de la Salud en su versión abreviada. Para el análisis de los datos se utilizaron estadísticas descriptivas y el test de la t de Student. Resultados: Al alta, la calidad de vida mostró un aumento significativo (p < 0,05), es decir, las personas mayores reportan mejores puntuaciones de calidad de vida después de haber participado en las intervenciones que tiene el centro de adultos mayores. Conclusiones: La calidad de vida se debe considerar una medida clave para evaluar los resultados de las intervenciones realizadas en los centros de adultos mayores (AU)

Objectives: To examine the changes in the quality of life of a group of older people participating in an adult day care center in Santiago, Chile. Methodology: Longitudinal study with two applications, one at admission and the other at the end of participation in the adult day care center, among 35 older people over 60 years belonging to the adult day care centers in Santiago, Chile. Quality of life was measured with the World Health Organization BREF instrument. Descriptive and analytical statistics were used for data analysis (t Student test). Results: This study showed a significant increase in quality of life (p < 0.05); older people reported better scores for quality of life after having participated in the interventions that the adult day care center has. Conclusions: Quality of life should be considered a key outcome when evaluating the results of interventions in adult day care center (AU)

Adult Day Services, Health Equity for Older Adults With Complex Needs, and the COVID-19 Pandemic.

Morbidity and mortality from COVID-19 have unduly affected older adults from racial and ethnic minority groups. In this article, we highlight the experiences and vulnerabilities of diverse older adults with complex health and social needs when their access to vital, but overlooked, community-based adult day service centers (ADSCs) was abruptly cut off during a pandemic. Pandemic-related ADSC closures left vulnerable older adults and their care partners without essential daily support and services, such as health monitoring and socialization. However, the magnitude of the impact of ADSC closures on well-being, particularly among members of racial/ethnic minority groups, has yet to be measured with any form of "big data" because large-scale, nationally representative data sets consisting of participant-level information and outcomes associated with ADSC participation do not yet exist. Unmet needs of older adults resulting from pandemic-related ADSC closures are underrecognized because of a lack of systematic data collection, undermining efforts to achieve health equity. We call on ADSCs to link rigorous collection of racial and ethnic data to quality measures of access to equitable "age-friendly" care as a means of better supporting diverse community-dwelling older adults beyond the COVID-19 pandemic. (Am J Public Health. 2022;112(10):1421-1428. https://doi.org/10.2105/AJPH.2022.306968).

Experiences of Disabled Older Adults in Tokyo's Adult Day Care Centers during COVID-19-A Case Study.

The COVID-19 pandemic resulted in social isolation among elderly people with disabilities. Adult daycare (ADC) is an important community care option for socialization among people with disabilities. However, their experiences with ADC remain underexplored. Thus, this study investigated the experiences of community-dwelling disabled elderly with ADC from the perspective of socialization. Four older women from Tokyo with disabilities, availing of one ADC service, were interviewed across two sessions between November 2020 and January 2021. The transcribed interviews and field notes were analyzed qualitatively. This yielded eight categories: two pertaining to context ("restricted social interaction outside of ADC", "feeling simultaneously grateful and ashamed of oneself as a recipient of care services"), and six pertaining to experience with ADC ("take a catastrophic defensive posture in situations where one's perception of value is shaken", "express oneself positively to justify one's daily life", "have trouble knowing what to do", "put oneself in a shaded exchange relationship", "examine the value of elderly people in need of care in society", and "savor regular contact with others"). Ensuring the use of ADC as a safe place for interaction while considering pandemic-related needs is important to develop policy and practical responses to restricted socialization during COVID-19.

Utilization of ADCCs and quality of life among older adults: ethno-regional disparities in Israel.

BACKGROUND: Adult day care centers (ADCCs) are a common service provided for frail older adults in the community. We examined the influence of older adults' utilization of ADCC's on their quality of life (QoL), and whether ethno-regional disparities are factors in the gaps found concerning QoL in different regions and between different ethnic groups. METHODS: Cross sectional data were collected through structured interviews with 360 older adults attending ADCCs. Participants represented three ethnic groups and three regions in Israel. QoL was assessed by SF-36 questionnaire. RESULTS: The results revealed a positive correlation between weekly hours at the ADCC, satisfaction with attending ADCC, and QoL. Older adults living in the central region had higher QoL than those living in the southern and northern regions. Veteran Israeli Jews reported higher QoL than FSU immigrants Israeli Arabs in all regions. Connection to one's residential area was also correlated with QoL. A significant moderating effect of the interaction (ethnicity*area of residence) on QoL was also revealed. CONCLUSIONS: Attending ADCC is a vital community services to promote QoL in later life. Gaps in ADCC utilization between ethnic groups and residential region may cause disparities in QoL, specifically, in minority groups and those living in peripheral regions. Service providers should minimize the disparities by improving accessibility and availability for each person regardless of ethnicity and region of residence.

[Predictors of intensity of use of adult day care centers in people with cognitive impairment]. / Prädiktoren für die Nutzungsintensität von Tagespflegen bei Menschen mit kognitiven Einschränkungen.

BACKGROUND: Adult day care is an established concept in Germany for people with cognitive impairment; however, only a small fraction of people in need for care actually use adult day care. Studies so far highlighted some predictors for the use of adult day care; however, it remains unclear which factors are associated with the intensity of use. OBJECTIVE: To identify relevant predictors for the intensity of use of adult day care using the Andersen healthcare utilization model. MATERIAL AND METHODS: Data used were obtained within the project dementia in day care with psychosocial MAKS interventions (DeTaMAKS), which studied adult day care users with cognitive impairments and their family caregivers. A logistic regression was performed to predict frequent or low use of adult day care. RESULTS: The following factors were significantly associated with higher intensity of use: civil status of adult care user being widowed or single, higher educational level of caregiver, higher care level, longer duration of adult day care use and more mental and behavioral symptoms of the adult day care user. The sensitivity analysis for cohabiting dyads additionally showed a higher intensity of use with a lower age of the caregiver and shorter distance between place of residence and adult day care but not with respect to educational level of the caregiver and mental and behavioral symptoms of the user. CONCLUSION: The results show a need for adult day care, which increases with caregivers being employed and users living outside of permanent relationships. A short distance to the adult care center as well as flexible care options may increase the frequency of use.

Interrelaciones entre el sentido de la vida, la actividad física, la red de apoyo social, la edad y el género en adultos mayores / Interrelationships between the meaning of life, physical activity, social support network, age, and gender in older adults

Resumen Introducción: los adultos mayores que asisten a los centros diurnos tienen la oportunidad de interactuar con sus pares y realizar actividades, lo cual podría incidir en su sentido de la vida. Objetivo: evidenciar las asociaciones entre el sentido de la vida, la actividad física, la red de apoyo social, la edad y el género en siete centros diurnos de la provincia de Heredia, Costa Rica. Metodología: el estudio es cuantitativo de corte transversal. Se eligieron siete centros diurnos de los cuales se seleccionó una muestra por conveniencia de 77 adultos mayores. Las variables investigadas fueron el sentido de la vida, la actividad física, la red de apoyo social, la edad y el género. Para la recolección de datos se utilizaron autoreportes y los investigadores ayudaron a aclarar dudas sobre las preguntas. Resultados: el 46 % de las personas mayores reportó una falta de sentido de la vida y un 36 % un nivel de actividad física baja. Se determinó una asociación significativa entre la red de apoyo social y el sentido de la vida (.= .911; p < .001), entre la edad y la red de apoyo social (.=.30 .=.048), y entre el apoyo social y el género femenino (.=-6.08, .=.010). Conclusiones: la red de apoyo social es un predictor del sentido de la vida, así como la edad y el género predicen la red de apoyo social; pero no la actividad física reportada sobre las variables investigadas.

Abstract Introduction. Older adults attending daycare centers are in an environment in which different variables are interrelated and could shape their meaning of life, among other aspects. Objective: To analyze the associations between the meaning of life, physical activity, social support network, age, and gender in seven-day centers in the province of Heredia, Costa Rica. Methodology: This is a cross-sectional quantitative study. Seventy-seven older adults were recruited from seven-day centers. The variables investigated were the meaning of life, physical activity, social support network, age, and gender. Self-reports were collected and researchers clarified any doubts. Results: 46% of the participants reported a meaningless life and 36% low levels of physical activity. Significant associations were found between social support network and meaning of life (. = .91; . <.001), age and social support network (. = .30 . = .048), and social support and female gender (. = -6.08, . = .010). Conclusions: The social support network is a predictor of the meaning of life and age and gender predict the social support network, but not the physical activity reported in the variables investigated.

Design and evaluation of a dashboard to support the comprehension of the progression of patients with dementia in day centers.

BACKGROUND AND OBJECTIVE: In day centers, people with dementia are assigned to specific groups to receive care according to the progression of the disease. This article presents the design and evaluation of a dashboard aimed at facilitating the comprehension of the progression of people with dementia to support decision-making of healthcare professionals (HCPs) when determining patient-group assignment. MATERIALS AND METHOD: A participatory design methodology was followed to build the dashboard. The grounded theory methodology was utilized to identify requirements. A total of 8 HCPs participated in the design and evaluation of a low-fidelity prototype. The perceived usefulness and perceived ease of use of the high-fidelity prototype was evaluated by 15 HCPs (from several day centers) and 38 psychology students utilizing a questionnaire based on the technology acceptance model. RESULTS: HCPs perceived the dashboard as extremely likely to be useful (Mdn=6.5 out of 7) and quite likely to be usable (Mdn=6 out of 7). Psychology students perceived the dashboard as quite likely to be useful and usable (both with Mdn=6). CONCLUSIONS: Making use of a participatory design helped foster in HCPs a sense of ownership of the dashboard, thus facilitating its acceptance. The creation of low-fidelity and high-fidelity prototypes led to identifying valuable, timely, and specific feedback at different stages of the development process as well as to establishing a set of lessons learned for the development of dashboards in the healthcare domain.

Adult Day Services Center Participant Characteristics: United States, 2018.

An estimated 251,100 participants were enrolled in adult day services centers (ADSCs) in the United States in 2018 (1). Compared with users of other long-term care services, ADSC participants were younger and more racially and ethnically diverse (2). ADSC participants have a diverse set of needs, with many participants requiring assistance with activities of daily living (ADLs) and having chronic health conditions (3). This report presents national estimates of selected characteristics of participants of ADSCs from the 2018 National Study of Long-Term Care Providers.

Polypharmacy is associated with malnutrition and activities of daily living disability among daycare facility users: A cross-sectional study.

ABSTRACT: Polypharmacy influences malnutrition and activities of daily living (ADL) in older individuals owing to side effects such as anorexia. This study aimed to examine whether polypharmacy (5 or more drugs) is associated with malnutrition and ADL disability among daycare facility users.This cross-sectional study was performed in a daycare facility specializing in rehabilitation. Malnutrition was defined according to the Global Leadership Initiative on Malnutrition criteria and ADL disability according to the "criteria for determination of the daily life independence level (bedridden level) of elderly with disabilities."In total, 103 of the 134 included individuals were analyzed. Thirty-three (32.0%) participants were malnourished, 46 (44.7%) had ADL disability, 58 (56.3%) qualified as cases of polypharmacy, and 9 (8.7%) experienced loss of appetite. Multivariable logistic regression analysis showed that polypharmacy was independently associated with malnutrition and ADL disability. Separate analyses of each type of drug revealed that proton pump inhibitors (that impair protein absorption and assimilation), anticonstipation drugs, and antihypertensive drugs were associated with malnutrition, whereas proton pump inhibitors, anticonstipation drugs, antidyslipidemia drugs, and antidiabetic drugs were associated with ADL disability. The only factor related to anorexia was the loss of pleasure of eating, which in turn was related to psychological stress.The side effects of polypharmacy among individuals with malnutrition and ADL disability may include impaired protein absorption and assimilation caused by proton pump inhibitors, but not anorexia. Further multicenter prospective studies are required to confirm these findings.

Valores normativos del consumo de oxígeno máximo en las personas mayores de los centros día de la ciudad de Tunja, Colombia / Normative values of maximum oxygen consumption in the elderly in day centers of the city of Tunja, Colombia

Objetivo Determinar los valores normativos de consumo de oxígeno en personas mayores de los centros de día de la ciudad de Tunja, Colombia. Materiales y métodos Se realizó un estudio descriptivo de tipo transversal con un tamaño muestral de 121 participantes, a los cuales se les aplicó el protocolo de Bruce modificado para determinar el consumo de oxígeno, construyendo a partir de estos resultados la distribución percentílica mediante el método de mínimos cuadrados, a través del software estadístico R Studio®. Resultados El promedio de edad de los participantes fue de 70,98 ± 8,8 años, prevaleció el género femenino y la presencia de comorbilidades. Se encontró en los resultados una relación inversa entre la edad y el VO2máx, evidenciando que a mayor edad menor es el consumo de oxígeno (p < 0,05; Rho -0,42). Conclusiones Se presenta un modelo de normalización para el consumo de oxígeno dado en MET y en mL/kg/min, proporcionando estándares a nivel nacional y regional de valores de referencia válidos para las personas mayores, siendo aplicable en los procesos de evaluación e intervención (AU)

Objective To determine the normative values of oxygen consumption in older adults in the day centres of the city of Tunja, Colombia. Materials and methods A descriptive cross-sectional study was carried out with a sample size of 121 participants, to whom the modified Bruce protocol was applied to determine oxygen consumption, building from these results the percentile distribution using the method of least squares, through R Studio® statistical software. Results The average age of the participants was 70.98 ± 8.8 years, the female gender and the presence of comorbidities prevailed. An inverse relationship between age and VO2 max was found in the results, showing that the older the age, the lower the oxygen consumption (p < 0.05; Rho -0.42). Conclusions A normalization model for oxygen consumption given in MET and in mL/kg/min is presented, providing standards at the national and regional level valid reference values for the elderly, being applicable in evaluation and intervention processes (AU)

Ancianos: relación entre residencia y estado de salud / Elderly: relationship between residence and health status

Introduction: The European population is aging, for every 100 young people there are 128 elderly. There is a decrease in the number of elderly people living in their family environment. The main objective of this study is to identify the differences in the general health status of the elderly according to their residence: in families or in others types of centres (nursing home, host family or national integrated network of integrated care (NINIC)). Material and Methods: This is an observational study, using a sample of 254 elderly patients admitted to the Internal Medicine Service. Results: Of the patients studied, 78,7% lived at home/with relatives, 15,4% in nursing homes, 3,15% in host families and 2,75% in NINIC. Age ranged from 65 to 99 years, with a median of 80 years (SD=7,97). Patients from their homes were more independent/mild dependence (X(3)=59.8, p<0.001), although there were no significant differences in the number of comorbidities (t(252)=0.029, p=0.999). However, patients from others centres had more neurological pathology (X(1)=12.39, p<0.001). There were no statistically significant differences in the number of medications usually taken, although patients from others centres had more potentially inappropriate medications (t(252)=5.85, p<0.001) and potential prescribing omissions (t(252)=3.71,p<0.001). Patients at home had fewer rehosts (X(1)=5.14, p=0.039). There were more intercurrences (X(1)=19.0, p<0.001) and more deaths at 6months after discharge (X(1)=16.3, p<0.001) from others centres. Conclusion: In a population less attended by families, these differences in relation to their dwelling places are paramount. (AU)

"Advocating Every Single Day" so as Not to be Forgotten: Factors Supporting Resiliency in Adult Day Service Centers Amidst COVID-19-Related Closures.

Adult day centers (ADCs) are nonresidential settings that support the health and social needs of vulnerable older adults. Due to ADCs' congregate nature and participants' compromised health status, many ADCs have been forced to close during the COVID-19 pandemic. It is unknown how closures have impacted service delivery at ADCs. Guided by the Resiliency Activation Framework, we (a) identified consequences resulting from closures of ADCs during the COVID-19 pandemic and (b) described factors that have enabled the ADC community to remain resilient in the wake of challenges brought on by the pandemic. We conducted 2 focus groups in California (n = 12), and individual interviews with ADC staff members (n = 8) in 7 other states. The results of a directed content analysis revealed perceived declines in physical, cognitive, and mental health of ADC users and increased caregiver strain. Access to human, social, economic, and political capital were essential for supporting ADCs in buffering the impacts of the pandemic on the older adults they serve but were not consistently available. Research is urgently needed that quantifies the impacts of the pandemic on ADC users and their caregivers to inform policy and advocacy efforts in the wake of the pandemic.

Advance Directives State Requirements, Center Practices, and Participant Prevalence in Adult Day Services Centers: Findings From the 2016 National Study of Long-Term Care Providers.

OBJECTIVES: Adult day services centers (ADSCs) may serve as an entrée to advance care planning. This study examined state requirements for ADSCs to provide advance directives (ADs) information to ADSC participants, ADSCs' awareness of requirements, ADSCs' practice of providing AD information, and their associations with the percentage of participants with ADs. METHODS: Using the 2016 National Study of Long-Term Care Providers, analyses included 3,305 ADSCs that documented ADs in participants' files. Bivariate and linear regression analyses were conducted. RESULTS: Nine states had a requirement to provide AD information. About 80.8% of ADSCs provided AD information and 41.3% of participants had documented ADs. There were significant associations between state requirements, awareness, and providing information with AD prevalence. State requirement was mediated by awareness. DISCUSSION: This study found many ADSCs provided AD information, and ADSCs that thought their state had a requirement and provided information was associated with AD prevalence, regardless of state requirements.

Behavioural intervention to reduce disruptive behaviours in adult day care centres users: A randomizsed clinical trial (PROCENDIAS study).

AIM: This study assesses the effect of an intervention to reduce the disruptive behaviours (DB) presented by care recipient users of adult day care centres (ADCC), thereby reducing caregiver overload. While ADCC offer beneficial respite for family caregivers, the DB that many care recipients show promote resistance to attending these centres, which can be a great burden on their family caregivers. DESIGN: Randomized controlled clinical trial. METHODS: The study was carried out with 130 family caregivers of people attending seven ADCC in the municipality of Salamanca (Spain), randomly distributed into intervention and control groups. The intervention was applied across eight sessions, one per week, in groups of 8-10 people where caregivers were trained in the Antecedent-Behavior-Consequence (ABC) model of functional behaviour analysis. The primary outcome was the reduction of DB measured with the Revised Memory and Behavior Problems Checklist (RMBPC). RESULTS: An average reduction in the RMBPC of 4.34 points was obtained in the intervention group after applying the intervention (p < 0.01 (U de Mann-Whitney); Cohen d = 1.00); furthermore, differences were found in the Center for Epidemiologic Studies Depression Scale (CES-D) (U = -2.67; p = 0.008; Cohen d = 0.50) and in the Short Zarit Burden Interview (Short ZBI) (t = -4.10; p < 0.01; Cohen d = 0.98). CONCLUSION: The results obtained suggest that the implementation of this intervention could reduce both the frequency of DB occurrence and the reaction of the caregiver to their appearance. Improvement was also noted in the results regarding overload and emotional state of the family caregiver. IMPACT: To our knowledge, this is the first randomized clinical trial to show that an intervention based on the ABC model could reduce the frequency and reaction of DB of care recipients in ADCC increasing their quality of life, and improving the mental health and overload of their family caregivers.

Test-Retest Reliability of Pain Measures in Institutionalized Older Adults: Number of Painful Body Sites, Pain Intensity, and Pain Extent.

OBJECTIVE: The reliability of pain assessment in frail and older adults has seldom been assessed. This study aims to assess the test-retest reliability of (1) the number of painful body sites, (2) pain intensity, and (3) pain extent in institutionalized older adults. METHODS: Seventy-four older adults who were institutionalized were assessed in 2 separate sessions, 2 days to 1 week apart, for pain intensity, number of painful body sites, and pain extent (in pixels) using a vertical pain numeric scale (0 to 10), a body chart divided into 50 body regions, and ImageJ, respectively. Intraclass correlation coefficients (ICCs), standard error of measurement (SEM), and minimal detectable differences (MDDs) were calculated. RESULTS: In session 1, the mean values (± standard deviation) were 5.54 ± 2.12 points for pain intensity, 4.47 ± 3.27 for number of painful body sites, and 2,726.00 ± 2,322.09 for pain extent. ICCs were 0.82 (95% confidence interval [CI] = 0.72 to 0.89) for pain intensity, 0.89 (95% CI = 0.83 to 0.93) for number of painful body sites, and 0.74 (95% CI = -0.07 to 0.91) for pain area. The MDDs were 2.46 for pain intensity, 3.14 for number of painful body sites, and 4,997.60 for pain extent. CONCLUSIONS: The vertical pain rating scale and the body chart seem reliable to assess pain intensity and number of pain sites, respectively. The wide CI for the ICC found for pain area and the high measurement error compromise its potential clinical relevance.

The use of community advisory boards in pragmatic clinical trials: The case of the adult day services plus project.

Community advisory boards (CABs) have become increasingly common and important in translational research in health care including studies focusing on home and community-based services. CABs are composed of stakeholders who share interest in research projects and typically include patients/clients, practitioners, community members, policymakers, and researchers. CABs advise researchers on issues ranging from research design and recruitment to implementation and dissemination. In this article, the researchers detail their experiences with the CAB for a pragmatic clinical trail of Adult Day Services (ADS) Plus, an education and support intervention for family caregivers of older adults with dementia using adult day services. Lessons learned, guidelines, and best practices are then presented for developing and working with a CAB in healthcare research.