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Day centers: Safe and stimulating environments for older adults in loss of autonomy

The Bottom Line

  • Many older adults and caregivers are benefiting from day centres, which offer programs of activities in professional care settings.
  • Day centres have four main purposes: providing social and preventive services; supporting independence; supporting health and daily living needs; and providing respite to caregivers.
  • Before deciding if a day centre is right for you (or your loved ones): discuss with your health and social care providers to identify your health and social needs, find a listing of existing and recognized day centres near you, and plan to visit at least three day centres to ask questions and get a general feeling of the environment.

Many community-dwelling older adults have complex health and social needs, particularly those in loss of autonomy or suffering from debilitating illnesses. These older adults rely heavily on informal and family caregivers to support them. The job of a caregiver can be an emotional rollercoaster and they often require much needed breaks. As for the older adults, they may be at greater risk of becoming socially isolated, and may require safe and stimulating environments that could help to maintain their autonomy.(1; 2)

Many older adults and caregivers are benefiting from day centres, which offer programs of activities in professional care settings. These activities are designed for older adults who require supervised care during the day, or those who are lonely or socially isolated. Day centres enable older adults to socialize and enjoy planned activities among a group of older adults, while still receiving needed health and social services. In doing so, day centres also offer informal and family caregivers respite from caregiving duties while knowing that their loved ones are in a safe and stimulating environment.(3)

But what does research tell us about these day centres?

What the research tells us

A recent scoping review examined 77 English-language studies published between 2005 and 2017 on how day centres are perceived, their benefits and their purposes.(4) Of note, the review focused on "general" day centres and thus excluded studies of day centres exclusively for older adults with dementia, or for those receiving palliative care or end-of-life care.

What are the purposes of day centres?
The review identified four main purposes of day centres:

1. Providing social and preventive services

By offering these types of services, day centres aim to:
- promote the maintenance of physical, psychological and social capacities (older adults attending day centres feeling more stimulated and confident and are more likely to pursue social activities outside day centres);
- develop a support network for older adults (and thus encourage them to continue to attend day centres);
- improve their mental health (less depression and anxiety) or prevent the decline of their mental health; and
- provide access to other services, such as occupational therapy, nutrition or screening services for example.

The studies identified in this scoping review revealed a diversity of programs offered in day centres aiming to provide social and preventive services, including: programs based on humor; transportation, exercise and self-help programs; organized volunteer programs; psycho-social group work; group discussions to promote social engagement and learning; health awareness programs; or auditory and visual screening programs.

2. Supporting independence
It seems that attending day centers delays the time when long-term care is needed. By allowing older adults to maintain their functions longer, it allows them to stay longer at home.

The studies revealed many programs offered at day centres to support the independence of older adults, including: moderate intensity exercise programs aimed at improving stability and flexibility, and fall prevention programs.

3. Supporting health and daily living needs
The studies identified a multitude of programs offered at day centres to support health and daily living needs, including: blood pressure monitoring programs offered by nurses (sometimes via a telehealth kiosk); self-management education programs; or medicine review programs offered by pharmacy students. Research evidence shows that, in day centres with exercises and nutritional programs, older adults experienced fewer falls and reported better overall health.

4. Providing respite to caregivers
Lastly, another key purpose of day centres is to provide respite to caregivers. Research evidence suggests that caregivers of older adults who attend day centres may have a better psychological quality of life than others.

Who benefits from day centers?
Older adults who are socially isolated and lack support networks seem to be more likely to visit day centres. Research evidence shows that these are mainly elderly women living alone or who are widowed, divorced or single, low-income, who have different health issues and who take multiple medicines.

How are day centres perceived?
Although they are recognized in the continuum of care in many countries, day centres are not always fully recognized by health professionals. Some studies found that managers of day centres felt that the terms used to describe their services (for example, "day care centres") could contribute to the stigmatization of day centre clients as being disabled and very old. In addition, these managers had the impression that health professionals do not understand the added value of day centres.

As for older adults, they have mixed perceptions of day centres. Some of them do not want to define themselves as old, isolated, sick or unhappy, and are thus reluctant to use services offered in day centres. Others view day centres much more positively as community places to practice different activities and to socialize. Canadian studies show that day centers seem to be part of our culture and are quite well recognized and respected by their clients.

Are day centres right for you (or your loved ones)?

There may be many day centres out there. While some of these day centres are providing services to older adults with a wide range of health and social needs, others are dedicated to older adults suffering from specific conditions (for example, Alzheimer's disease and related forms of dementia) or receiving certain types of care (for example, palliative care or end-of-life care).

Before deciding if a day centre is right for you (or your loved ones):
- discuss with your health and social care providers to identify your needs, and to identify a day centre that could respond to them;
- check the websites of your ministry of health, your regional health authority, or disease-specific organizations (for example, the Alzheimer Society of Canada) for any listing of existing and recognized day centres near you; and
- plan to visit at least three day centres (if possible) so that you can meet the personnel, ask all your questions, and get a general feeling of the environment of each day centre.


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References

  1. McMaster Optimal Aging Portal. Supporting caregivers of frail older adults. 16 July 2019.

  2. McMaster Optimal Aging Portal. Dementia caregiving: Take care of yourself while caring for others. 18 December 2018.

  3. National Adult Day Services Association. About Adult Day Services – NADSA: adult day care services. Retrieved 28 August 2019.

  4. Orellana K, Manthorpe J, Tinker A. Day centres for older people: A systematically conducted scoping review of literature about their benefits, purposes and how they are perceived. Ageing & Society. 2018.

DISCLAIMER: The blogs are provided for informational purposes only. They are not a substitute for advice from your own healthcare professionals.

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