Adult day center programs and their associated outcomes on clients, caregivers, and the health system: a scoping review

Author(s): Ellen, M.E., Demaio, P., Lange, A., and Wilson, M.G.

Published In: Gerontologist, 57 (6): e85-e94

Study Aim/Purpose: The purpose of this paper was to summarize findings and identify gaps in the literature evaluating outcomes of stand-alone adult day center (ADC) programs serving older adults in the community. 

Summary of Methods: The authors conducted a scoping review of evaluations of standalone ADCs published in English from 2004 through October 2014 searching Medline, Embase, CINAHL, PsychINFO, and AgeLine (Supplementary File I). Search terms used were “senior” and derivatives such as “older adult”, “elder” or “aged,” and “respite care” or “day care” and derivatives. Using these search terms and inclusion criteria, authors identified 76 studies. Study population characteristics, methods, outcomes measured, and findings were extracted and coded. Coded extracts were mapped by type of outcome assessed, the study population, disease focus, service focus and healthy system considerations. 

Summary of Results: The authors note that the majority of studies on standalone ADC focus on older adults with dementia, and that the majority of these studies focus on outcomes related to respite for caregivers. At the same time, studies of ADCs and the non-dementia population were more likely than studies of the dementia population to assess the implementation components of the ADCs, including health promotion and screening, and strategies such as information, education, competencies development and facilitation of decision-making. Across populations studied, the authors found a substantial amount of literature showing that ADC use has positive health, social, and psychological and behavioral outcomes for both care recipients and caregivers. In contrast, the authors found limited research on the accessibility of ADC care or its cost-effectiveness and system outcomes. Additionally, they report ambiguous findings in the studies examining ADC as a deterrent to long-term care placement, social isolation and further cognitive decline. 

Study Limitations (as cited by authors): The authors cited the following limitations of their review, noting that some limitations are common in scoping reviews: 1) the review excluded research not published in peer-reviewed journals; 2) none of the identified studies were conducted in lower-middle-income countries; 3) the study outcomes are not necessarily attributable to only use of ADCs; and 4) the coding was conducted by only one researcher, limiting the reliability of the results. 

Authors’ Discussion/Conclusions: The authors suggest that more in-depth analysis of ADC outcomes is needed through systematic reviews that empirically assess the effects of different ADC models on older adults and their caregivers. They also recommend that future research differentiate the outcomes of ADCs based on the population served, the programming provided, and how the services are used. This research, they suggest, could translate into processes and mechanisms that would identify the individual needs of older adults and their families and provide access to the appropriate kinds of providers and programs for their needs.