Adult Day Health Center Participation and Health-Related Quality of Life

Author(s): Schmitt, E.M., Sands, L.P., Weiss, S., Dowling, G., and Covinsky, K.

Published In: The Geronotologist, 50(4): 531-540

Study Aim/Purpose: The purpose of this study was to assess the association between participation in an adult day health center (ADHC) in the San Francisco Bay Area and quality of life for the participants who suffer from multiple chronic conditions and functional limitations. 

Summary of Methods: The study used a prospective case/comparison group design collecting information from older adults within three weeks of enrollment in an ADHC and then 12 months later. The intervention group was 57 newly enrolled participants who attended ADHC two or more days and the comparison group was 67 community-dwelling older adults from the same geographic area who did not attend ADHS, but would have met eligibility criteria for attendance if referred. Interviews were conducted in the primary language of the participants (English, Cantonese, or Mandarin), allowing participants to respond either verbally or by pointing to a response choice on a card printed in a large font. Quality of life, the study’s primary outcome, was assessed using the Medical Outcomes Survey Form (SF 36). Participants’ ability to perform ADLs was assessed using the Physical Self-Maintenance Scale. Cognitive status was assessed suing the Mini-Mental Status Examination. Depression was assessed using the self-reported Geriatric Depression Scale, and comorbidity was assessed using the Charlson Comorbidity Index. 

Summary of Results: ADHC participation was associated with perceived reductions in the extent to which participants’ physical and emotional health problems affected their regular daily activities. Secondary analyses showed that changes in daily physical functioning, depressed affect, or cognitive functioning did not explain the improvements found in the two quality of life domains for the ADHC participants. 

Study Limitations (as cited by authors): The authors note that although they measured and controlled for many factors likely to predict quality of life, it is possible that unmeasured differences, such as aspects of the individual’s living situation or receipt of services other than home care, could have over- or under-estimated the increases in quality of life attributable to ADHC participation. They also note that a definitive evaluation of ADHC would require a randomized controlled trial, but note that in most extant RCTs of ADHC the participants received only small dosages of ADHC and the studies thus have had mixed outcomes. 

Authors’ Discussion/Conclusions: A possible explanation of the study results presented by the authors is that “the multilevel ADHC approach provides a social and physical environment tailored to participants’ functional level in which participants are able to comfortably meet the demands of the environment. In contrast, individuals with functional limitations who do not attend ADHC may experience more problems in everyday functioning because they are predominantly in an environment with demands that exceed their competence level.” In terms of future evaluation research on ADHCs, the authors recommend more research “to better understand the dose-outcomes relationship of ADHC attendance on participants.”