Re-thinking the nature of day programs for people with dementia: Implications for research

Study Aim/Purpose:  This was a literature review to seeking to identify weaknesses in past research that could help improve future research on day programs for people with dementia to better inform policy and practice. Specifically, the review sought to identify prevailing assumptions about the purpose and structure of day programs for people with dementia, as well as trends in day program evaluation methodology and findings.

Summary of Methods:  The study authors used a methodology called “problematization” to conduct a systematic review of historical texts and research literature on day programs serving people with dementia. Initially they searched the CIHAHL, MEDLINE and SCOPUS databases and reviewed reference lists to identify early discussions regarding day program use for people with dementia. Next, to identify trends in the research and commonly cited texts, the authors conducted a review of 11 literature reviews concerning: 1) day programs for older adults; 2) day program use for people with dementia; and 3) respite care where day programs were analyzed as a separate category. They used this review to build inclusion and exclusion criteria for a more comprehensive literature search which identified 426 abstracts published from 1990-2018. These were screened and the authors read 98 published papers and selected 36 articles for in-depth analysis.

Summary of Key Findings:  The authors highlight the three common impacts of day program services n examined in the: medically related outcomes for people with dementia, effectiveness in providing support for family caregivers, and broader impacts on the health and social service systems including preventing or limiting use of more expensive in-hone or long-term care.

From the more in-depth analysis of studies the authors identified three assumptions that guide the majority of the research on day programs and limit the utility of the research and its findings. First, they point out that the research mainly treats dementia as a problem of the individual. Second,  when measuring effects, the researchers treat participation in day programs as single unform units of substitute care but usually do not consider the process of service delivery or other factors such as those that may affect attendance frequency of retention. Third, the space of day programs is viewed narrowly as a simple background to care, without considering other contextual factors such as other services, the community, or home. They also find that studies of the family response to day programs have not found definitive impacts because of their narrow focus on the outcome of caregiver relief from stress (achieved by changing the caregiver’s appraisal of the person with dementia’s needs and giving them time away from caregiving.).

Limitations of Studies Reviewed (as cited by authors):  See above given that the focus of the review itself is on the limitations of the assumptions in the studies reviewed.

Authors’ Discussion/Conclusions:  The authors conclude that the research literature’s prominent assumptions about day programs have limited the scope and depth of understanding about how these programs  work, and assessments of their effects for persons with dementia and as support interventions for caregivers. They recommend that to improve the quality of day programs and expand access to them researchers should use an approach that examines the process and practices of day programs and does so in the context of the care infrastructure beyond the physical location of day programs. They also suggest that evaluations examine other potential effects for caregivers. They conclude that using this “relational orientation” future research can better demonstrate multiple effects of day care programs and how these effects may be differently manifested in diverse care infrastructure arrangements.