The effectiveness of adult day services for older adults: A review of the Literature from 2000 to 2011

Author(s): Fields, N.L., Anderson, K.A., and Dabelko-Schoeny, H.

Published In: Journal of Applied Gerontology, 33 (2): 130-163

Study Aim/Purpose: The aim of the study was to summarize literature from 2000-2011 on Adult Day Services (ADS) effectiveness and make recommendations for future research. The study was intended to update a similar review conducted by Gaugler and Zarit in 2001. 

Summary of Methods: The researchers summarized findings from published qualitative and quantitative, peer-reviewed English language studies of ADS effectiveness (i.e. effects on participant, caregiver or health care utilization). Articles were identified through searches of Medline, Ageline, Psychology and Behavioral Sciences Collection, Social Work Abstracts, SOCIndex, and CINAHL, and Google Scholar. The search was conducted with the terms: adult day, adult day services, adult day health care, respite services, community-based care, and community-based long-term care. Multiple reviewers independently assessed the abstracts to determine whether they met the criteria of being studies of effectiveness of ADS. 

Summary of Key Results: 61 studies were included in the final literature review sample. Of these 39 related to participant outcomes, 19 related to caregiver outcomes and 10 related to ADS and health care utilization. The authors equate care receiver participation in ADS with receipt of respite by the caregiver. A table listing the methods and findings of each reviewed article is provided in the body of the article. Key findings on caregiver and health utilization outcomes are summarized below: 

ADS use and caregiver outcomes: Several studies reviewed demonstrated that ADS attendance and the general benefits provided by ADS (e.g., respite and basic ADS programming) had significant positive effects on caregiver burden and stress. Two reviewed studies found that caregivers who received supplemental caregiver support services along with ADS had significantly higher feelings of competence or increased capacity to manage challenging behaviors than caregivers who only received usual ADS services. Another study of the Best Friends Approach to ADS for dementia care (i.e., involving a person-centered philosophy and special staff and volunteer training) found gains in overall quality of life for caregivers. 

ADS use and health care utilization: Several studies on timing of nursing home placement had inconsistent results more often showing that ADS programs do not delay nursing home placement. One study of ADS use for individuals with dementia found the association between ADS use and shorter time to nursing home placement was significant for wife caregivers but not for daughter caregivers. The authors conclude that caregivers who used high amounts of ADS may have used these services as a transition or “stepping stone” to institutionalization. Two reviewed small studies examining the effectiveness of supplemental caregiver supports provided with ADS found lower rates of nursing home placement and greater delays in nursing home placement for users of ADS programs providing supplemental caregiver supports than for users of usual ADS programs. One reviewed study of a pilot ADS program that provided acute health services after a participant was discharged from a hospital stay found significant reductions in hospital readmissions among pilot participants compared to participants who were sent to skilled nursing facilities, home health, or home with outpatient services or self-care after hospital discharge. 

Limitations of Studies Reviewed (as cited by the author): They authors indicated that while their literature review was comprehensive, it may have missed several small studies of ADS. 

Authors’ Discussion/Conclusions: The authors conclude that ADS can benefit caregivers, for example, by reducing their burden and stress. However, they suggest that their review leaves many questions unanswered including: what elements of ADS programming have significant effects; what type of participants and caregivers are helped by ADS; how much ADS usage is needed to have an effect; and the mechanisms through which ADS has effects and under what circumstances. At the same time, the authors point out that measuring the effects of a specific type of ADS program for a specific population is challenging due to the small size of most ADS programs and inter- and intraprogram variability in the services offered. 

With regard to research on the effect of ADS on nursing home placement and other health care utilization, the authors recommend future research include: effects of prior ADS use on participants and caregivers after transition to institutional settings; cost effectiveness of ADS programming; and large scale evaluations of ADS programming that have promise for reducing health care costs, such as those that address chronic health conditions.