Day care at green care farms: a novel way to stimulate dietary intake of community-dwelling older people with dementia?

OBJECTIVE: This study aimed to compare dietary intake of older people with dementia receiving day care at regular day care facilities (RDCFs) or at so-called green care farms (GCFs). DESIGN AND SETTINGS: A comparative cross-sectional study was performed at 10 GCFs and 10 RDCFs in the Netherlands. PARTICIPANTS: 30 subjects from GCFs and 23 subjects from RDCFs, aged 65 years or over, were included in the study. Subjects from GCFs were mostly married males who were aged younger than the subjects from RDCFs who were mostly widowed females. MEASUREMENTS: Dietary intake of the subjects was observed and/or recorded both at home and during their time at the day care facility. RESULTS: In the GCF group, average total energy intake was significantly higher than in the RDCF group (8.8 MJ/d vs. 7.2 MJ/d). Also total carbohydrates and protein intakes were higher in the GCF group than in the RDCF group (with 257 g/d vs. 204 g/d, and 76 g/d vs. 65 g/d respectively). In addition, average total fluid intake was significantly higher in the GCF group than in the RDCF group (2577 g/d vs. 1973 g/d). Multiple linear regression analyses revealed that after taking possible confounders into account, day care type was still significantly related to the intake of energy, carbohydrates and fluids. CONCLUSION: This study suggests beneficial effects of this new type of day care on dietary intake by community-dwelling older people with dementia.

[Towards a protocol for the good use of the day hospital: an analysis of the level of the care supplied]. / Verso un protocollo per il buon uso del Day Hospital: analisi del livello di assistenza fornita.

Day hospital (DH) is an intermediate way of assistance between ambulatory activity and ordinary hospitalization, with the object of increasing efficiency of hospital services. Nowadays data about real efficiency of DH use are lacking, but probably inappropriateness of DH use is high. Aim of our study has been to analyze the complexity of the services provided by DH in our hospital in 1996. Therefore, we have analyzed 100 case sheets, regarding medical DHs, selected at random among the DHs performed in the year. Our analysis has evidenced that 67.7% of DHs had only one access and in 37% of accesses only one service has been performed. 31.1% of DHs required only clinical evaluation, laboratory analyses, ECG or chest X-ray. 59% of DHs had diagnostic reasons, only 10% therapeutic reasons. Only in 35 of the 75 patients who used DH (46.6%), DH was the only recovery in the year, the others have been recovered more than one (from 1 to 6). In conclusion, our data show that complexity of DH is low and that DH seems substitute ambulatory services rather than ordinary hospitalization.

The value of the Rivermead Behavioural Memory Test (Children's Version) in an epidemiological study of older adults with Down syndrome.

The Rivermead Behavioural Memory Test for Children (RBMT-C) was used to assess a population-based sample of 74 people with Down syndrome (DS) aged 30 years and over (range 30-65 years) living in the Cambridge health district. Given the high age-specific risk of Alzheimer-like neuropathology in people with DS, the aim of this study was to determine whether this test provided a suitable measure of memory function in an older population of adults with DS who were at the age of risk for Alzheimer's disease. We also investigated whether there was a significant difference in everyday memory performance between different age, gender and day-centre groups. The level of learning disability in our sample ranged from mild, through severe to profound. Individuals with severe or profound learning disability were virtually untestable on this and other cognitive tests, but for the remaining two-thirds of the group, the RBMT-C could be used to assess memory function. Significant differences in memory function were found between younger (30-44 years) and older (45+ years) participants. Performance also varied between groups (e.g. from different day centres), illustrating the importance of population-based samples when determining the value of such tests. Ongoing longitudinal studies are required to establish the extent to which the RBMT-C is useful in assessing change in retrospective and prospective memory.

A study of the characteristics of the dementia patients and caregivers in dementia-nonspecific adult day care programs.

OBJECTIVE: To determine if basic differences exist between the patients and caregivers of a representative group of dementia-nonspecific medical versus social adult day care centers with specific programs for dementia patients. DESIGN: A telephone interview questionnaire survey. SETTING: North Central North Carolina. PARTICIPANTS: A total of 242 adult day care dementia patients and caregivers from three medical and three social nondementia-specific adult day care centers. MEASUREMENTS: Dementia patient variables: Day care subtype (medical or social); length of stay; number of days attended; age; sex; race; educational level; marital status; religious affiliation; income; living status; number of medical conditions; number of prescription medications; function; ADL status (walking, eating, bathing, dressing, grooming, toileting); continence status; number and type of abnormal behaviors; formal help status (hospitalization during day care, part or full-time nursing home attendance, or home healthcare assistance); transportation; and financial assistance. Caregiver variables: day care subtype; age; sex; race; educational level; marital status; religious affiliation; income; number of medical conditions; number of prescription medications; informal help (family friends or other non-paid help); paid help (friend, other, home health, or nursing home); relationship to patient; employment status; and level of caregiver burden. MAIN RESULTS: There were 144 medical and 62 social adult day care dementia patients and caregivers who agreed to participate. The average age of the patient was 77.9 years (SD +/- 8.4), and that of the caregiver was 57.7 years (SD +/- 13.9); 68.4% of the patients and 75.4% of the caregivers were females. Dementia patients in the medical subtype day care had a shorter length of stay than social day care patients; this did not reach statistical significance. There were significantly more white patients and caregivers in the medical than in the social subtype day care, 83.1% versus 50% and 83.3% versus 50.8%, respectively. Dementia patients of the medical subtype also had significantly more education, income, less function, and more symptoms of depression than dementia patients in the social subtype. Dementia patients of the medical subtype also had more abnormal psychological behaviors than their social subtype counterparts, with borderline significance (P = .071). There were more married caregivers in the medical subtype than in the social subtype day care. Caregivers of dementia patients in the medical subtype had significantly more paid help and caregiver burden than did caregivers of dementia patients in the social subtype. CONCLUSIONS: In this study, there appear to be key differences between the dementia patients and caregivers of medical versus social adult day care centers as to demographic and health-related variables. The differences in demographic variables appear to be associated with socioeconomic factors, whereas the decreased function and greater number of depressive symptoms of the medical dementia patients may reflect poorer health as reflected by the greater amount of paid help and increased caregiver burden experienced by the caregivers of medical dementia patients. These findings should be verified in prospective studies.

Ambulatory case mix funding systems in Canada.

The implementation of inpatient case mix funding in Alberta and Ontario does not allow for adequate incentives to shift resources to an outpatient basis, where appropriate, or to provide outpatient care efficiently. This paper explores the prospects and problems of further extending case mix tools into this area. The availability of tools to characterize output for day surgery, special clinics and emergency care is surveyed. We conclude that case mix funding is desirable and feasible for ambulatory surgery; however, it is questionable for emergency care and special clinics. However, developments in this area in the United States will continue, and this will likely maintain an interest in Canada.

Classification of adult day care: a cluster analysis of services and activities.

Using data from a 1986 national census survey of 774 adult day care (ADC) centers, this study (a) determined whether distinct classes of ADC could be identified based on measures of program services and activities, and (b) delineated the distinguishing characteristics of such classes on other available measures of structure, process, and client population. A cluster analysis of 10 "process" measures of services and activities identified 6 classes of ADC centers: Alzheimer's Family Care, Rehabilitation, High Intensity Clinical/Social, Moderate Intensity Clinical/Social, General Purpose, and Low Scoring. Validity was examined by developing a set of expectations for pairs of classes on other available variables. Of 12 expectations, 11 were supported by the statistical tests. Finally, profiles of the 6 classes were developed to describe the classes on 30 other characteristics. The findings clarify the settings to which previous ADC studies are generalizable and indicate a need for effectiveness studies on special classes of ADC.

Adult Day Care centres in British Columbia: models, characteristics and services.

Adult Day Care (ADC) is increasingly being recognized as an important sub-system of the continuing care system. This paper reviews models developed in the United States and Britain and compares them, and the services they offer, with centres in British Columbia, Canada. Data on British Columbia are from a study in which all 49 centres in the province provided detailed information about their staffing, operating characteristics, activities and services. The study found B.C. compared favourably in providing services needed by ADC clients. Key differences between the B.C. centres and those in the U.S. and U.K. were: a larger proportion of B.C. centres were not affiliated with any other organization; B.C. centres admitted a range of clients and were less likely to cater exclusively to special needs groups; and, B.C. centres were more likely than centres in the U.S. to provide a number of services such as: dental care, transportation, bathing and physiotherapy.

Partial hospitalization: a review of recent literature.

The author reviews recent studies on the evaluation of partial hospitalization programs in North America and Europe. The lack of a clear definition of partial hospitalization is one of the factors leading to its underutilization, many authorities believe. After discussing the nomenclature and emphasizing the importance of classifying programs by function--day hospitals, day treatment programs, and day care centers--the author reviews the recent literature and makes recommendations in the framework of this nomenclature.