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Short breaks help maintain caring relationships, enabling people to remain living in their own homes and contributing significant economic benefit to public services. However, relatively little is known about the added social value generated by community-based short breaks. To address this evidence gap, we explored the feasibility of using a social return on investment (SROI) evaluation to explore a day support service in North Wales for people living with dementia and their unpaid carers. Following good practice for evaluating complex interventions, we developed a logic model based on the literature and interviews to understand the mechanisms and outcomes of the day support service. Using questionnaires, we quantified outcomes for the current service cohort, which included people living with dementia, unpaid carers, and paid companions. Seven people living with dementia, three unpaid carers, and four companions completed questionnaires. By following the SROI analysis approach, three key learning points were identified. The first was around ways to capture outcomes from all stakeholder subgroups expected to experience material change. The second concerned the importance of collecting longitudinal data. This included the need to consider how to adapt the SROI method to work with small populations. The third concerned how to value "maintenance" of wellbeing as well as improved wellbeing. [ABSTRACT FROM AUTHOR]

Older care recipients living at home increasingly rely on support from informal caregivers. As informal caregivers often combine these caregiving tasks with other tasks, such as paid work, they are at risk of becoming overloaded. To decrease informal caregiver burden, different forms of support are available that also affect older care recipients' lives, such as respite care, technology, or home care. The aim of this qualitative study was to obtain more insight into the perceptions, potential concerns and preferences of older informal care recipients about the use of support to relieve informal caregivers. We performed a story completion writing task among 23 informal care recipients aged 65 years or older, using hypothetical situations to let them reflect on different caregiver relief support options. The task was followed-up by a story-mediated interview. We used thematic analysis to inductively analyze story completions and interviews. We found that older informal care recipients were often willing to use support to relieve their caregivers, to ensure their wellbeing. However, they were also concerned about how the use of such support may conflict with their interests, preferences and values (e.g. respect for their autonomy, privacy, having a trusting relationship with a caretaker, paying attention to human aspects in care). Older adults were most hesitant to use adult day care facilities and technological support options. While these areas of tensions cannot always be completely resolved, it is important to jointly identify and discuss these, and work towards solutions to balance the respective interests, values and needs of older adults and caregivers. Health and social care professionals and older adults' personal networks may help in overcoming hesitation to use support. [ABSTRACT FROM AUTHOR]

Day centres are increasingly being established, as many older persons are isolated and in need of meaningful activities and social interaction with others. Previous research has shown that day centres are still an important arena for older attendees to socialise and engage in meaningful activities, although day centres are increasingly introducing activities as part of rehabilitation programmes to enhance physical and mental enablement. However, little is known about what attendees and staff regard as meaningful activities. Based on a multi‐site ethnographic investigation at four day centres in Denmark and Norway in 2018 and 2019, this article examines how staff and attendees alike 'utilise' day care centres to pursue meaningful activities and what is considered meaningful for those attending and working there. Furthermore, this article discusses the potential for person‐centred care in communities like day centres. Our study shows that activities are first and foremost perceived as meaningful if they enhance an enjoyable social dimension with 'a touch of fresh news'. Hence, day centres function as a social space where elderly attendees can share stories and news based on personal experiences from the past and present. Consequently, person‐centred care in day care centres preferably facilitates communities to give attendees something new and refreshing to bring back home with them—and not only facilitate personal histories, preferences and wishes. [ABSTRACT FROM AUTHOR]

Compassion has been suggested as a relevant variable for understanding dementia caregivers' psychological distress. The objectives were to analyse the psychometric properties of the Caregiving Compassion Scale (CCS) and to explore the association between caregivers' compassion and their emotional health. Two hundred and thirty‐six dementia caregivers were evaluated for compassion, depressive symptoms, guilt, ambivalence, care‐recipient's functional and cognitive status, frequency of behavioural problems and desire to institutionalise the care‐recipient. Exploratory factor analyses, correlations and regression analyses were done. Two factors were obtained. The factor labelled "Distress from witnessing the care recipient suffering" was associated with higher stress linked to witness depressive problems in the care‐recipient and with caregivers' ambivalence and guilt levels. The factor labelled "Motivation/disposition for helping" was associated with less desire for institutionalisation, and it showed a negative association with ambivalence and guilt feelings. The CCS seems to be a valid and reliable scale for assessing compassion in dementia caregivers. [ABSTRACT FROM AUTHOR]

The growing number of people living with dementia will result in increased costs of dementia worldwide. The e‐Health intervention 'Exergaming' may improve health and quality of life of people with dementia, but the cost‐effectiveness is unknown. We assessed the cost‐effectiveness of exergaming compared to regular activities from a societal perspective in day‐care centres (DCC) for people with dementia and their informal caregivers (IC) alongside a cluster randomised controlled trial. We included 112 dyads (person with dementia and IC) from 20 psychogeriatric DCCs (11 exergaming, 9 control) across the Netherlands. Exergaming consisted of interactive cycling at least twice a week for 6 months. Measurements were conducted at baseline (T0), after 3 (T1) and 6 (T2) months. Primary outcomes were minutes of physical activity, mobility of the participants with dementia (Short Physical Performances Battery, SPPB), and Quality‐Adjusted Life‐Years (QALYs) of participants with dementia and ICs. ICs filled out cost diaries to measure healthcare and informal care utilisation during the study. There were no statistically significant differences in outcomes or costs between the groups at the level of participants with dementia, the ICs or the dyad. With regard to QALYs and SPPB, the probability that exergaming is cost‐effective compared to control was low for all possible willingness‐to‐pay (WTP) thresholds. However, for physical activity at WTP thresholds of 0, 50 and 250 Euros per additional minute of physical activity, the probability of cost‐effectiveness is 0.46, 0.84 and 0.87, respectively. Exergaming in DCC was not cost‐effective compared to usual activities. However, considering the small sample size and the large number of missing observations, findings should be interpreted with caution. Future studies with larger samples are recommended to obtain definitive answers on the cost‐effectiveness of exergaming. This trial was registered in the Netherlands Trial Register (NTR5537/NL5420). [ABSTRACT FROM AUTHOR]

There is a focus on how to provide care for the increasing number of people with dementia, and day care services have been highlighted as an important service. The present study aims to provide an in‐depth comparison of the emotional well‐being of participants at farm‐based and regular day care services related to different aspects of the care environments. We used the Maastricht Electronic Daily Life Observation‐tool to observe and register aspects of the care environment at the services. Observations took place at ten farm‐based day care services, with 42 participants, and seven regular day care centres, with 46 participants. Observed mood was considered an indicator for the emotional well‐being of the participants and used as the primary outcome. The analyses showed a general positive mood for all participants, regardless of type of day care service. The unadjusted analyses showed more emotional well‐being for the participants at farm‐based day care across a range of factors compared to regular day care. The linear mixed model found that regardless of service type the activities (1) exercise and dancing, and (2) quiz, music and spiritual activities were associated with emotional well‐being. In addition, social interaction, either with one person or two or more people, were also associated with emotional well‐being regardless of service type. The mixed model further demonstrated an association between attending farm‐based day care services and positive mood compared to regular day care services. Based on the findings social interaction and social activities seem important to emotional well‐being. This highlights the social aspect of the day care services and future research should investigate how one can facilitate good social interactions at day care services. The positive association between farm‐based day care services and emotional well‐being may potentially reflect a positive influence of the farm setting and the farm service providers. [ABSTRACT FROM AUTHOR]

In addition to palliative care delivery at home or in hospital, palliative day care centres occupy an in‐between position in palliative care. In palliative day care centres, multidisciplinary teams provide holistic care and support for people with (chronic) life‐limiting conditions, or clients, in a homely surrounding, allowing them to remain living at home while attending a specialist palliative care service. This study aims to evaluate palliative day care centres from a user perspective. We conducted a full‐population cross‐sectional survey of clients (N = 86) and their family caregivers (N = 63) in all five palliative day care centres in Flanders, Belgium from January until December 2019. We used validated instruments supplemented with self‐developed items to measure participants' reasons for use, support provided, unmet support needs and added value to other (palliative) care services across palliative care domains, i.e., physical, psychological, social and spiritual care. Response rate was 77% for clients and 81% for family caregivers. The most often indicated reasons for use were that the client needs social contacts (clients: 73%, caregivers: 65%), to enable the client to live at home as long as possible (resp. 58%, 55%) and to reduce the family caregiver's mental burden (resp. 42%, 65%). Three out of four family caregivers felt better able to combine daily activities with caring for the client (77%) and felt better able to perform their family care‐giving tasks (77%) because the client attends the palliative day care centre. Thirty‐six per cent of clients had received support for social needs exclusively in the palliative day care centre and not from any professionals outside palliative day care. Palliative day care centres seem to be of added value for those care domains to which often less attention is paid in other settings, particularly social and emotional support, both for clients and family caregivers. [ABSTRACT FROM AUTHOR]

The objectives of the study were (a) to compare self‐reported Quality of Life (QoL) in a 24‐month follow‐up of people with dementia attending day care designed for people with dementia (day‐care group, DC) with people with dementia who did not attend day care (control group, CG) and (b) to explore factors associated with QoL. A quasi‐experimental design with a 24‐month follow‐up period was used. The DC group included 181 participants recruited from 53 day‐care services. The CG included 76 participants recruited from 19 municipalities with no available day care designed for people with dementia. The sample covered the four health regions of Norway and inclusion period lasted from December 2013 to July 2015. The Quality of Life in Alzheimer's Disease (QoL‐AD) scale was used as the outcome measure. The differences in QoL between groups and the associations between participant characteristics and QoL, such as depressive symptoms and functional dependency, were examined using a linear mixed model. In the multiple model, the overall trend in QoL did not differ significantly between the DC and CG. However, the DC group exhibited significantly higher self‐reported QoL than the CG at all time points (p < 0.001 at T0, p = 0.018 at T12, and p = 0.006 at T24). Participants with shallow or no awareness who attended day care had significantly higher scores on QoL‐AD than persons with full awareness (p = 0.017). More depressive symptoms (p < 0.001) and higher functional dependency (p < 0.001) were associated with lower self‐reported QoL. The study revealed higher scores of self‐reported QoL among people attending day care compared with those who did not attend, showing that day care might have positive impact on the lives of people with dementia. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify how the family care of people living with dementia could be supported to make reliance on family care sustainable in the long term despite the impact of stress. A Realist Evaluation (Pawson & Tilley, 1997) was conducted to investigate this aim. An initial review established 'coping' as a primary means of mediating stressors associated with caregiving. However, there was a need to specify which coping approaches/strategies are most effective. In‐depth interviews were conducted with a purposive sample of family carers (n = 18) in a suburb in North East England from 2016 to 2017. Analysis of the data revealed 'social coping' (SC) that included an emotional support component as a critical mediator of family carer stress. Several key hindrances to the utilisation of SC, including underpinning causal factors, are explicated. Ways in which these hindrances might be overcome are discussed and guidelines introduced for how family carers, formal providers and practitioners can facilitate SC as a critical coping strategy in sustaining the family care of people with dementia over the long term. [ABSTRACT FROM AUTHOR]

Population ageing resulting from declining fertility and extended life expectancy has been occurring rapidly throughout the world. Older adults are faced with multiple physical, psychological and social changes that challenge their sense of self and capacity for healthy ageing. Intergenerational programmes (IGP) in communities have been developed to address a variety of social issues brought about by the population ageing. These programmes focus on promoting intergenerational social contact, supporting educational programmes and facilitating intellectual and/or physical activities in the older adults. This study intended to explore the perception of community‐dwelling older adults towards an IGP in a senior day care centre in Singapore. Purposive sampling was adopted to recruit 15 participants for the study. Individual face‐to‐face interviews were conducted until data saturation was achieved. Interviews were audio‐taped and transcribed verbatim. Thematic analysis was carried out. Four themes and 13 sub‐themes emerged: (1) IGP enhances memory and strength; (2) social interaction between older adults and younger generation; (3) emotional responses to IGP; and (4) attitudes and perception towards the younger generation. The current study illustrated the dynamic social interaction between older adults and the younger generation, as well as the perceived benefits of the IGP. The relationship formed between the two generations entailed companionship, mutual care, trust and affection. Participation in the IGP provided the older adults an opportunity for active engagement in society and development. Continuous effort must be put in to ensure continuity of integration and empowerment of older adults, including the removal of obstacles and barriers that exclude or discriminate against them. The study findings will help facilitate the customisation of IGP to meet the needs of the older adults. With a well‐planned and structured IGP, significant physical, emotional and psychosocial outcomes could benefit the older adults and the younger generation. [ABSTRACT FROM AUTHOR]

There is a lack of robust evidence regarding outcomes for day care use among older people living with long‐term conditions (LTCs). Day care is provided by independent, private and voluntary and charitable sectors. This systematic review aims to establish current evidence of outcomes for older people with LTCs attending day care services and outcomes on carers, across all service models. Narrative synthesis of quantitative and qualitative data was undertaken. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. A systematic literature search was carried out across eight electronic databases and reference lists of key journals between 2004 and October 2020 were searched. Searches returned 1,202 unique titles. Forty‐five articles from 16 countries met the criteria on review of title, abstract and full article. There is limited evidence suggesting improved levels of perceived psychological health, quality of life, perceived general health, physical health and functioning for older people attending day care who have LTCs. The respite function of day care resulted in positive outcomes for carers. Studies evaluating outcomes for participants or carers were limited in quantity and quality. There is limited information regarding outcomes for day care attendance for older people with multiple LTCs from existing literature. Further research focusing on LTCs and day care attendance would benefit this field. [ABSTRACT FROM AUTHOR]

People with dementia should be able to live in the community, and day care services are recommended as a means for people to live in their own homes for as long as possible. In this study we wanted to compare the quality of care at one type of small‐scale day care situated at community farms to regular day care provided in connection with residential care facilities for elderly people. A total of 42 participants from 10 farm‐based day care offers and 46 participants from seven regular day care offers were included. A qualitative observational design using the validated Maastricht Electronic Daily Life Observation tool was used. The data were collected between March and June 2018. Ecological momentary assessments of the activities taking place, level of engagement, physical effort, location, social interaction and mood were conducted while the participants attended their day care offer. The results showed that familiar daily activities were common at farm‐based day care, and a linear mixed model analysis showed that farm‐based day care attendees used more physical effort, spent more time outdoors, had more social interaction and experienced more positive mood compared to regular day care attendees. These findings contribute with valuable information about care provided at different types of day care services, and indicate that farm‐based day care has more activities with the potential to meet the social and activity needs of people with dementia compared to regular day care. There are two main implication of this study. First, regular day care services should focus on including more familiar daily activities found to be important for attendees' sense of identity and feelings of contributing. Second, regular day care services should utilise the potential of available outdoor areas as time spent outdoors has been found to facilitate physical activity, relaxation, health and well‐being. [ABSTRACT FROM AUTHOR]

Singapore is a tropical country with a high density of day‐care facilities whose indoor environments may be adversely affected by outdoor fine particle (PM2.5) air pollution. To reduce this problem requires effective, evidence‐based exposure‐reduction strategies. Little information is available on the penetration of outdoor PM2.5 into day‐care environments. Our study attempted to address the following objectives: to measure indoor infiltration factor (Finf) of PM2.5 from outdoor PM2.5 and to determine the building parameters that modify the indoor PM2.5. We collected indoor/outdoor 1‐min PM2.5 from 50 day‐care classrooms. We noted mean Finf ± SD of 0.65 ± 0.22 in day‐care rooms which are naturally ventilated and lower Finf ± SD values of 0.47 ± 0.18 for those that are air‐conditioned: values which are lower than those reported in Singapore residences. The air exchange rates were higher in naturally ventilated rooms (1.47 vs 0.86 h−1). However, fine particle deposition rates were lower for naturally ventilated rooms (0.67 ± 0.43 h−1) compared with air‐conditioned ones (1.03 ± 0.55 h−1) presumably due to composite rates linked to the filters within the split unit air‐conditioners, higher recirculation rates, and interior surfaces in the latter. Our findings indicate that children remaining indoor in daycares where air‐conditioning is used can reduce their PM2.5 exposures during outdoor pollution episodes. [ABSTRACT FROM AUTHOR]

Farm‐based day care for people with dementia is supposed to improve the participants quality of life by using activities and resources of the farm environment to promote mental and physical health. In this paper, we describe the characteristics of those attending farm‐based day care services in Norway and explore the association between individual and farm characteristics and the quality of life. A sample of 94 people with dementia who attended farm‐based day care was recruited from 25 farms between January 2017 and January 2018. The data collection was performed using standardized instruments. Information about the farms was retrieved from a former study. The association between the participants' quality of life and their individual and/or farm characteristics was examined with a linear multilevel regression model. The participants had a mean age of 76 years, 62% were men, and 68% had additional education after primary school. Most of them had mild (54.3%) or questionable dementia (18.3%). A few participants used antipsychotics (3.7%), tranquilizers (9.9%) and painkillers (13.6%), while a higher number used antidepressants (30.9%). Quality of life was associated with the experience of having social support (p =.023), a low score on depressive symptoms (p <.001), and spending time outdoors at the farm (p <.001). The variation between the farm‐based day care services in the participants' reported quality of life was related to time spent outdoors at the farm. In light of the present study, it seems as farm‐based day care is addressing people with dementia in an early stage, dominated by men, with quite good physical and medical condition. The strong association between quality of life and spending time outdoors underscores that facilitation for outdoor activity should be prioritized in all types of dementia care. [ABSTRACT FROM AUTHOR]

Objective. Nature has a significant impact on general well-being. However, till date, little psychophysiological evidence is available on the benefits of nature-based activities in adults. The primary goal of this study was to determine the physiological and psychological benefits of horticultural activity in adults. The participants were instructed to perform the making of a flower basket (horticultural activity) and a computer task (i.e., control activity) was compared. Methods. A total of 40 Chinese females (mean age 22.2 ± 0.9 years) participated in this experiment. The Blood pressure, the State-Trait Anxiety Inventory (STAI), and the electroencephalograms (EEGs) were used to measure the participants' psychophysiological responses. Results. Analysis of the STAI data showed a lower anxiety score after performing the horticultural activity than after performing the control activity. Furthermore, in the EEG evaluation, variations in the brainwaves were observed after both activities. Conclusions. The study results suggest that horticultural activity induced physiological and psychological relaxation in adults. [ABSTRACT FROM AUTHOR]

Studies conducted in nursing homes/hospitals have shown that organizational culture plays an important role in care delivery and group culture leads to better quality of care. To explore the organizational culture and care delivery in adult day services (ADS) centers in Taiwan, we used both quantitative and qualitative research methods. Quantitative data from the Competing Values Framework (CVF) assessment showed that the group culture was dominant at all three centers. Qualitative data from observation and staff interviews uncovered both group and nongroup cultural elements. The group cultural elements, such as flexible management, teamwork environment, and sharing the same values, contributed to good care; however, the nongroup cultural elements, such as the staff-centered view, hierarchy, and conflicts within the leadership, led to negative staff-staff and staff-clients interactions. Further research is needed to untangle the complexity between quality care delivery and organizational culture. [ABSTRACT FROM AUTHOR]

Importance. Psychological factors and glaucoma knowledge are closely related to the effects of glaucoma treatment. Background. Studies comparing anxiety and depression levels and glaucoma knowledge between glaucoma day-case patients and inpatients are limited. Design. Randomized clinical trial. Participants. Consecutive patients undergoing surgery were prospectively enrolled. Methods. Patients were randomized into the day-case group or the inpatient group. All of the patients underwent corresponding procedures for treatment, care, and education. All participants were asked to complete the General Condition Questionnaire, the Hospital Anxiety and Depression Scale (HADS), and the Gray Glaucoma Knowledge Questionnaire (GGKQ) at admission and the HADS and GGKQ at discharge. Main Outcome Measures. The scores for the General Condition Questionnaire, the HADS, and the GGKQ. Results. In total, 216 patients were enrolled in this study, including 119 day ward patients and 97 inpatients. There were no significant differences between the two groups in terms of their baseline demographic and clinical data (P>0.05). The baseline HADS-anxiety (HADS-A), HADS-depression (HADS-D), and GGKQ scores were similar in both groups (P>0.05). Before discharge, the difference in HADS-A scores between the two groups was not significant; however, the HADS-D scores of the day-case inpatients were significantly lower (α = 0.05, P<0.001), and the GGKQ scores of day-case inpatients were significantly higher than those of the inpatients before discharge (α = 0.05, P<0.001). Conclusions and Relevance. Day ward patients had lower levels of depression and higher levels of glaucoma knowledge. [ABSTRACT FROM AUTHOR]

To date, exposure studies linking dust‐mite allergens with asthma and allergic morbidities have typically relied on sampling from representative locations in the home for exposure assessment. We determine the effects of differing microenvironments allergen exposures on asthma and asthma severity among 25 case and 31 control preschool children in Singapore. Blo t 5 allergen levels in various niches from the children's home and day‐care microenvironments as well as their Blo t 5 time‐weighted concentrations were determined. Eosinophilic cationic protein (ECP) levels from the children's saliva as markers for airway inflammation were obtained. Salivary ECP levels were higher in children with asthma than those without and the strength of association increased with higher salivary ECP levels. Although there was no relationship between time‐weighted Blo t 5 concentrations with salivary ECP levels among the controls, a positive statistically significant relationship was noted among cases, demonstrating the effects of cumulative exposure on asthma severity. Avoidance measures to reduce Blo t 5 allergen exposure should include all microenvironments that asthmatic children are exposed throughout the day. [ABSTRACT FROM AUTHOR]

Cognitive impairments (CI), associated with the consequences of Alzheimer's disease and other dementias, are increasingly prevalent among older adults, leading to deterioration in self-care, mobility, and interpersonal relationships among them. Innovative Assistive Technologies (IAT) such as electronic reminders and surveillance systems are considered as increasingly important tools to facilitate independence among this population and their caregivers. The aim of this study is to synthesise knowledge on facilitators and barriers related to acceptance of and use of IAT among people with CI and their caregivers. This systematic review includes original papers with quantitative, qualitative, or mixed methods design. Relevant peer-reviewed articles published in English between 2007 and 2017 were retrieved in the following databases: CINAHL; PubMed; Inspec; and PsycINFO. The Mixed Method Appraisal Tool (MMAT) was used for quality assessment. We retrieved thirty studies, including in total 1655 participants from Europe, USA/Canada, Australia, and Asia, enrolled in their homes, care-residences, day-care centres, or Living Labs. Two-thirds of the studies tested technologies integrating home sensors and wearable devices for care and monitoring CI symptoms. Main facilitators for acceptance and adherence to IAT were familiarity with and motivation to use technologies, immediate perception of effectiveness (e.g., increase in safety perceptions), and low technical demands. Barriers identified included older age, low maturity of the IAT, little experience with technologies in general, lack of personalization, and support. More than 2/3 of the studies met 80% of the quality criteria of the MMAT. Low acceptance and use of IAT both independently and with caregivers remains a significant concern. More knowledge on facilitators and barriers to use of IAT among clients of health care and social services is crucial for the successful implementation of innovative programmes aiming to leverage innovative technologies for the independence of older people with CI. [ABSTRACT FROM AUTHOR]

Aim: To increase our understanding of challenges in implementing multidisciplinary organisational models in hospitals. Background: Health‐service policies internationally are pushing for multidisciplinary and patient‐centred organising models but there are challenges involved in moving from profession‐ and discipline‐based organising to the new solutions. Method: Qualitative case study, interview and document data collected in real time following the implementation process. Results: It was possible to argue for and against the new department applying either a business‐like logic or a professional logic. The respective logics gave different prescriptions for how a hospital department should be organised. Conclusion and Implications for Nursing Management: The institutional logics perspective enables managers to understand resistance to new ways of organising work and may be useful in trying to foresee and handle challenges in implementing new organisation models. Managers need to analyse models carefully in terms of which parts may be seen as problematic in their own organisation, and invite all relevant stakeholders into participatory change processes. If the goal is to gather multiple professions and disciplines under one manager in order to increase patient centredness, arrangements must be made for professionals to stay connected to the wider community of practice centred around their specialized knowledge and skills. [ABSTRACT FROM AUTHOR]

Studies have examined the impact of environments on long-term care residents’ quality of life; however, environment gets little attention in adult day services (ADS). The current study gives voice to clients and staff by capturing their perceptions of the physical and social environments of their ADS centers. Data were collected from 23 interviews with staff and clients and 270 hours of participant observations at two ADS centers in Taiwan. The authors triangulated field notes with interview transcriptions and analyzed them with the Grounded Theory coding procedure method. Findings reveal clients’ and staff members’ perceptions of appropriate and inappropriate physical and social environmental features affecting quality of life at the center and reflecting Taiwanese culture. We address how perceived appropriate features can be sustained or replicated and how perceived inappropriate influences can be remedied. Results can be translated into action research by implementing supportive environments for both staff and clients at ADS centers. [ABSTRACT FROM AUTHOR]

Individuals managing the challenges of life‐limiting illness require adequate social support to maintain quality of life. Qualitative research reports that patients value highly the social support obtained in palliative care interventions such as day care and group therapies. This systematic review aims to summarise existing quantitative evidence on palliative care interventions that facilitate social support. Research literature was systematically searched using electronic databases and key journals. Searches returned a total of 6,247 unique titles of which sixteen were eligible for inclusion. Interventions include group therapies, group practical interventions and palliative day care. Outcome measures and study designs were heterogeneous. Only one study used a validated outcome measure of social support. Benefits were influenced by participant characteristics such as baseline distress. Partial economic evaluation was attempted by two studies. Methodological challenges include attrition and use of outcome measures that were insensitive to change. Statistically significant results were reported in psychological and physical domains. Evidence is limited due to methodological issues and a scarcity of quantitative research, particularly regarding long‐term benefits and cost‐effectiveness. Interventions may be more beneficial to some groups than others. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the efficacy of ketorolac with local anesthesia compared to local anesthesia alone for perioperative pain control in day care retinal detachment surgery. The randomized controlled trial included 59 eyes of 59 participants for retinal detachment surgery who were randomly assigned (1 : 1) into the ketorolac (K) group and control (C) group. All participants underwent conventional local anesthesia while patients in the K group received an extra administration of preoperative ketorolac. Participants in the K group had a statistically significantly lower intraoperative NRS score (median 1.0 versus 3.0, P=0.003), lower postoperative NRS score (median 0 versus 1.0, P=0.035), fewer proportion of rescue analgesic requirement (10% versus 34.5%, P=0.023), and lower incidence of postoperative nausea and vomiting (13.3% versus 41.4%, P=0.015) compared to the C group. Intraocular pressure (IOP) changes (△IOP) were significantly reduced in the K group (median 1.9 versus 3.0, P=0.038) compared to the C group 24 hours postoperatively. In conclusion, the combination of local anesthesia with ketorolac provides better pain control in retinal detachment surgery compared to local anesthesia alone. The beneficial effect of ketorolac with local anesthesia may contribute to a wider-spread adoption of day care retinal detachment surgery. This trial is registered with ClinicalTrials.gov NCT02729285. [ABSTRACT FROM AUTHOR]

Many European welfare states are replacing comprehensive welfare schemes with selective and conditional entitlements. Such changes affect the recognition of vulnerable citizens' needs, which are increasingly framed as private responsibilities to be met by the voluntary sector. Repeated interviews with 30 clients affected by cutbacks to publicly financed (day)care in the Netherlands show that although disabled and elderly citizens are often hesitant to open their doors to volunteers, they do experiment with voluntarism to reduce their social isolation, both by receiving voluntary care and by engaging in volunteer work themselves. However, the turn to voluntarism does not always prompt recognition of the needs of vulnerable citizens. This study signals how disappointing and sometimes demeaning experiences with volunteers can increase feeling of misrecognition. We conclude that the virtues of voluntarism may be overstated by policy makers and that the bases of recognition should be reconsidered as welfare states implement reform. [ABSTRACT FROM AUTHOR]

The combination of growing demand for long-term care and higher expectations of care staff needs to be set in the context of long-standing concerns about the sustainability of recruitment and retention of front-line staff in the United Kingdom. Organisational and work environment factors are associated with vacancy levels and turnover rates. The aim of the current analysis was to investigate changes in turnover and vacancy rates over time experienced by a sample of social care employers in England. Taking a follow-up approach offers potentially more accurate estimates of changes in turnover and vacancy rates, and enables the identification of any different organisational characteristics which may be linked to reductions in these elements over time. The study constructed a panel of 2964 care providers (employers) using 18 separate data sets from the National Minimum Data Set for Social Care during 2008-2010. The findings indicate slight reductions in vacancy rates but the presence of enduring, high turnover rates among direct care workers over the study period. However, the experience of individual employers varied, with home-care providers experiencing significantly higher turnover rates than other parts of the sector. These findings raise questions around the quality and motivations of new recruits and methods of reducing specific vacancy levels. At a time of increased emphasis on care at home, it is worthwhile examining why care homes appear to have greater stability of staff and fewer vacancies than home-care agencies. [ABSTRACT FROM AUTHOR]

Purpose: Short‐term group cognitive‐behavioral therapy (GCBT) with weekly homogeneous group sessions for treating specific anxiety disorders is relatively well developed and recognized. However, 12 weeks of intensive daily therapy for mixed anxiety and personality disorders is not. The current article aims to fill this gap by presenting the method of intensive transdiagnostic GCBT for anxiety disorders with comorbid personality disorders in a day hospital setting. Preliminary studies showed that participants exhibited significant improvement during this type of treatment. Conclusions: This article reviews the advantages of group therapy that is transdiagnostic over the homogeneous group and individual therapy formats. Practice Implications: The detailed description of the current therapeutical program may facilitate the development of similar programs in day clinic settings. [ABSTRACT FROM AUTHOR]

The majority of people with dementia live at home, and informal carers assume the role of key care providers, often supported by formal services. The purpose of this pilot study was to assess home-based care arrangements, to illustrate utilisation of formal services over time and to identify factors associated with perceived stability of the care situation from the informal carer's perspective. A self-administered questionnaire (D- IVA 'Instrument for Assessing Home-Based Care Arrangements for People with Dementia') was developed and distributed in a provincial-rural setting in Germany as a cross-sectional survey. Data analysis used descriptive statistics, unbiased conditional inference trees and thematic analysis for open-ended questions. In total, 84 care arrangements were assessed. The majority of participants were direct relatives of the care-dependent person [mostly adult children (48.8%) or spouses (27.4%)]. Formal services were already sought in the first year after onset of memory problems. The most frequently used formal services were home care nursing services (53.0%), day care (49.4%) and respite care (29.6%), whereas 15.5% did not use any type of formal support. Companion home visit, home care nursing service and day care were used over the longest periods of time. The recruitment strategy used in this study may have recruited persons who were relatively more dependent on their informal carers. In this small sample, carers' perceived stability of the care situation was high, and this was associated with the country of origin and sex of the person with dementia ( P = 0.004 and 0.023 respectively). Most care arrangements consisted of a mix of informal and formal services. However, informal carers assumed prime responsibility. The questionnaire D- IVA proved to be suitable. It remains a challenge to further examine factors associated with perceived stability and to explain the phenomenon in its whole complexity. Further research using the D- IVA should consider applying complementing quantitative measures as well as qualitative methods. [ABSTRACT FROM AUTHOR]

Power training has been proposed as a more effective type of resistance training for older adults for functional performance. It is not yet known whether older adults respond appropriately to instructions for power versus strength training. The purpose of this study was to determine the velocity during strength and power training, with elastic resistance bands, in older adults attending a geriatric rehabilitation day program. It was hypothesized that power training would be faster than strength training, but that there would be large interindividual differences. Nine older patients (70 to 86 years) performed power and strength training of the ankle dorsiflexor and plantar flexor muscles using elastic resistance bands. Training sessions were filmed to assess the velocity of training. Power training occurred at faster velocities as compared to strength training (P<0.01) for both muscle groups. However, a wide variation was observed between participants in the training velocities. Older adults attending geriatric rehabilitation do have the potential to develop faster contractions during power training as compared to strength training. Nevertheless, the actual velocities achieved differed between individuals. This could explain some of the mixed findings of studies on power training. Hence, researchers should monitor velocity when comparing different types of resistance training. [ABSTRACT FROM AUTHOR]

Respite care is a cornerstone service for the home management of people with dementia. It is used by carers to mitigate the stress related to the demands of caring by allowing time for them to rest and do things for themselves, thus maintaining the caring relationship at home and perhaps forestalling long-term placement in a residential aged care facility. Despite numerous anecdotal reports in support of respite care, its uptake by carers of people with dementia remains relatively low. The aim of this paper was to examine the factors that constitute the use of respite by carers of people with dementia by reviewing quantitative and qualitative research predominantly from the years 1990 to 2012. Seventy-six international studies of different types of respite care were included for this review and their methods were critically appraised. The key topics identified were in relation to information access, the barriers to carers realising need for and seeking respite, satisfaction with respite services including the outcomes for carers and people with dementia, the characteristics of an effective respite service and the role of health workers in providing appropriate respite care. Finally, limitations with considering the literature as a whole were highlighted and recommendations made for future research. [ABSTRACT FROM AUTHOR]

This article reports the findings from a literature review of day care services undertaken during March-June 2012 and repeated in May 2013. The databases searched included AgeInfo, Embase, Medline, PsycINFO, Social Care Online, Web of Science and the publication platform Ingenta Connect as well as specialist older people's sites. It discusses these findings in the context of services for older people in the UK, defined as those aged 65 years and over. The aim of the scoping review was to identify what is known about how day services (here confined to congregate day care or day centres) will meet the challenges posed by the Equality Act 2010 in supporting different user groups, such as lesbian, gay, bisexual and transgender older people or older people from minority ethnic groups. The review found that research on all aspects of day services was limited and that information about older people using such services was often provided context-free. It concludes that those funding or evaluating day services' support to diverse groups of older people need to urgently address matters such as differential access and differential views about specific services. [ABSTRACT FROM AUTHOR]

The job satisfaction of live-in foreign domestic helpers ( FDHs) may influence their caring motivation and the quality of care they provide, which may in turn affect the health status of care recipients. This study identifies the factors affecting job satisfaction of FDHs caring for people with dementia in Hong Kong, focusing especially on the role of FDHs' adaptation status, job self-efficacy and care recipients' situation. A total of 152 FDHs taking care of people with dementia were recruited from 6 day care centres for elderly people in Hong Kong when they attended with their care recipients. Data were collected from February to August 2011 and the response rate was 95%. Participants completed questionnaires which included measures of care recipients' dementia severity and disruptive behaviours, FDHs' demographic factors, personal adaptation status, caregiving self-efficacy and job satisfaction. Hierarchical regression analysis was conducted to analyse the data. The results showed that longer stay in Hong Kong, better fluency in Cantonese (local dialect), greater satisfaction in living conditions, higher caregiving self-efficacy and less disruptive behaviour of care recipients were independently associated with stronger job satisfaction in FDHs looking after people with dementia. On the basis of these findings, we would suggest that employers should consider helpers who have been in Hong Kong for a longer period of time and speak fluent Cantonese, and have previous experience of taking care of people with dementia. In addition, FDHs caring for people with dementia may benefit from carer training which improves their self-efficacy in dementia care. [ABSTRACT FROM AUTHOR]

This study was designed to focus on the patient perspective in a reorganisation of care processes at a cancer day care unit (CDU). The effects of dose banding and of taking blood samples one day (or more) before the day care treatment (on Day −1) are investigated in terms of throughput efficiency and perceived service quality. Data were collected by mapping patient processes in detail and surveying patients in two CDUs at a university hospital (n = 308). A univariate model was used to investigate the effect of these factors on patient throughput time, and perceived service quality was examined with multiple linear regression. Taking blood samples on Day −1 decreases patient throughput time and increases the perceived service quality by improving the patient's perception of technical expertise and the outcome. This has a globally positive effect on patients' perceived service quality. Dose banding affected neither patient throughput time nor perceived service quality. Taking the pretreatment blood sample on Day −1 can be considered an important process design characteristic, as it increases both efficiency and service quality. [ABSTRACT FROM AUTHOR]