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Nearly 30 years after the 1993 National Institute of Health (NIH) Revitalization Act, which required the inclusion of women and racial/ethnic minority groups into government-funded clinical trials, minority groups remain underrepresented in research, and disparities in health outcomes and longevity remain. These problematic trends are particularly evident when considering Black and community-based research in Alzheimer's disease and related dementia (ADRD). Deeply rooted historical race-based mistreatment in research and in the health care system at large along with ineffective recruitment approaches persists as barriers to the low participation of Black participants in dementia care studies. In this article, we explore Critical Race Theory, its tenets, and applicability to inform national strategies to encourage participation of Black participants in ADRD research. We describe how Critical Race Theory constructs (e.g., race consciousness, storytelling, and praxis) can be used to inform recruitment strategies of Black caregivers for people living with dementia into community-based research. We provide a case example that draws upon our NIH-funded Adult Day Service Plus randomized trial and its engagement of Black caregivers into a community-based biomarker research arm of the main trial. Although the contribution of this article is primarily theoretical, in the spirit of Critical Race Theory it is also a call for action to transform dementia care research by offering a conceptual tool to assure inclusivity of Black participants, who are disproportionately affected by dementia when compared to other racial groups., (© The Author(s) 2022. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

An understanding of adult day service centers' (ADC) impacts on clients' health and well-being has been hampered by a lack of large-scale data. Standardizing data collection is critical to strengthening ADC programs, demonstrating their effectiveness, and enabling them to leverage additional funding streams beyond Medicaid. We distributed an electronic survey on current data collection efforts to ADCs nationally to determine categories of data ADCs are collecting related to clients' health. In our sample ( N = 248), only 32% of ADCs collected patient-level data for research and analysis-most commonly on activities of daily living, cognition, nutrition, and caregiver strain. However, validated assessment tools were used in less than 50% of the cases. ADCs are willing to collect data: More than 70% reported a willingness to participate in future studies. National studies piloting data collection protocols with uniform outcome measures are needed to advance the understanding of ADCs' capabilities and impacts.

Objectives: Within an implementation study, we investigated the effectiveness of a combined community-based day care programme for persons with dementia and their carers versus traditional psychogeriatric nursing home-based day care. The effects on needs, sense of competence, burden and quality of life of the family carers were studied., Methods: A pretest-posttest control group design among family carers of people with dementia who joined community-based day care centres ( n  = 67) or nursing home-based day care centres ( n  = 64)., Results: After six months, family carers using community-based day care more often expressed an unmet need for support regarding psychological distress than carers utilising nursing home-based day care. No effect of community-based day care on sense of competence was found. However, carers with a low sense of competence at baseline using community-based compared to nursing home-based day care became less emotionally burdened by behaviour and mood problems of their relative. Conclusion and discussion: Overall, no added value of community-based day care on needs, sense of competence, burden and quality of life was found. Increased unmet needs on psychological distress may have been caused by the increased awareness of carers participating in the carer programme of community-based day care regarding their own unmet support needs. For carers with a low sense of competence, community-based day care proves to decrease the impact of behaviour and mood problems of their relative. A larger controlled follow-up study is recommended to understand the long-term effects of community-based day care over nursing home-based day care.

Background and Objective: This study explored Arab American stakeholders' perceptions about potential future adult day programming to inform geriatric service providers about relevant services for culturally diverse older adults. Research Design and Method: Participants ( N = 28) in five focus groups were recruited through a social service provider in Metropolitan Detroit, Michigan. Results were analyzed using thematic analysis. Results: Themes included basic requirements, promoting clear and transparent understanding of adult day programs (ADPs), respecting the person, social engagement and activities, explaining complex ethnic and geographic identities, and implementing diversity. Discussion and Implications: ADP service providers can enhance services by drawing on the life experiences, resilience, and creativity of older Arab Americans. Person-focused policies and programs that draw on the strengths of the diverse local community should be developed and communicated clearly for potential participants, family members, and service providers.

Adult day care (ADC) provides various services for meeting clients' needs. Based on the mini-Delphi method with 46 ADC staff and the discussions with eight ADC administrators, this study developed and finalized a comprehensive logic model to represent the elements of ADC. For the three basic structures of a logic model-inputs/activities, outputs, and outcomes-the model contained seven core categories and 23 sub-categories. The ADC inputs/activities consisted of two core categories: "Place to stay" and "Intervention from staff". These inputs/activities caused two kinds of outputs: "Clients' experiences" and "Families' experiences". "Accumulating experiences" with repeated ADC visits was established as the link between the ADC outputs and outcomes, which were "Clients' change" and "Families' change". ADC centers provide various experiences for their clients and their caregivers, ranging from the fulfillment of needs for fundamental care to psychiatric care and self-actualization. Improving various model-related inputs/interventions can produce better experiences and outcomes. The model can guide ADC administrators, policymakers, and researchers in the evaluation of a heterogeneous ADC service program that is community-based, thereby ensuring optimal care for clients with an efficient use of resources.

Background and Objectives: People with dementia and carers do not always access respite services in a timely manner, or in some cases, at all. Although carers' perspectives on respite access have been explored, other stakeholder perspectives, especially providers and people with dementia, are underrepresented in the existing literature. The aim of this study was to synthesize multiple stakeholders' perspectives, including people with dementia, on accessing respite services in the context of dementia., Research Design and Methods: Purposive maximum variation sampling was used. Semi-structured interviews were conducted with 35 key stakeholders, including people with dementia (n = 6), carers (n = 9), respite frontline staff (n = 4), respite managers (n = 8), primary care professionals (n = 3), and policy-makers/academics (n = 5). The process of consent is outlined. Data were interpreted inductively using thematic analysis. Reflexivity was considered throughout the research process., Results: Three themes ("Service Acceptability," "Navigational Knowledge and Skills," "Constructing and Adjudicating Respite Need") were identified that relate to how access to respite services is negotiated between service providers and dyads., Discussion and Implications: A number of the findings support previous research; however, novel findings discussed relating to the access negotiation process include (a) the ambiguous legitimacy of respite needs, in a system configured to deliver a biomedical model of care and which considers nonmedical care as a family responsibility, and (b) the constraining effects of disparate conceptualizations of "respite" between carers and providers. Future research should interrogate the appropriate boundaries of public responsibility in relation to respite service planning/delivery for dementia, with particular reference to client preferences for community and in-home provision., (© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: There is growing emphasis on empirical validation of the efficacy of community-based services for older people and their families, but research on services such as respite care faces methodological challenges that have limited the growth of outcome studies. We identify problems associated with the usual research approaches for studying respite care, with the goal of stimulating use of novel and more appropriate research designs that can lead to improved studies of community-based services., Method: Using the concept of research validity, we evaluate the methodological approaches in the current literature on respite services, including adult day services, in-home respite and overnight respite., Results: Although randomized control trials (RCTs) are possible in community settings, validity is compromised by practical limitations of randomization and other problems. Quasi-experimental and interrupted time series designs offer comparable validity to RCTs and can be implemented effectively in community settings., Conclusion: An emphasis on RCTs by funders and researchers is not supported by scientific evidence. Alternative designs can lead to development of a valid body of research on community services such as respite.

Adult Day Service (ADS) centers offer a variety of services to meet the needs of older adults and their caregivers. During the last decade, ADS has received increased attention due to shifts in policy toward home and community-based services for an aging population. This article reviews the effectiveness of ADS from 2000 to the present, with particular attention given to caregiver and participant outcomes, health care utilization, and future directions in ADS research. Multiple databases were searched to identify relevant research and 61 articles were selected for review based on inclusion criteria. The results of this review emphasize the need to implement and test more specific interventions targeting the needs of the ADS population.

Our nation is aging and unprepared to meet the needs of community-dwelling seniors and their caregivers. This study explored the perceived need for and use of adult day care services (ADS) in a low-income population. A random sample of 537 patient-caregiver dyads were recruited in home care agencies, and separate in-home surveys were conducted. Patients and caregivers were primarily women and 50.2% were of Hispanic origin. Although half (n = 267/537, 49.7%) of the caregivers had a perceived need for using ADS, only 19.1% of these caregivers used these services, mostly in the context of severe patient cognitive impairment. There were no racial or ethnic differences among ADS users and nonusers. The overall low use of ADS in a growing ethnically diverse senior population with a perceived need for services warrants further investigation and action as states seek to decrease nursing home placement and find solutions for our looming caregiving crisis.

This article presents an argument for reforming Australian public policy in favor of social care, rather than family, residential, or community care, for the elderly, sick, and disabled. After noting policy assumptions that families are the focus of caring and women are the natural caregivers, the paper describes changes in Australian family structures that militate in favor of policy reform. Trends related to marriage and childbearing, women in the labor force, family incomes, the aging population, legislation, and employment practices are analyzed. The paper then considers the impact of financial cutbacks on community care. The terminology of "care" and "caring" is analyzed, and hidden assumptions and connotations of this terminology are discussed. The paper then provides estimates of the numbers of Australians with particular needs for care and offers evidence that women are the main caregivers for children, the disabled, and the elderly. Discussion then turns to the caring role, covering such topics as the caregivers' need for specialized knowledge and instrumental and emotional support; stress levels; the hierarchy of public support; and research needs. Costs of care are considered next, with an emphasis on the indirect social costs of the enormous contributions that families are required to make to care provision. Next, Australia's Home and Community Care (HACC) program, the main funding source for caregiver support, is described, and a care plan linking HACC agencies with informal sources of care is suggested. New directions for care are recommended with respect to community support for caregivers, housing, research needs, empowerment, employer roles, and new family roles. Finally, a social caring model that would ensure nationwide availability of adequate public services is outlined. (AC)

Examined caregiver listening responses as they occurred in conversations with an Alzheimer's patient. Videotaped 26 episodes of conversations between caregivers and patients in adult day health care setting. Found that sensitive listening and partial entry into the patient's frame (reality) may be effective response to prevent behavior and anxiety-related outbursts. (Author/NB)

Evaluates the Post-Hospital Support Program for frail elderly patients at Johns Hopkins Hospital in Baltimore (Maryland) who were returning home to the care of a non-paid caregiver for at least a year. Results showed reduction in caregiver stress and in number of days spent in hospital after initial release. (JS)

Discusses the purpose of adult day care, procedures for providing qualified personnel for adult day care centers, and legislative requirements for nurse aides. (Author)

Background and Objectives Home- and community-based services (HCBS) are underutilized, despite offering significant health benefits to both care recipients and caregivers. Drawing upon Andersen's extended behavioral model of health services use, we examined individual- and county-level factors influencing HCBS utilization for dementia care in rural Appalachia. Research Design and Methods We analyzed data from telephone interviews with 123 dementia family caregivers in rural Appalachian counties (M age = 64.7, SD age = 12.2). Multilevel analyses were conducted to examine the effects of individual-level and county-level factors on the use of home-based services (home healthcare and personal care services) as well as community-based services (adult day care and transportation services). Results Results indicated that caregivers' receipt of informal support from family or friends was associated with more use of home-based services (B = 0.42, p =.003). Conversely, longer travel times to service providers were linked to use of fewer community-based services (B = −0.21, p <.001). Residing in counties with more home health agencies was associated with higher utilization of home-based services (B = 0.41, p =.046). However, higher county tax expenditures for HCBS were not linked to home-based or community-based service use. Discussion and Implications Findings suggest that informal support in caring for the person living with dementia enables HCBS use in rural Appalachia. In contrast, limited geographic accessibility and service availability can impede HCBS use in rural regions. Policymakers are urged to allocate direct public funding to service providers to expand service availability in underresourced rural regions. [ABSTRACT FROM AUTHOR]

Background: Older adults with frailty have surgery at a high rate. Informal caregivers often support the postoperative transition in care. Despite the growing need for family and caregiver support for this population, little is known about the experience of providing informal care to older adults with frailty during the postoperative transition in care. The purpose of this study was to explore what is important during a postoperative transition in care for older adults with frailty from the perspective of informal caregivers. Methods: This was a qualitative study using an interpretive description methodology. Seven informal caregivers to older adults [aged ≥ 65 years with frailty (Clinical Frailty Scale score ≥ 4) who had an inpatient elective surgery] participated in a telephone-based, semi-structured interview. Audio files were transcribed and analyzed using reflexive thematic analysis. Results: Four themes were constructed: (1) being informed about what to expect after surgery; (2) accessible communication with care providers; (3) homecare resources are needed for the patient; and (4) a support network for the caregivers. Theme 4 included two sub-themes: (a) respite and emotional support and (b) occupational support. Conclusions: Transitions in care present challenges for informal caregivers of older adults with frailty, who play an important role in successful transitions. Future postoperative transitional care programs should consider making targeted information, accessible communication, and support networks available for caregivers as part of facilitating successful transitions in care. [ABSTRACT FROM AUTHOR]

To identify facilitators, barriers, and formulate recommendations for the implementation of exergames for people with dementia (PWD) in day-care centers (DCCs). Within a randomized controlled trial into the effectiveness of exergaming, 73 PWD with their informal caregivers (IC) from 11 DCCs in the Netherlands and two exergame providers participated in a process evaluation. This was a mixed-methods study using focus groups, semi-structured interviews, the Measurement Instrument for Determinants of Innovations, forms for DCC staff, and a short satisfaction questionnaire. We used descriptive statistics for the quantitative outcomes, and thematic analysis for qualitative data. The Medical Research Council guidance for process evaluation was used to identify facilitators and barriers to the implementation, mechanisms of impact, and context. Implementation-related facilitators and barriers were the availability of budget, staff, equipment, instructions, location, and supervision. Mechanisms of impact-related facilitators were experienced positive effects on physical functioning and mobility, cognitive, emotional, and social functioning, and quality of life. Barriers were mainly linked to the need to customize the intervention for each participant. Contextual facilitators were support and enthusiasm from others; barriers were costs and planning. Recommendations by DCC staff involved technical support, instructions, responsibility, location, supervision, planning, and exergaming as a group or individually. Users, IC, and staff positively valued exergaming. We found various facilitators and barriers leading to recommendations for successful implementation. We recommend further research into tailoring exergaming to specific users and contexts, and into usability and cost-effectiveness. This may contribute to further dissemination and implementation of exergaming for PWD. [ABSTRACT FROM AUTHOR]

Daycare maltreatment refers to abusive and/or neglectful acts perpetrated by teachers, directors, non-professionals or volunteers, family members of staff, and peers in a daycare setting. Despite growing evidence of its occurrence, the prevalence and consequences of daycare maltreatment for the child, the parent(s), and their dyad are largely unknown. This qualitative systematic literature review was conducted to synthesize the existing literature referring to daycare maltreatment, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In order to be included in the analysis, the manuscripts needed to report empirical findings regarding maltreatment in daycare settings, be written in English, be published in a peer-reviewed journal or a dissertation, and be accessible by our research team. In all, 25 manuscripts met the above criteria and were included in the review. Our results indicate that reports of daycare maltreatment are characterized by early age of abused children, inferring mainly to sexual, physical, and emotional abuse. The majority of these manuscripts reported caregivers' and teachers' abuse, while peer victimization was reported much less. In addition, the findings demonstrated a higher representation of female perpetrators compared to abuse in other scenarios. Although some indications of long-term implications are reported in the manuscripts, a well-validated measure for assessment of daycare maltreatment seems to be lacking. These findings contribute to a more nuanced understanding of the complex experience and ramifications of daycare maltreatment, providing insight into its multi-faceted implications. [ABSTRACT FROM AUTHOR]

Background Studies focusing on the return to work (RTW) experiences of patients with a brain tumor (BT) are scarce. We aimed to explore, in-depth, the occupational expectations, experiences, and satisfaction of patients who RTW after a BT diagnosis and treatment, those not able to, and their family caregivers. Methods This multicenter, cross-sectional study utilized semi-structured interviews and reflexive thematic analysis. Interviews were conducted with adults diagnosed with primary BT, in employment/self-employed before diagnosis, currently in follow-up care, and also with their caregivers. Results In total, 23 interviews (17 patients/6 caregivers) took place. Five themes were developed: (1) Early (adjustments and) expectations: "Thought I would be back at work the following Monday"; pre-treatment patients wanted to be better informed about potential recovery time and side-effects. (2) Drivers to RTW: "Getting my life back on track"; RTW was seen as a symbol of normality and also dictated by financial pressures. (3) Experiences returning to work: "It's had its ups and downs": patients who had successfully returned were supported by employers financially, emotionally, and practically. (4) Required support: "He had surgery and that was it": suggested support included a back-to-work scheme and comprehensive financial support. (5) Caring and paid work: The "juggling act": carer's work was significantly impacted; often reducing/increasing their working hours while managing increasing caring demands. Conclusions Future research focusing on RTW in neuro-oncology populations is needed. Interventions should be developed to improve employer/employee communication, and increase knowledge about BT care and possibilities for RTW, to support patients and caregivers towards sustained employment. [ABSTRACT FROM AUTHOR]

Background: Staff caregivers of day care centers provide many activities for older people. However, there is a lack of a systematic curriculum based on Taiwanese culture to improve cognitive function, self-care ability, and depressive mood status in these individuals. Purpose: This study was designed to test the effectiveness of a series of localized cognitive stimulation training courses implemented by direct caregivers and aimed at improving cognitive function, self-care ability, and depressive mood in older people at day care centers. Methods: This cluster-randomized controlled trial research was conducted over a four-month period. The participants were randomly assigned to the experimental, comparison, or control groups based on their day care center affiliation. The experimental group received a series of localized cognitive stimulation training sessions with musical rhythm courses from day care center direct caregivers. The cognitive function, self-care ability, and depression mood state of the three groups were then tested. Results: The experimental group reported statistically significant changes in average scores for attention, feeding, and depressive mood. After controlling for time and degree of participation in activities, the comparison group reported a lower average score for cognitive function at timepoint 3. Conclusions/Implications for Practice: The results of this study support caregivers at day care centers implementing a series of localized cognitive stimulation training course interventions to prevent declines in activities of daily living and cognitive function and ameliorate depressive mood in older adults. In the future, a larger sample size should be used to improve the effectiveness of the intervention. [ABSTRACT FROM AUTHOR]

Although Hispanic/Latino older adults are at disproportionate and increased risk for Alzheimer's disease and related dementias, few evidence-based supportive care interventions are specifically developed for or adapted for this population. Adapting a supportive care intervention requires more than Spanish language translation; it necessitates an understanding of cultural nuances and care preferences of Hispanic/Latino families and staff who implement the intervention. This article describes the cultural adaptation of the Adult Day Service Plus intervention for delivery by staff to Hispanic/Latino caregivers, which was guided by the cultural adaptation process model. Also, using the Framework for Reporting Adaptations and Modifications—Enhanced, we discuss (a) when modifications were made, (b) who determined the modifications needed, (c) what aspects of the intervention were modified, (d) the relationship to fidelity and how fidelity was maintained, and (e) reasons for modifications. Modifications to the delivery and content were changed to reflect the values and norms of both the Hispanic/Latino staff and the caregivers they serve. As supportive interventions for caregivers are developed and implemented into real-world settings, inclusion of cultural elements may enhance research participation among Hispanic/Latino provider sites, people living with dementia, and their caregivers. Cultural adaptation is an essential consideration when developing, adapting, and implementing previously tested evidence-based interventions. Cultural adaptation offers an important lens by which to identify contextual factors that influence successful adoption to assure equity in the reach of evidence-based programs. [ABSTRACT FROM AUTHOR]

Dementia Day Care Centres (DDCCs) are defined as services providing care and rehabilitation to people with dementia associated with behavioural and psychological symptoms (BPSD) in a semi-residential setting. According to available evidence, DDCCs may decrease BPSD, depressive symptoms and caregiver burden. The present position paper reports a consensus of Italian experts of different disciplines regarding DDCCs and includes recommendations about architectural features, requirements of personnel, psychosocial interventions, management of psychoactive drug treatment, prevention and care of geriatric syndromes, and support to family caregivers. DDCCs architectural features should follow specific criteria and address specific needs of people with dementia, supporting independence, safety, and comfort. Staffing should be adequate in size and competence and should be able to implement psychosocial interventions, especially focused on BPSD. Individualized care plan should include prevention and treatment of geriatric syndromes, a targeted vaccination plan for infectious diseases including COVID-19, and adjustment of psychotropic drug treatment, all in cooperation with the general practitioner. Informal caregivers should be involved in the focus of intervention, with the aim of reducing assistance burden and promoting the adaptation to the ever-changing relationship with the patient. [ABSTRACT FROM AUTHOR]

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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]

Due to the increasing ageing population, how can caregivers effectively provide long-term care services to meet the older adults' needs with finite resources is emerging. In addressing this issue, nursing homes are striving to adopt smart health with the internet of things and artificial intelligence to improve the efficiency and sustainability of healthcare. This study proposed a two-echelon responsive health analytic model (EHAM) to deliver appropriate healthcare services in nursing homes under the internet of medical things environment. A novel care plan revision index is developed using a dual fuzzy logic approach for multidimensional health assessments, followed by care plan modification using case-based reasoning. The findings reveal that EHAM can generate patient-centred long-term care solutions of high quality to maximise the satisfaction of nursing home residents and their families. Ultimately, sustainable healthcare services can be within the communities. [ABSTRACT FROM AUTHOR]

To examine the expectations of informal caregivers, nurses, and dementia trainers regarding the support of (physical and psychosocial) human needs by humanoid social assistive robots (SARs) in dementia care. A qualitative study was conducted with 11 homogeneous focus groups of informal caregivers, nurses and dementia trainers providing dementia care at home, in adult daycare centers, or in nursing homes. A qualitative content analysis was performed using a concept- and data-driven coding frame. Focus group discussions with 52 individuals were held. Participants reported mostly positive expectations and stated that SARs could offer potential support in all components of human needs, especially in avoiding danger (e.g. recognise danger, organise help), communication/contact with others (e.g. enable telephone calls, provide company), daily activities (e.g. remind of appointments, household obligations), recreational activities (e.g. provide music), eating/drinking (e.g. help cook), and mobility/body posture (e.g. give reminders/instructions for physical exercise). Participants also mentioned some negative expectations in all human needs, predominantly in communication/contact with others (e.g. loss of interpersonal interaction) and avoiding danger (e.g. scepticism regarding emergencies). Participants stated that SARs had great potential to provide assistance in dementia care, especially by reminding, motivating/encouraging and instructing people with dementia. Informal caregivers and nurses also considered them as useful supportive devices for themselves. However, participants also mentioned negative expectations, especially in communication/contact with others and avoiding danger. These findings demonstrate the support caregivers and dementia trainers expect from humanoid SARs and may contribute to their optimisation for dementia care. [ABSTRACT FROM AUTHOR]

Background:The long-term care insurance system for the elderly is being implemented as a social support for the elderly in need of care. As of 2022, as the use of adult day care centre among home benefits is on the rise, it is necessary to devise measures to reduce the caregiving burden and family conflicts targeting the caregivers of the elderly who use adult day care centre. Objectives: The purpose of this study is to examine the dual mediating effect of caregiving mastery and self-esteem on the relationship between caregiving burden and family conflict. Methods:In this study, 304 caregivers of the elderly who received a long-term care grad and were using anadult day care centre were targeted. The data were analysed using SPSS PC+ Win. 24.0 and SPSS PROCESS macro 4.1. Applied statistical techniques were descriptive statistics, reliability analysis, correlation analysis, and double mediating effect analysis. Results:First, the age and length of support for caregivers increased the caregiving burden, but the health and economic status of caregivers lowered the caregiving burden and family conflict, and improved caregiving mastery and self-esteem. Second, the caregiving burden of the family caregiver was 2.51 points (out of 5 points) and family conflict was low at 1.85 points (out of 5 points). The parameter, caregiving mastery, was at 3.40 points (out of 5 points) and self-esteem was at 3.40 points (out of 4 points), which is a fairly high level. Third, the higher the caregiving burden, the higher the family conflict was, but the effect of the caregiving burden on family conflict through caregiving mastery and self-esteem was lowered. Conclusions: In order to reduce the impact of the burden of care on family conflict, it is necessary to improve the ability to solve problems in a positive way, such as mastery of caring and selfesteem. This suggests that adult day care centre need to provide caring education for family caregivers to increase their caring skills and provide counselling to improve their self-esteem. [ABSTRACT FROM AUTHOR]

The United States (US) has been at war for almost two decades, resulting in a high prevalence of injuries and illnesses in service members and veterans. Family members and friends are frequently becoming the caregivers of service members and veterans who require long-term assistance for their medical conditions. There is a significant body of research regarding the physical, emotional, and social toll of caregiving and the associated adverse health-related outcomes. Despite strong evidence of the emotional toll and associated mental health conditions in family caregivers, the literature regarding suicidal ideation among family caregivers is scarce and even less is known about suicidal ideation in military caregivers. This study sought to identify clusters of characteristics and health factors (phenotypes) associated with suicidal ideation in a sample of military caregivers using a cross-sectional, web-based survey. Measures included the context of caregiving, physical, emotional, social health, and health history of caregivers. Military caregivers in this sample (n = 458) were mostly young adults (M = 39.8, SD = 9.9), caring for complex medical conditions for five or more years. They reported high symptomology on measures of pain, depression, and stress. Many (39%) experienced interruptions in their education and 23.6% reported suicidal ideation since becoming a caregiver. General latent variable analyses revealed three distinct classes or phenotypes (low, medium, high) associated with suicidality. Individuals in the high suicidality phenotype were significantly more likely to have interrupted their education due to caregiving and live closer (within 25 miles) to a VA medical center. This study indicates that interruption of life events, loss of self, and caring for a veteran with mental health conditions/suicidality are significant predictors of suicidality in military caregivers. Future research should examine caregiver life experiences in more detail to determine the feasibility of developing effective interventions to mitigate suicide-related risk for military caregivers. [ABSTRACT FROM AUTHOR]

Adult day centers (ADCs) are nonresidential settings that support the health and social needs of vulnerable older adults. Due to ADCs' congregate nature and participants' compromised health status, many ADCs have been forced to close during the COVID-19 pandemic. It is unknown how closures have impacted service delivery at ADCs. Guided by the Resiliency Activation Framework, we (a) identified consequences resulting from closures of ADCs during the COVID-19 pandemic and (b) described factors that have enabled the ADC community to remain resilient in the wake of challenges brought on by the pandemic. We conducted 2 focus groups in California (n = 12), and individual interviews with ADC staff members (n = 8) in 7 other states. The results of a directed content analysis revealed perceived declines in physical, cognitive, and mental health of ADC users and increased caregiver strain. Access to human, social, economic, and political capital were essential for supporting ADCs in buffering the impacts of the pandemic on the older adults they serve but were not consistently available. Research is urgently needed that quantifies the impacts of the pandemic on ADC users and their caregivers to inform policy and advocacy efforts in the wake of the pandemic. [ABSTRACT FROM AUTHOR]

Data is needed to provide insight into the issue of preference around consent for use of pediatric clinical data for research. This study evaluated caregivers' preferences concerning use of their child's clinical information. Caregivers of children (n = 101; response rate 81.5% of n = 124) presenting for psychological evaluation at an urban medical center viewed a video regarding how the information contained in their child's medical record could be used for research. An anonymous survey following the video indicated that: 1) >90% of caregivers felt comfortable with their child's information being used; 2) >90% of caregivers felt their child's privacy would be adequately protected; 3) 98% of caregivers reported themselves to be as or more likely to return to the institution after viewing the video; 4) 60% of caregivers felt no additional consent procedures beyond viewing the video were needed, while 20% preferred an opt-out and 20% preferred a traditional consent procedure. Caregiver demographic variables were largely unrelated to consent preferences. Overall, caregivers reported strong support for use of their child's clinical data for research purposes. [ABSTRACT FROM AUTHOR]

Population aging causes the prevalence of hypertension to increase, which increases the incidence of dementia and leads to premature death. The simultaneous development of these two diseases accelerates the progression of dementia, leading to a reduction in the patient's quality of life. This is difficult for caregivers, as it causes them to shoulder a greater burden and brings greater emotional stress, resulting in their wanting to end the care relationship or even neglect or abuse patients. In addition, their own mental and physical health is also severely affected, causing them to seek medical treatment themselves. In view of this problem, we propose a cloud-based physiological sound-controlled intelligent music and blood-pressure control system to assist family caregivers of dementia patients to reduce their burden as well as their stress. We interview family caregivers regarding the benefits of this system in assisting them and find that most caregivers find the system to be helpful. [ABSTRACT FROM AUTHOR]

Many studies have documented the impact of maker experiences on children's learning, but few have examined how caregivers participate in maker activities in museums, both as facilitators of their children's learning and as learners in their own right. This qualitative study involved observations and interviews with 88 caregivers participating in a range of making and tinkering activities at a science museum. Aspects of the physical setting (including the arrangement and familiarity of tools and materials) and social setting (including facilitators' interactions with children versus caregivers) influenced whether families participated and the roles that caregivers played (observing, facilitating, or making). Across these roles, caregivers described benefitting as learners — by noticing their children's abilities and interests, learning new ways to support their children's learning, or fostering their own creativity. The results highlight strategies that museums can use to create inclusive maker activities that recognize caregivers' many roles and motivations during family visits. [ABSTRACT FROM AUTHOR]

Adult day services (ADS) provide respite for dementia caregivers and directly reduce exposure to behavioral and psychological symptoms of dementia (BPSD). This study examines the psycho-behavioral mechanism on how daily ADS use may benefit caregivers' daily affect through its impact on the distress associated with BPSD stressor exposure. The sample consists of dementia caregivers (N = 173) who participated in an ADS intervention across 8 days. Multilevel structural equation modeling was conducted to examine the within- and between-person mediating effects of BPSD distress on the direct associations between daily ADS use and daily negative and positive affect. ADS days were associated with lower daily negative affect and higher daily positive affect; the significant within-person effect of ADS use on daily affect was mediated by daily BPSD distress. Findings highlight the association between daily ADS use and caregiver affective well-being. This understanding is important for designing respite and other interventions to help dementia caregivers manage the daily stress of caregiving. [ABSTRACT FROM AUTHOR]

Background: Autologous bone marrow transplantation is a curative procedure for hematological diseases and immune deficiencies. The unique and intensive nature of this treatment requires distinctive care during and post the entire transplant course. Nursing intervention for caregivers post autologous bone marrow transplantation patients at home is an important component of the care that improves and develops knowledge and practice of the caregivers, to take care of the patients in order to help them follow the demanding treatment plan to reach recovery. Aim to evaluate the effect of nursing intervention for caregivers of postautologous bone marrow transplantation patients at home. Material and Method: A Quasi-experimental study was carried out among convenient sample of 143 patients and their caregivers who attended the follow up clinic during the first six months post autologous bone marrow transplantation. The study was conducted among patients and their caregivers in three different hospitals Sheikh Zayed Specialized Hospital, National oncology institute, and Nasser institute at outpatient’s follow-up clinics. A self-administered questionnaire of patients and their caregivers’ demographic data, and reported checklist of caregivers’ knowledge and practices toward post-autologous bone marrow transplantation patients at home. Results: there was a statistically significant difference between pre and post nursing intervention, which indicate improvement in caregivers’ knowledge and practice post implementation of the nursing intervention program, and positive correlation between their knowledge and practice. Conclusion and Recommendations: Although caregivers had adequate knowledge, practice on some aspects, gaps were identified. There is a need for educational interventions and discharge plan to upgrade knowledge and practices of the caregivers of post autologous bone marrow transplantation patient at home. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study was to identify dementia knowledge, attitude, and caregiving appraisal among caregivers of older adults with dementia using a dementia care center. Methods: The participants were 113 caregivers of older adults with dementia using a dementia care center. The data were collected using the questionnaires for dementia knowledge, attitude, and caregiving appraisal. Data were analyzed by descriptive statistics, Pearson's correlation, and multiple regression test using the SPSS/WIN 24.0. Results: Positive correlations were revealed between dementia knowledge and attitude (r=.36, p<.001). Dementia attitude positively correlated with caregiving satisfaction (r=.40, p<.001) and caregiving mastery (r=.31, p<.001). Dementia attitude negatively correlated with caregiving burden (r=-.47, p<.001), caregiving demand (r=-.35, p<.001), and caregiving impact (r=-.40, p<.001). The factors influencing caregiving appraisal were dementia attitude (negative component: β=-.48, p<.001, positive components: β=.41, p<.001, neutral components: β=-.42, p<.001) and caregiving duration (negative component: β=-.28, p=.004, positive components: β=.26, p=.010). These factors contributed negative components (25.2%), positive components (18.4%), and neutral components (25.5%) of the variance in caregiving appraisal. Conclusion: The results of this study suggest it is necessary to develop nursing interventions for caregivers of older adults with dementia to improve dementia attitude. [ABSTRACT FROM AUTHOR]

This study presents the case of an innovative Adult Day Program model resulting from a community–college partnership, with a formative evaluation of its contributions. A triangulation of data sources were used (existing documents, seniors' records, survey of caregivers). An overview of the historical development of the Adult Day Program model, and its underlying partnership, is presented. The model demonstrated feasibility and satisfaction by the community served, and opportunities for students' training in real settings. Province-wide efforts should support the expansion of services based on this model, which may also be replicated in other environments to complement traditional long-term care services. [ABSTRACT FROM AUTHOR]

Fall injuries are the leading cause of injury death in older adults, yet despite this, health-care providers do not routinely incorporate fall prevention into practice. A fall prevention training program was developed for non-clinical caregivers serving community-dwelling older adults using the CDC's STEADI tool. The project outcomes revealed statistically significant increases in items related to knowledge and confidence in fall risk and assessment. Findings could guide the development of fall prevention training programs targeted at non-clinical caregivers to community-dwelling older adults. [ABSTRACT FROM AUTHOR]

Household-based caregivers serve an important role in protecting the health of cancer patients, who may be vulnerable to infectious diseases due to their cancer treatments. Caregiver preventive care should be prioritized to maintain continuity of care and to reduce potential for transmission of infectious diseases to cancer patients. Uptake of vaccines, such as influenza vaccine, is suboptimal in the United States in general, as well as among caregivers for cancer patients. Little is known about the types of information about vaccination and prevention of infectious diseases (e.g. influenza) presented to caregivers of cancer patients. A qualitative content review of NCI cancer center websites (N = 70), searching for vaccine-related information and the need for and availability of vaccines for caregivers, and comparison of the availability of this information to that for caregiver support groups and general preventative health information (e.g. diet, exercise) for caregivers or patients was conducted. While 53 of 70 (76%) cancer centers routinely presented general preventative health information for caregivers or patients, only eight (11%) cancer centers had any information about vaccinations for caregivers or patients. Of these eight cancer center websites, only one had information about vaccinations for caregivers or family contacts. As vaccinations confer both individual and community-level protection against infectious diseases, promotion of routine vaccination for caregivers should be considered as part of caregiver support resources provided by cancer centers. This can include changes such as including this information on cancer center websites or adding to caregiver support resource documents. [ABSTRACT FROM AUTHOR]

An amendment to this paper has been published and can be accessed via the original article. [ABSTRACT FROM AUTHOR]

Residential caregivers are the central figures responsible for the children in their charge. Their work is physically and emotionally taxing, and carried out under pressure: they are prone to burnout. In addition, their status is lower than that of other staff. This study aimed to identify the strategies to improve caregiver functioning that have been adopted in Israel's residential social-service facilities, and to examine the extent of their implementation. A two-stage, mixed-methods study design was employed. In the qualitative stage, six successful care facilities were identified; their directors were interviewed in depth using the Learning from Success method. In the quantitative stage, a survey was administered to 95 directors, using open and closed questions. Six best-practice strategies for working with caregivers were identified: careful screening, training, ongoing supervision, personal and professional support mechanisms, flexible schedules, and a clear work plan and procedures. While these strategies were applied to some extent in most facilities, they varied in scope and implementation. Using a regression model, we found a connection between the implementation of these strategies and the directors' satisfaction with the caregivers' work. We discuss recommendations that can help directors incorporate the six strategies in residential homes and meet the challenges directors face in their work with caregivers. [ABSTRACT FROM AUTHOR]