Assessing the Impact of DAy Programs on Individuals Living with Dementia and Their Family/friend Caregivers

Adult day programs provide critical supports to both, older adults with dementia in the community, and their family/friend caregivers. This is critical because ensuring high-quality care in the community for as long as possible, and avoiding or delaying facility-based continuing care are key priorities of individuals with dementia, their caregivers, and healthcare systems. While 61% of the 597,000 Canadians with dementia live in the community, about 10% of newly admitted nursing home residents have relatively low care needs that could be met in the community with the right supports. Caregivers to individuals with dementia (most of whom are women) provide more care hours per week (26 vs 17) than caregivers to older adults without dementia, are more likely to experience distress (45% vs 26%), and a caregiver's risk of distress is 1.6 times higher if the individual in need of care exhibits behavioural problems. However, research on the effectiveness of day programs is inconsistent. Generally, the methodological quality of studies is poor, and we especially lack Canadian research and research on individuals with multiple, intersecting vulnerabilities. Our research objectives are:

1. To evaluate the association of day program exposure with primary outcomes (better quality of life of attendees and caregivers), and secondary outcomes (better mental health of attendees and caregivers, increased time to admission to congregate care, slower cognitive and physical decline of attendees, lower rates of attendees' and caregivers' emergency room registrations, hospital admissions, and days in hospital) 2. To compare day program use patterns, attendee and caregiver social identities, day program characteristics, and day program outcomes between the 4 provinces 3. To explore what attendee and caregiver social identities, and day program characteristics are associated with primary and secondary outcomes, and with day program attendance/non-attendance

In this prospective, cross-provincial cohort study (York Region, Ontario; Interior Health, British Columbia; Calgary, Alberta; Winnipeg, Manitoba), a total of 1,000 day program attendees with dementia (250 per region), plus their primary caregivers will be recruited. A comparison group of 2,000 non-attendees with dementia and their caregivers will be created. Participants' longitudinal health administrative data will be combined with repeated (baseline and after 1 and 2 years) surveys to include critical variables not routinely collected by healthcare systems (e.g., quality of life, social identities). Primary study outcomes are quality of life of the person with dementia and their caregiver. Secondary study outcomes include mental health of individuals with dementia and caregivers, cognitive and physical decline of individuals with dementia, time to admission to congregate care, and system-level rates of emergency room registrations, hospital admissions, and days in hospital (including alternative level of care) of individuals with dementia and caregivers. Using a day program survey, we will also assess day program characteristics (e.g., number of spaces, staffing, programming). Using general estimating equations and time-to-event models, these outcomes will be compared between groups of day program exposure (no, low, medium, high). Models will be adjusted for community-based services (e.g., home care, respite care), day program characteristics, social identities of older adults and caregivers, time since day program admission, and other older adult and caregiver characteristics.

• Older adult mental health [Срок оценки: Baseline (Jan-Mar 2025), and after 1 and 2 years]
• Caregiver distress [Срок оценки: Baseline (Jan-Mar 2025), and after 1 and 2 years]
• Caregiver symptoms of depression [Срок оценки: Baseline (Jan-Mar 2025), and after 1 and 2 years]
• Caregiver symptoms of anxiety [Срок оценки: Baseline (Jan-Mar 2025), and after 1 and 2 years]
• Presence or absence of physical decline among older adults [Срок оценки: Baseline (Jan-Mar 2025), and after 1 and 2 years]
• Presence or absence of cognitive decline among older adults [Срок оценки: Baseline (Jan-Mar 2025), and after 1 and 2 years]
• Older adult time to admission to a continuing care home [Срок оценки: From date of home care admission until the date of admission to a continuing care home or loss to follow up (i.e., death, move out of province), whichever came first, assessed up to 2.5 years (between baseline and 2-year follow up)]
• Older adult emergency room registrations [Срок оценки: 1 and 2 years after the baseline data collection (which is estimated to be carried out Jan-Mar 2025)]
• Caregiver emergency room registrations [Срок оценки: 1 and 2 years after the baseline data collection (which is estimated to be carried out Jan-Mar 2025)]
• Older adult hospital stays [Срок оценки: 1 and 2 years after the baseline data collection (which is estimated to be carried out Jan-Mar 2025)]
• Caregiver hospital stays [Срок оценки: 1 and 2 years after the baseline data collection (which is estimated to be carried out Jan-Mar 2025)]
• Older adult primary care provider visits [Срок оценки: 1 and 2 years after the baseline data collection (which is estimated to be carried out Jan-Mar 2025)]