The Impact of Day Centers on the Progression of Alzheimer’s Disease
With an aging global population, the prevalence of Alzheimer’s disease and memory decline among older adults has rapidly increased in recent years (Honjo et al., 2020). As a result, nurses, regardless of their specialty, will be tasked with caring for these patients more frequently and thus should be prepared to provide effective support and education. Though there is currently no cure for Alzheimer’s disease, various interventions and treatments can be implemented to slow its progression (Honjo et al., 2020). These include medications, psychology, occupational therapy, and, of particular interest, day center programs. These programs provide physical, cognitive, and social stimulation for patients, and their impact on slowing disease progression has yielded positive results in multiple studies.
Problem Statement and Research Question
Though various medications and other non-pharmacological therapies have shown promise, a cure for Alzheimer’s Disease and related memory impairments is still lacking (Honjo et al., 2020). Yet certain interventions may slow the process of cognitive decline and lead to improved quality of life for both patients and families. Among these are day center programs, which may slow cognitive decline through the use of therapies such as music, exercise, art, reminiscence, and social programs. Through participation in these programs, patients can receive the in-depth care required to maintain and improve their cognitive ability and combat social isolation, a common negative impact of memory decline (Sun et al., 2022). With this in mind, the following paper addresses the effectiveness of day centers and related programs in slowing the negative manifestations, particularly cognitive decline, associated with Alzheimer’s disease.
Theoretical Framework
Alzheimer’s Disease is a condition that impacts the whole person, with effects on one’s physical, mental, and emotional health and well-being. Jean Watson’s Theory of Human Caring, which consists of ten separate but interconnected factors, is one that also addresses the whole patient. Watson championed the power of relationships, positive environments, and holistic care that encompasses far more than just a patient’s physical condition. Factors include “creating a healing environment” and “instillation of faith and hope” (Watson, 1979). Similarly, the topic studied in this paper also relates to caring for the whole individual. Instead of treating memory impairments with just medication, the research addressed here seeks to explore whether meeting other needs, such as the need for social relationships and meaningful cognitive stimulation, all within a positive day center environment, can be just as important and effective as pharmacological interventions.
Synthesis of Literature
The correlation between day center usage and the progression of Alzheimer’s disease has been the topic of a handful of research studies, three of which were analyzed to generate conclusions (Appendix A and B).
A retrospective analysis study conducted in 2020 by Japanese researchers found that participation in day center programs yielded significant improvements in cognitive function, based on scores received on Mini Mental Status Exams (MMSEs). Participants in the study, all patients at a memory clinic, took the MMSE before starting a day center program and again after six months of participation. Taking into consideration the various anti-Alzheimer’s medication regimens patients were prescribed, 68.8% of participants improved their scores (compared to 45.4% of patients who chose not to utilize day center programs), and researchers concluded that day centers were a “useful non-drug therapy” to slow cognitive decline (Honjo et al., 2020). An additional retrospective analysis study conducted in Taiwan found similar “significant improvements” in cognitive function after six months of treatment at a day center according to MMSE scores, results that were “consistent with previous reports” (Lin et al., 2021). Patients participated in programs consisting of activities such as reminiscence therapy, horticulture, music, and art, and the specific benefits of each were discussed.
Yet it is difficult to research the impact of day centers on cognitive function in patients with dementia without considering additional advantages of these programs. Indeed, many studies focused on multiple outcomes of day center programs, including physical independence, social connectedness, and reduced caregiver burden. A qualitative study among day center participants in Ontario, Canada, found that programs were associated with improved physical and mental well-being, decreased social isolation, and greater positivity (Sun et al., 2022). Additionally, the 2021 study by Lin et al. also concluded that day center participation improved physical functioning, as measured through ADL and IADL scores. It is clear that existing research points to a multitude of benefits by day centers, extending far beyond cognitive impacts and instead affecting the quality of life for patients with Alzheimer’s disease and their caregivers.
Though the literature surrounding this topic strongly supports the benefits of day centers on the progression of Alzheimer’s disease, many studies pointed to the need for additional research as well as interventions to promote the benefits of these programs to a wider audience. Honjo et al. (2021) suggest the need to study the impacts of specific interventions that day centers may implement, as they can vary between programs. Other studies claimed that further “longitudinal analyses with larger numbers of participants” would be necessary to truly establish a correlation (Lin et al., 2021). These studies also addressed the need for further education and workforce development. Unfortunately, memory conditions are often accompanied by feelings of shame and apathy, both of which may limit a patient’s willingness to engage in a day center program (Honjo et al., 2020). Other factors that can limit patient access to treatment include cost (Lin et al., 2021) and the need for more workers to staff programs (Sun et al., 2022). As a whole, though existing research strongly suggests a positive correlation between day center participation and slowed decline of cognitive function in patients with Alzheimer’s disease, it is clear that the need for additional research, education, and awareness exists.
Conclusion and Implications for Practice
The aforementioned evidence points towards a positive link between day centers and the delayed progression of Alzheimer’s disease. Studies have found that day center attendance is associated with improved cognitive function (Honjo et al., 2020), reduced social isolation (Sun et al., 2022), and increased ADL and IADL performance (Lin et al., 2021). As a whole, research links day centers with improving the quality of life for those living with dementia, as well as their caregivers.
Yet it is challenging to trend data surrounding the cognitive ability of those with Alzheimer’s, thus meriting the need for further research. Additional studies, with larger numbers of patients and day centers participating, would be beneficial to better understand the connection between day centers and delaying disease progression. Similarly, the impact of specific interventions and therapies implemented in programs is a topic for consideration. There remain many unknowns surrounding Alzheimer’s disease itself, which creates additional challenges when measuring and understanding how certain activities in day centers may improve the quality of life for those suffering from the disease.
As nurses prepare to care for greater numbers of patients with Alzheimer’s disease and related cognitive impairments, it is critical for them to have an understanding of the various treatments and therapies available for these conditions. Not only does this allow nurses to provide valuable education to patients and families, but also to use their knowledge to communicate and care for these individuals appropriately. For example, a nurse who is aware of the benefits of reminiscence (a common intervention used in day center programs) can use the principles of this therapy when working with patients. Nurses can also strive to create therapeutic environments for those in their care, thus addressing the whole patient beyond their disease or physical condition. Additionally, they can observe and report various trends they may see in their work, which can improve existing research and contribute to new best practice developments.
Our population is aging, and patients with memory conditions are present in nearly every unit and specialty of nursing. Nurses are tasked to care for these patients holistically and can use the interventions provided at day centers as a framework for providing care in hospitals and other settings of practice.
References
Honjo, Y., Ide, K., & Takechi, H. (2020). Use of day services improved cognitive function in patients with Alzheimer’s disease. Psychogeriatrics: The Official Journal of the Japanese Psychogeriatric Society, 20(5), 620–624. https://doi.org/10.1111/psyg.12558
Lin, C.F., Wu, J.J., Huang, Y.H., Ju, L.Y., Lin, S.Y., Chou, Y.C., & Lin, C.S. (2021). Impact of day care services on physical and cognitive functions in old people with dementia in a medical center in central Taiwan. Health and Quality of Life Outcomes, 19(1), 170. https://doi.org/10.1186/s12955-021-01806-9
Masters, K. (2014). Nursing Theories: A Framework for Professional Practice (2nd ed.). Jones & Bartlett.
Sun, W., Bartfay, E., Smye, V., Biswas, S., Newton, D., Pepin, M., & Ashtarieh, B. (2022). Living well with dementia: The role volunteer-based social recreational programs in promoting social connectedness of people with dementia and their caregivers. Aging & Mental Health, 26(10), 1949–1962. https://doi.org/10.1080/13607863.2021.1950614
Watson, J. (1979). Nursing: The philosophy and science of caring. Little, Brown & Company.
Appendix A
Evidence Table
| Author last name, year of publication, and title | Research Question/Research Objective | Type of Evidence (Qualitative, Quantitative, etc) | Sample (Population size, setting, etc.) | Design | Independent Variable ORIntervention | Dependent Variable/Outcome | Significant Results | Limitations/Gaps | Strengths | Evidence level and quality |
| Honjo, Y., Ide, K., & Takechi, H. (2020). | This study was conducted to explore the relationship between day center attendance and cognitive progression of Alzheimer’s disease and dementia. | Quantitative | 161 participants, all outpatients at 3 memory clinics in Japan (thus, they all had some form of memory impairment, such as dementia). 106 participants attended day center programs, 55 did not. | Retrospective analysis: Researchers analyzed mini mental status exams (MMSE) that were administered to participants, once prior to beginning day center programs and the other after 6 months of participation. | Participation at day center programs. | Cognitive function, (assessed through MMSE scores) | After 6 months, MMSE scores improved in 68.8% of day center participants compared to 45.4% nonparticipate. The amount of score improvement among day center users was statistically significant (p-value 0.0062). | – Researchers allowed patients to choose how often to attend the day program, so frequency in attendance varied. – Participants could choose whether or not to attend programs, so there was no random assignment to treatments. – Excluded patients when behavioral & psychological symptoms of dementia | – Patients from multiple different day centers participated. – Anti-Alzheimer’s medications that patients took were taken into consideration when evaluating MMSE score improvement. – Participants were tested at equal intervals (before beginning the program and 6 months into participation). | We believe this study’s evidence is strong and the quality of research is high. |
| Lin, C.F., Wu, J.J., Huang, Y.H., Ju, L.Y., Lin, S.Y., Chou, Y.C., & Lin, C.S. (2021). | This study was conducted to learn about the effects of day care services on physical and cognitive functioning in older adults with dementia. | Quantitative | 18 participants, all of whom attended a geriatric day care center in Taiwan. All participants had been diagnosed with dementia. | Retrospective analysis: Researchers evaluated the results of various assessments that were given to patients at 6-month intervals. These included ADL & IADL scores, mini-mental status exams (MMSE) and nutritional assessments. | Participation at day care center program. | Physical and cognitive function, as well as family stress burden. | After 6 months, improvements in ADL and MMSE scores were noted. Researchers stated that “significant improvements” in physical and cognitive status were observed (p-value 0.026) Quality of life scores were also higher, and family caregiver burden was also shown to be reduced. | – The study lacked a control group (all participants attended the day center program, so results cannot be compared to a group who didn’t attend day centers.) – The medications patients were taking were not considered when analyzing assessment score improvements. – Small sample size | – Multiple positive effects of day programs were analyzed (such as impact on physical function, cognition, and quality of life) | We believe this study’s evidence is strong and the quality of research is high, despite a few limitations. |
| Sun, W., Bartfay, E., Smye, V., Biswas, S., Newton, D., Pepin, M., & Ashtarieh, B. (2022). | This study attempted to explore the effects of social recreational programs on patients with dementia, specifically on social isolation. | Qualitative | 31 participants:- 11 dementia patients- 7 volunteers- 13 caregivers All participants were associated with the “Living Well with Dementia” program (based in Ontario, Canada) | Exploratory qualitative descriptive research: Researchers conducted one-on-one interviews with each study participant. These interviews followed a predetermined interview guide and utilized open-ended questions. | Participation in a social recreational program. | Social connectedness and impact on physical and mental well-being. | Major themes generated from the interviews suggest that social recreational programs are associated with improved physical and mental well-being, social connections, and greater positivity among people with dementia and caregivers. | – Potential for self-reported bias – Lack of diversity among participants (mostly Caucasian), and exclusion of patients with severe dementia. – Relatively small sample size, and only collecting data from one social recreational program. | – All interviews used the same guidelines and framework. – Addressed many different effects of social programs, including caregiver burden, social connectedness, and physical and mental well-being. | We believe this study is of high quality despite some limiting factors. |
Appendix B
Annotated Bibliography
Honjo, Y., Ide, K., & Takechi, H. (2020). Use of day services improved cognitive function in patients with Alzheimer’s disease. Psychogeriatrics: The Official Journal of the Japanese Psychogeriatric Society, 20(5), 620–624. https://doi.org/10.1111/psyg.12558
Synopsis: This study, a retrospective analysis, was conducted to evaluate the effects of day centers on the progression of Alzheimer’s disease and dementia. Researchers analyzed the results of Mini-Mental State Examinations (MMSE) administered to 161 patients with Alzheimer’s disease who received treatment at a memory clinic in Japan, some of whom utilized day service programs and others who did not. These examinations were administered twice for each patient, once upon first visiting the memory clinic and another after 6 months of participation in day center services. Ultimately, a statistically significant correlation between day center attendance and higher MMSE scores after 6 months was noted. It was concluded that day center programs were beneficial for slowing the progression of Alzheimer’s disease and an effective non-pharmacological intervention for improving cognitive function.
Evaluation: We believe this study is both credible and beneficial to our research. The researchers utilized many different day centers (authors stated that “several dozen” different programs were attended by patients in the study), thus obtaining data from a wide range of different programs. All patients were evaluated at the same intervals, before beginning participation and after six months, and their anti-Alzheimer’s medications were taken into account when evaluating their scores. Authors utilized references that were mostly published within ten years. As a whole, this study adds meaningful information and depth to our research, highlighting the relationship between day center participation and improved cognitive function.
Lin, C.F., Wu, J.J., Huang, Y.H., Ju, L.Y., Lin, S.Y., Chou, Y.C., & Lin, C.S. (2021). Impact of day care services on physical and cognitive functions in old people with dementia in a medical center in central Taiwan. Health and Quality of Life Outcomes, 19(1), 170. https://doi.org/10.1186/s12955-021-01806-9
Synopsis: This study, a retrospective analysis, was conducted to evaluate the impact of day care services on the physical and cognitive manifestations of dementia. Researchers analyzed the results of ADL scores, mini-mental status exams, mini-nutritional assessments, and other assessments on 18 patients at a geriatric day care center in Taiwan. These examinations were administered twice for each patient, before and after 6 months of treatment. Ultimately, researchers found a statistically significant correlation between day center attendance and higher ADL, IADL, and MMSE assessment scores after 6 months, thus reflecting an improved physical and cognitive function. They concluded that day center programs were beneficial as a non-pharmacological intervention for improving physical and cognitive functioning in dementia.
Evaluation: We believe this study is both credible and beneficial to our research. Researchers addressed multiple potential positive effects of day programs, including their impact on physical and cognitive function as well as quality of life. They also provided insight into specific interventions at the day center, including reminiscence therapy, exercise, and horticulture. However, this study had some limitations, including the lack of a control group (all participants were attending a day program), not taking various medication regimens into account, and the small sample size. Yet as a whole, this study adds meaningful information and depth to our research, highlighting the relationship between day care services and physical and cognitive manifestations of dementia.
Sun, W., Bartfay, E., Smye, V., Biswas, S., Newton, D., Pepin, M., & Ashtarieh, B. (2022). Living well with dementia: The role volunteer-based social recreational programs in promoting social connectedness of people with dementia and their caregivers. Aging & Mental Health, 26(10), 1949–1962. https://doi.org/10.1080/13607863.2021.1950614
Synopsis: This study, which used an exploratory qualitative descriptive research design, was conducted to evaluate the effects of social recreational programs on patients with dementia, specifically on social isolation. Researchers conducted interviews with patients with dementia who attended the Living Well with Dementia social recreational program in Ontario, Canada, as well as their caregivers and volunteers. Researchers used an interview guide and audio-recorded all conversations, then used thematic analysis to identify overarching and sub-themes. Ultimately, they found and concluded that social recreational programs were beneficial in giving individuals with dementia a better sense of social connectedness, positive attitudes, and improved physical and mental well-being.Evaluation: We believe this study is both credible and beneficial to our research. Researchers utilized the same framework and questions for all interviews, and this framework was pilot-tested prior to interviews. Additionally, the study addressed different aspects of social recreational programs, including the impact on caregivers and role of volunteers. However, this study had some limitations, including self-bias among participants (for instance, reporting perceived changes that may not exist), and exclusion of patients with severe dementia. Yet as a whole, this study adds meaningful information and depth to our research, highlighting the positive impacts of social recreational programs on the social, physical, and mental well-being of patients with dementia.
