The Major Challenges Facing The U.S. Today
The site for this DEC will be the Virginia Tech Adult Day Services in Blacksburg, VA. The following literature review examines the aging older adult population and the complexity of caregiver burden including strategies for caregiver relief such as adult day centers (ADC) and education. Additionally, Polatajko, Townsend, & Craik’s (2007) Canadian Model of Occupational Performance and Engagement (CMOP-E) and the Prepared Family Caregiver Model provide perspectives through which occupational therapy (OT) can be considered in the context of adult day services.
Doctoral Experiential Component The Accreditation Council for Occupational Therapy Education (ACOTE) established that the DEC is a 16-week in-depth experience designed for doctoral students to develop advanced skills (those that are beyond a generalist level) in at least one of the following eight content areas: clinical practice skills, research skills, administration, leadership, program and policy development, advocacy, education, or theory development. The focus of this DEC was based upon developing advanced skills in leadership, education, research, and program and policy development. In order to develop advanced skills, specific objectives were developed and mentorship was provided to support a successful project. The following sections discuss the DEC site and factors that influenced project development and implementation. VA Tech Adult Days Services The DEC site for this project was the Virginia Tech Adult Day Services in Blacksburg, VA. The mission of this program is to provide the following: 1) a state-of-the-art center dedicated to the well-being and optimal functional capacity of its adult participants, 2) a resource for caregiver support, 3) an educational experience for students interested in gerontology, 4) a research facility for students and faculty focused on care of frail elderly persons, 5) dissemination of research findings to scholars, professionals, policy makers and other community members, and 6) a sense of community among generations of children, college students, and adults.
Virginia Tech Adult Day Services operates its program and educational opportunities using the philosophy of person-centered care. This philosophy is based on the concept that all individuals are unique, and client preferences and values are the center of care. Additionally, this concept emphasizes inclusion of family members in the client’s plan of care. The program not only utilizes the person-centered care philosophy to support families in keeping their older adult in their home and community, but to also provide a platform for the services that the participant engages in each day. Individuals attending the program have access to the following services (but are not limited to): personal care, social, cultural, educational, intergenerational, physical exercise, leisure, nutrition, and transportation. For example, among other various activities, an individual may have a morning coffee and chat with another participant, share life stories, work educational puzzles, or engage in memory and cognitive activities on a typical day. Virginia Tech Adult Day Services offers care to up to 18 individuals per day between the ages of 19-106 with the average age being 75 years old.
Aging Older Adults
Recent statistics indicate that the global population aged 60+ was 962 million in 2017, more than double the aging population in 1980. The number of older adults aged 60+ is estimated to double again by 2050 making the adult population reach nearly 2. 1. billion. One area that must be considered with the steady increase in aging older adults is the level assistance needed to support these individuals. There is a significant amount of variability that exists within the aging older adults in terms of functional abilities. Anderson et. al. (2012) found that among the adults aged 65-75 years old 13. 0% of men and 21. 8% of women reported some form of limitation affecting their function. Likewise, among the individuals aged 85+, 40. 4% of men and 55. 9% of women reported at least one limitation.
Investigators considered a limitation as deficits in the ability to stoop/kneel, reach overhead, write, walk 2-3 blocks, or lift 10 lbs. As a result of these limitations, the aging adult population faces challenges in the ability to engage in meaningful activities such as activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Gobbens (2018) found that decreased engagement in ADLs and IADLs results in poor quality of life. Furthermore, engagement in these activities has been found to facilitate a sense of purpose in life for older adults and provides opportunity for inclusion and involvement with others. Without adequate support from a caregiver, some individuals do not have opportunities to participate in their occupations. As a result of these challenges in the aging population, informal caregiving has become more prevalent.
Caregivers and Caregiver Burden
Virginia Tech Adult Day Services goes beyond offering services to the individuals attending the program by providing educational opportunities to the participants’ informal caregivers. An informal caregiver is defined by the Family Caregiver Alliance (2018) as “an unpaid individual (for example, a spouse, partner, family member, friend or neighbor) involved in assisting with activities of daily living and/or medical tasks. ” A study completed in 2015 concluded that approximately 43. 5 million caregivers provided unpaid care to an adult or child within the last twelve months and 15% provided care to for two adults.
More recently, research has explored the profile of caregivers. Kim, Lee, Cheon, Hong, & Chang (2018) indicated that the average age of caregivers is 42 and range in age from 18-68. The majority of caregivers are female, non-Hispanic Caucasian, married, educated and live in an urban area. Caregivers are typically the care recipient’s child or grandchild and, on average, spend 24. 42 hours per week caregiving for their loved one. One common theme that has emerged among caregivers is caregiver burden. Even though caregiving has been shown to create a sense of fulfillment for some individuals, caregivers often view the experience as a chronic stressor. The chronic stress experienced by informal caregivers can have negative psychological, behavioral, physiological effects on their well-being. Specifically, literature has found that caregivers experience an abundant amount of emotional distress which can contribute to an impaired immune system, coronary heart disease, and early death. Caregiving for an individual often includes several responsibilities: maintaining two residences, medication management, cleaning, preparing meals, coordinating oxygen and other treatment-related activities, etc. . Though there are many factors that influence the extent of caregiver burden, caregiving without choice has been identified as the one of the most significant factors in caregiver burden.
Additionally, caregivers are often not adequately prepared with information to fulfill their role as an informal caregiver. In Barry, Dalwadi, & Jacobson (2017) only one third of caregivers indicated that they were asked by health care personnel what they needed to support their loved one or what needed for support for themselves. The lack of adequate information can increase the anxiety often felt by caregivers. The Prepared Family Caregiver Model There are several demands that are placed on caregivers that are often overlooked. Since caregivers often spend more time with clients compared to healthcare professionals, it is crucial that caregivers are educated (i. e. manuals, training programs) adequately to support their role. The literature indicates educational emphasis should be placed on supporting their problem-solving skills. Models such as the Prepared Family Caregiver (1996) have been shown to guide healthcare providers in adequately educating caregivers. This model, which is summarized by the acronym COPE (creativity, optimism, planning, expert information) is a problem-solving model that explains the scope of caregiving and how health care providers can support and educate caregivers. The goals of this model are to maximize caregiver success and improve the sense of the fulfillment and efficacy in caregivers. The creativity component refers to the caregiver viewing the problem from a new perspective and using creativity to develop a new solution. The optimism component to the model emphasizes the caregiver’s interpersonal skills that allows him or her to effectively communicate optimism. The planning component to effective problem-solving is developing a unique plan for a specific situation based on expert information. This could include obtaining relative information, identifying facts from assumptions, setting realistic goals, and indicating who will complete certain tasks. The fourth component, expert information, is obtaining guidance for how to address the care recipient’s problems. The caregiver should know what to do to support their loved one, but must also find a deeper understanding of their role in the care of their loved one. Adult Day Centers As of 2016, there are at least 4, 600 adult day centers in the United States with more than 286, 300 participants attending an adult day service on any given day.
Adult day centers provide outpatient support services to individuals who are unable to safely remain at home unsupervised for several hours per day or have a desire to engage in more social interaction. These facilities were originally created to prevent isolation, depression, and cognitive and physical decline among older adults. Furthermore, these facilities have been found to improve the quality of life for caregivers and individuals attending the program. The services offered by an ADC allows the individual to remain living at home or in the community for a longer period of time since facilities include supervision by supportive and professional staff members. Services that are offered at ADC attends to the client’s nutritional, daily living, and social needs. Though ADC support individuals with a variety of conditions, as many as 20% of the participants have chronic mental health issues while over 40% of all ADC attendees have some form of physical disability.
Adult days services also play a major role in the lives of caregivers as a means of respite. Previous studies demonstrated that ADC reduced the exposure to caregiving related stressors by as much as 43%. The caregivers who allow their loved one to attend adult day services regularly have positive health-related, social, psychological, and behavioral outcomes. The chronic stress accompanied with caregiving has been shown to impact biological dysregulation, including cortisol response. Cortisol, one of the body’s regulatory hormones, plays a role in the central, metabolic system, and immune system. Stressful situations, such as caregiving, cause cortisol response to malfunction thus impacting one’s health. Investigators found that utilizing adult day services regularly alleviated some of the emotional responses felt by caregivers and better regulated cortisol levels.
