Adult Day Services, Health Equity for Older Adults With Complex Needs, and the COVID-19 Pandemic

Abstract

Morbidity and mortality from COVID-19 have unduly affected older adults from racial and ethnic minority groups. In this article, we highlight the experiences and vulnerabilities of diverse older adults with complex health and social needs when their access to vital, but overlooked, community-based adult day service centers (ADSCs) was abruptly cut off during a pandemic. Pandemic-related ADSC closures left vulnerable older adults and their care partners without essential daily support and services, such as health monitoring and socialization. However, the magnitude of the impact of ADSC closures on well-being, particularly among members of racial/ethnic minority groups, has yet to be measured with any form of “big data” because large-scale, nationally representative data sets consisting of participant-level information and outcomes associated with ADSC participation do not yet exist. Unmet needs of older adults resulting from pandemic-related ADSC closures are underrecognized because of a lack of systematic data collection, undermining efforts to achieve health equity. We call on ADSCs to link rigorous collection of racial and ethnic data to quality measures of access to equitable “age-friendly” care as a means of better supporting diverse community-dwelling older adults beyond the COVID-19 pandemic. (Am J Public Health. 2022;112(10):1421–1428. https://doi.org/10.2105/AJPH.2022.306968 )

Effect of the COVID‐19 pandemic on meaningful activity engagement in racially and ethnically diverse older adults

“…For example, availability of informal (caregiver) and formal services like in‐home supportive services were not included, which may have greater social and emotional impacts. However, formal and informal supports like family caregivers and adult day services were abruptly cut off or withdrawn during the pandemic 11,13 . Second, while we speak of meaningful activities, NHATS questions asked strictly about activity participation and participation may not equate to meaningfulness.…”

“…29 Covariates included age; sex; functional status; income; geographic region; anxiety and depression; and presence of transportation problems. Participant sex (male/female) and geographic region (Northwest/Midwest/South/West) were from the 2015 (Round 5 baseline) survey while the other variables were time-varying covariates, taken from each survey round: age (continuous), functional status (derived continuous variable of a total number of activities of daily living [ADLs] for which they received help [yes/no], including eating, bathing, toileting, dressing, walking outside, moving around inside, and getting out of bed [range 0-7 ADLs]), income (quintiles), anxietydepression (none to minimal [score 0-2]; mild [3][4][5]; moderate [6][7][8]; severe [9][10][11][12]), and presence of transportation problems (yes/no). For income, we used an imputed value for annual income when total annual income was unavailable.…”

“…However, formal and informal supports like family caregivers and adult day services were abruptly cut off or withdrawn during the pandemic. 11,13 Second, while we speak of meaningful activities, NHATS questions asked strictly about activity participation and participation may not equate to meaningfulness. However, NHATS specifically chose these activities as they are elective but valued and meaningful to older adults.…”

“…4,5 Personal, individual-level factors include functional limitations, cognitive impairment, psychological motivation, 6 and income 7 while other aspects include neighborhood-level factors (e.g., the built environment, transportation availability), 8,9 social support systems, 10 and policies that support adult day services programs and formal paid caregivers such as in-home support services. 11 In 2020, the start of the COVID-19 pandemic profoundly altered all our lives. Containment measures such as shelter-in-place and physical distancing may have reduced mortality and morbidity, but at the same time limited the ability of older adults in particular to stay physically active, 12,13 and increased social isolation and feelings of loneliness 14 ; all of which can further exacerbate psychological stress and increase risk for cognitive decline and depression.…”

“…In aging adults, a combination of personal and external factors may limit or facilitate their ability to participate in meaningful activities 4,5 . Personal, individual‐level factors include functional limitations, cognitive impairment, psychological motivation, 6 and income 7 while other aspects include neighborhood‐level factors (e.g., the built environment, transportation availability), 8,9 social support systems, 10 and policies that support adult day services programs and formal paid caregivers such as in‐home support services 11 …”