Research evidence on day centres for older people

This review covers 45 articles published between 2004 and 2020 and is by Catherine Lunt and colleagues’ (2021)

• There was some evidence (albeit limited) of improved levels of perceived psychological health, quality of life, perceived general health, physical health and functioning for older people with long-term conditions attending day care services.
• Day care’s respite function resulted in positive outcomes for carers. 

This review covers 77 articles published between 2005 and 2017 and is by Katharine Orellana and colleagues’ (2020)

• Day centre attendance and participation in interventions taking place within them may have a positive impact on older attenders’ mental health, social life, physical function, and quality of life. Day centres make available social contact, activities and interventions that improve quality of life, support the management of existing conditions, and may prevent declining health and function. The group environment is important.
• Mainly in non-UK settings, day centres have proven to be convenient community venues for a range of daily, short- and long-term, preventive and health-related interventions (short-term focused programmes of activity) run by trained staff or volunteers, or by health or social care professionals which are accessible to relevant target groups of people.
• Interventions taking place in day centres that were focused on change or maintenance/prevention mainly showed positive outcomes, including cost-effectiveness and potential for cost savings.
• Day centre models vary between countries.

This review covers 21 articles published between 1998 and 2017 and is by Virginia Maffioletti and colleagues’ (2019)

• Day centre attendance by people living with dementia contributed to continued living with family – that is, it delayed a move to a care home.
• The rest (respite) from caring stressors improved carers’ quality of life and health.
• Staff support also increased carers’ feelings of confidence and self-confidence to postpone a care home move.

This review covers 16 articles published between 2011 and 2016 and is by Janice Du Preez and colleagues’ (2018)

• Day centre attendance positively impacts attenders with dementia through their social engagement and participation in meaningful activities with peers with whom they feel safe, understood and comfortable.
• Feeling validated by staff improved attenders’ mood; this supported better relationships at home.
• Family carer outcomes are better and moves to care homes are delayed when service providers actively invite carers to be involved in activity planning and provide education and counselling support to carers.

This review covers 76 articles published between 2004 and 2014 and is by Moriah Ellen and colleagues’ (2017)

• Day centre attendance leads to positive health-related, social, and psychological and behavioural benefits in people receiving care and for their carers. Both people receiving care at day centres and their carers were highly satisfied with these services.
• Overall, day centres appear to offer varying services that can address challenges in the health system such as providing appropriate care for older people, enabling them to continue to live at home (age in place), while also providing low-cost services for this growing group.

This review covers 19 articles published before 2013 and is by Signe Tretteteig and colleagues (2015)

• Family carers of people living with dementi experienced their relatives' use of day centres as: 

  a) respite (i.e. they benefited from having a break from caring) and

  b) as a support service which helped to improve their competence in caring for their relative with dementia. 

  Carers experienced feelings of safety and relief, a reduced caring burden and improved motivation to continue caring.

• Outcomes depended on the quality of treatment of their relative at their day centre and how the service met the carers’ needs for flexibility, support, information, and responsibility sharing.

This review covers 61 articles published between 2001 and 2011 and is by Noelle Fields and colleagues (2014)

• Day centre attendance has more positive impact on emotional wellbeing than physical functioning. Attenders experience improvements in:

  a) overall wellness, improvements in physical and emotional, perceived psychosocial wellbeing, and positive changes in social support and quality of life; 

  b) overall wellbeing and dementia symptoms

  c) in intergenerational day centres, feeling needed.

• Attenders who were cognitively impaired benefited from ‘music therapy and art-based activity ‘interventions’ (programmes of activity).
• Physical ‘interventions’ improved gait, motor skills and reduced falls. 
• The above suggests that day centres are a useful community building in which to deliver evidence-based interventions.
• Attendance can reduce carer burden and stress and contribute to overall carer wellbeing, especially for people caring for a family member with dementia. 
• Evidence about how day centre attendance impacts on usage of other services is unclear.

This review covers 52 articles about respite services, 21 of which were about day centres, published between 1985 and 2004 and is by Hilary Arksey and colleagues (2004)

• Evidence suggests that day care providing respite for carers may be cost-effective in the long term. Four economic evaluation studies were identified. All four suggested that the benefits of day care might be similar to, or greater than, those achieved through standard care. Two suggested that day care might be cost saving and two suggested that it might provide greater benefits than standard care but at a higher cost.
• Many carers placed a high value on day centres and felt there were benefits for themselves and their relative with dementia.
• People with dementia enjoy the company, the sense of belonging and the activities provided.
• Some studies showed clear improvements in carers’ physical health, stress and psychological wellbeing; others showed no change.
• Some evidence suggested that day care attendance might prevent a move to residential care.

A study by Laura Bennett, Ailsa Cameron and colleagues.

• Older people, carers and local stakeholders considered day care a vital part of the social care landscape. Day care is well-placed to play a central role in local place-based partnerships.
• Day centres support their older attenders’ physical and mental wellbeing and health and provide purposeful activity.
• Older people value the supportive opportunities for connection and joy. 
• Having a regular extended break benefits carers’ mental health and helps them to sustain their caring role. Knowing their family member is enjoying themselves enables the break to be guilt-free.
• Day centres are a source of information and advice for carers.
• The two strongest factors that predict day centre use are not being married or co-habiting and being aged 85 or older (roughly four times more likely to use these services).

A study by Catrin Noone.

• Day centres are places in which genuine engagement and rapport-building can generate trust. In these spaces, older clients and carers feel part of a family and the day centre is not considered a ‘service’ or ‘intervention’.
• Day centre are places in which staff and volunteers observe and demonstrate care, promote inclusivity and encourage participation, by applying a ‘person-led’ (which is more than person-centred) approach.
• This sort of ‘relational practice’ that takes place in day centres can transform the lives of the older people attending them in many ways, offering a protected space to connect, learn, feel joy, mourn, and negotiate feelings of loneliness.

A study by Catherine Lunt and colleagues.

• People with long-term conditions who started to attend a day centre for the first time experienced lower levels of loneliness after 12 weeks compared with when they started to attend.
• A larger proportion of people attending ‘Blended’ (i.e. run by a mix of paid staff and volunteers) and ‘Volunteer-led’ services (i.e. with no paid staff) reported a reduction in loneliness (compared with people attending services run solely by Paid staff).
• People with long-term conditions reported a positive change in health and wellbeing over 3 months.
• People using Blended and Volunteer-led services reported better or the same health outcomes across most EQ5D3L (standardised questionnaire) domains than Paid (i.e. run by paid staff only) services.

A study by Katharine Orellana and colleagues.

• Day centre attendance enhanced quality of life for people with mobility restrictions and at risk of declining independence. They supported their mainly socially isolated and housebound attenders to age in place by focusing on their wellbeing and preventing deterioration and acted on any safeguarding or health concerns.
• Day centres were communities that ‘enabled’ and offset loss or isolation. They were life-enriching gateways to companionship, activities, the outside world (i.e. away from the home environment), to practical support, information and other services, to the community, and to enjoyment.
• Attenders' quality of life improvements / outcomes were directly because of day centre attendance.
• The ASCOT (validated tool) domains with the highest gain (outcome) scores were social participation, occupation (the way time was spent) and feeling a personal sense of significance (feelings of dignity). Social participation/companionship and how time was spent were also attenders’ favourite things about their day centre.
• Outcomes were achieved despite most people attending their day centres for only one or 2 days a week (i.e. 4.5–12 hours a week excluding travelling time).
• By monitoring attenders’ health and wellbeing and providing practical support, information and facilitating access to other services, centres offered added value. This added value goes beyond the purposes for which centres are commissioned or funded, beyond what may be assumed to be covered by an aim of improving quality of life or supporting people to remain at home, and beyond what attenders may have expected, given their reasons for attending.
• Older people had low awareness, generally, of day centres before they started to attend one. Most had not known their day centre existed before attending it.
• People had started to attend their day centre because they had experienced different types of loss and/or wanted something different to do (mainly due to declining health, bereavement, retirement, service closure and the consequences of these). People wanted social contact, something to do, to get out of their home or to improve their mental health, to improve their physical health through exercise and meals, to improve their mental health or to accompany a partner for whom they provided care.
• Carer outcomes included feeling supported and encouraged in their caring role, feeling reassured, respite (free time, emotional respite, time in which to deal with practical matters, time for self-care and a sense of control), an improved relationship with their relative, social participation with people they liked, and useful information. Some described the day centre as a ‘lifeline’.
• Carers' quality of life improvements were directly because of their relative’s day centre attendance (i.e. their relative’s day centre attendance made a unique contribution to their lives that they would not have experienced otherwise).
• Day centres made a unique wellbeing contribution to the lives of their volunteers (who were often older people themselves, but younger than attenders) and staff (i.e. added something to their lives that they would not have experienced were it not for their day centre role). They were a source of active ageing for their volunteers.
• Attenders, volunteers and staff particularly valued the group environment and continuity that centres provided which contributed to the development of person-centred relationships and, for staff/volunteer role satisfaction.

A study by Robert Hagan and colleagues.  

• Older people felt the programme was felt to be a purposeful and meaningful experience that also involved valuable social relations and resulted in learning from what was presented in group activities.
• Many enjoyed attending their programmes. 
• The model included obligatory attendance at each activity (whether educative or simply watching the television news) which some people did not welcome. When activities were not reablement-related, they would have preferred to choose alternative activities (e.g. sit alone or smoke a cigarette instead of watching the news).
• After the programme ended, some participants engaged with other services offering social contact, but this ‘step-down’ model (i.e. stopping day centre attendance after the programme ends) is not appropriate for everyone. It is important to recognise the importance of maintaining friendships made or rekindled after the programme period.

A study by Anne Marie Rokstad and colleagues.  

• Findings indicated positive outcomes from day care for both people with dementia and carers.
• Satisfaction was linked with doing meaningful activities, getting out of the home, strengthening social connections and staff’s careful facilitation of positive and welcoming atmosphere.
• Any initial reluctance to use a day centre later turned into enjoyment. Attendance provided structure, conversations, mealtimes and meaningful activities.
• Day centres provided respite and reassurance for carers. They benefited from time apart from their relative (which supported their relations when together) and from the support they experienced from staff.
• Day centre attenders’ wellbeing increased and their function improved.

A study by Ailsa Cameron and colleagues.

• Volunteers were involved with day centres in a variety of ways. They assisted paid day centre staff, including filling gaps in provision particularly if there were staff shortages – but did not provide personal care.
• Sometimes, day centres were reliant on them to open - even day centres employing staff.
• Volunteers joined in with activities alongside older people as well as providing them with support.
• Volunteers brought expertise and experience.

A study by Kritika Samsi and colleagues.

• If a move to a care home is a possibility for the future, using a day centre within, or adjoining, a care home will help to build relationships that may ease the transition for both the person with dementia and their family carer.

A Norwegian study reported that self-reported quality of life over 2 years was higher among people with dementia attending day care compared with a group of people with dementia who did not attend a day centre. Interestingly, the day centre attenders with lower awareness levels had higher self-reported quality of life scores than those who had full awareness. Although it cannot be assumed that these were directly because of day centre attendance, other similarities between the two groups suggested that day centre attendance might have had a positive impact on their lives.

Japanese research reported improved cognitive function among day centre service users with dementia after they had attended a day centre for six months compared with non-users of day centres over the same period. Importantly, improvements were not linked with frequency of day centre attendance. That is to say that cognitive function improved as a result of day centre attendance, and the number of days attended each week did not play a role. The conclusion was that day centre attendance is a useful non-drug therapy.  

Norwegian research reported that the positive impact of day centre attendance on the daily lives of people with dementia was due to addressing areas of their lives that had been affected by dementia: physical function, cognition, wellbeing and their home situation. Day centres enhanced the rhythm, activities, and social support in their everyday lives. The staff made the centres a safe place to be by fostering a sense of inclusion and belonging among their attenders.  

Norwegian research found that day centres relieved family carers by meeting the person with dementia’s needs for social community, nutrition, physical activity, and structure and variety in everyday life. Family members’ day centre attendance gave carers a feeling of freedom and increased the time available to be spent on their own needs, to be social and to work or do practical tasks undisturbed. It also had a positive impact on the relationship between the family carer and the person with dementia.  

A US study found that black carers of people living with dementia who attended a day centre over a 6-month period experienced fewer depressive symptoms than a similar group whose relative did not attend a day centre.  

An Irish study highlighted how age-friendly day centre facilities are essential to supporting local ageing in place strategies. Older people value their day centres, describing their experience as being home-from-home. Regular attendance offers the opportunity for assessment, case finding, early intervention and health promotion for health and social care professionals. District nurses were the most frequent referrers.

Attenders taking part in a Swedish study of social day centres described them as places that provide a structure and something to do in everyday life. Day centres enable their attenders to create new social relationships and enable a sense of belonging and feelings of being needed by others. Social day centre attendance becomes more important over time because it offers structure for daily routines after losing friends and spouses. Staff help by facilitating interactions between attenders. They are places where doing, being, becoming and belonging are facilitated, and thus they contribute to health and well-being.  

Canadian research with an older people’s community centre concluded that these services could make an important contribution to reducing social isolation and loneliness by providing leisure activities that support relationships and lead to feelings of belonging which is integral to wellbeing. Experiencing a welcoming environment and opportunities for meaningful involvement, and the ability of the service to meet diverse interests and needs underpinned contributed greatly to feelings of belonging.

Research about day centre activities in Denmark and Norway reported that day centres function as social spaces where people can share stories and news based on personal experiences from the past and present. Within day centres, facilitating communities that give attenders something new and refreshing to take back home with them can be seen to be person-centred care.

An Australian study reported that day centre attendance had beneficial effects on older people’s health, well-being and social engagement, with the diversity of activities contributing to happiness. Staff played the important role of facilitating social participation. Availability, accessibility and the cost of transport and the service itself were the biggest barriers to day centre use.  

Japanese research reported that day centres for older disabled people provide an age-friendly and disability-friendly safe place in which people enjoyed spending time with other people who may share similar experiences as themselves and interacting with staff. Making new friends and enjoying new interests made people feel happy and energised. Some people found that being surrounded by others with similar or worse disabilities affected their self-image positively and others found the reverse, or found it uncomfortable.

A Swedish study reported that day centre staff play an important role in providing opportunities for older people to maintain their health and participation in meaningful activities. Key staff actions are facilitating activities, establishing a good group dynamic while also supporting individual participation and facilitating social interaction. Activities available at centres are affected by other factors, including limitations relating to the premises, activity cost and restrictive guidelines and regulations. 

German research with regular day centre attenders revealed differing leisure activity preferences. Preferred activities included social, learning, productive, resting, play, travel, and physical activities. The most important activity group was revelling in memories and catching up on the news.

Japanese research reported that the most common reason for attending a day centre (among attenders who were independent and who needed support with the Activities of Daily Living) was to fulfil a need for social participation. Other reasons (among those with physical support needs) were to receive support with personal care and exercise, and carer relief. Day centres provide a place that is safe and provides the opportunity to socialise. Outcomes included maintenance of physical and mental health, alleviation of loneliness and reduction of family caregiving burden.  Key to outcomes was feeling a desire to revisit the day centre (i.e. continuity and familiarity were important).

A US study reported that day centre staff’s expertise is under-recognised. Day centres are flexible social environments in which staff manage the behavioural and psychological symptoms of dementia in an evidence-based and person-centred way. They personalised the way they worked with individuals – monitoring, engaging, socially stimulating and, when necessary, de-stimulating them.   

A US study concluded that updating and broadening activity programmes and introducing technology to day centres would help support ethnically diverse older people with a sense of purpose. Such changes would necessitate financial investment.  

Chinese research found that day centres provided a place for people to socialise, eat meals and bathe, compensating for difficulties in doing these things at home or elsewhere. However, the concept of ‘day care’ was culturally foreign to many people who made assumptions about types of activities they would be able to do or meals they would be given at centres. These assumptions hindered service uptake, as did costs.  

Spanish research found that, overall, (relatively active) older women attending day centres increased their activity slightly compared with women who did not go to a day centre, whereas men attending day centres did less activity than those who did not. Women engaged in more physical activities at day centres, increasing their light activity by 8% and doubling their moderate-to-vigorous activity. Men chose to join sedentary activities (e.g. playing cards, reading the newspaper).  

• A humour-based programme significantly improved life satisfaction and led to new social networks that extended beyond day centres. (US)   
• Another humour-based programme significantly lowered anxiety and depression and significantly improved psychological wellbeing but did not impact on general health, health-related quality of life and psychological distress. (Israel) 

• Hearing screening for people with sight loss improved links with a co-located support programme for hearing impaired people. (Canada)  
• Blood pressure monitoring by trained volunteers reduced blood pressure in people with or without diagnosed hypertension. (US).  
• Blood pressure monitoring by nurses via telehealth kiosks reduced blood pressure in people with hypertension. (US).  
• Medication reviews by pharmacy students led to the resolution of many medication-related problems and better medication use. (US)  
• A health outreach programme addressed individual need and targets for both partners (housing provider and public health). (US)

• An evidence-based, moderate-intensity weight-bearing exercise programme significantly improved lower body strength, agility, balance, walking speed and right-hand grip in older people needing help with one or more Activities of Daily Living (ADLs).(Australia)  
• A core stability and flexibility exercise programme improved spinal ranges of motion, but sacral/hip and thoracic flexibility, improvements in the lumbar area were not significant. (Italy).  
• An evidence-informed, tailored group exercise and walking programme for older attenders without severe cognitive impairment led to them eating more solid food. Walking with poles at day centres led to significant improvements to health-related quality of life associated with activity and function and to some aspects of posture and maintained mobility. However, fitness and physical function (except mobility - measured by Timed Up and Go (TUG) test did not change. Pole walking is like Nordic walking but without the need for licensed instructor training. See reference details for further information about TUG. (Japan). 
• A programme of education-focused falls prevention improved mobility. (Japan).  
• A behavioural intervention to increase walking and reduce urinary incontinence (UI) decreased incidence of UI in sedentary older people who improved their balance, gait strength and endurance by walking more and improved their physical activity and performance. (US)  
• Pelvic floor muscle training (Kegel exercises) to reduce UI with supportive coaching by a GP significantly decreased urinary incontinence (UI) in women. (Spain) 

• Self-management education sessions over 4 weeks significantly improved knowledge of heart failure, management and maintenance among people diagnosed with heart failure. (US)  
• A 12-week self-management education programme significantly improved self-rated ability to take preventive actions, manage symptoms, find and use appropriate medical care and make care decisions with health professionals. Participants’ physical activity and performance and their mental health-related quality of life also improved. (US)  
• A lifestyle modification programme delivered by trained lay people led to clinically significant weight loss in obese people. (US)
• A programme of low-impact exercise, nutrition education and weight management for people with multiple chronic conditions led to significant improvements to fitness, daily walking distance and hours of weekly exercise, and body measurements, as well as significant reductions in depression. (US)

• Discussion groups to promote social engagement and learning improved social engagement, mutual understanding and tolerance and intellectual stimulation. They also improved relationships with staff and better staff understanding of attenders. (Ireland).  
• Participating in an intergenerational programme supported nutrition, leading to day centre attenders with and without dementia eating more solid food than usual on the days they participated in a centre’s intergenerational programme. (US)  
• Organised volunteering improved self-perceived health, improved feelings of purpose and self-esteem. However, after intervention had finished, participants’ self-esteem and self-perceived health significantly lowered, although this remained above baseline measurements (i.e. before volunteering). (US)  
• Brain fitness activities of the type that may ordinarily take place in day centres improved self-perceived health and improved general wellbeing, perceptions of happiness and living an interesting life. (Canada)  
• Psychosocial group work lowered mortality and reduced use of health services over a two-year follow-up period.  Cognition improvements were also experienced by lonely older people; these remained significantly improved after one year. (Finland). 
• An eight-week ‘life review therapy’ programme led to significantly higher life satisfaction for day centre attenders taking part compared with a similar group of day centre attenders who did not. (Taiwan)
• A transport, exercise and self-help programme led to small improvements in levels of depression - although higher with mild depression. New social networks that extended beyond day centres were developed. Although 40% of women reported developing new friendships, men did not develop any. One conclusion was that the model tested was not the most appropriate. (Norway)
• A reablement-focused integrated care programme for day centre attenders and carers helped carers cope, feel satisfied and improved how they view their caring abilities but did not improve attenders’ physical and mental function.