Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-11T06:34:37.006Z Has data issue: false hasContentIssue false
  • English
  • Français

Non-use of day care services for dementia in Singapore — a dilemma for caregivers

Published online by Cambridge University Press:  01 December 2016

Shan Huang Open the ORCID record for Shan Huang [Opens in a new window] ,
Konstadina Griva ,
Christina A. Bryant  and
Philip Yap
Shan Huang*
Affiliation:
Psychology Service, Department of Psychological Medicine, Khoo Teck Puat Hospital, Singapore Department of Psychology, National University of Singapore, Singapore Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
Konstadina Griva
Affiliation:
Department of Psychology, National University of Singapore, Singapore
Christina A. Bryant
Affiliation:
Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
Philip Yap
Affiliation:
Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore Geriatric Education & Research Institute, Singapore
*
Correspondence should be addressed to: Ms Shan Huang, Psychology Service, Department of Psychological Medicine, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore. Phone: (+65) 66024705; Fax: (+65) 6602 3646/6602 3647. Email: huang.shan@alexandrahealth.com.sg.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Day care services for patients with dementia (PWD) are generally under-utilized worldwide despite evidence of positive outcomes, such as improved behavioral, psychological, and cognitive functioning for patients, and reduced caregiver burden. This study sought to gain an in-depth understanding of the reasons for non-utilization of day care services in Singapore using qualitative methodology.

Methods:

A purposive sample of 16 caregivers of PWD who had never attended day care services participated in semi-structured interviews. Interviews were audio-recorded and transcribed verbatim. Data analysis was based on an Interpretative Phenomenological Analysis framework.

Findings:

Caregivers recognized the importance of engagement for PWD, yet were constrained by patients’ refusal to attend day care, which caregivers attributed to the patients’ negative beliefs about day care and fear of abandonment by their families. Caregivers also raised concerns about service delivery issues, the suitability of activities at day care, and their perceptions of the patients’ ability to integrate into the setting. Non-utilization was also related to caregivers’ low perceived need due to the availability of alternative care arrangements (e.g. having a domestic helper and adequate family support).

Conclusions:

Caregivers generally understand the value of day care but several factors tip the balance in favor of non-use. These include culturally bound caregiving values and perceptions, and inadequacies in service delivery. Negative perceptions about services highlight the need to enhance the image and standards of day care and increase awareness of the benefits of day care for PWD beyond its custodial role.

Keywords

dementiaday careservice non-utilizationcaregivingqualitative
Type
Research Article
Information
International Psychogeriatrics , Volume 29 , Issue 3 , March 2017 , pp. 455 - 466
Copyright
Copyright © International Psychogeriatric Association 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.). Washington, DC: American Psychiatric Association.Google Scholar
Biggerstaff, D. and Thompson, A. R. (2008). Interpretative phenomenological analysis (IPA): a qualitative methodology of choice in healthcare research. Qualitative Research in Psychology, 5, 214–224.Google Scholar
Brodaty, H., Thomson, C., Thompson, C. and Fine, M. (2005). Why caregivers of people with dementia and memory loss don't use services. International Journal of Geriatric Psychiatry, 20, 537–546.Google Scholar
Chan, S. W. (2010). Family caregiving in dementia: the Asian perspective of a global problem. Dementia and Geriatric Cognitive Disorders, 30, 469–478.Google Scholar
Chong, M. S. et al. (2013). Cost of informal care for community-dwelling mild-moderate dementia patients in a developed Southeast Asian country. International Psychogeriatrics, 25, 1475–1483.Google Scholar
Cox, C. (1997). Findings from a statewide program of respite care: a comparison of service users, stoppers, and nonusers. The Gerontologist, 37, 511–517.Google Scholar
Davie, S. (2014). Lien foundation makes available 10 free designs of pre-schools, urges rethink on spaces for pre-schools. The Straits Times Singapore: Singapore Press Holdings.Google Scholar
Day, K., Carreon, D. and Stump, C. (2000). The therapeutic design of environments for people with dementia a review of the empirical research. The Gerontologist, 40, 397–416.Google Scholar
Dong, X., Zhang, M. and Simon, M. A. (2014). The expectation and perceived receipt of filial piety among Chinese older adults in the greater chicago area. Journal of Aging and Health, 26, 1225–1247.CrossRefGoogle ScholarPubMed
Durand, M., James, A., Ravishankar, A., Bamrah, J. S. and Purandare, N. B. (2009). Domiciliary and day care services: why do people with dementia refuse? Aging and Mental Health, 13, 414–419.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Gallagher-Thompson, D. et al. (2012). International perspectives on nonpharmacological best practices for dementia family caregivers: a review. Clinical Gerontologist, 35, 316–355.Google Scholar
Kosloski, K., Montgomery, R. J. and Youngbauer, J. G. (2001). Utilization of respite services: a comparison of users, seekers, and nonseekers. Journal of Applied Gerontology, 20, 111–132.Google Scholar
Lévesque, L., Cossette, S., Potvin, L. and Benigeri, M. (2000). Community services and caregivers of à demented relative: users and those perceiving à barrier to their use. Canadian Journal on Aging/La Revue Canadienne du Vieillissement, 19, 186–209.Google Scholar
Lim, J., Goh, J., Chionh, H. L. and Yap, P. (2012). Why do patients and their families not use services for dementia? perspectives from a developed Asian country. International Psychogeriatrics, 24, 1571–1580.Google Scholar
Liu, D., Hinton, L., Tran, C., Hinton, D. and Barker, J. C. (2008). Reexamining the relationships among dementia, stigma, and aging in immigrant Chinese and vietnamese family caregivers. Journal of Cross-Cultural Gerontology, 23, 283–299.Google Scholar
Ministry of Health Singapore (2012). More facilities to help seniors age-in-place [Online]. Available at: http://www.moh.gov.sg/content/moh_web/home/pressRoom/pressRoomItemRelease/2012/more-facilities-to-help-seniors-age-in-place.html; last accessed 23 July 2013.Google Scholar
Morris, J. C. (1993). The clinical dementia rating (CDR): current version and scoring rules. Neurology, 43, 2412–2414.Google Scholar
Mossello, E. et al. (2008). Day care for older dementia patients: favorable effects on behavioral and psychological symptoms and caregiver stress. International Journal of Geriatric Psychiatry, 23, 1066–1072.Google Scholar
Phillipson, L. and Jones, S. C. (2012). Use of day centers for respite by help-seeking caregivers of individuals with dementia. Journal of Gerontological Nursing, 38, 36–27.CrossRefGoogle ScholarPubMed
Robinson, A. et al. (2012). Seeking respite: issues around the use of day respite care for the carers of people with dementia. Ageing and Society, 32, 196.CrossRefGoogle Scholar
Robinson, K. M., Buckwalter, K. C. and Reed, D. (2005). Predictors of use of services among dementia caregivers. Western Journal of Nursing Research, 27, 126–140; discussion 141–127.Google Scholar
Smith, J. A. (1996). Beyond the divide between cognition and discourse: using interpretative phenomenological analysis in health psychology. Psychology & Health, 11, 261–271.Google Scholar
Squires, A. (2008). Language barriers and qualitative nursing research: methodological considerations. International Nursing Review, 55, 265–273.Google Scholar
Temasek Cares (2012). Building Community: Temasek Cares - iPAL (Integrated Promoters of Active Living) [Online]. Available at: http://www.temasekcares.org.sg/programmes/build-Com-ipal.html; last accessed 15 December 2014.Google Scholar
Teo, J. (2016). Enrichment lessons for dementia patients. The Straits Times (p. B14) Singapore: Singapore Press Holdings.Google Scholar
Toseland, R. W., McCallion, P., Gerber, T. and Banks, S. (2002). Predictors of health and human services use by persons with dementia and their family caregivers. Social Science and Medicine, 55, 1255–1266.Google Scholar
Weber, S. R., Pirraglia, P. A. and Kunik, M. E. (2011). Use of services by community-dwelling patients with dementia: a systematic review. American Journal of Alzheimer's Disease and Other Dementias, 26, 195–204.Google Scholar
Woods, B., Aguirre, E., Spector, A. E. and Orrell, M. (2012). Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database of Systematic Reviews, 2, CD005562.Google Scholar
Yeoh, B. S. and Huang, S. (2010). Foreign domestic workers and home-based care for elders in Singapore. Journal of Aging and Social Policy, 22, 69–88.Google Scholar
Zanetti, O. et al. (1999). Insight in dementia: when does it occur? Evidence for a nonlinear relationship between insight and cognitive status. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 54B, P100–P106.Google Scholar
Zarit, S. H., Stephens, M. A. P., Townsend, A. and Greene, R. (1998). Stress reduction for family caregivers: effects of adult day care use. The Journals of Gerontology, 53B, S267–277.Google Scholar