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How and why adult day programs influence admissions to long-term care homes for persons living with dementia: A program theory based on a realist review
Medveyuk S, Vervaecke D, Nguyen H, Corbett K, Dymchuk E, Baghini BZ, Slavescu I, Tate K et al.. Research Square, 2026-06-30
Topic: Health services, long-term care and technology
Background Adult day programs (ADPs) are a community-based continuing care service for older adults, including those living with dementia, and their family or friend caregivers. Evidence regarding the effect of ADPs on long-term care (LTC) home admission is inconsistent. Objectives To develop a realist program theory explaining how and why APDs influence LTC home admission for people living with dementia. Methods We searched CINAHL, EBM Reviews, JBI EBP Database, Embase, Medline, APA PsycInfo, and Social Work Abstracts (inception to January 6, 2026), and screened reference lists of relevant reviews and included studies. We included original studies of any design that reported details on contexts and mechanisms explaining how and why ADPs influence LTC home admissions for people living with dementia. We excluded studies not reporting results specific to persons living with dementia or focusing on settings other than ADPs. Pairs of research team members independently screened titles, abstracts, and full texts, completed a critical appraisal of included studies’ methodological quality, and extracted Context-Mechanism-Outcome (CMO) statements. Discrepancies were reconciled by consensus after each step. Results We included 17 studies, of which we extracted eight CMO statements. Six CMO statements were synthesized into a program theory. ADPs delay LTC home admission through relational processes involving attendees, caregivers, and ADP staff. Key mechanisms include staff observation and early identification of changing care needs, effective communication with caregivers, caregiver respite and support, and high-quality care. APDs that actively integrate and support caregivers, provide person-centered care, promote attendance, and are accessed early strengthen caregivers’ capacity to continue supporting persons living with dementia. Conclusions To reduce the risk of LTC admissions for individuals living with dementia, ADPs and ADP policies need ensure structures and processes that facilitate early, continued, and sufficient access, as well as high quality support of individuals living with dementia and their caregivers. Contexts and mechanisms associated with attendees’ and caregivers’ social determinants of health, and system-level contexts and mechanisms that influence ADPs are important knowledge gaps to be addressed by studies and to be incorporated in our program theory in the future. Registration PROSPERO, CRD42024504030
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APA 7th
Medveyuk, S., Vervaecke, D., Nguyen, H., Corbett, K., Dymchuk, E., Baghini, B. Z., et al. (2026). How and why adult day programs influence admissions to long-term care homes for persons living with dementia: A program theory based on a realist review. Research Square. https://doi.org/10.21203/rs.3.rs-9918025/v1
Vancouver
Medveyuk S, Vervaecke D, Nguyen H, Corbett K, Dymchuk E, Baghini BZ, et al. How and why adult day programs influence admissions to long-term care homes for persons living with dementia: A program theory based on a realist review. Research Square. 2026. doi:10.21203/rs.3.rs-9918025/v1.
BibTeX
@article{medveyuk2026-b46b3dcd,
author = {Medveyuk, S. and Vervaecke, D. and Nguyen, H. and Corbett, K. and Dymchuk, E. and Baghini, B. Z. and Slavescu, I. and Tate, K. and others},
title = {{How and why adult day programs influence admissions to long-term care homes for persons living with dementia: A program theory based on a realist review}},
journal = {Research Square},
year = {2026},
doi = {10.21203/rs.3.rs-9918025/v1},
url = {https://doi.org/10.21203/rs.3.rs-9918025/v1}
}
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Key findings
- We excluded studies not reporting results specific to persons living with dementia or focusing on settings other than ADPs.
- Results We included 17 studies, of which we extracted eight CMO statements.
- Contexts and mechanisms associated with attendees’ and caregivers’ social determinants of health, and system-level contexts and mechanisms that influence ADPs are important knowledge gaps to be addressed by studies and to be incorporated in our program theory in the future.
Study details
- Participants17
- Evidence strengthLow
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 27 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for study design, effect reported and randomised / blinded because the record does not state it. We have no data on times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 17 of the 62 points we could judge it on, which is 27 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (Research Square) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 1 / 4 | 17 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 17 / 62 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 17 of the 62 points we could judge it on is 27 out of 100. |
| Total | 27 / 100 | Capped to 16 because this is not a peer-reviewed article. |
What each of these 20 components measures, and what this score is not →
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