PHD: Quality of care at farm-based day care services for people with dementia – the farm as a setting for promoting health, well-being and quality of life

Summary

Background: There is an increasing prevalence of dementia worldwide, with an estimated 35.6
million people living with dementia in 2010. This number is expected to double by 2030 and double
again by 2050. The increasing number of people with dementia and the burden the disease places
on those affected and their informal caregivers have prompted the World Health Organization to
name dementia a global public health challenge. In Norway, the national dementia plans have
highlighted day care services for people with dementia as a “missing link” in the care pathway, and
state that they should provide their participants with activities, stimulation, good experiences and
meaningful days. Most day care services in Norway are so-called regular day care services situated at
already existing care facilities such as nursing homes. There has been a call for diversification of day
care services, and farm-based day care services for people with dementia have been highlighted as
an innovative service. These are day care services located at farms using the farm-setting and
activities actively in the service. Previous research has noted many potential benefits of farm-based
day care services for people with dementia, but there is still a need for further research.

Aim: The aim of this thesis is therefore to investigate the quality of care at farm-based day care
services for people with dementia. To aid in this, the thesis had sub-aims looking at physical activity,
emotional well-being and quality of life and subjective well-being for participants at farm-based day
care services.

Method: We conducted a longitudinal study where we followed participants at farm-based day care
services for 12 months. We collected data on a range of measures, including quality of life, at startup,
6 months and 12 months. We also gathered physical activity data using actigraphy for a
subsample of the participants in conjunction with the data collection at 6 months. For both the
longitudinal data and activity data we also included comparison groups from regular day care. Lastly,
researchers in the Farm-based Dementia Care Project, conducted an observational study using the
Maastricht Electronic Daily Life Observation-tool, looking at different aspects of daily life at both
farm-based and regular day care services for people with dementia.

Results: Based on the collected data on physical activity we found that participants at farm-based
day care services had a higher level of physical activity than participants at regular day care services.
Further, the participants at farm-based day care services were more physically active the days they
were at the farms, compared with the days they were not at the farms.

We also found based on observational data that participants at day care services for people with
dementia generally had good emotional well-being while at the service, but that the participants at
farm-based day care services had higher emotional well-being for several of the factors and activities
at the day care services compared to those attending regular day care services. We also found,
adjusting for activities and other factors, that attending farm-based day care services was associated
with higher emotional well-being. In addition, social interaction and the activities exercise and
dancing, and quiz, music and spiritual activities were associated with emotional well-being
regardless of the type of service.

Lastly, based on the longitudinal data we found a larger, but not clinically significant, decrease in
self-reported quality of life after 12 months among the participants of farm-based day care services
compared to regular day care services. Further analyses suggested that changes in the social
domains were the main difference between the two groups. Additionally, with-in group analyses of
those attending farm-based day care services showed that subjective well-being remained stable
throughout the 12 months. Further, among the service-related factors at farm-based day care
services, time spent outdoors at the service and number of participants were associated with quality
of life, while time spent outdoors was associated with subjective well-being.

Conclusion: Based on the findings the overall conclusion of this PhD-thesis is that farm-based
dementia day care services provide quality care for its participants through providing physical
activity, social activity and good experiences for the participants. Further, the quality of care at farmbased
day care services are equal to regular day care. Based on the findings farm-based services can,
especially regarding physical activity and good experiences, potentially provide more quality care
than regular day care services. Farm-based day care services can therefore help alleviate the need
for additional care services for people with dementia, and promote health and well-being for the
participants.