This study investigated the relationship between rehabilitation participation and emotional or physical changes over one year among 157 community-dwelling older adults utilizing day-care services. Participants were evaluated using the Mini-Mental State Examination (MMSE), Geriatric Depression Scale-15 (GDS-15), Apathy Evaluation Scale (AES), and Short Physical Performance Battery (SPPB). Rehabilitation engagement was measured via the Pittsburgh Rehabilitation Participation Scale (PRPS) over three consecutive days, categorizing individuals into good and poor participation groups based on a threshold score of four. Statistical comparisons between initial and one-year follow-up data were conducted using Wilcoxon’s rank sum test. Among the participants, who had an average age of 83 years, further analysis divided them into three subgroups based on their cognitive functioning (MMSE scores of $\ge24$, 20–23, and 19–10). The results revealed that within the moderate-to-severe cognitive impairment subgroup (MMSE 19–10), individuals with high rehabilitation participation experienced a significant increase in apathy (higher AES scores) and a significant decline in lower limb motor function (lower SPPB scores) after one year. Consequently, the authors conclude that older adults with dementia who actively participate in day-care rehabilitation may paradoxically face an increased risk of worsening apathy and reduced physical function over time.
