Adult day service use and reductions in caregiving hours: Effects on stress and psychological well-being for dementia caregivers

Author(s): Gaugler, J. E., Jarrott, S. E., Zarit, S.H., Stephens, M-A.P. Townsend, A., and Greene, R.

Published In: International Journal of Geriatric Psychiatry, 18 (1), 55–62

Study Aim/Purpose: The objective of this study was to determine whether adult day service (ADS) use and its related reductions in primary caregiving hours would positively impact caregivers’ negative emotional appraisals (i.e. exhaustion and fatigue, feeling of being trapped in the caregiving role) and levels of psychological distress. 

Summary of Methods: This study used a quasi-experimental design with a treatment group of caregivers of individuals with dementia who would be using adult day services (ADS) in a NJ statewide program and a control group of caregivers of individuals with dementia residing in a similar sociodemographic region (Northeastern Ohio) where ADS were not widely available. The cohort of 169 treatment caregivers and 231 comparison caregivers completed interviews at baseline and three months later and these results were included in the data analysis. In addition to collecting basic descriptive information on the caregivers at baseline, at each interview caregivers provided information for the month prior to each interview on the following topics: 1) number of hours they spent assisting and/or managing ADLs, IADLs, behavior problems and memory problems during a typical day; 2) caregivers; perceptions of their role captivity (being trapped in care responsibilities), role overload, level of worry and strain and psychological well-being; 3) care demands measured by the occurrence of behavioral problems, problems with memory loss for their relative with dementia; 4) whether their relative with dementia required their assistance to complete ADLs and IADLs; and 5) the number of hours of assistance provided by other family members or paid help. The regression analysis to test associations between ADS use and hours of caregiving and caregiver stress controlled for multiple variables including: sociodemographic characteristics of the caregivers and care recipients; frequency and severity of problematic behaviors, ADL/IADL dependencies, and cognitive impairment of the individual with dementia; and the amount of assistance provided by other family members or paid help. 

Summary of Key Results: The primary statistically significant finding was that caregivers using ADS who reported decreases in hours spent helping with memory problems were more likely to report decreases in “role overload” than the comparison group of non-ADS users. An opposite interaction effect occurred for change in worry and strain among a subgroup of non-ADS users: non-ADS users who reported greater decreases in their relatives ADL dependencies over the three-month study period were more likely to report decreases in worry than were ADS users. 

Study Limitations (as cited by authors): Since this was a quasi-experimental study design, the authors state that “Unknown variations (in the characteristics of the treatment and control groups) at baseline may have influenced the robustness of the results.“… “Also relying on caregivers’ self-reported time estimates in the month prior to each interview may have increased the potential for recall error.” 

Authors’ Discussion/Conclusions: The authors suggest that the following as explanation for the study’s positive findings of associations between ADS use and reported “role overload.” By relinquishing care demands for several hours a week, adult day service users could have had more time to complete other necessary demands efficiently when compared to caregivers whose relatives remained at home, thus leading to decreased feelings of exhaustion. Alternatively, some adult day programs may have provided services that helped reduce more severe disorientation and/or repetitious questioning on the part of clients. By addressing the memory problems of clients, adult day services may have offered caregivers the relief necessary to reduce feelings of exhaustion and fatigue.