Adult day service use decreases likelihood of a missed physician’s appointment among dementia caregivers

Author(s): Parker, L.J., Gaugler, J.E., Samus, Q., and Gitlin, L.N.

Published In: J Am Geriatr Soc, 67: 1467-1471

Study Aim/Purpose: The study examined the association between adult day services (ADS) use for community-dwelling persons with dementia and a missed physician’s appointment among their family caregivers. 

Summary of Methods: The authors conducted secondary analysis of baseline data collected for two randomized controlled trials evaluating behavioral interventions for community-living persons with moderate-stage dementia (Advancing Caregiver Training and Care of Persons with Dementia in their Environments). The sample consisted of 509 English-speaking adult family caregivers who were living with the person with dementia and providing at least four hours of daily care. A missed physician appointment in the past six months was the primary outcome assessed. Predisposing factors examined included race, education, and whether the caregiver was a spouse. Enabling factors assessed included adult day service use, social support, and employment status of the caregiver. The medical needs of the caregivers were assessed by self-report of the number of chronic health conditions of caregivers using the 13-item National Health Interview Survey, and psychological needs were assessed by measuring caregiver burden using the 12-item Zarit Burden Interview Short Form. 

Multivariate logistic regression analyses were used to identify the predisposing, enabling and need factors associated with a missed physician appointment, adjusted by an interaction term between race and ADS use to examine if racial differences in adult day service use were associated with a missed physician’s appointment. 

Summary of Results: Thirty-seven percent of the sample used adult day services. Caregivers who utilized ADS were 49 percent less likely to miss a physician’s appointment compared to those who did not these services. Regardless of ADS use, black caregivers were more likely than white caregivers to miss a physician appointment. Older age was associated with decreased odds of missing an appointment. Additionally, caregivers with more chronic health conditions were more likely to report that they had missed a physician’s appointment than those with fewer chronic health conditions. 

Limitations of Study: The authors note several limitations of this study. First, the study relied on a convenience sample of caregivers who had volunteered for the trial and thus may have been more likely to use ADS or similar services. Second, the analysis, that was based on self-report of ADS use and missed appointments, may have been subject to recall bias. Third, generalizability of the findings to rural caregivers may not be applicable since the study sample primarily included an urban population. 

Authors’ Discussion/Conclusions: Findings indicate ADS use may offer caregivers respite to attend medical appointments. The authors recommend that ADS programming be expanded to encourage health-promoting behaviors among caregivers. For future research, the authors recommend studies to examine if ADS use is associated with other positive health behaviors among caregivers. Additionally, the authors recognize the cultural and access barriers that black caregivers may face in accessing health care and recommend that home and community-based services both improve their access to adult day services and provide the support needed to help them attend to their own self-care.