Does adult day service use improve well-being of Black caregivers of people living with dementia?

Study Aim/Purpose:  The purpose of this study was to examine the association between the use of adult day services (ADS) and depressive symptoms among Black caregivers of people living with dementia.

Summary of Methods: The researchers conducted a cross-sectional study using data collected as part of baseline surveys of 135 Black caregivers in two intervention trials in Philadelphia: Advancing Caregiver Training (n=72) and Care of Persons with Dementia in their Environments (n=63). Both trials had the same eligibility criteria: caregivers had to be English-speaking, at least 21 years old, living with the person with dementia, and providing at least four hours of daily care. Depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression (CES-D) scale. Respondents were asked whether they experienced each of 10 symptoms rarely or most of the time in the past week. Using this scale, the scores were summed ranging from 0 to 30. A cutoff score of 8 identifies individuals at risk of clinical depression. Chi-square and Student’s t-tests were used to compare those who use ADS in the past 6 months to those who did not. The authors used regression analyses to examine the association between depressive symptoms and ADS use, controlling for caregiver burden, social support, self-related health, religious/spiritual coping, and demographic characteristics.

Summary of Results: The mean age of all caregivers was 60, with more than three-quarters (79.1%) having some college or a college degree, and the large majority (90%) being female. About half (54.6%) provided care for a nonspouse. Almost half (48.0%) reported having social support and nearly three-quarters (70.7%) rated their own health as good to excellent. There was no observed difference in ADS use by any of the covariates or demographic variables, including measures of employment status and financial strain.

With regard to the association between ADS use and depressive symptoms, those caregivers who used ADS within the past six months reported statistically significantly fewer depressive symptoms compared to those who did not. Further, the mean CES-D score for those who used ADS in the past 6 months was 8.3, compared to 10.3 for those who did not use ADS. In addition, good/very good and excellent self-rated health and older age were independently associated with lower rates of depressive symptoms.

Study Limitations (as cited by authors):  The authors pointed out that while they found associations, they were not able to determine the causal pathways between ADS usage and depressive symptoms or how the dosage of ADS use (i.e., length of time during the day and over time) may have affected the depression outcome.

Authors’ Discussion/Conclusions:  The authors emphasized that their findings are novel, as no previous studies have explicitly examined the relationship between ADS use and depressive symptoms among Black caregivers. They also highlighted the need for future research to examine within-group differences, as their research did, noting that comparisons between Blacks and Whites may mask important differences in health and psychosocial experiences within each group. The authors suggest a need for future research to better elucidate the causal pathway between ADS use and reduced depression among caregivers, as well as research into factors affecting ADS usage, availability and accessibility. Additionally, they recommend research to examine how cultural values or norms regarding caregiving affect Black caregivers’ reporting of depressive symptoms and their decisions regarding ADS use.

With regard to the implications of their research findings for clinical practice, the authors suggest that providers would benefit from a better understanding that nonpharmacologic strategies and community support programs, such as ADS, can support quality of life and provide relief to caregivers and that the Medicare Wellness visit include referrals to ADS as needed. They also highlight the need for policy-focused research to identify financial structures, policy, and programming needed to enhance access to ADS.