Effectiveness of day care in supporting family caregivers of people with dementia: A systematic review

Author(s): Maffioletti, V.L.R., Baptista, M.A.T., Santos, R.L., Rodrigues, V. M., Dourado, M.C.N.

Published In: Dement Neuropsychol, 13(3): 268–283

Study Aim/Purpose: The purpose of this paper was to summarize literature on the strategies used in day care for supporting family caregivers of people with dementia, as well as their effects on family caregiver burden, coping strategies, and quality of life. 

Summary of Methods: The authors conducted a systematic review of literature published In English or Portuguese from 1998 to 2017. The search was performed using PubMed, PsycInfo, Scopus and SciELO databases with search keywords: “day care” or “care day” or “partial hospitalization”; “dementia” or “Alzheimer disease” or “Alzheimer’s disease” or “Alzheimer type dementia”; “caregiver” or “family caregiver” or “carers”; and “quality of life” or health related quality of life”; and “adaptation, psychological” or “coping behavior” or “coping skills.” The authors included cross-sectional or longitudinal descriptive studies; evaluation studies using randomized or non-randomized designs, including both those with and without control groups; and other studies of caregiver outcomes of day care for people with dementia. Exclusion criteria were used as well, such as studies focused on the outcomes for persons with dementia. The authors also screened titles for inclusion based on a rating of the quality of their research methods using the Mixed Methods Assessment tool. After review by all the authors, 21 papers were included. Ten of the 21 studies were conducted in the USA, three in the Netherlands, one in Norway, one in Norway and Scotland, one in Iceland, one in Hong Kong, one in Australia, one in Italy, one in Sweden and one in Germany. No randomized controlled trials were found. 

Summary of Results: The authors found great heterogeneity in the structure and organization, intervention strategies, and theoretical bases of the day care programs studied. At the same time, 10 of the 21 studies did not fully describe the activities offered, which the authors attributed to the fact that the studies focused on investigating the benefit of the break from care for the family caregiver rather than the content of the services provided to the patient. Where it could be determined, some programs studied offered activities only for the person with dementia, while others offered activities for the dyad. Where behavioral improvements were identified, this was also associated with reduced burden for family caregivers. Integrated programs providing activities for the dyad found increased feelings of competence and self-confidence of family caregivers, allowing them to postpone institutionalization. 

Study Limitations (as cited by authors): The authors cautioned that the heterogeneity of the day care programs’ structure and organization, design and theoretical basis, and the size of the study samples hinders cross-study comparison. They also highlighted the variation in assessment methodologies used across studies. For example, some studies compared outcomes on days with day care treatment to the days when the person with dementia was cared for at home; others compared outcomes of family caregivers using day care to non-users, while others only interviewed the family caregivers of day care users. 

Authors’ Discussion/Conclusions: The authors conclude that despite the great diversity of methods, samples, measuring instruments and interviews, most of the studies reported similar positive results in reducing family caregiver burden, thus use of day care for persons with dementia appears to be promising for improving the health and quality of life for their family caregivers. Their findings suggest that programs serving both the patient and family caregiver offer a more promising approach than those that only serve the patient, and that they have potential to promote health, prevent disease, and minimize burden and enable long-term care in non-institutional settings. At the same time, the authors cautioned that the conception of day care as only a respite service for the benefit of the caregiver restricts the understanding and evaluation of its role as a treatment and rehabilitation service for persons with dementia as well as a source of guidance and support for their family caregivers.