Effectiveness of respite care in supporting informal caregivers of persons with dementia: A systematic review

Study Aim/Purpose: This study was designed as a systematic review of studies on the impact of respite care for caregivers of persons with dementia. 

Summary of Methods: The authors conducted a systematic search of articles published since 2000 on the effect of respite care on caregivers, care recipients or health care resource use, where the caregivers are informal and the care recipients had been diagnosed with dementia and live primarily at home. The search was conducted using PubMed and Web of Science and included studies written in English, German, Dutch, and French. Only studies using experimental design studies (with RCTs), quasi-experimental design with comparison groups, pre/post intervention outcome studies without a control group, and cohort studies were included. The studies were also evaluated to be of strong, medium or weak methodological quality, using the Quality Assessment Tool for Quantitative Studies. 

Summary of Key Results (related to studies of effectiveness): The authors identified 17 studies for review, with varying levels of quality. A summary of key findings is grouped below by respite care type. 

Out-of-home day care respite. Six of the eight day care program studies indicated improvement in caregiver burden and stress related outcomes. Six of the seven day care program studies indicated decreased behavioral problems and possibly improved sleep quality for care recipients. Two studies found that respite day care alone actually accelerated time to nursing home placement for persons with dementia. At the same time, one methodologically strong study comparing receipt of adult day care integrated with support and information services to a control receiving only day care found significant impact on care recipient behavioral problems and an increased delay in nursing home placement for the individuals who received the integrated programming. 

Temporary residential admission. One study found a positive effect of temporary residential respite on caregiver sleep quality during the temporary respite period. No other impacts on caregivers or strong positive impacts on care recipients were found. 

In-home respite. The review found only one study of in-home respite for persons with dementia and rated it as having weak methodological quality. 

Limitations of Studies Reviewed (as cited by the author): The authors note that the comparability of respite studies is limited because various types of respite services are often poorly described and vary in terms of the lengths of respite offered; the respite studied is used for varying reasons; and, the studies use different outcome measures. 

Authors’ Discussion/Conclusions: They authors recommend that more research be conducted to enable the measurement of impact of a specific model of respite care, especially in the area of in-home respite care. And, these studies should look at outcomes at three levels: the caregiver, the care recipient, and health care resource utilization.