Effects of Adult Day Care on Daily Stress of Caregivers: A Within-Person Approach

Author(s): Zarit, S.H., Kim, K., Femia, E.E., Almedia, D.M., Savla, J. and Molenaar, P.C.M.

Published In: J Gerontol B Psychol Sci Soc Sci, 66 (5): 538–546

Study Aim/Purpose: The objective of this study was to examine the effects of adult day service (ADS) programming in New Jersey on exposure to and emotional response to stressors for family caregivers of individuals with dementia. 

Summary of Methods: This study used a “within-person withdrawal design” using 24-hour daily diaries (using the Daily Record of Behavior, an expanded version of the widely used Revised Memory and Behavior Problems Checklist) completed by 121 caregivers (primarily spouses and adult daughters). Two days of consecutive diaries were used to measure care related stressors at baseline (for two days prior to ADS use) and for two ADS-use and two non-ADS use days, each at one month and two months after beginning the program. In-home interviews were also conducted to assess caregiver and patient characteristics, measure severity of dementia and the patient’s functioning on ADLs and IADLs, and to collect information on frequency of behavioral, memory, and mood problems that occurred in the past week. 

Summary of Results: Analysis found that after one and two months of ADS use, the mean total exposure of caregivers to stressors stayed approximately the same on non-ADS days, while exposure on ADS days went down from just over 2 hours each day to 75 minutes at one month and to 52 minutes at two months. Most of the difference was accounted for by the time the person with dementia was away from the caregiver, but there were also significant reductions in behavior problems for the person with dementia during the evening and improved sleep immediately following ADS use. Additionally, the average reported length of caregiver upset per behavior problem decreased significantly across all days over the two-month period. 

Study Limitations (as cited by authors): Although the authors suggest their “within-person withdrawal design” is a strong study design for examining the effects of an intermittent intervention such as respite, they also point out several limitations to their study including: the small sample size, sample having higher levels of education and income than the population of the state as a whole, daily assessments not including measures of caregivers’ own emotional distress or health symptoms, and the fact that the authors were not able to test the effects of order of ADS and non-ADS days or lagged or cumulative effects of ADS use. 

Authors’ Discussion/Conclusions: The authors suggest the following implications of their study findings for respite programming: “By reducing behavioral problems and improving sleep in people with dementia, even in small amounts, ADS and other activity-based programs may be of considerable value to caregivers and may help keep their relative at home for a longer period of time.”