Enhancing quality of life of families who use adult day services: short- and long-term effects of the Adult Day Services Plus Program

Author(s): Gitlin, L.N., Reever, K., Dennis, M.P., Mathieu, E., and Hauck, W.W.

Published In: The Gerontologist, 46 (5): 630-639

Study Aim/Purpose: The study’s purpose was to examine the short and long-term effects of the Adult Day Service Plus (ADS Plus) program, which integrates care management within adult day center services with the goal of “helping family caregivers develop problem-solving and coping skills, improve social and instrumental support, and enhance perceived competence in managing the difficult behaviors of their impaired elder.” 

Summary of Methods: The study used a quasi-experimental design. The intervention group was comprised of caregivers enrolled in two centers’ ADS Plus programs and the control group was comprised of caregivers enrolled at a center where their elder relatives received only the usual ADS. 129 caregivers were enrolled in the study and interviewed by the program social worker at baseline, 106 were available at the 3 month follow-up assessment, 74 were available at the 6-month assessment, and 58 were available at the final 12-month assessment. Trained interviewers, who were not familiar with the study hypotheses conducted in-person or telephone interviews at 3, 6 and 12-month follow-ups. The primary outcomes assessed during these interviews were: 1) caregiver depression (measured using the 10-item version of the Center for Epidemiologic studies-Depression scale); 2) burden (measured using 123 items from the Zarit Burden Interview); 3) memory and problem behaviors and self-efficacy in managing these behaviors (measured using the Zarit and Zarit 24-item Memory and Problem Behaviors scale); 4) perceived degree of change in well-being (measured using the 13-item Perceived Change Index); 5) time for healthy behaviors (measured using 6 items from the NIH Resources for Enhancing Alzheimer’s Caregivers’ Health initiative); 6) number of days using ADS; and 7) nursing home placement during the study period. 

Summary of Key Results: At 3-month follow-up, ADS Plus participants reported less depression, improved confidence managing behaviors, and enhanced well-being compared to the basic ADS group. Long-term effects analyses (6 and 12months) showed that, compared with controls, ADS Plus participants continued to report less depression and enhanced confidence managing behaviors. Additionally, mean use of ADS services was 37 days longer for ADS Plus participants than controls and ADS Plus users had fewer nursing home placements than those who received basic ADS. 

Study Limitations (as cited by authors): The authors did adjust for differences between the groups in all analyses. However, they were unable to control for potential confounders such as quality and number of staff-family interactions that may have differed across sites. They also note that the attrition rate was substantially different between groups, which may have affected the analyses of long-term effects. 

Authors’ Discussion/Conclusions: “The study clearly demonstrates the potential benefits of targeting both the older person using ADS as well as the family caregiver in assessment and treatment.” This approach “may also serve as a model for integrating caregiver assessment and treatment into other long term care service programs that traditionally target only the impaired adult.” Furthermore, “although an important objective of ADS is to help families delay nursing home placement, this study suggests that without systematically targeting the concerns of family caregivers, this objective may not be fully achieved.” The authors suggest that further research is needed to substantiate the findings of this study to other centers, examine the components of the intervention to determine which components contribute to improved caregiver outcomes, and to conduct analyses of costs and cost savings.