Immediate and Lagged Effects of Daily Stress and Affect on Caregivers’ Daily Pain Experience

Study Aim/Purpose: The authors examined the immediate and lagged daily pain outcomes associated with daily levels of stress and adult day service (ADS) use among family caregivers of persons with dementia. 

Summary of Methods: This longitudinal study involved daily telephone interviews with 173 family caregivers of persons with dementia who live in the same household and indicated that their primary responsibility is helping the individual with daily tasks, and whose care recipient attended ADS more than 2 days per week. Participants were initially interviewed in person to collect sociodemographic and baseline data (e.g. duration of care, ADL impairment of the individual with dementia, caregiver over-the-counter medication use, and reports of bodily pain frequency and interference). Subsequent daily telephone interviews assessed the following measures over eight consecutive days: (1) daily bodily pain; (2) use or nonuse of ADS; (3) daily positive and negative affect; (4) care related subjective stress; and, (5) non-care related subjective stress. Multilevel models were used to examine the relationship between daily stress and pain and interaction effects of stressors and caregiver affect within the context of ADS use. 

Summary of Results: The authors found a significant association between care-related subjective stress and daily bodily reported bodily pain for the same day. Although ADS use alone was not associated with bodily pain, bodily pain was higher on ADS days when noncare-related stress was higher. Lagged effects revealed a significant interaction between use of ADS one day and the next day’s positive affect and bodily pain. That is, caregivers who reported higher positive affect one day after ADS use also reported lower pain that next day. 

Study Limitations (as cited by authors): Authors suggested several limitations of their study including potential selection bias since caregiver enrollment was voluntary, their use of only a single item as a measure of pain, and the fact that they did not examine the effects of positive perceptions of caregiving on caregiver outcomes. While their findings showed decrease in pain associated with prior day ADS use and positive affect, they noted that the findings could not inform what a clinically meaningful decrease in pain would be. 

Authors’ Discussion/Conclusions: The authors recommend further research to examine the combined effects of ADS use, noncare-related stress and positive affect. Additionally, they suggest that the cause of the reported physical pain will also be an important consideration for future research. This research, they explain, is important to identify the best kinds of interventions to reduce pain and associated stressors among informal caregivers, such as modules for caregivers regarding physical activity and active coping strategies such as mindfulness for pain management.