Impact of adult day services on behavioral and psychological symptoms of dementia

Author(s): Fernia, E.E., Zarit, S.H., Stephens, M.A., and Greene, R.

Published In: The Gerontologist, 47 (6): 775-788

Study Aim/Purpose: The study examined the short-term (2 month) effects of adult day services (ADS) participation by individuals with dementia on their behavioral and psychological symptoms of dementia (BPSD) immediately after ADS use and on days when not using ADS. 

Summary of Methods: A quasi-experimental design was used, comparing reports of caregivers of individuals with dementia enrolled in a NJ ADS program (N= 133) with reports from a control group of similar caregivers not using these services (N= 68). Baseline data included responses to an in-person, at-home interview of caregivers; observational logs of Daily Record of Behavior (a measure developed by the authors and adapted from the Revised Memory and Behavior Problems Checklist to document occurrence and duration of relatives’ behaviors and moods for two 24-hour periods). At one and two months after baseline, caregivers completed DRB logs for four days, including days the individuals with dementia were at ADS and days at home. Impact analysis included data on five domains: depressive symptoms, agitated behavior, night-time sleep disturbances, ADL-related behaviors, and memory issues. 

Summary of Results: The ADS use group showed a significantly greater decline in duration of night-time sleep problems than the comparison group, although the occurrence of those problems was similar in both groups. The effects for the ADS group on duration of sleep problems were stronger on ADS use days vs. non ADS use days. At the same time, no significant cross-group differences were found for either occurrence or duration of depressive symptoms or agitated behavior. However, within-group analysis for the ADS group found that the occurrence of depressive symptoms and incidence of agitated behaviors were all significantly lower over time on ADS days compared with non-ADS days. 

Study Limitations (as cited by authors): The authors cited study design limitations including the study’s short-term nature, and lack of reporting on specific domains or missing data from caregivers’ logs. Authors note that “attrition could have had an impact caused by differences in characteristics of participants who were missing data–who tended to be older, have older persons with dementia, and more often came from the ADS group.” The authors also point to the limitations of using a quasi-experimental design to evaluate treatment outcomes. 

Authors’ Discussion/Conclusions: The authors discuss the importance of connecting services provided at ADS to outcomes for participants with dementia: “In the present study, the ADS participants engaged in about 30 minutes of daily physical activity and only 13% of participants took naps while at the program. This compares to 75% of participants who took naps on non-ADS days. These results suggest the need for further study to explore the extent to which targeted activities and training might improve sleep.” They also suggest that “future studies of the impact of ADS on behavioral and other dementia-related problems could adopt a more strategic approach to targeting people for interventions… People with a particular type of problem could then be matched with the right types of activities…. There may also be a need to involve caregivers in the treatment plan so that they could carry over some of these strategies to the home.”