The effects of adult day care services on family caregivers’ daily stress, affect, and health: outcomes from the Daily Stress and Health (DaSH) Study

Author(s): Zarit, S.H., Kim, K., Femia, E.E., Almedia, D.M., and Klein, L.C.

Published In: The Geronotologist, Vol 54, Issue 4, pages 570-579

Study Aim/Purpose: The objective of this study was to examine the effects of adult day service (ADS) programming on reported daily stressor exposure, affect, and health symptoms of caregivers of individuals with dementia (IWD). 

Summary of Methods: This study used a “within-person withdrawal design” with a sample of 173 relative caregivers of IWD in New Jersey, the Philadelphia and Pittsburgh metropolitan areas, northern Virginia, and Denver, Colorado. Data on caregivers’ daily experience of care-related stressors, non-care stressors, positive events, anxiety symptoms, anger, depressive symptoms, positive effect, and health symptoms were collected during evening telephone interviews for 8 consecutive days. 

Summary of Results: Multilevel models indicated that caregivers reported significantly lower care-related stressors on ADS days compared with non-ADS days. Caregivers’ experiences of noncare stressors were significantly higher on ADS days as were their experiences of positive events on ADS days. Examining the association of stressors with caregiver affect and health symptoms, researchers found both types of stressors were associated with more depressive symptoms, anger, anxiety symptoms, and health symptoms, whereas positive events were associated with fewer of these daily affects and health symptoms. Additional analysis of the interaction between total number of ADS days used and daily affect found that among caregivers who reported higher care-related stressors, ADS use had a buffering effect on depressive symptoms. 

Study Limitations (as cited by authors): Although the authors suggest their “within-person withdrawal design” and measures of daily ADS use and daily stress, affect and health are components of a strong study design for examining the effects of an intermittent intervention such as respite, they do suggest that there could be potential selection bias in a study sample that includes only volunteers who already used ADS. 

Authors’ Discussion/Conclusions: The authors suggest both the importance of understanding the daily effects of ADS use and the need to build upon these findings in future research. They highlight the importance of research to measure the long-term impacts of respite programs, including differences in response to ADS dosage and the cumulative effects of ADS use.