The influence of day care centers for people with dementia on family caregivers: An integrative review of the literature

Author(s): Tretteteig, S., Vatne, S. and Rokstad, A.M.M.

Published In: Aging & Mental Health, 20(5): 450-462

Study Aim/Purpose: The aim of the study was to summarize and analyze existing research on the influence of adult day care centers (DCCs) for people with dementia on family caregivers. 

Summary of Methods: The review used an integrative review framework to summarize findings of peer-reviewed published qualitative and quantitative studies located through searches of Pub Med, the Norwegian Electronic Health Library – Full Text, AMED (1985-2013), Embase (1996-2013), Ovid MEDLINER (1996-2013) and PaycINFO (1987-2013). The search was conducted with the following terms: relatives/next of kin/family-carer/informal carer and day-care/day-care-center and dementia. Only studies that included the family caregiver and described their needs, their experiences and/or the effects of DCCs on persons with dementia were included. Quality of the papers was assessed by a mixed methods appraisal tool. 

Summary of Key Results (related to studies of effectiveness): A total of 19 studies was included in the final literature review sample. Of these, two were solely qualitative, 15 were quantitative (8 using randomized controls), and two used mixed-methods designs. Qualitative and mixed methods studies reviewed found that caregivers (more so women than men) want a DCC that improves their competence in caring for the care recipient, cares well for the person with dementia, and makes the caregiver feel there is shared responsibility for their loved one. Studies examining the effects of DCC on caregiver burden found that DCC use can reduce caregiver burden, but findings were mixed, with a larger decline in feelings of overload among daughters and daughters-in-law than for wives. Several studies reviewed found use of DCCs with good caregiver support was associated with increased motivation for the caregiver role and postponement or prevention of institutional placement. Finally, the research also pointed to two mediating factors affecting respite use and thus its outcomes: (1) the gender of the carer and relationship of the caregiver to the care recipient (child or spouse); and (2) the level of impairment of the person with dementia. For example, one study found that family caregivers of a person with dementia who dropped out of a DCC after a few months had significantly higher values of worry, overload, and role captivity than those who remained in the program. 

Limitations of Studies Reviewed (as cited by the author): The authors noted that many of the studies reviewed had small sample sizes. Further, they stressed that while numerous studies examine the outcomes of DCCs, there has been no standardized definition of content or quality of DCC services across studies or how these programs are tailored to meet individuals’ needs. 

Authors’ Discussion/Conclusions: While their review indicates that DCCs have the potential to provide much needed respite and support service for family caregivers, the authors recommend that future research and practice in the respite field place an increased focus on both the provision of respite time and caregiver support, taking the diversity of family caregivers’ and care recipients’ needs into consideration.