Embedding Caregiver Support within Adult Day Services: Outcomes of a Multi-site Trial

Abstract

Abstract Background and Objectives Adult day services (ADS) provide quality-of-life benefits to people with dementia , but few provide systematic caregiver support. We report outcomes of a multi-site, national trial testing a staff-delivered caregiver program, ADS Plus. Research Design and Methods Cluster randomized trial involving 34 ADS: 18 sites provided ADS (controls); 16 provided ADS and ADS Plus (intervention). Trained staff met with caregivers to provide dementia education, support/validation, referrals/linkages, and strategies for care challenges and self-care over 12-months. Main outcomes included depressive symptoms (CES-D) and well-being at 6-and 12-months, and client attendance over 12-months. Results Of 203 caregivers (Intervention=102; Control=101), 5.9% at 3-months, 12.8% at 6-months, and 22.7% at 12-months were lost-to-follow-up. Caregivers were predominantly female (80.3%), with 76.4% identifying as white/Caucasian, 14.8% Black/African American, and 12.3% Hispanic/Latino. Most (88.2%) had ≥college education and were 65.0 years old (SD=13.46). For those with 6-month data, 40.4% control and 40.2% ADS Plus caregivers had depressed symptoms (≥16 CES-D) at baseline. By 6-months, 43.6% control versus 34.2% ADS Plus caregivers had ≥16 scores (odds ratio=0.38, p=0.072). By 12-months, after covariate adjustments, ADS Plus caregivers reported reduced total depression scores versus controls (p=0.013) and lower depressed affect scores (p=0.015). Of 18 sites providing 12-month client attendance data, nine intervention sites reported 126.05 days attended versus 78.49 days for nine control sites (p=0.079). Discussion and Implications Compared to ADS alone, by 12-months ADS Plus improved caregiver mood and increased ADS utilization by 60.6%. Results support ADS staff delivering evidence-based caregiver support to enhance ADS benefits.