Taking a Break: Daily Respite Effects of Adult Day Services as Objective and Subjective Time Away From Caregiving

Abstract

Background and Objectives Adult day services (ADS) can provide emotional and physical relief for caregivers of persons with dementia. While prior studies conceptualized ADS use at the aggregate level as a dichotomous construct, little is known about objective and subjective respite as distinct constructs. This study investigated how objective and subjective breaks from caregiving were associated with caregivers’ daily emotional well-being. Research Design and Methods Family caregivers (N = 173) whose relatives were using ADS at least twice a week participated in daily interviews over eight consecutive days (day N = 1,359). Participants provided information on daily respite hours and daily affect. They also reported perceived frequency of breaks from caregiving responsibilities and primary and secondary caregiving stressors (i.e., overload and work conflict). Multilevel models were used to examine the research questions. Results On average, caregivers reported 7.12 respite hours on ADS days and 1.74 respite hours on non-ADS days. Having more objective respite was associated with higher positive affect, whereas more subjective respite was associated with lower negative affect, after controlling for ADS use and other covariates. Further, caregivers with greater work conflict experienced more benefits to their positive affect as a result of objective respite. Discussion and Implications Objective and subjective respite are unique aspects of caregiving that may have varying impact on caregivers. Respite may be especially beneficial for caregivers experiencing conflict between work and caregiving.

Temporal Patterns of Behavioral and Psychological Symptoms of Dementia and Caregiver Distress: Associated Daily and Individual Factors

“…Importantly, this study found that caregiver distress overnight was buffered by ADS use, which provided time away from caregiving in the daytime (Wylie et al, 2021). On days when persons with ADRD used ADS, caregivers perceived BPSD as less stressful at nighttime.…”

“…ADS is beneficial to family caregivers by reducing their exposure to daily BPSD by up to 40% and caregivers' distress associated with BPSD in the daytime (Vandepitte et al, 2016;Zarit et al, 2011Zarit et al, , 2014. Indeed, on average, caregivers reported 7.12 respite hours when their relatives used ADS, compared to 1.74 respite hours when they were at home with persons with ADRD (Wylie et al, 2021). For persons with ADRD, attending ADS during the day may also help reduce sundown syndrome, possibly because it can help better engage persons with ADRD in social and physical activities compared with a non-ADS day when the persons with ADRD stay at home (Woodhead et al, 2005;Yevchak et al, 2012), and perhaps provide more exposure to daylight (Ancoli-Israel et al, 2003;Gnanasekaran, 2016).…”

Dementia patient and caregiver relevant outcomes currently being reported by adult day service centers in the United States

“…Indeed, socialization and social support are defining elements of ADS and caregiver respite has been found to be one of the more effective services offered by ADS centers. 20 ADS would be well served to focus on these outcome domains as the resulting data could paint a more complete picture.…”

“…These are key functions of home and community‐based services and such services “can decrease unnecessary medical services utilization, delay institutionalization, and improve the quality of life of both patients with ADRD and their caregivers.” 19 This is not to say that ADS centers do not provide these services; rather, they may not be reporting this data. Indeed, socialization and social support are defining elements of ADS and caregiver respite has been found to be one of the more effective services offered by ADS centers 20 . ADS would be well served to focus on these outcome domains as the resulting data could paint a more complete picture.…”