DaSHDaily Stress and Health Study

Benefits of Adult Day Services for Caregivers: Effective, Sustainable and

Affordable

Steven H. Zarit, Ph.D.Penn State University

LTSS Policy SummitOctober 1, 2014

Szarit @psu.edu

Acknowledgements

Support for this research was provided by the following grants: National Institute on Aging, grant RO1

AG031758, “Daily Stress, Health and Well-being of Family Caregivers

National Institute on Aging, grant RO 1 AG11354, “Stress Reduction for Caregivers of Persons with Dementia”

National Institute of Mental Health, grant RO1 MH59027, “Reducing Behavior Problems in Dementia: Day Care Use”

Benefits of Adult Day Services for Family Caregivers

Overview The challenges facing family

caregivers Respite as a strategy for lowering

stress Daily Stress and Health Study:

Protecting the health and well-being of caregivers

Conclusions and questions

The Costs of Caregiving

Increased subjective stress

Increased emotional distress

Increased health problems

Increased mortality

Respite as a Strategy for Lowering Caregiving Stress

Respite provided by family Paid respite

Adult Day Services In-home respite Overnight or short-term institutional

respite

The Daily Stress and Health of Caregivers (DaSH) Study

DAILY STRESSO

RS

Caregivers are exposed to care-related stressors

about 140 min./day

ADS Uselowers daily

stressexposure by

43%

STRESSHORMONE

S:CORTISOL

,DHEA-S

Emotions (depression

, anger, positive feelings)

Health

How We Conducted the DaSH Study

Day1

Day2

Day3

Day5

Day7

Day8

Day2

Day2

DAY 1

2 3 54 7 86

Before getting out of bed

30 min after getting out of bed

Before lunch

Afternoon (~ time when relative returns from ADS)

Bedtime

5 saliva samples each day

Phone interviews for 8 consecutive days

• Some of the days caregivers used ADS

• Some of the days they did not use ADS (non-ADS days)

• Measures: Daily stressors; daily affect

Participant Saliva Collection Kit

Cortisol as a Precursor of Illness

Short-term activation (i.e., cortisol elevation) is adaptive

Repeated or prolonged activation (e.g., caregiving) leads to dysregulation of cortisol

a. Cortisol overproduction b. Blunted diurnal salivary cortisol rhythm

c. Cortisol dysregulation is associated with depression, problems with learning & memory, inadequate immune system activation; chronic health problems

DHEA-S as a Precursor of Illness

• DHEA-S is a hormone that protects the body from damaging effects of cortisol

• More DHEA-S is better

• Chronic stress attenuates the DHEA-S response

• Positive benefits of DHEA-S• Increases positive emotions and decreases

depression

• Lowers risk of cardiovascular disease

• May protect against damage of brain neurons leading to Alzheimer's disease

• Lowers risk of mortality

DHEA-S

Dehydroepiandrosterone-Sulfate

Daily Stress and Health Study

DESCRIPTION OF PARTICIPANTSN = 173

Caregivers’ Characteristics Mean or % Range

Age (in years) 62.70 39-89

Relationship to Care Receiver•Spouse•Daughter/ daughter-in-law•Other

39%56%5%

Gender (women) 89%

Race (white) 73%

Employed 41%

Duration of care •Less than 1 year•1 to 5 years•More than 5 years

10%57%33%

Age of Care Receiver (in years) 82.39 57-100

Gender of Care Receivers (women) 61%

The Daily Stress and Health of Caregivers (DaSH) Study

DAILY STRESSO

RS

Caregivers are exposed to care-related stressors

about 140 min./day

ADS Uselowers daily

stressexposure by

43%

STRESSHORMONE

S:CORTISOL

,DHEA-S

Emotions (depression

, anger, positive feelings)

Health

Normal diurnal cortisol pattern

wak

ing

30 m

inut

es

befo

re lu

nch

5:00

PM

befo

re b

ed0

2

4

6

8

10

12

14

Normal cortisol pattern

cortisol

Avera

ge C

ort

isol (n

mol/L)

Cortisol on ADS and non-ADS days: Low morning rise

Cortisol on ADS and non-ADS days: Medium low morning rise

Effects of ADS Use on DHEA-S

No same day effects of ADS Lagged effects: DHEA-S was higher on

days following ADS use Levels of DHEA-S covaried significantly

with positive emotion

Daily Stress and Health Study

EXAMPLE: PARTICIPANT 1134

Daily DHEA-S and Positive Affect

The Daily Stress and Health of Caregivers (DaSH) Study

DAILY STRESSO

RS

Caregivers are exposed to care-related stressors

about 140 min./day

ADS Uselowers daily

stressexposure by

43%

STRESSHORMONE

S:CORTISOL

,DHEA-S

Emotions (depression

, anger, positive feelings)

Health

Implications of DASH

Each day of adult day care use results in improved levels of key stress hormones for carergivers

These improvements reduce the risk of illness for caregivers

Improvements in emotional responses also have implications for long-term health

Caregivers who used more ADS days at the initial study period had better functional health

The Potential Role of ADS and Other Forms of Respite in Lowering Burden

Sustainable help Affordable Effective

Limitations of Adult Day Service Programs

Limited ability to serve small towns and rural areas

Unwillingness of the person with dementia to attend

Reluctance of caregivers to use respite services

Not covered by Medicare

Investigative Team

Steven Zarit

David Almeida

Elia Femia

Laura Klein

Mary Jon BarrineauAmanda LeggettYin LieuAllison Reamy

Peter MolenaarMichael Rovine Kyungmin KimCourtney Whetzel

Summary and Questions

ADS use relieves caregivers’ exposure to stressors

ADS use improves caregivers’ levels of stress hormones, which reduces risk of illness

ADS use leads to improved emotional well-being of caregivers

For more information or copies of DaSH publications, contact Dr. Steven Zarit szarit@psu.edu