For family of dementia patients, adult day care can help

NEW YORK (Reuters Health) - Regularly using adult day care services for a family member with dementia may help reduce stress for caregivers, a new study suggests.

“Caring for someone with dementia often involves high levels of daily stress,” Steven H. Zarit said. “This amount of stress exerts wear-and-tear on the body.”

Zarit led the new study at The Pennsylvania State University in University Park.

Some researchers have thought that adult day care may actually increase stress, because of the extra effort of getting the person ready to go in the morning and transitioning back in the evening. But based on this and a previous study, that doesn’t seem to be true, Zarit said.

“What we found is that each day a caregiver uses adult day care interrupts a part of the body’s stress response, and leads to a more normal level of a key stress hormone, DHEA-S,” he said.

DHEA-S, short for dehydroepiandrosterone-sulfate, is produced by the adrenal glands. Some studies have shown that high levels of this hormone can help protect the body against the damaging effects of stress.

But prolonged exposure to stress can deplete DHEA-S levels, the authors write in The American Journal of Geriatric Psychiatry.

Their study included 151 people caring for a family member with dementia who used an adult day care service at least twice a week. The caregivers were an average of 62 years old, and their family members with dementia were an average of 82.

For eight days, caregivers reported their stressors and mood levels by phone once daily and collected their own saliva samples to be tested for DHEA-S five times per day.

The researchers found that caregiver DHEA-S levels were higher on the day following an adult day care day, suggesting that a break from caring for their family member allowed their body to restore this hormone level.

Caregivers who used the day care service more often tended to have higher average mood scores for the eight days than those who used it less frequently. Their mood levels tended to mirror their DHEA-S hormone levels, with better mood on days with higher DHEA-S scores, but there was no connection to symptoms of depression.

“For years researchers have amassed a large literature on the emotional stress and strain of caregiving,” Susan T. Charles, who was not involved in the new study, told Reuters Health in an email.

Charles studies emotional processes across the adult life span at the University of California, Irvine.

This study offers a solution on how to lessen the effects of stress, she said.

“Given the rise in the number of people caregiving for a family member with dementia as our population ages, this issue is becoming more central to our public health,” Charles said.

“Stress related to managing a relative’s challenging behaviors, helping a relative complete daily tasks or assisting them with their medications can lead to stress that spills over to other parts of a caregiver’s life such as family conflict and disruption, lost wages due to fluctuations in employment and difficulty in maintaining important friendships outside of the caregiving situation,” said Joseph E. Gaugler. He researches community-based services for caregiving families at the University of Minnesota School of Nursing in Minneapolis and was not involved in the new research.

“This accumulation of care-related and life-related stress can then lead to negative mental or physical health outcomes on the part of family caregivers, including depression, impaired health or immune system response or even mortality,” Gaugler said.

Many family caregivers either do not know of adult day care services, or think that the services are only “babysitting” and do not take advantage of them, he said. But a good program includes therapeutic activities that can help people with chronic illnesses like Alzheimer’s disease maintain function at a higher level, Zarit said.

“Activities such as exercise, cognitive stimulation and social programs can be very helpful for maintaining functioning, and can be carried out in a respectful way,” he said.

Area Agencies on Aging can be found throughout the country and maintain a list of community resources. That would be a good place for caregivers to start looking for information on adult day care programs, Zarit said.

Gaugler recommends the National Adult Day Services Association homepage (, which has a "find a center new you" search tool, and the eldercare locator at

SOURCE: The American Journal of Geriatric Psychiatry, online February 3, 2014.