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More evidence adult daycare eases stress on dementia caregivers

By Shereen Lehman

NEW YORK (Reuters Health) - The stress of caring for a family member with dementia may take a toll on health over time, but a new study suggests that even one day off can shift caregivers’ stress levels back toward normal.

Based on measurements of the stress hormone cortisol, researchers found that caregivers had healthier stress responses on days when the dementia patient went to adult daycare. Even anticipation of the day off had an effect on cortisol levels.

“This study reinforces the notion that caregivers need support and sometimes that support means sharing the care,” said an expert who was not involved in the study.

Dr. Gary Kennedy, director of the Division of Geriatric Psychiatry at Montefiore Medical Center in New York, said that sharing the care means the caregiver has some time off and that’s important because the caregiver’s health is critical to the care receiver’s health.

“If the caregiver is comfortable, at ease, calm, in good spirits, that’s going to carry over to the person who’s receiving the care,” he told Reuters Health. “And conversely if the caregiver is upset, that person with dementia is going to be affected by that.”

The study team, led by Laura Cousino Klein at Pennsylvania State University, writes in The Gerontologist, “Interventions such as adult daycare services that provide partial relief from daily stressors may help caregivers provide care longer while reducing their risk of illness.”

Past studies have documented the stress that caregivers feel, and their sense of relief when they get a break from caregiving. But none have quantified the benefits of time off by measuring changes in cortisol, the authors write.

Cortisol is a hormone that supports the “fight or fight” response. Normally, its levels are highest about an hour after waking and then decline over the rest of the day. But in times of stress, cortisol may soar and remain abnormally high or levels may flatten out, a signature of “burnout.”

Unhealthy cortisol levels and patterns have been linked to depression and cognitive problems as well as suppressed immune responses and other illnesses, the study team points out.

To measure the potential health effects of giving caregivers a break, the researchers included 158 people caring for a family member with dementia who used an adult daycare service at least twice a week.

For eight days, caregivers reported their stressful events and experiences and their moods by telephone once daily and collected their own saliva samples five times a day to be tested for cortisol.

In general, the researchers found that caregivers had fewer care-related stressors and more positive experiences on the days their loved ones were at daycare, but they did experience a little more stress not related to caregiving.

However, looking at daily fluctuation in cortisol levels, the study team found improved patterns on days when daycare was used. Among people whose levels were usually high, cortisol fell and among people with the flattened “burnout” pattern, cortisol levels returned to a more normal variation.

In addition, researchers found that better cortisol regulation began in the morning, even before the study participant’s loved one left for the day.

“Caregivers may look forward to adult daycare service days and begin the days with a greater focus on getting through their morning routine,” the authors write.

The researchers cannot say how long the changes last or their benefit, if any, over the long term.

Kennedy noted that the study may not apply to everyone because it focused on a selected sample of people who have already found the need to bring their family member with dementia into some kind of care setting.

“It’s important to realize that there are lots of dementia caregivers who don’t need any assistance - they manage remarkably well,” he said.

That may be because “the person they’re taking care of doesn’t manifest the behavioral problems that maybe a majority of dementia patients do” or because the caregivers have found ways to minimize stress, he said. “Some families just get this and they have multiple individuals who provide support so it just works without any outside support.”

SOURCE: http://bit.ly/1Btrhxs The Gerontologist, online July 4, 2014.

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