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Effectiveness of day care services for dementia patients and their caregivers
Abstract
Aim. To examine the effectiveness of a dementia-specific day care centre in Hong Kong. Methods. 27 men and 63 women with dementia aged 56 to 97 and newly admitted to a dementia-specific day care centre were assessed at baseline, month 6, and month 12 using the following tools: Zarit Burden Inventory (ZBI), Mini-Mental State Examination (MMSE), Cohen-Mansfield Agitation Inventory (CMAI), Lawton instrumental activities of daily living (IADL) assessment, modified Barthel Index (BI), modified functional ambulation category (MFAC), Berg balance scale (BBS), mini nutritional assessment (MNA), and personal wellbeing index-intellectual disability (PWI-ID). Results. 51 (57%) of the 90 participants dropped out during the 12-month study period; 23, 14, and 14 of them did so within 3 days, 6 months, and 6 to 12 months, respectively. The ZBI score for caregiver's stress decreased significantly at month 12 (t=3.41, p=0.002). The MMSE score for cognitive function and the PWI-ID score for quality of life were maintained at months 6 and 12. The MNA score for nutrition level improved significantly at month 6 (t=4.18, p<0.001). However, there was a significant deterioration at month 12 in the Lawton IADL score (t=2.66, p=0.012) and the modified BI score (t=2.79, p=0.009) for daily living ability, and the MFAC score for mobility (Z=2.95, p=0.003). The CMAI score for behavioural and psychological problems increased significantly at month 6 (t=-2.12, p=0.041). Conclusion. Dementia-specific day care centre reduced caregiver's burden and maintained cognitive function and quality of life of the dementia participants. Self-care ability, mobility and behavioural problems did not improve.
... Place. Ten out of the twenty-one studies were conducted in the USA, [22][23][24][25][26][27][28][29][30][31] three in the Netherlands, [32][33][34] one in Norway, 35 one in Norway and Scotland, 36 one in Iceland, 37 one in Hong Kong, 38 one in Australia, 39 one in Italy, 40 one in Sweden 41 and one in Germany. 42 No articles on DC in Latin America were found. ...
... Sample. Nineteen studies included FC of both genders, [22][23][24]26,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] predominantly women, while two included females only, 25,27 Regarding the type of FC relationship with the PwD, fifteen studies included spouses, children and others, [22][23][24]26,28,[31][32][33][34][35][36][37][38][39]41 two included only wives and daughters, 25,27 whereas four studies did not specify the kinship. 29,30,40,42 All articles reported that people were diagnosed with dementia, without specifying the causes. ...
... Sample. Nineteen studies included FC of both genders, [22][23][24]26,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] predominantly women, while two included females only, 25,27 Regarding the type of FC relationship with the PwD, fifteen studies included spouses, children and others, [22][23][24]26,28,[31][32][33][34][35][36][37][38][39]41 two included only wives and daughters, 25,27 whereas four studies did not specify the kinship. 29,30,40,42 All articles reported that people were diagnosed with dementia, without specifying the causes. ...
Objective:
to analyze the support strategies used by the DC for FC, their methodological and theoretical models, as well as the respective benefits for FC burden, coping strategies and quality of life.
Methods:
a systematic review following the Prisma methodology was performed on PubMed, PsycInfo, Scopus and SciELO electronic databases in August, 2018. The search keywords were “day care”, “dementia” or Alzheimer disease, “caregiver”, “quality of life” and “psychological adaptation”.
Results:
twenty-one studies were included. No randomized controlled trials were found. The provision of education, counseling and support, access to information, the professionals' expertise and the quality of their relationship with DC users were highlighted by caregivers. Compared to standard programs centering on PwD, the integrated program focused on PwD and FC activities showed increased feelings of competence and self-confidence of FC to postpone institutionalization. Heterogeneity in the structure and organization of the DC programs, intervention strategies and theoretical basis was observed.
Conclusion:
Integrated programs are a promising approach that addresses the needs and demands of PwD and their FC in a multidimensional manner.
... Caregiver burden was measured in four intervention studies and significantly decreased in two cases (W, M) (Mossello et al., 2008;Kwok et al., 2003). In the other two studies (S, M), there was some decrease, although not significant (Baumgarten et al., 2002;Zank and Schacke, 2002). ...
... In the other two studies (S, M), there was some decrease, although not significant (Baumgarten et al., 2002;Zank and Schacke, 2002). The two studies that showed a significant reduction in the burden explicitly mentioned that caregiver support was a part of the day care programonce provided by a case manager (Kwok et al., 2003) and once through caregiver counseling (Mossello et al., 2008). In another study (S), caregiver stress was found to decrease on days when the recipients received day care (Zarit et al., 2011). ...
... Three of these six day care programs (M, M, S) concluded that the use of day care decreased behavioral problems in the care recipient (Zarit et al., 2011;Zank and Schacke, 2002;Mossello et al., 2008). In contrast, the study (W) with the smallest sample size could not find any decrease (Kwok et al., 2003), while another study (S) could not find any reduction in total behavioral problems except for in night-time sleep disturbances (Femia et al., 2007). This conclusion corresponds with another study that also indicates improved sleep after day care (Zarit et al., 2011). ...
Objective:
Supporting informal caregivers of persons with dementia is considered to be an effective strategy for improving the well-being of caregivers and care recipients and for delaying nursing home placement. Although considerable research has been conducted to investigate the effectiveness of psychoeducational interventions, cognitive behavioral therapy, and occupational therapy, research into the effectiveness of respite care is rare. This systematic review aims to investigate the effectiveness of different types of respite care in supporting informal caregivers of persons with dementia.
Methods:
A systematic literature search was conducted using Web of Science and PubMed, and the Quality Assessment Tool for Quantitative Studies was used to assess the methodological quality. Randomized controlled trials, quasi-experimental studies, pretest-posttest studies without a control group, and cohort studies were included.
Results:
Seventeen papers met the inclusion criteria. Day care services are effective in decreasing caregiver burden and behavioral problems in persons with dementia, but they also accelerate time to nursing home admission. The results of temporary residential admission are rather mixed and show unexpected adverse effects on both caregivers and care recipients. High-quality comparable evidence on community-based respite care is still lacking, although earlier qualitative evidence indicated promising results.
Conclusion:
Unlike in previous reviews, we were able to draw some conclusions about the effectiveness of some types of respite care. There is nonetheless still a need for new intervention studies measuring the impact of respite care, especially in-home respite care programs, on the caregiver, the care recipient, and health care resource utilization.
... These centers offer stimulation and provide respite for informal caregivers. In some studies, the use of a community-based service has been shown to maintain cognitive function and improve patients' behavior, reduce caregivers' burden and delay or prevent institutionalization [9][10][11][12][13]. However, sometimes the living situation, health-related factors and special caregivers' burden lead to the earlier institutionalization of patients [14,15]. ...
Nowadays, there are plenty of programs and resources to prevent caregiver burden of patients with Alzheimer’s disease. In spite of that, many caregivers suffer high levels of burden and stress, which leads to an earlier institutionalization of patients. This study aimed to explore the predictors of burden in relative caregivers of patients attending day-care centers and the moderating role of caregiver kinship in these associations. A sample of a hundred and two patient–caregiver dyads was recruited. Burden was measured with a Zarit Burden Interview. Measures of patients’ cognition, insight, depression, behavioral disturbances, functional ability and overall physical health were considered as predictors. We found that apathy, irritability and delusions and, patients’ mobility are the main determinants of caregivers’ burden. The strength of relationship between delusions and irritability was higher in spouse caregivers. Interventions to reduce burden should be adapted to the specific needs of a particular type caregiver.
... Certains programmes de répit de jour (day care) ont démontré leur efficacité dans la baisse du fardeau des proches aidants. Cependant, il est important de retenir que ces programmes ont explicitement démontré que le soutien aux proches aidants faisait aussi partie de leur programme (205,275). ...
Dans un contexte d’évolution démographique accompagné par l’augmentation des maladies de types démence, un des défis de santé publique est de soutenir les proches aidants pour lutter contre leur épuisement et l’hospitalisation des proches malades (2). En effet, les proches aidants luttent contre les problèmes quotidiens, l’isolement et les problèmes financiers. Ils manquent d’information et de formation et expriment un besoin de répit et de reconnaissance de leurs compétences (3). La reconnaissance est un besoin élémentaire qui passe entre autres par la collaboration avec l’entourage des proches aidants. De ce fait, la question de recherche d programme Hestia concerne les partenariats entre les proches aidants et les institutions de santé permettant de favoriser leur reconnaissance.Le programme de recherche Hestia est un programme complet de quatre études qui dans un premier temps avait pour ambition d’identifier les facteurs influençant la prise de décision des dispositifs de répit. Puis, des éléments de résultat ont permis la conception de l’étude suivante qui avait pour objectif d’identifier les partenariats potentiels entre les institutions liées à la santé et les proches aidants de personnes confrontées à la démence. Le partenariat entre les soignants et les proches aidants étant identifié comme primordial pour favoriser la reconnaissance de ces derniers, la mise en visibilité de leurs compétences était nécessaire pour envisager une intervention fondée sur le partenariat gagnant/gagnant.Les études du programme de recherche Hestia ont montré que les proches aidants et les institutions liées à la santé étaient, sous certaines conditions, favorables à une collaboration fondée sur le partenariat gagnant/gagnant et ceci dans le domaine de la formation, de l’organisation/gestion, de la recherche, des soins, de l’accompagnement ainsi que dans la prestation de service. De plus, onze compétences ont été mises en avant alors qu’au travers de la littérature sept compétences sont recensées.
... Nevertheless, there is a consensus to suggest that the burden of care can be relieved by using formal services (e.g. dementia-specific day care centres [13]) to assist family carers to support people with dementia living in the community, and thereby continue with their care for a longer period [14]. This is in line with the goal of the Hong Kong Government that puts emphasis on the family to provide care in the community through the provision of formal services. ...
Background
Caring and supporting older people with dementia have become a major public health priority. Recent reports have also revealed a diminishing number of family carers to provide dementia care in the future. Carers who are engaged in the caring role are known to bear significant psychological, practical and economic challenges as the disease advances over time. Seemingly, evidence indicates that the burden of care can be relieved by formal services. This study aims to explore decision-making experiences of family members of older adults with moderate dementia towards the use of community support (CS) and residential care home (RCH) services.
Method
A large multi-site constructivist grounded theory in a range of non-government organizations and a private aged home will frame this Hong Kong study. Purposive sampling will begin the recruitment of family members, followed by theoretical sampling. It is estimated that more than 100 family members using CS and RCH services will participate in an interview. The process of successive constant comparative analysis will be undertaken.
Discussion
The final product, a theory, will generate an integrated and comprehensive conceptual understanding which will explain the processes associated with decision-making of family members for dementia sufferers. Deeper understanding of issues including, but not exclusive to, service needs, expectations and hopes among family carers for improving service support to serve dementia sufferers in CS and RCH services will also be revealed. Importantly, this study seeks to illustrate the practical and strategic aspects of the theory and how it may be useful to transfer its applicability to various service settings to better support those who deliver formal and informal care to the dementia population.
... Medical consultation, advice and referral for financial and social welfare support, training or talks about dementia care, and social and recreational activities are all provided for patients, together with support and assistance for caregivers. One self-financed day care center for people with dementia, the Jockey Club Centre for Positive Ageing, conducted a prospective study on newly admitted clients and found that the burdens (as measured by ZBI) on family caregivers were significantly reduced after a year's usage of the center [50]. ...
To achieve the goal of ageing-in-place, informal family caregivers who look after older people at home are of crucial importance. In Hong Kong, over half of all elderly people who receive informal care are cared for by their children. Despite traditional Chinese beliefs concerned with filial piety, these caregivers, particularly if they have to deal with dementia or stroke patients, often face very heavy burdens, which may in turn lead to higher risk of institutionalization, and in some extreme cases abuse of the elderly. Deterioration in functional and cognitive status of the care recipient produces two of the main factors adding to the caregiver burden, while assistance from domestic helpers and a sense of self-efficacy may reduce it. Some initiatives, such as training programs for caregivers, which may ameliorate their situation have been established. In this chapter, existing and new evidence is presented on the risk factors and consequences of caregiver burden among the Hong Kong Chinese population, and strategies to tackle such burdens are discussed.
... In Spain, contrary to other European countries, nursing homes are usually rejected by the family caregivers and considered only as a last resource (Lopez, Losada, Romero-Moreno, M arquez-Gonz alez, & Mart ınez-Mart ın, 2012). This is not the case of day-care centers that offer both physical and cognitive stimulation to patients and also respite and support to caregivers (Kwok, Young, Yip, & Ho, 2013). Current therapies are mainly aimed at alleviating symptoms and improving quality of life (QoL) and well-being (Keating & Gaudet, 2012;Moniz-Cook et al., 2008;Moyle, Fetherstonhaugh, Greben, Beattie, & AusQoL group, 2015). ...
Background:
An understanding of the determinants of quality of life in Alzheimer's disease (AD) is required in order to develop effective interventions to promote patients' well-being. Most studies have pointed out depression, functional ability and environmental factors. However, unmeasured confounders can jeopardize the interpretation of the results.
Objectives:
To explore the mediating role of depression in the association between functional status and QoL, and establish a procedure to detect confounding variables.
Methods:
A sample of 192 AD patients and their respective caregivers were recruited from day centers and health care centers in the region of Murcia (Spain). The mediating effect was evaluated using causal mediation analysis. Covariates were introduced into the model in a stepwise fashion and sensitivity analyses were performed to assess the influence of potential confounders.
Results:
Self-rated depression acted as a partial mediator between functional status and quality of life. The mediating effect was positive and significant even after including both patient- and caregiver-related covariates. Only if confounders explained more than 80% of the residual variance in the mediator or in the outcome, the mediating effects would not be positive.
Conclusions:
The effect of lack of autonomy on the QoL is mostly explained by the negative consequences on mood status. The sensitivity analysis confirms the robustness of this finding.
Aim
The study assessed the association between boosting the workforce supply by types of long-term care services and in-home deaths among older people at the municipality level.
Methods
A fixed-effect panel data analysis was conducted using administrative data for every 3 years from 2008 to 2014. The outcome was the proportion of home deaths, excluding those due to external factors, such as suicide or accident. The explanatory variables were the full-time equivalent numbers of care workers engaged in in-home services, day services, short-stay services, and long-term care facilities per 1000 population aged 65 years and older. Ordinary least squares estimation was conducted, with standard errors corrected for clustering at the prefecture level, adjusting the covariates.
Results
Analysis included 1706 municipalities. One care worker increase providing day services per 1000 population aged 65 years and older was associated with a 0.09% increase in the proportion of deaths at home (95% CI: 0.008–0.17). Although statistically non-significant, the number of care workers providing in-home services was positively associated with the proportion of home deaths, whereas the number of those providing short-stay services and providing long-term care facilities and nursing home services were inversely associated with home deaths.
Conclusions
Given the increased number of care-dependent older people who opt to stay at home until death, and their informal caregivers who have the burden and stress of care, the findings suggest that policymakers should ensure that the number of care workers for day services is sufficient for supporting care recipients and informal caregivers. Geriatr Gerontol Int 2021; ••: ••–••.
Background:
Transcultural studies regarding the comparison of levels of burden in caregivers of patients with Alzheimer's disease (AD) from Europe and Latin America are rare. We designed this study to investigate the differentiating factors associated with burden in Brazilian and Spanish caregivers of patients with AD.
Methods:
This is a cross-sectional study composed by samples of outpatients with AD and their caregivers from Brazil (n = 128) and Spain (n = 146). Caregivers answered the Zarit Burden Interview (ZBI) and a Sociodemographic Questionnaire. Patients were assessed with the Mini-Mental State Examination (MMSE), Functional Activities Questionnaire (FAQ), Disability Assessment for Dementia (DAD), Neuropsychiatric Inventory (NPI), and Clinical Dementia Rating (CDR) Scale.
Results:
In the multivariate regression analysis, high burden levels were reported in Brazil, when caregivers were female (p = 0.025) and when patients did not attend Day Care Center (p = 0.025). In Spain, high burden levels were associated with living with the patient (p = 0.014), younger caregivers (p = 0.003), and participation of patients at Day Care Center (p = 0.046). Also, different neuropsychiatric symptoms explained high burden levels: in Brazil, depression (p < 0.001) and anxiety (p = 0.024) and, in Spain, apathy/indifference (p < 0.001), agitation/aggression (p = 0.019) and irritability/lability (p = 0.027).
Conclusions:
Caregivers' gender, patients who attended Day Care Center and neuropsychiatric symptoms were differentiating factors in the burden of Brazilian and Spanish caregivers.
Background. A survey was conducted to investigate the usage pattern of day care centres for the elderly by demented clients and the difficulties perceived by staff in caring for them. Methods. In-charge persons of 59 government day care centres in Hong Kong were asked to fill out a self-administered questionnaire about the composition of day care users and the difficulties perceived by staff in caring for demented clients. Results. 55 of the 59 persons responded. 98% of the respondents reported that demented clients with good mobility were very or quite difficult to take care of, compared to non-demented physically disabled clients. The main perceived hindrances were manpower shortage (54.5%) and insufficient space (20%). Conclusion. With the ageing population, day care services are in great demand in Hong Kong. Future development of day care services should take into account issues of manpower shortage and insufficient space.
To measure and compare perceived financial burden, use of services, and perceived unmet service needs of supporters of demented and non-demented elderly people.
Comparison study of age and sex matched demented and non-demented elderly people and their supporters.
25 primary health care teams in Dundee.
114 community resident elderly (age over 65) people with dementia, 114 age and sex matched comparators, and the main informal supporter of each elderly person.
Carers' perceptions of financial impact of looking after an old person, service use (from a list of locally available services), unmet service needs, and needs for three types of generic service (help with supervision, housework, or personal care).
Financial impact was low, except for extra household expense in the dementia group. There was significantly greater use of mainstream domiciliary and day care services in the dementia group. Dementia was nevertheless associated with a high level of unmet need, mainly for more mainstream support and help with supervision of the elderly person.
Supervisory care for demented elderly people should be further developed within an expanded domiciliary service to meet supporters needs.
In the past decade, pharmacological, behavioral, educational, and environmental interventions for individuals with dementia have addressed a variety of goals: improving cognitive status, delaying the onset of symptoms, reducing behavioral problems such as depression and agitation, and maximizing activities of daily living. It is important not only to ameliorate symptoms but also to evaluate the extent to which an intervention improves the quality of life (QOL) of the person being treated (Logsdon et al., 2002).
This longitudinal study examined whether the use of adult day care services delayed time to nursing home placement in persons with Alzheimer's disease.
Two hundred and eighteen adult day care clients with Alzheimer's disease were recruited from 16 adult day programs in a large metropolitan area. Two hundred and ninety eight persons with Alzheimer's disease but not using adult day care were recruited from a federally funded Alzheimer's diagnostic center and frequency matched to adult day care users on age, gender, race, and level of cognitive impairment. Participants were followed at 3-month intervals for up to 48 months. Cox proportional hazards models were used to examine the effects of adult day care and other fixed and time-varying factors on risk of nursing home placement.
Risk of nursing home placement increased significantly with the number of days of adult day care attendance, with this effect being substantially greater for men (hazard ratio or HR = 1.33; confidence interval or CI = 1.18-1.49) than for women (HR = 1.09; CI = 1.00-1.18). Participant disability and hospitalizations and caregiver age and burden were independent predictors, but their inclusion in the model did not alter the risk associated with adult day care.
More severe disease and greater caregiver burden did not explain the increased risk of nursing home placement among adult day care users with Alzheimer's disease. Rather, it appears that other unmeasured factors, such as a proclivity to institutionalize, may account for the association of adult day care to nursing home risk.
Objective: To validate the Chinese version of the Zarit Burden Interview as an instrument for assessing the stress experienced by carers of elderly patients with dementia. Patients and Methods: The Zarit Burden Interview was first translated into Chinese and then back-translated into English for comparison. Forty Chinese patients with mild to moderate de-mentia were recruited from 2 psychiatric clinics in Hong Kong. The Zarit Burden Interview, General Health Questionnaire, and Caregiver Activity Survey were completed by the patients' carers. Two raters rated another 16 carers separately for assessment of inter-rater reliability. Results: The intraclass correlation coefficient was 0.99 and the split half correlation coefficient was 0.81, suggesting a high inter-rater reliability and internal consistency. The correlation be-tween the Zarit Burden Interview and the General Health Questionnaire was 0.59 (p < 0.001), and the correlation between the Zarit Burden Interview and the Caregiver Activity Survey was 0.57 (p < 0.001), suggesting high conceptual validity. Conclusion: The Chinese version of the Zarit Burden Interview is a valid and reliable tool to evaluate the stress experienced by carers of elderly people with dementia in Hong Kong.
To evaluate a case management (CM) model for people with mild dementia, whereby resources within the family and in the community were mobilized and optimally used.
Community dwelling psychiatric and geriatrics outpatients with mild dementia were randomized to receive CM by a trained occupational therapist for 4 months (CM group, N = 59) or usual care only (control group, N = 43). Primary outcome indicators included the Zarit Burden Scale (ZBI), General Health Questionnaire (GHQ), and Personal Well-Being Index for Adult (PWI-A) of the family caregivers. Secondary outcome indicators included the Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia (CSDD), and Personal Well-Being Index for Intellectually Disabled (PWI-ID) of the demented subjects as measured at fourth and twelfth months.
CSDDis reduced in the CM group at fourth month, but not at twelfth month. The changes in outcome variables of persons with dementia did not differ between the groups (Mann-Whitney U-test, p > 0.05). At follow-up, CM group used more day care and domestic helpers than control group (chi (2), p > 0.05).
Case management for Chinese persons with mild dementia outpatients did not show significant effects in reducing caregiver burden, but encouraged family caregivers to seek external support.
This study examined the impact of the Severe Acute Respiratory Syndrome (SARS) outbreak in Hong Kong in 2003, on the subjective wellbeing (SWB) of elderly people and a younger comparative sample. The Personal Wellbeing Index (PWI), a contemporary instrument employed to measure SWB, was also examined for its psychometric performance to substantiate its use.
A total of 302 older adults (age 65 + years) and 158 younger adults (age 35-46 years) were recruited from different districts. Data were collected by individual face-to-face interviews.
While elderly people living in severely infected districts showed significantly lower levels of SWB, these levels and those of the younger sample were found to remain within the normative range. A major mitigating factor was an increased sense of community-connectedness. Other characteristics linked to low wellbeing levels included chronic illness, female gender, low education and unemployment. The living districts, characterized by varying extents of infection, had stronger associations with SWB than participants' age. The PWI demonstrated good psychometric performance and also more robustness with elderly people, including its sensitivity to the sense of population threat.
Psychological resilience was identified among both the elderly and younger age-groups in Hong Kong during the SARS pandemic. The PWI is verified as a suitable instrument for SWB measurements.
Family units (N = 541) of impaired elderly persons and caregivers were randomly assigned to a control group or one of five treatment groups
eligible for a variety of respite or educational services. After 12 months of service eligibility, caregivers of elderly persons
remaining in the community reported lower levels of subjective burden. Services appeared to delay nursing home placement among
families with adult child caregivers, but encouraged placement by spouse caregivers.
After a baseline interview of 642 caregivers of aged Alzheimer's disease victims, half were offered formal respite care. Over
12 months, families with respite care maintained their impaired relative significantly longer in the community (22 days).
Although respite was ineffective for caregiver burden and mental health, satisfaction was very high. Although not a strong
intervention, respite care can increase caregivers' quality of life.
This study examined outcomes of Korean day care for demented elderly Koreans. Changes in the cognitive function and agitation of demented elderly individuals were assessed over time. A one-group repeated measures design was used. The data were collected on a sample of 13 individuals from March to August 1999. The cognitive function of the subjects remained stable during the 10-week study period, while their level of agitation increased over time, indicating a need for the examination of factors that affect problematic behaviors of the demented elderly. This pilot study showed that day-care programs in Korea may be an effective way to maintain the stability of cognitive function in elderly Koreans with mild- to moderate-stage dementia. Further investigation of effective behavioral modifications within day-care settings could justify additional government support of Korean day-care programs for those suffering from dementia.
The objective of this study was to determine whether adult day service use interacts with decreases in primary caregiving hours (i.e. the time caregivers spent on activities of daily living/instrumental activities of daily living, memory problems, and behavior problems for patients) to alleviate caregiver stress and negative mental health over time.
Three-month longitudinal data from the Adult Day Care Collaborative Study (n=400) were used.
Decreases in memory problem hours among adult day service users were associated with reduced feelings of role overload; decreases in ADL hours among non-users were associated with decreases in worry and strain over a three-month period.
The findings suggest that adult day services are potentially effective in restructuring caregiving time and providing respite to family members.
This study tested the effectiveness of a dementia care management program for Chinese families of relatives with dementia on caregivers' and patients' health outcomes over a 12-month follow-up period.
The dementia care management program is an educational and supportive group for caregivers that lasts six months. A controlled trial was conducted with 88 primary caregivers of persons with dementia in two dementia care centers in Hong Kong. Family members were assigned randomly to either the dementia care program or standard care. The two groups were compared for patients' symptoms and institutionalization rates and caregivers' quality of life, burden, and social support upon recruitment and six and 12 months after group assignment.
Over the 12-month follow-up period, patients with family members in the dementia care program showed significantly greater improvements in symptoms and institutionalization rates and their caregivers reported significantly greater improvements in quality of life and burden compared with the control group.
The findings provide evidence that the dementia care management program can improve the psychosocial functioning of Chinese persons with dementia and their caregivers.
To assess the effects of Day Care (DC) on older subjects with dementia and their caregivers.
Thirty patients with dementia, consecutively admitted to a DC, were compared with 30 patients, matched for age and cognitive function, who received usual home care (HC). Primary caregivers were compared as well. At baseline and after 2 months, patients were assessed for cognitive and functional status, behavioral and psychological symptoms [Neuropsychiatric Inventory (NPI)] and psychotropic drugs use, and caregivers were evaluated for care burden [Caregiver Burden Inventory (CBI)] and depressive symptoms.
After adjusting for potential confounders, NPI score significantly decreased in DC group, with a reduction of psychotropic drugs prescription, whereas it increased in HC. No significant between-group difference was observed for cognitive and functional change. CBI significantly decreased in DC, but not HC, caregivers, with no significant between-group difference in depressive symptoms change.
A 2-month period of DC assistance is effective in reducing behavioral and psychological symptoms of dementia patients and in alleviating caregivers' burden.