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J Gerontol B Psychol Sci Soc Sci. 2011 Sep;66(5):538-46. doi: 10.1093/geronb/gbr030. Epub 2011 Jun 3.

Effects of adult day care on daily stress of caregivers: a within-person approach.

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Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA 16802, USA.


OBJECTIVES. This article examined exposure to and appraisal of care-related stressors associated with use of adult day services (ADS) by family caregivers of individuals with dementia.


Using a within-person withdrawal design (A-B-A-B), we compared caregivers' exposure to and appraisal of behavior problems on days their relative attended and did not attend ADS. Participants were 121 family caregivers enrolling a relative with dementia in an ADS program. Daily assessments were obtained prior to the person's attending ADS for the first time and after 1 and 2 months of attendance on days the person attended and did not attend ADS.


Total exposure to stressors and stress appraisals decreased significantly over time on ADS days compared with non-ADS days. Most of this difference was accounted by the time the person with dementia was away from the caregiver, but there were also significant reductions in behavioral problems during the evening and improved sleep immediately following ADS use. DISCUSSION. ADS use lowered caregivers' exposure to stressors and may improve behavior and sleep for people with dementia on days they have ADS. The study highlights how a within-person design can identify the effects of an intermittent intervention, such as ADS.

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