"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
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
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.
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.
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"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
"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 (http://nadsa.org), which has a "find a center new you"
search tool, and the eldercare locator at
The American Journal of Geriatric
Psychiatry, online Feb. 3, 2014.
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