AgeWell Collaboratory, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA.
Center on Aging and Health, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
Gerontologist. 2024 Apr 1;64(4). doi: 10.1093/geront/gnad107.
Adult day services (ADS) provide quality-of-life benefits to people with dementia, but few provide systematic caregiver support. We report outcomes of a multisite, national trial testing a staff-delivered caregiver program, ADS Plus.
Cluster-randomized trial involving 34 ADS: 18 sites provided ADS (controls) and 16 provided ADS and ADS Plus (intervention). Trained staff met with caregivers to provide dementia education, support/validation, referrals/linkages, and strategies for care challenges and self-care over 12 months. Main outcomes included depressive symptoms (Center for Epidemiological Studies Depression Scale [CES-D]) and well-being at 6 and 12 months, and client attendance over 12 months.
Of 203 caregivers (Intervention = 102; Control = 101), 5.9% at 3 months, 12.8% at 6 months, and 22.7% at 12 months were lost to follow-up. Caregivers were predominantly female (80.3%), with 76.4% identifying as White/Caucasian, 14.8% Black/African American, and 12.3% Hispanic/Latino. Most (88.2%) had ≥college education and were 65.0 years old (SD = 13.46). For those with 6-month data, 40.4% control and 40.2% ADS Plus caregivers had depressed symptoms (≥16 CES-D) at baseline. By 6 months, 43.6% control versus 34.2% ADS Plus caregivers had ≥16 scores (odds ratio = 0.38, p = .072). By 12 months, after covariate adjustments, ADS Plus caregivers reported reduced total depression scores versus controls (p = .013) and lower depressed affect scores (p = .015). Of 18 sites providing 12-month client attendance data, 9 intervention sites reported 126.05 days attended versus 78.49 days for 9 control sites (p = .079).
Compared with ADS alone, by 12 months, ADS Plus improved caregiver mood and increased ADS utilization by 60.6%. Results support ADS staff delivering evidence-based caregiver support to enhance ADS benefits.
NCT02927821.
成人日间服务（ADS）为痴呆患者提供生活质量方面的益处，但很少有服务提供系统的护理人员支持。我们报告了一项多地点、全国性试验的结果，该试验测试了一种由员工提供的护理人员计划，即 ADS Plus。
这是一项涉及 34 个 ADS 的聚类随机试验：18 个站点提供 ADS（对照组），16 个站点提供 ADS 和 ADS Plus（干预组）。经过培训的工作人员与护理人员会面，提供有关痴呆症的教育、支持/验证、转介/联系，以及应对护理挑战和自我护理的策略，为期 12 个月。主要结果包括在 6 个月和 12 个月时的抑郁症状（流行病学研究中心抑郁量表 [CES-D]）和幸福感，以及在 12 个月时的客户出勤率。
在 203 名护理人员中（干预组=102 名；对照组=101 名），3 个月时有 5.9%、6 个月时有 12.8%、12 个月时有 22.7%的护理人员失访。护理人员主要是女性（80.3%），其中 76.4%为白种人/高加索人，14.8%为黑人/非裔美国人，12.3%为西班牙裔/拉丁裔。大多数（88.2%）具有大学及以上学历，年龄为 65.0 岁（标准差=13.46）。对于那些有 6 个月数据的人，40.4%的对照组和 40.2%的 ADS Plus 护理人员在基线时就有抑郁症状（CES-D≥16）。到 6 个月时，对照组有 43.6%的护理人员和 ADS Plus 护理人员的 CES-D 评分≥16（优势比=0.38，p=0.072）。到 12 个月时，经过协变量调整后，ADS Plus 护理人员报告的总抑郁评分低于对照组（p=0.013），抑郁情绪评分也较低（p=0.015）。在提供 12 个月客户出勤率数据的 18 个站点中，9 个干预站点报告了 126.05 天的出勤，而 9 个对照站点为 78.49 天（p=0.079）。
与单独的 ADS 相比，到 12 个月时，ADS Plus 改善了护理人员的情绪，并将 ADS 的利用率提高了 60.6%。结果支持 ADS 工作人员提供基于证据的护理人员支持，以增强 ADS 的益处。
NCT02927821。
