Embedding Caregiver Support Within Adult Day Services: Outcomes of a Multisite Trial

Laura N Gitlin, David Roth, Katherine Marx, Lauren Parker, Sokha Koeuth, Holly Dabelko-Schoeny, Keith Anderson, Joseph E. Gaugler

Research output: Contribution to journalArticlepeer-review


Background and Objectives: 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. Research Design and Methods: 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. Results: 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). Discussion and Implications: 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.

Original languageEnglish (US)
Article numbergnad107
Issue number4
StatePublished - Apr 1 2024


  • Community-based care
  • Dementia care
  • Hybrid design
  • Implementation science

ASJC Scopus subject areas

  • General Medicine


Dive into the research topics of 'Embedding Caregiver Support Within Adult Day Services: Outcomes of a Multisite Trial'. Together they form a unique fingerprint.

Cite this