The data showing whether or not respite programs are effective interventions for caregivers are mixed. Pinquart & Sørensen (2006) report that caregivers showed decreased burden and depression and increased SWB while no significant effects were observed for time to institutionalization, CR symptoms or knowledge/awareness of caregiver issues. An experimental study by Zarit et al (1998) demonstrated that how much respite care a caregiver received made a difference as to whether or not any therapeutic effect was observed. They found, in fact, that reductions in anger and depressive symptoms were possible if CR were able to attend adult day services at least twice a week for three months. While these results point to positive evidence in favour of respite services, Schoenmakers et al (2010) found that respite care actually increased burden. These mixed results on respite interventions were also found in a meta-analysis of respite programs conducted by Mason et al (2007) where adult day care, respite packages, in home respite, host family respite and institutional respite were all looked at. Varying strengths of experimental study were pooled and it was found that a small effect in favour of reduction of burden and a slightly larger but still modest reduction in depression. These results were heavily cautioned because of methodogical weaknesses of the underlying studies. The pooled results show relatively modest or weak support and where the individual interventions show more robust findings, the generalizability of the findings outside of the experimental design (e.g. to wider populations) is unknown. When ‘unpacked’, individual subcategories of respite such as adult day services show positive effects, in agreement with other studies. Qualitatively there is evidence in support of respite programs, however statistically (as a category) the studies conducted to date do not reliably demonstrate impacts on caregivers. According to Mason et al (2007), the “existing evidence base does not allow any firm conclusions about effectiveness or cost-effectiveness to be drawn and is unable to inform current policy and practice.” Further, a Cochrane Review conducted by Lee (2004) that was based on three RCTs also found that “no evidence of efficacy of respite care for people with dementia or their caregivers.” It should be noted that none of the studies included in Lee (2004) provided respite for longer than six weeks and one of the studies used a pay-per-use version of respite services rather than a free of charge model.
The complexity of the caregiving process for both caregiver and CR presents a significant challenge to those who wish to understand and measure outcomes of interventions such as respite. The variability of experimental results suggests a greater understanding of what caregiving means to a caregiver (e.g. caregiver appraisal) is required and should form part of any intervention strategy, especially if/when caregivers entrust the care of their loved ones to others.
Care Renewal: Reaching out to Caregivers. The policy implications of 13 caregiver respite projects. Victoria Order of Nursing.
This paper examines the experience of 13 organizations from across Canada that carried out projects intended to help caregivers achieve respite. The paper identifies common themes emerging from the projects and makes policy recommendations to address the gaps they revealed.