title: Anticipating an Easier Day: Effects of Adult Day Services on Daily Cortisol and Stress.
abstract: OBJECTIVE
  Family caregivers experience high levels of stress that place them at risk for poor health outcomes. We explore whether an intervention which lowers caregivers' daily exposure to stressors, adult day services (ADS), leads to improved regulation of the stress hormone, cortisol, which has implications for health and well-being.
  
  
  METHODS
  Participants (N = 158) were family caregivers of individuals with dementia (IWD) who were using ADS. Eligibility included: the IWD had a dementia diagnosis, IWD used ADS at least twice a week, and IWD and caregiver lived in the same household. A within-subject treatment design was used to compare caregivers' diurnal cortisol responses on days they received the intervention (ADS use by the IWD) and days they did not. Participants completed daily interviews over eight consecutive days and provided five saliva samples on each of those days. Primary outcomes were salivary cortisol awakening response (CAR) and cortisol area under the curve with respect to ground (AUC-G).
  
  
  RESULTS
  Caregivers with a "burned-out" or flattened CAR, and associated low AUC-G on non-ADS days displayed a more normative CAR and AUC-G response on ADS days. Restored cortisol regulation was also observed on ADS days among caregivers with the highest CAR and AUC-G levels on non-ADS days.
  
  
  CONCLUSIONS
  Results indicate that ADS use improves caregivers' cortisol regulation, which could enhance long-term health outcomes. Effects may be due to caregivers' anticipation of an easier day when the IWD attends ADS.
authors.affiliation: Department of Biobehavioral Health, Pennsylvania State University, University Park. Penn State Institute of the Neurosciences, The Pennsylvania State University, University Park. lcklein@psu.edu.
authors.forename: Laura Cousino
authors.initials: LC
authors.lastname: Klein
authors.affiliation: Department of Human Development and Family Sciences, University of Texas at Austin.
authors.forename: Kyungmin
authors.initials: K
authors.lastname: Kim
authors.affiliation: Department of Human Development and Family Studies, Pennsylvania State University, University Park.
authors.forename: David M
authors.initials: DM
authors.lastname: Almeida
authors.affiliation: Department of Human Development and Family Studies, Pennsylvania State University, University Park.
authors.forename: Elia E
authors.initials: EE
authors.lastname: Femia
authors.affiliation: Department of Human Development and Family Studies, Pennsylvania State University, University Park.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rovine
authors.affiliation: Department of Human Development and Family Studies, Pennsylvania State University, University Park.
authors.forename: Steven H
authors.initials: SH
authors.lastname: Zarit
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D003704:Dementia / Q000628:therapy*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D012463:Saliva / Q000737:chemistry; D013315:Stress, Psychological / Q000175:diagnosis / Q000378:metabolism*
chemical_list: D006854:Hydrocortisone
keywords: Adult day services; Cortisol; Family caregivers; Stress