This study examines total formal and informal care costs attributable to Alzheimer's disease for persons living in the community and in institutions. The total cost of caring for an Alzheimer's patient in northern California is approximately $47,000 per year whether the patient lives at home or in a nursing home, but the cost breakdown differs in the two settings. For community-resident patients, three-fourths of the total cost represents an imputed value for unpaid informal care compared with 12 percent for institutionalized patients. Formal services are financed primarily by individuals and their families. Over 60 percent of the services provided to patients in either care setting were paid out of pocket. With projected increases in the number of persons at risk of developing Alzheimer's disease, the economic impact of the disease on future long-term care costs will be significant.

Subjects with possible or probable Alzheimer's disease who live alone are more likely to be women, and more likely to be poor than those living with others. They are also older and have milder cognitive impairments and a shorter disease duration. Living arrangement is a significant predictor of service utilization even with other factors held constant. Subjects living alone were less likely to use medical services such as physicians and hospitals, and more likely to use services such as homemaker chore and home-delivered meals. In addition, they were more likely to use no services than those living with others.

This study was designed to test the hypothesis that follow-up rates for women with abnormal breast screening results would vary by age, ethnicity and initial screening results in California's Breast Cervical Cancer Control Program. The sample was composed of women in this screening program who had received abnormal clinical breast exam (N = 5239) or mammography results (N = 1202). Chi-squared analysis showed significant differences by age and initial screening results but in logistic regression analysis the only demographic variable to retain significance in analysis was age, although size of the clinic was also highly significant. Older women should be targeted as a group needing assistance with compliance with follow-up recommendations.

This study presents detailed estimates of the hours and cost of informal care provided to Alzheimer's disease patients in Northern California. Data were collected over 12 months from 93 community-residing patients and their caregivers and from 94 institutionalized patients and their caregivers. Patients residing in the community received an average of 286 hours per month of unpaid care, whereas institutionalized patients received 36 hours per month. Alternative methods of imputing informal costs are described. The annual value of informal care (in 1990 dollars) is $34,517 for the noninstitutionalized sample and $5,542 for the institutionalized sample. The determinants of informal caregiving were examined and compared in the two settings. The more cognitively impaired the individual, the higher the informal costs no matter what the residential setting. In an institutional setting, the younger the patient and caregiver, the higher the costs. If a caregiver is not a spouse, higher informal care costs were also found.