Costs of care for people with dementia just before and after nursing home placement: primary data from eight European countries

Wübker, Ansgar; Zwakhalen, Sandra; Challis, David; Suhonen, Riitta; Karlsson, Staffan; Zabalegui, Adelaida; Soto, María; Saks, Kai; Sauerland, Dirk

doi:10.1007/s10198-014-0620-6

Cited by 112 publications

(152 citation statements)

References 33 publications

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“…In Western countries, the costs associated with the care of older adults with dementia are mostly related to costs of in-home nursing and nursing home care [1]. The costs of nursing home care are higher compared to the costs of in-home nursing care in most countries [15,16]. In the majority of cases in the Nordic countries (defined as Norway, Sweden, Denmark, Finland and Iceland), the professional care of older people is handled by public health care services.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Severity of Dementia in Nursing Home Residents

Helvik¹,

Engedal

Benth

et al. 2015

Dement Geriatr Cogn Disord

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Background/Aims: The aim of this study was to compare the presence and severity of dementia in two large cross-sectional samples of nursing home residents from 2004/2005 and 2010/2011. Methods: Demographic information as well as data on the type of nursing home unit, length of stay before assessment, physical health, regularly used prescribed drugs and Clinical Dementia Rating scale scores were used in the analyses. Logistic and linear regression models for hierarchical data were estimated. Results: The odds of the occurrence and of a greater severity of dementia were higher in 2010/2011 than in 2004/2005. Independent of the time of study, married men had more severe dementia than single men, and single women had more severe dementia than single men. Conclusion: The findings may reflect the increase in the need for more nursing home beds designed for people with dementia between 2004/2005 and 2010/2011.

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Section: Introductionmentioning

confidence: 99%

Prevalence and Severity of Dementia in Nursing Home Residents

Helvik¹,

Engedal

Benth

et al. 2015

Dement Geriatr Cogn Disord

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“…This is generally also seen as a lower-cost option than admission, 5 but this will not always be the case. 39 Recognising and finding ways to reduce or manage physical health problems, 36 agitation 40 and depression 41 in Alzheimer's patients could significantly reduce the risk of institutionalisation, which has implications for primary and secondary healthcare.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…This has international relevance, of course, even though the structural characteristics, funding arrangements and associated incentives in different health and care systems often lead to different patterns of service usage and costs. 39 …”

Section: Strengths and Limitationsmentioning

confidence: 99%

Predictors of care home and hospital admissions and their costs for older people with Alzheimer's disease: findings from a large London case register

et al. 2016

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ObjectivesTo examine links between clinical and other characteristics of people with Alzheimer's disease living in the community, likelihood of care home or hospital admission, and associated costs.DesignObservational data extracted from clinical records using natural language processing and Hospital Episode Statistics. Statistical analyses examined effects of cognition, physical health, mental health, sociodemographic factors and living circumstances on risk of admission to care home or hospital over 6 months and associated costs, adjusting for repeated observations.SettingCatchment area for South London and Maudsley National Health Service Foundation Trust, provider for 1.2 million people in Southeast London.ParticipantsEvery individual with diagnosis of Alzheimer's disease seen and treated by mental health services in the catchment area, with at least one rating of cognition, not resident in care home at time of assessment (n=3075).InterventionsUsual treatment.Main outcome measuresRisk of admission to, and days spent in three settings during 6-month period following routine clinical assessment: care home, mental health inpatient care and general hospital inpatient care.ResultsPredictors of probability of care home or hospital admission and/or associated costs over 6 months include cognition, functional problems, agitation, depression, physical illness, previous hospitalisations, age, gender, ethnicity, living alone and having a partner. Patterns of association differed considerably by destination.ConclusionsMost people with dementia prefer to remain in their own homes, and funding bodies see this as cheaper than institutionalisation. Better treatment in the community that reduces health and social care needs of Alzheimer's patients would reduce admission rates. Living alone, poor living circumstances and functional problems all raise admission rates, and so major cuts in social care budgets increase the risk of high-cost admissions which older people do not want. Routinely collected data can be used to reveal local patterns of admission and costs.

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“…Overall, and not surprisingly, there is general agreement that as the disease progresses the costs increase, especially once institutionalisation is required [3, 4]. Furthermore, informal care costs often form the majority of total costs [5].…”

Section: Introductionmentioning

confidence: 99%

Resource utilisation, costs and clinical outcomes in non-institutionalised patients with Alzheimer’s disease: 18-month UK results from the GERAS observational study

et al. 2016

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BackgroundAlzheimer’s disease (AD), the commonest cause of dementia, represents a significant cost to UK society. This analysis describes resource utilisation, costs and clinical outcomes in non-institutionalised patients with AD in the UK.MethodsThe GERAS prospective observational study assessed societal costs associated with AD for patients and caregivers over 18 months, stratified according to baseline disease severity (mild, moderate, or moderately severe/severe [MS/S]). All patients enrolled had an informal caregiver willing to participate in the study. Healthcare resource utilisation was measured using the Resource Utilization in Dementia instrument, and 18-month costs estimated by applying unit costs of services and products (2010 values). Total societal costs were calculated using an opportunity cost approach.ResultsOverall, 526 patients (200 mild, 180 moderate and 146 MS/S at baseline) were recruited from 24 UK centres. Mini-Mental State Examination (MMSE) scores deteriorated most markedly in the MS/S patient group, with declines of 3.6 points in the mild group, 3.5 points in the moderate group and 4.7 points in the MS/S group; between-group differences did not reach statistical significance. Patients with MS/S AD dementia at baseline were more likely to be institutionalised (Kaplan–Meier probability 28% versus 9% in patients with mild AD dementia; p < 0.001 for difference across all severities) and had a greater probability of death (Kaplan–Meier probability 15% versus 5%; p = 0.013) at 18 months. Greater disease severity at baseline was also associated with concomitant increases in caregiver time and mean total societal costs. Total societal costs of £43,560 over 18 months were estimated for the MS/S group, versus £25,865 for the mild group and £30,905 for the moderate group (p < 0.001). Of these costs, over 50% were related to informal caregiver costs at each AD dementia severity level.ConclusionsThis study demonstrated a mean deterioration in MMSE score over 18 months in patients with AD. It also showed that AD is a costly disease, with costs increasing with disease severity, even when managed in the community: informal caregiver costs represented the main contributor to societal costs.

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Costs of care for people with dementia just before and after nursing home placement: primary data from eight European countries

Cited by 112 publications

References 33 publications

Prevalence and Severity of Dementia in Nursing Home Residents

Prevalence and Severity of Dementia in Nursing Home Residents

Predictors of care home and hospital admissions and their costs for older people with Alzheimer's disease: findings from a large London case register

Resource utilisation, costs and clinical outcomes in non-institutionalised patients with Alzheimer’s disease: 18-month UK results from the GERAS observational study

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