Dementia severity and the longitudinal costs of informal care in the Cache County population

Abstract

Background Dementia costs are critical for influencing healthcare policy, but limited longitudinal information exists. We examined longitudinal informal care costs of dementia in a population-based sample. Methods Data from the Cache County Study included dementia onset, duration and severity assessed by the Mini Mental State Examination (MMSE), Clinical Dementia Rating Scale (CDR) and Neuropsychiatric Inventory (NPI). Informal cost of daily care (COC) was estimated based on median Utah wages. Mixed models estimated the relationship between severity and longitudinal COC in separate models for MMSE and CDR. Results 287 subjects [53% female, mean (sd) age was 82.3(5.9) years] participated. Overall COC increased by 18%/year. COC was 6% lower per MMSE-point increase and compared with very mild dementia, COC increased over 2-fold for mild, 5-fold for moderate and 6-fold for severe dementia on the CDR. Conclusions Greater dementia severity predicted higher costs. Disease management strategies addressing dementia progression may curb costs.

Closer caregiver and care‐recipient relationships predict lower informal costs of dementia care: The Cache County Dementia Progression Study

“…As reported previously [12], at alternating visits, a caregiver completed a caregiver activity survey about how much time was spent over the past 24 hours by all caregivers providing supportive care for the participant in areas such as answering questions, leaving reminders, using transportation, dressing, assisting with meals and eating, assisting with grooming, and supervising the participant's activities. Values for each activity were summed to a maximum of 16 hours per day, following practices used in previous studies [25, 26].…”

“…To estimate the cost of informal care in 2012 dollars, we used the same approach as in the prior cost paper on this cohort [12]. We used the Utahan median hourly wage as reported in the U.S. Bureau of Labor's Occupational Employment Statistics for the year of the visit (spanning from 2002-2011), adjusting for inflation using a derived Medical Consumer Price Index (MCPI) multiplier based on the “medical care services” values from the annual average Urban Consumer Price Index [27].…”

“…The purpose of this paper is to extend previous findings related to the informal costs of dementia care [12, 16-17] by examining whether care-related factors associated with slower disease progression (closeness, kin-relationship and problem-focused coping), also predict lower costs over time. As care environment factors are modifiable, these analyses can provide important insights into potential cost-saving areas of dementia care.…”

“…The DPS is comprised of community dwelling participants, where all dementia cases were clinically diagnosed and followed for as many as 10 years after the diagnosis of dementia, with rich information including caregiving hours, dementia progression, and caregiver factors [11]. In a previous study of the informal costs of care in this population-based sample, we demonstrated that longitudinal costs increased with dementia severity [12], as assessed by the Mini-Mental State Exam (MMSE) [13] as a cognitive measure; the Clinical Dementia Rating (CDR) [14] scale as a functional measure; and the Neuropsychiatric Inventory (NPI) [15] as a behavioral measure.…”

Memantine for treatment of moderate or severe Alzheimer’s disease patients in urban China: clinical and economic outcomes from a health economic model

“…Although a number of recent studies have investigated its economic impact [29,[46][47][48][49], no best practice method for costing has been agreed on to date. It is evident that more data are required to estimate this economic burden accurately, particularly in countries such as China, where methods applied in developed countries may not be appropriate.…”