Alzheimer's Disease Care: Costs And Potential Savings

Leon, Joel; Cheng, Chiu-Ping; Neumann, Peter J.

doi:10.1377/hlthaff.17.6.206

Cited by 219 publications

(169 citation statements)

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“…While families provide significantly less informal care once an individual with dementia moves to a nursing home, some level of care from family members will likely continue. 5,12 However, even using these conservative measures, and using the low-range opportunity cost estimate, the national annual cost of dementia caregiving still reaches almost $14 billion per year. Future research should examine how the additional tasks related to dementia caregiving, such as providing supervision for safety and monitoring behavioral problems, add to the burden and costs identified in this study.…”

Section: Discussionmentioning

confidence: 99%

“…5 Other studies used statistical modeling to determine the``net'' caregiving attributable to dementia after adjusting for the presence of coexisting chronic conditions. 7,9,12 Our analysis used a statistical modeling methodology, as described below, that is similar to this latter group of studies.…”

Section: Conceptual Model Of Informal Caregiving For Dementiamentioning

confidence: 99%

“…As such, the statistical model identifies the incremental caregiving attributable to dementia, net of differences in caregiving due to the presence of comorbidities and taking into account other differences between groups. 7,12 The number of ADL and IADL limitations was not controlled for in the regression model since, as shown in Figure 1, we hypothesize (on the basis of prior studies 5,10,13 ) that the majority of informal care provided for those with dementia is due to differences in ADL/IADL limitations in those with dementia, as compared to those with normal cognitive function.…”

Section: Independent Variables and Statistical Model For Identifying mentioning

confidence: 99%

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National Estimates of the Quantity and Cost of Informal Caregiving for the Elderly with Dementia*

et al. 2001

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OBJECTIVE:Caring for the elderly with dementia imposes a substantial burden on family members and likely accounts for more than half of the total cost of dementia for those living in the community. However, most past estimates of this cost were derived from small, nonrepresentative samples. We sought to obtain nationally representative estimates of the time and associated cost of informal caregiving for the elderly with mild, moderate, and severe dementia. DESIGN:Multivariable regression models using data from the 1993 Asset and Health Dynamics Study, a nationally representative survey of people age 70 years or older (N = 7,443).SETTING: National population-based sample of the community-dwelling elderly. MAIN OUTCOME MEASURES:Incremental weekly hours of informal caregiving and incremental cost of caregiver time for those with mild dementia, moderate dementia, and severe dementia, as compared to elderly individuals with normal cognition. Dementia severity was defined using the Telephone Interview for Cognitive Status. R E S U L T S :A f te r a d j u s t i n g fo r s oc i o d e m o g r a p h i c s , comorbidities, and potential caregiving network, those with normal cognition received an average of 4.6 hours per week of informal care. Those with mild dementia received an additional 8.5 hours per week of informal care compared to those with normal cognition (P < .001), while those with moderate and severe dementia received an additional 17.4 and 41.5 hours (P < .001), respectively. The associated additional yearly cost of informal care per case was $3,630 for mild dementia, $7,420 for moderate dementia, and $17,700 for severe dementia. This represents a national annual cost of more than $18 billion. CONCLUSION:The quantity and associated economic cost of informal caregiving for the elderly with dementia are substantial and increase sharply as cognitive impairment worsens. Physicians caring for elderly individuals with dementia should be mindful of the importance of informal care for the well-being of their patients, as well as the potential for significant burden on those (often elderly) individuals providing the care.

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Section: Discussionmentioning

confidence: 99%

Section: Conceptual Model Of Informal Caregiving For Dementiamentioning

confidence: 99%

Section: Independent Variables and Statistical Model For Identifying mentioning

confidence: 99%

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National Estimates of the Quantity and Cost of Informal Caregiving for the Elderly with Dementia*

et al. 2001

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“…1,12 Common health conditions in PLWD include diabetes, vascular or heart disease, hypertension, chronic obstructive pulmonary disease, musculoskeletal disorders and chronic cardiac failure. 1,13,14 There is increasing evidence to support an association between Alzheimer's disease and cardiovascular risk factors such as hypertension and hypercholesterolaemia. [15][16][17] It has been argued that in older age groups Alzheimer's disease should be considered as a diffuse clinical syndrome representing the gradual accumulation of multiple pathologies rather than as a discrete neuropathological entity.…”

Section: Dementia and Comorbiditymentioning

confidence: 99%

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Bunn

Burn

Goodman

et al. 2016

Health Serv Deliv Res

116

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BackgroundAmong people living with dementia (PLWD) there is a high prevalence of comorbid medical conditions but little is known about the effects of comorbidity on processes and quality of care and patient needs or how services are adapting to address the particular needs of this population.ObjectivesTo explore the impact of dementia on access to non-dementia services and identify ways of improving the integration of services for this population.DesignWe undertook a scoping review, cross-sectional analysis of a population cohort database, interviews with PLWD and comorbidity and their family carers and focus groups or interviews with health-care professionals (HCPs). We focused specifically on three conditions: diabetes, stroke and vision impairment (VI). The analysis was informed by theories of continuity of care and access to care.ParticipantsThe study included 28 community-dwelling PLWD with one of our target comorbidities, 33 family carers and 56 HCPs specialising in diabetes, stroke, VI or primary care.ResultsThe scoping review (n = 76 studies or reports) found a lack of continuity in health-care systems for PLWD and comorbidity, with little integration or communication between different teams and specialities. PLWD had poorer access to services than those without dementia. Analysis of a population cohort database found that 17% of PLWD had diabetes, 18% had had a stroke and 17% had some form of VI. There has been an increase in the use of unpaid care for PLWD and comorbidity over the last decade. Our qualitative data supported the findings of the scoping review: communication was often poor, with an absence of a standardised approach to sharing information about a person’s dementia and how it might affect the management of other conditions. Although HCPs acknowledged the vital role that family carers play in managing health-care conditions of PLWD and facilitating continuity and access to care, this recognition did not translate into their routine involvement in appointments or decision-making about their family member. Although we found examples of good practice, these tended to be about the behaviour of individual practitioners rather than system-based approaches; current systems may unintentionally block access to care for PLWD. Pathways and guidelines for our three target conditions do not address the possibility of a dementia diagnosis or provide decision-making support for practitioners trying to weigh up the risks and benefits of treatment for PLWD.ConclusionsSignificant numbers of PLWD have comorbid conditions such as stroke, diabetes and VI. The presence of dementia complicates the delivery of health and social care and magnifies the difficulties that people with long-term conditions experience. Key elements of good care for PLWD and comorbidity include having the PLWD and family carer at the centre, flexibility around processes and good communication which ensures that all services are aware when someone has a diagnosis of dementia. The impact of a diagnosis of dementia on pre-existing conditions should be incorporated into guidelines and care planning. Future work needs to focus on the development and evaluation of interventions to improve continuity of care and access to services for PLWD with comorbidity.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…In general, this disease con-stitutes a leading socioeconomic problem since individuals with dementia require a high amount of healthcare and social and economic services both for the patients as well as their family and caregivers [2][3][4]. This disease has some of the highest healthcare and nonhealthcare costs, with the costs being especially high for the patient's family, particularly in the terminal stages of the disease [2,5,6].…”

Section: Introductionmentioning

confidence: 99%

Prospective One-Year Cost-of-Illness Study in a Cohort of Patients with Dementia of Alzheimer's Disease Type in Spain: The ECO Study

Coduras

Rabasa

Frank

et al. 2010

JAD

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Abstract. In this study, we analyzed the economic impact of one-year healthcare and non-healthcare resources utilization by patients with dementia of Alzheimer's disease (AD) under usual medical practice in Spain. A one-year, prospective, naturalistic, multicenter cohort study was designed to recruit patients with mild, moderate to severe, and severe AD according to Clinical Dementia Rating scale: the ECO study. Healthcare resources (medical visits, drugs and concomitant treatments, complementary and diagnostic tests, institutionalization and use of home-nursing facilities) and non-healthcare resources (inventory materials, consumables, professional and non-professional caregivers' time for care and supervision) were recorded and valued at 2006 prices. A total of 560 patients with possible/probable AD by DSM-IV-NINCDS-ADRDA criteria were included in the study: 68% women, 77 ± 6 years old, 29% treatment naïve. Monthly average cost per patient was 1,425.73, and increased 10.08% at the end of the study (baseline monthly cost; 1,316.22). Non-healthcare costs ( 1059.00, 74.30% of total cost) decreased 4.30/month (0.40%) at the end of the year, while healthcare costs, which presented a total average of 366.66, grew by 136.94 in the period (54.06%), mainly due to cost of drugs, nursing home utilization, and institutionalization. The 87.26% of the overall cost ( 1,244.22) was not financed by National Health Service (NHS), and the majority of this cost corresponded to caregiver-associated cost. The caregiver's total burden represented 70.86% of the overall cost-of-illness. In conclusion, monthly overall mean cost of dementia of AD type was high in Spain ( 1,412.73). Almost 88% of the cost-of-illness is funded by the patient's own family, adding a financial burden to the suffering of these families.

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Alzheimer's Disease Care: Costs And Potential Savings

Cited by 219 publications

References 6 publications

National Estimates of the Quantity and Cost of Informal Caregiving for the Elderly with Dementia*

National Estimates of the Quantity and Cost of Informal Caregiving for the Elderly with Dementia*

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Prospective One-Year Cost-of-Illness Study in a Cohort of Patients with Dementia of Alzheimer's Disease Type in Spain: The ECO Study

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