Effect of diabetes on caregiver burden in an observational study of individuals with Alzheimer’s disease

Abstract

BackgroundThe burden on caregivers of patients with Alzheimer’s disease (AD) is associated with the patient’s functional status and may also be influenced by chronic comorbid medical conditions, such as diabetes. This post-hoc exploratory analysis assessed whether comorbid diabetes in patients with AD affects caregiver burden, and whether caregivers with diabetes experience greater burden than caregivers without diabetes. Caregiver and patient healthcare resource use (HCRU) were also assessed.MethodsBaseline data from the GERAS observational study of patients with AD and their caregivers (both n = 1495) in France, Germany and the UK were analyzed.Caregiver burden was assessed using the Zarit Burden Interview (ZBI). Caregiver time on activities of daily living (ADL: basic ADL; instrumental ADL, iADL) and supervision (hours/month), and caregiver and patient HCRU (outpatient visits, emergency room visits, nights hospitalized) were assessed using the Resource Utilization in Dementia instrument for the month before the baseline visit. Regression analyses were adjusted for relevant covariates. Time on supervision and basic ADL was analyzed using zero-inflated negative binomial regression.ResultsCaregivers of patients with diabetes (n = 188) were younger and more likely to be female (both p < 0.05), compared with caregivers of patients without diabetes (n = 1307). Analyses showed caregivers of patients with diabetes spent significantly more time on iADL (+16 %; p = 0.03; increases were also observed for basic ADL and total caregiver time but did not reach statistical significance) and had a trend towards increased ZBI score. Patients with diabetes had a 63 % increase in the odds of requiring supervision versus those without diabetes (p = 0.01). Caregiver and patient HCRU did not differ according to patient diabetes.Caregivers with diabetes (n = 127) did not differ from those without diabetes (n = 1367) regarding burden/time, but caregivers with diabetes had a 91 % increase in the odds of having outpatient visits (p = 0.01).ConclusionsThis cross-sectional analysis found caregiver time on iADL and supervision was higher for caregivers of patients with AD and diabetes versus without diabetes, while HCRU was unaffected by patient diabetes. Longitudinal analyses assessing change in caregiver burden over time by patient diabetes status may help clarify the cumulative impact of diabetes and AD dementia on caregiver burden.

Differences in risk factors and chronic conditions between informal (family) carers and non-carers using a population-based cross-sectional survey in South Australia

“… 50 Other chronic conditions such as diabetes have been evident in a small number of population and clinical studies about informal caregivers. 22 In the biomedical literature, authors have described the link between long-term informal caregiving, chronic stress and physiological changes including the metabolic syndrome and other endocrine and immune conditions. 24 51 Some of these studies have investigated the impact of caring for a spouse with dementia or a child with a disability where carers were seen to be more at risk of serious chronic physical conditions (such as CHD) or mental health conditions.…”

“… 19 21 Diabetes and other chronic health conditions have also been identified and investigated among carer populations. 22 …”

Diabetes-Related Topics in an Online Forum for Caregivers of Individuals Living With Alzheimer Disease and Related Dementias: Qualitative Inquiry

“…Our study revealed that forum users, who take care of individuals with ADRD and diabetes, frequently reported increased distress and neglect of self-care, both of which may contribute to a decrease in health status and quality of life for both the care recipient and family caregivers [ 61 ]. Previous studies reported that the time spent on daily activities and supervision by caregivers was higher when caring for individuals with ADRD and diabetes compared with caring for those with ADRD without diabetes [ 62 ]. Consequently, the level of the caregiver’s perceived burden increases [ 63 - 66 ].…”

Biomedical health profiles of unpaid family carers in an urban population in South Australia

“…Few published Australian population surveys that included carers have featured specific chronic conditions such as diabetes [20], while self-report health surveys conducted in Brazil, the USA and other countries have reported Type 2 diabetes in informal carers. In the biomedical literature there has been limited attention given to investigating diabetes-related characteristics in carers, and with the exception of one study [52], the emphasis has usually been on Type 2 diabetes in the person being cared for, rather than the carer.…”