Patient Dependence and Longitudinal Changes in Costs of Care in Alzheimer’s Disease

Abstract

Background/Aims: To examine the incremental effect of patients’ dependence on others, on cost of medical and nonmedical care, and on informal caregiving hours over time. Methods: Data are obtained from 172 patients from the Predictors Study, a large, multicenter cohort of patients with probable Alzheimer disease (AD) followed annually for 4 years in 3 University-based AD centers in the USA. Enrollment required a modified Mini-Mental State Examination score ≧30. We examined the effects of patient dependence (measured by the Dependence Scale, DS) and function (measured by the Blessed Dementia Rating Scale, BDRS) on medical care cost, nonmedical care cost, and informal caregiving time using random effects regression models. Results: A one-point increase in DS score was associated with a 5.7% increase in medical cost, a 10.5% increase in nonmedical cost, and a 4.1% increase in caregiving time. A one-point increase in BDRS score was associated with a 7.6% increase in medical cost, a 3.9% increase in nonmedical cost and an 8.7% increase in caregiving time. Conclusions: Both functional impairment and patient dependence were associated with higher costs of care and caregiving time. Measures of functional impairment and patient dependence provide unique and incremental information on the overall impact of AD on patients and their caregivers.

Longitudinal predictors of informal and formal caregiving time in community-dwelling dementia patients

“…The time invested in informal caregiving in our study [wave 3: 2.3 (±3.4) up to wave 4: 2.8 (±3.0), in hours per day] was quite moderate compared to other studies [5,7,9]. This is worth mentioning since the cognitive impairment observed in our study was very similar especially compared to an American sample [7] [at baseline, our study: mean MMSE = 20.1 (±5.1); Zhu et al [7]: mean MMSE = 20.5 (±5.5)] which has a markedly higher mean informal caregiving time (in hours per day).…”

“…This is worth mentioning since the cognitive impairment observed in our study was very similar especially compared to an American sample [7] [at baseline, our study: mean MMSE = 20.1 (±5.1); Zhu et al [7]: mean MMSE = 20.5 (±5.5)] which has a markedly higher mean informal caregiving time (in hours per day). Furthermore, since these studies [5,7,9] did not assess formal caregiving time, comparisons are restricted to informal caregiving hours. Differences in informal caregiving time might mainly be explained by differences in formal caregiving time, in assessing informal caregiving time, in caregiving systems and in culture.…”

“…Moreover, they found that individuals married with patients suffering from dementia provided more hours of informal care in comparison to individuals with other relations to patients. To the authors' knowledge, predictors have been investigated rarely in a longitudinal setting [6][7][8][9]. Available studies investigated predictors of informal caregiving time but did not consider complementarily provided formal care.…”

“…Moreover, at baseline mean BDRS was 4.5 (±3.0) and mean MMSE was 20.5 (±5.5). Furthermore, Zhu et al [9] also used data from the Predictors Study. At baseline, mean informal caregiving time was 3.0 in hours per day, mean BRDS was 2.8 (±1.4) and MMSE was 22.1 (±3.8).…”

“…At baseline, mean informal caregiving time was 3.0 in hours per day, mean BRDS was 2.8 (±1.4) and MMSE was 22.1 (±3.8). By using longitudinal regressions (log hours of informal care as outcome measure) Zhu et al [7,9] found an association between informal caregiving time with BDRS and Dependence Scale (DS).…”