Langa K M, Chernew M E, Kabeto M U, Herzog A R, Ofstedal M B, Willis R J, Wallace R B, Mucha L M, Straus W L, Fendrick A M
Division of General Medicine, Department of Medicine, the Institute for Social Research, University of Michigan, Ann Arbor, Mich., USA.
J Gen Intern Med. 2001 Nov;16(11):770-8. doi: 10.1111/j.1525-1497.2001.10123.x.
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.
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).
National population-based sample of the community-dwelling elderly.
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.
After adjusting for sociodemographics, 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 dollars for mild dementia, 7,420 dollars for moderate dementia, and 17,700 dollars for severe dementia. This represents a national annual cost of more than 18 billion dollars.
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.
照顾老年痴呆患者给家庭成员带来了沉重负担，而且可能占社区中痴呆患者总费用的一半以上。然而，过去对这笔费用的大多数估计都来自规模小且缺乏代表性的样本。我们试图获得全国具有代表性的关于轻度、中度和重度老年痴呆患者非正式照料时间及相关成本的估计。
使用1993年资产与健康动态研究的数据建立多变量回归模型，该研究是一项对70岁及以上人群进行的全国代表性调查（N = 7443）。
以全国社区居住老年人为基础的样本。
与认知正常的老年人相比，轻度痴呆、中度痴呆和重度痴呆患者非正式照料的每周增加时长以及照料者时间的增加成本。痴呆严重程度通过认知状态电话访谈来定义。
在对社会人口统计学、合并症和潜在照料网络进行调整后，认知正常的老年人每周平均接受4.6小时的非正式照料。与认知正常的老年人相比，轻度痴呆患者每周额外接受8.5小时的非正式照料（P < .001），而中度和重度痴呆患者分别额外接受17.4小时和41.5小时（P < .001）。每例轻度痴呆患者非正式照料的相关年度额外成本为3630美元，中度痴呆为7420美元，重度痴呆为17700美元。这意味着全国每年的成本超过180亿美元。
老年痴呆患者非正式照料的数量和相关经济成本巨大，且随着认知障碍的恶化而急剧增加。照顾老年痴呆患者的医生应意识到非正式照料对患者福祉的重要性，以及对那些（通常也是老年人）提供照料者造成巨大负担的可能性。
