Hostname: page-component-6bf8c574d5-vmclg Total loading time: 0 Render date: 2025-02-23T16:01:21.263Z Has data issue: false hasContentIssue false
  • English
  • Français

Longitudinal costs of caring for people with Alzheimer's disease

Published online by Cambridge University Press:  23 September 2014

Paddy Gillespie ,
Eamon O’Shea ,
John Cullinan ,
Jacqui Buchanan ,
Joel Bobula ,
Loretto Lacey ,
Damien Gallagher ,
Aine Ni Mhaolain  and
Brian Lawlor
Paddy Gillespie*
Affiliation:
School of Business and Economics, National University of Ireland, Galway, Ireland Irish Centre for Social Gerontology, National University of Ireland, Galway, Ireland
Eamon O’Shea
Affiliation:
School of Business and Economics, National University of Ireland, Galway, Ireland Irish Centre for Social Gerontology, National University of Ireland, Galway, Ireland
John Cullinan
Affiliation:
School of Business and Economics, National University of Ireland, Galway, Ireland
Jacqui Buchanan
Affiliation:
Janssen Alzheimer Immunotherapy, Dublin, Ireland
Joel Bobula
Affiliation:
Janssen Alzheimer Immunotherapy, Dublin, Ireland
Loretto Lacey
Affiliation:
Janssen Alzheimer Immunotherapy, Dublin, Ireland
Damien Gallagher
Affiliation:
St James's Hospital, Mercer's Institute for Research on Ageing, Ireland
Aine Ni Mhaolain
Affiliation:
St James's Hospital, Mercer's Institute for Research on Ageing, Ireland
Brian Lawlor
Affiliation:
St James's Hospital, Mercer's Institute for Research on Ageing, Ireland
*
Correspondence should be addressed to: Dr. Paddy Gillespie, School of Business and Economics, NUI Galway, Galway, Ireland. Phone: +353-(0)91-495740; Fax: +353-(0)91-524130. Email: [email protected].
Get access

Abstract

Background:

There has been an increasing interest in the relationship between severity of disease and costs in the care of people with dementia. Much of the current evidence is based on cross-sectional data, suggesting the need to examine trends over time for this important and growing cohort of the population.

Methods:

This paper estimates resource use and costs of care based on longitudinal data for 72 people with dementia in Ireland. Data were collected from the Enhancing Care in Alzheimer's Disease (ECAD) study at two time points: baseline and follow-up, two years later. Patients’ dependence on others was measured using the Dependence Scale (DS), while patient function was measured using the Disability Assessment for Dementia (DAD) scale. Univariate and multivariate analysis were used to explore the effects of a range of variables on formal and informal care costs.

Results:

Total costs of formal and informal care over six months rose from €9,266 (Standard Deviation (SD): 12,947) per patient at baseline to €21,266 (SD: 26,883) at follow-up, two years later. This constituted a statistically significant (p = 0.0014) increase in costs over time, driven primarily by an increase in estimated informal care costs. In the multivariate analysis, a one-point increase in the DS score, that is a one-unit increase in patient's dependence on others, was associated with a 19% increase in total costs (p = 0.0610).

Conclusions:

Higher levels of dependence in people with Alzheimer's disease are significantly associated with increased costs of informal care as the disease progresses. Formal care services did not respond to increased dependence in people with dementia, leaving it to families to fill the caring gap, mainly through increased supervision with the progress of disease.

Keywords

Alzheimer’s diseasecostslongitudinal analysisdependencefunction
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 5 , May 2015 , pp. 847 - 856
Copyright
Copyright © International Psychogeriatric Association 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alzheimer's Disease International (ADI). (2010). World Alzheimer Report 2010. The Global Economic Impact of Dementia. Available at: http://www.alz.org; last accessed 14 April 2014.Google Scholar
Alzheimer's Research Trust (ART). (2010). The Economic Burden of Dementia and Associated Research Funding in the United Kingdom. Oxford, UK: Health Economics Research Centre, University of Oxford.Google Scholar
American Psychological Association (APA). (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington DC: American Psychiatric Press.Google Scholar
Barnett, J. H., Lewis, L., Blackwell, A. D. and Taylor, M. (2014). Early intervention in Alzheimer's disease: a health economic study of the effects of diagnostic timing. BMC Neurology, 14, 101.Google Scholar
Central Statistics Office. (2010). Earnings and Labour Costs. Dublin, Ireland: CSO.Google Scholar
Comas-Herrera, A., Northey, S., Wittenberg, R., Knapp, M., Bhattacharyya, S. and Burns, A. (2011). Future costs of dementia-related long-term care: exploring future scenarios. International Psychogeriatrics, 23, 20–30.Google Scholar
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.Google Scholar
Drummond, M. F., Sculpher, M. J., Torrance, G. W., O’Brien, J. and Stoddart, G. L. (2005). Methods for the Economic Evaluation of Healthcare Programmes. Oxford, UK: Oxford University Press.Google Scholar
Ferri, C. P. et al. (2005). Global prevalence of dementia: a Delphi consensus study. Lancet, 366, 2112–2117.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-Mental State.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Gallagher, D. et al. (2010). Detecting prodromal Alzheimer's disease in mild cognitive impairment: utility of the CAMCOG and other neuropsychological predictors. International Journal of Geriatric Psychiatry, 25, 1280–1287.Google Scholar
Gelinas, I., Gauthier, L., McIntyre, M. and Gauthier, S. (1999). Development of a functional measure for persons with Alzheimer's disease: the disability assessment for dementia. American Journal of Occupational Therapy, 53, 471–481.Google Scholar
Gervès, C., Chauvin, P. and Bellanger, M. M. (2014). Evaluation of full costs of care for patients with Alzheimer's disease in France: the predominant role of informal care. Health Policy, 116, 114–122.Google Scholar
Gillespie, P. et al. (2013). The effects of dependence and function on costs of care for Alzheimer's disease and amnestic mild cognitive impairment in Ireland. International Journal of Geriatric Psychiatry, 28, 256–264.Google Scholar
Gustavsson, A. et al. (2010) Differences in resource use and costs of dementia care between European countries: baseline data from the ICTUS study. The Journal of Nutrition, Health & Aging, 14, 648–654.Google Scholar
Gustavsson, A. et al. (2011) Predictors of costs of care in Alzheimer's disease: a multinational sample of 1222 patients. Alzheimer's & Dementia, 7, 318–327.Google Scholar
Jonsson, L. et al. (2006). Determinants of costs of care for patients with Alzheimer's disease. International Journal of Geriatric Psychiatry, 21, 449–459.CrossRefGoogle ScholarPubMed
MacGregor, P. and O’Neill, C. (2007). Comparing utilisation of health services on the island of Ireland. In Nolan, B. (ed.), The Provision and Use of Health Services, Health Inequalities and Health and Social Gain (pp. 90–103). Dublin, Ireland: The Economic and Social Research Institute.Google Scholar
McDaid, D. (2001). Estimating the costs of informal care for people with Alzheimer's disease: methodological and practical challenges. International Journal of Geriatric Psychiatry, 16, 400–405.Google Scholar
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E.M. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. Neurology, 34, 939–944.Google Scholar
Murman, D. L., Von Eye, A., Sherwood, P. R., Liang, J. and Colenda, C. C. (2007). Evaluated need, costs of care, and payer perspective in degenerative dementia patients cared for in the United States. Alzheimer Disease and Associated Disorders, 21, 39–48.Google Scholar
O'Dwyer, C. et al. (2008). The Role and Future Development of the Meals-on-Wheels Service for Older People in Ireland. Dublin, Ireland: National Council on Ageing and Older People.Google Scholar
O'Shea, E. and Kennelly, B. (2008). The Economics of Mental Health Care in Ireland. Dublin, Ireland: Mental Health Commission.Google Scholar
Parsons, G. R. (2003). The travel cost model. In Champ, P. A., Boyle, K. J. and Brown, T. C. (eds.), A Primer on Non-Market Valuation (pp. 269–329). London: Kluwer.Google Scholar
Rapp, T. et al. (2012). Exploring the relationship between Alzheimer's disease severity and longitudinal costs. Value in Health, 15, 412–419.Google Scholar
Small, G. W., McDonnell, D. D., Brooks, R. L. and Papadopoulos, G. (2002). The impact of symptom severity on the cost of Alzheimer's disease. Journal of the American Geriatrics Society, 50, 321–327.Google Scholar
Smith, S. et al. (2010). Cost of Stroke in Ireland: Estimating the Annual Economic Cost of Stroke and TIA in Ireland. Dublin, Ireland: The Irish Heart Foundation.Google Scholar
Stern, Y. et al. (1994). Assessing patient dependence in Alzheimer's disease. Journal of Gerontology, 49, M216–M222.Google Scholar
Taylor, D. H. Jr., Schenkman, M., Zhou, J. and Sloan, F. A. (2001). The relative effect of Alzheimer's disease and related dementias, disability, and comorbidities on cost of care for elderly persons. The Journals of Gerontology. Series B: Psychological Sciences and Social Sciences, 56, S285–S293.Google Scholar
Wimo, A. W. and Winblad, B. (2003). Resource utilization in dementia: RUD Lite. Brain Aging, 3, 48–59.Google Scholar
Winblad, B. et al. (2004). Mild cognitive impairment–beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine, 256, 240–246.Google Scholar
Wolstenholme, J., Fenn, P., Gray, A., Keene, J. and Hope, T. (2002). Estimating the relationship between disease progression and cost of care in dementia. The British Journal of Psychiatry, 181, 36–42.Google Scholar
Zhu, C. W. et al. (2006a). Clinical characteristics and longitudinal changes of informal cost of Alzheimer's disease in the community. Journal of the American Geriatrics Society, 54, 1596–1602.Google Scholar
Zhu, C. W. et al. (2006b). Longitudinal study of effects of patient characteristics on direct costs in Alzheimer's disease. Neurology, 67, 998–1005.Google Scholar
Zhu, C. W. et al. (2008a). Patient dependence and longitudinal changes in costs of care in Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 26, 416–423.Google Scholar
Zhu, C. W. et al. (2008b). The effects of patient function and dependence on costs of care in Alzheimer's disease. Journal of the American Geriatrics Society, 56, 1497–1503.Google Scholar