Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-21T04:45:02.740Z Has data issue: false hasContentIssue false
  • English
  • Français

Predictors of caregiver burden and care costs for older persons with dementia in Taiwan

Published online by Cambridge University Press:  06 December 2018

Li-Jung Elizabeth Ku ,
Sheng-Mao Chang ,
Ming-Chyi Pai  and
Hui-Min Hsieh
Li-Jung Elizabeth Ku
Affiliation:
Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Sheng-Mao Chang
Affiliation:
Department of Statistics, National Cheng Kung University, Tainan, Taiwan
Ming-Chyi Pai*
Affiliation:
Division of Behavioral Neurology, Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan Alzheimer’s Disease Research Center, National Cheng Kung University Hospital, Tainan, Taiwan
Hui-Min Hsieh
Affiliation:
Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
*
Correspondence should be addresses to: Ming-Chyi Pai, Division of Behavioral Neurology, Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, No, 138, Sheng-li Road, North District, Tainan 704, Taiwan. Phone: +886-6-2353535-5534. Fax: +886-6-2088036. Email: [email protected]
Get access

Abstract

Objectives:

As a degenerative disease, the progression of dementia needs continued care provision and poses both psychological and financial burden for family caregivers of persons with dementia (PWD). This study seeks to compare predictors of care costs and caregiver burden, and to identify modifiable factors that could alleviate the burden faced by dementia caregivers.

Methods:

This study interviewed 231 PWD–caregiver dyads in a dementia clinic at a teaching hospital in southern Taiwan in 2013. A follow-up study was conducted a year later, and 167 dyads completed the second interview. Data collected included PWD characteristics, caregiver characteristics, relationship to PWD, and social support to caregivers. Caregiver burden was measured with the Zarit Burden Interview instrument. The association between each predictor variable and cost of care and caregiver burden scores was examined using linear mixed models.

Results:

Predictors of care costs were found to be different from predictors of caregiver burden: functional declines measured by Katz’s activities of daily living (ADL) scale were associated with total cost as compared to behavioral disturbance measured by Neuropsychiatric Inventory (NPI), which showed no impact on care costs. However, NPI was a significant predictor of caregiver burden. Caregivers who were better-off financially also reported significantly lower caregiver burden.

Conclusions:

Since predictors of care costs were different from the predictors of caregiver burden, providing training to caregivers in addressing PWD’s behavioral disturbance and proving financial assistance to low income caregivers could be effective in reducing caregiver burden.

Keywords

caregiver burdencare costsdementiainformal caregivers
Type
Original Research Article
Information
International Psychogeriatrics , Volume 31 , Issue 6: Issue Theme: Frailty, Cognition, and Mental Health , June 2019 , pp. 885 - 894
Copyright
© International Psychogeriatric Association 2018 

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

American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC: American Psychiatric Association.Google Scholar
Bergvall, N. et al. (2011). Relative importance of patient disease indicators on informal care and caregiver burden in Alzheimer’s disease. International Psychogeriatrics, 23, 73–85. doi: 10.1017/S1041610210000785.CrossRefGoogle ScholarPubMed
Bonsang, E. (2009). Does informal care from children to their elderly parents substitute for formal care in Europe? Journal of Health Economics, 28, 143–154. doi: 10.1016/j.jhealeco.2008.09.002.CrossRefGoogle Scholar
Bureau of National Health Insurance. (2013). Reimbursement Rule of Drugs Acting on the Nervous System. Taiwan: Bureau of National Health Insurance.Google Scholar
Chan, S. W. C. (2010). Family caregiving in dementia: the Asian perspective of a global problem. Dementia and Geriatric Cognitive Disorders, 30, 469–478. doi: 10.1159/000322086.CrossRefGoogle ScholarPubMed
Chiou, C. J., Chang, H. Y., Chen, I. P. and Wang, H. H. (2009). Social support and caregiving circumstances as predictors of caregiver burden in Taiwan. Archives of Gerontology and Geriatrics, 48, 419–424. doi: 10.1016/j.archger.2008.04.001.CrossRefGoogle ScholarPubMed
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, 2208–2314. doi: 10.1212/wnl.44.12.2308.CrossRefGoogle ScholarPubMed
Diggle, P. J., Heagerty, P. J., Liang, K.-Y. and Zeger, S. L. (2002). Analysis of Longitudinal Data, Oxford Statistical Science Series (Vol. 1), 2nd edn. Oxford: Oxford University Press.Google Scholar
Directorate-General of Budget, Accounting and Statistics. (2015). Report on the Manpower Utilization Survey. Taipei City, Taiwan: Executive Yuan. https://www.dgbas.gov.tw/public/Attachment/1061227_104.pdf.Google Scholar
Do, Y. K., Norton, E. C., Stearns, S. C. and Van Houtven, C. H. (2015). Informal care and caregiver’s health. Health Economics, 24, 224–237. doi: 10.1002/hec.3012.CrossRefGoogle ScholarPubMed
Dodel, R. et al. (2015). Determinants of societal costs in Alzheimer’s disease: GERAS study baseline results. Alzheimer’s & Dementia, 11, 933–945. doi: 10.1016/j.jalz.2015.02.005.CrossRefGoogle ScholarPubMed
Etters, L., Goodall, D. and Harrison, B. E. (2008). Caregiver burden among dementia patient caregivers: a review of the literature. Journal of the American Academy of Nurse Practitioners, 20, 423–428. doi: 10.1111/j.1745-7599.2008.00342.x.CrossRefGoogle ScholarPubMed
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. doi: 10.1016/0022-3956(75)90026-6.CrossRefGoogle ScholarPubMed
Gillespie, P. et al. (2015). Longitudinal costs of caring for people with Alzheimer’s disease. International Psychogeriatric, 27, 847–856. doi: 10.1017/S1041610214002063.CrossRefGoogle ScholarPubMed
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A. and Martin, R. L. (1982). A new clinical scale for the staging of dementia. The British Journal of Psychiatry, 140, 566–572. doi: 10.1192/bjp.140.6.566.CrossRefGoogle Scholar
Hughes, T. B. et al. (2014). Correlates of objective and subjective measures of caregiver burden among dementia caregivers: influence of unmet patient and caregiver dementia-related care needs. International Psychogeriatric, 26, 1875–1883. doi: 10.1017/s1041610214001240.CrossRefGoogle ScholarPubMed
International Monetary Fund. (2016). Implied purchasing power parity (PPP) conversion rate for Taiwan. World Economic Outlook Database. http://www.imf.org/external/pubs/ft/weo/2016/01/weodata/index.aspxGoogle Scholar
Katz, S., Ford, A. B., Moskowitz, R. W., Jackson, B. A. and Jaffe, M. W. (1963). Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychosocial function. JAMA, 185, 914–919. doi: 10.1001/jama.1963.03060120024016.CrossRefGoogle ScholarPubMed
Kim, H., Chang, M., Rose, K. and Kim, S. (2012). Predictors of caregiver burden in caregivers of individuals with dementia. Journal of Advanced Nursing, 68, 846–855. doi: 10.1111/j.1365-2648.2011.05787.x.CrossRefGoogle ScholarPubMed
Ku, L. J., Pai, M. C. and Shih, P. Y. (2016). Economic impact of dementia by disease severity: exploring the relationship between stage of dementia and cost of care in Taiwan. PloS One, 11, e0148779. doi: 10.1371/journal.pone.0148779.CrossRefGoogle ScholarPubMed
Leicht, H. et al. (2013). Predictors of costs in dementia in a longitudinal perspective. PloS One, 8, e70018. doi: 10.1371/journal.pone.0070018.CrossRefGoogle Scholar
Li, H., Jia, J. and Yang, Z. (2016). Mini-mental state examination in elderly Chinese: a population-based normative study. Journal of Alzheimer’s Disease, 53, 487–496. doi: 10.3233/JAD-160119.CrossRefGoogle ScholarPubMed
Lim, J., Goh, J., Chionh, H. L. and Yap, P. (2012). Why do patients and their families not use services for dementia? Perspectives from a developed Asian country. International Psychogeriatrics, 24, 1571–1580. doi: 10.1017/S1041610212000919.CrossRefGoogle Scholar
Lin, C. Y., Wang, J. D., Pai, M. C. and Ku, L. E. (2017). Measuring burden in dementia caregivers: confirmatory factor analysis for short forms of the Zarit Burden Interview. Archives of Gerontology and Geriatrics, 68, 8–13. doi: 10.1016/j.archger.2016.08.005.CrossRefGoogle ScholarPubMed
Montgomery, D. C., Peck, E. A. and Vining, G. G. (2015). Introduction to Linear Regression Analysis. New York: John Wiley & Sons.Google Scholar
Pearlin, L. I., Mullan, J. T., Semple, S. J. and Skaff, M. M. (1990). Caregiving and the stress process: an overview of concepts and their measures. Gerontologist, 30, 583–594. doi: 10.1093/geront/30.5.583.CrossRefGoogle ScholarPubMed
Prince, M., Wimo, A., Guerchet, M., Ali, G., Wu, Y. and Prina, M. (2015). World Alzheimer Report 2015. The Global Impact of Dementia. London: Alzheimer’s Disease International (ADI).Google Scholar
Schaller, S., Mauskopf, J., Kriza, C., Wahlster, P. and Kolominsky‐Rabas, P. L. (2015). The main cost drivers in dementia: a systematic review. International Journal of Geriatric Psychiatry, 30, 111–129. doi: 10.1002/gps.4198.CrossRefGoogle ScholarPubMed
Schwarzkopf, L. et al. (2012). Excess costs of dementia disorders and the role of age and gender—an analysis of German health and long-term care insurance claims data. BMC Health Services Research, 12, 165. doi: 10.1186/1472-6963-12-165.CrossRefGoogle ScholarPubMed
Tang, J. Y. et al. (2016). Validating a Cantonese short version of the Zarit burden interview (CZBI-Short) for dementia caregivers. Aging and Mental Health, 20, 996–1001. doi: 10.1080/13607863.2015.1047323.CrossRefGoogle ScholarPubMed
Tolkacheva, N., Van Groenou, M. B., De Boer, A. and Van Tilburg, T. (2011). The impact of informal care-giving networks on adult children’s care-giver burden. Ageing & Society, 31, 34–51. doi: 10.1017/s0144686x10000711.CrossRefGoogle ScholarPubMed
van der Lee, J., Bakker, T. J. E. M., Duivenvoorden, H. J. and Dröes, R.-M. (2014). Multivariate models of subjective caregiver burden in dementia: a systematic review. Ageing Research Reviews, 15, 76–93. doi: 10.1016/j.arr.2014.03.003.CrossRefGoogle ScholarPubMed
Wimo, A., Gustavsson, A., Jonsson, L., Winblad, B., Hsu, M. A. and Gannon, B. (2013). Application of resource utilization in dementia (RUD) instrument in a global setting. Alzheimer’s & Dementia, 9, 429–435e417. doi: 10.1016/j.jalz.2012.06.008.CrossRefGoogle Scholar
Wimo, A. and Prince, M. J. (2010). World Alzheimer Report 2010: The Global Economic Impact of Dementia. London: Alzheimer’s Disease International.Google Scholar
Wolfs, C. A. et al. (2012). Predictive factors for the objective burden of informal care in people with dementia: a systematic review. Alzheimer Disease and Associated Disorders, 26, 197–204. doi: 10.1097/WAD.0b013e31823a6108.CrossRefGoogle ScholarPubMed
Wu, C.-Y., Hu, H.-Y., Huang, N., Fang, Y.-T., Chou, Y.-J. and Li, C.-P. (2014). Determinants of long-term care services among the elderly: a population-based study in Taiwan. PloS One, 9, e89213. doi: 10.1371/journal.pone.0089213.CrossRefGoogle ScholarPubMed
Zarit, S. H., Reever, K. E. and Bach-Peterson, J. (1980). Relatives of the impaired elderly: correlates of feelings of burden. Gerontologist, 20, 649–655. doi: 10.1093/geront/20.6.649.CrossRefGoogle ScholarPubMed