Caregiver Time and Cost of Home Care for Alzheimer’s Disease: A Clinic-based Observational Study in Beijing, China

摘要

This cross-sectional study was conducted to estimate the caregiver time and calculate the cost of informal care for AD, and to explore the potential predictors of caregiver time. Seventy-one community-dwelling AD patient-caregiver dyads completed the assessment and questionnaire. AD patients were assessed with Mini-mental status examination (MMSE), activities of daily living (ADL), and Neuropsychiatric Inventory (NPI). Caregiver time was recorded using the Resource Utilization in Dementia (RUD). According to the MMSE score, subjects were classified as mild (n = 18), moderate (n = 43), and severe (n = 10) groups. The PADL care time was significantly different among three groups, with highest in severe group (172.5 ± 208.0 h/month), and least in mild group (24.9 ± 70.5 h/month) (F = 5.215, df = 2, P = 0.008). The supervision time was higher in severe group compared to mild group (F = 3.330, df = 2, P = 0.042), while there were no differences between mild and moderate groups, and between moderate and severe groups. There was no difference in IADL caregiver time among three groups. The estimated annual cost of PADL care ranged from 903 USD (mild) to 6,259 USD (severe), IADL care from 4042USD to 7645USD, and supervision from 871 USD to 6,172 USD. Stepwise logistic regression analysis showed that MMSE score was significant predictor of PADL care time. For every one unit increase in MMSE, the odds of PADL care time decrease by a factor of 0.791 (χ2 = 13.628, P = 0.000). Spouse caregivers significantly predict greater IADL care time (OR = 4.469, 95%CI = 1.248–15.999, P = 0.021), and male caregiver was a protector for IADL care time (OR = 0.157, 95%CI = 0.040–0.609, P = 0.007). The ADL score was a significant predictor of supervision time. For every one unit increase in ADL, the odds of supervision time increase by a factor of 1.132 (95%CI = 1.055–1.215, P = 0.001). Higher educational level of the patient predicted decrease in supervision time (OR = 0.888, 95%CI = 0.794–0.994, P = 0.038). Caregiver time and cost of home care for AD was substantial in China. Care time of PADL increased with the progression of cognitive decline. The IADL care time was strongly influenced by the biographical characteristics of caregivers. Supervision was mostly predicted by the functional status of the patient.