National estimates of the quantity and cost of informal caregiving for theelderly with dementia

OBJECTIVE: Caring for the elderly with dementia imposes a substantial burde n on family members and likely accounts for more than half of the total cos t of dementia for those living in the community. However, most past estimat es of this cost were derived from small, nonrepresentative samples. We soug ht to obtain nationally representative estimates of the time and associated cost of informal caregiving for the elderly with mild, moderate, and sever e dementia. DESIGN. 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). SETTING: National population-based sample of the community-dwelling elderly . MAIN OUTCOME MEASURES: Incremental weekly hours of informal caregiving and incremental cost of caregiver time for those with mild dementia, moderate d ementia, and severe dementia, as compared to elderly individuals with norma l cognition. Dementia severity was defined using the Telephone Interview fo r Cognitive Status. RESULTS: After adjusting for so cio demographics, comorbidities, and potent ial caregiving network, those with normal cognition received an average of 4.6 hours per week of informal care. Those with mild dementia received an a dditional 8.5 hours per week of informal care compared to those with normal cognition (P < .001), while those with moderate and severe dementia receiv ed an additional 17.4 and 41.5 hours (P < .001), respectively. The associat ed additional yearly cost of informal care per case was $3,630 for mild dem entia, $7,420 for moderate dementia, and $17,700 for severe dementia. This represents a national annual cost of more than $18 billion. CONCLUSION: The quantity and associated economic cost of informal caregivin g for the elderly with dementia are substantial and increase sharply as cog nitive impairment worsens. Physicians caring for elderly individuals with d ementia should be mindful of the importance of informal care for the well-b eing of their patients, as well as the potential for significant burden on those (often elderly) individuals providing the care.