TY - JOUR T1 - Informal caregiving for diabetes and diabetic complications among elderly americans. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2002 A1 - Kenneth M. Langa A1 - Sandeep Vijan A1 - Rodney A. Hayward A1 - M.E. Chernew A1 - Caroline S Blaum A1 - Mohammed U Kabeto A1 - David R Weir A1 - Steven J. Katz A1 - Robert J. Willis A1 - A. Mark Fendrick KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Cost of Illness KW - Costs and Cost Analysis KW - Diabetes Complications KW - Diabetes Mellitus KW - Disabled Persons KW - Female KW - Health Surveys KW - Humans KW - Hypoglycemic Agents KW - Insulin KW - Male KW - Time Factors AB -

OBJECTIVES: Little is known regarding the amount of time spent by unpaid caregivers providing help to elderly individuals for disabilities associated with diabetes mellitus (DM). We sought to obtain nationally representative estimates of the time, and associated cost, of informal caregiving provided to elderly individuals with diabetes, and to determine the complications of DM that contribute most significantly to the subsequent need for informal care.

METHODS: We estimated multivariable regression models using data from the 1993 Asset and Health Dynamics Among the Oldest Old Study, a nationally representative survey of people aged 70 or older (N = 7,443), to determine the weekly hours of informal caregiving and imputed cost of caregiver time for community-dwelling elderly individuals with and without a diagnosis of DM.

RESULTS: Those without DM received an average of 6.1 hr per week of informal care, those with DM taking no medications received 10.5 hr, those with DM taking oral medications received 10.1 hr, and those with DM taking insulin received 14.4 hr of care (p <.01). Disabilities related to heart disease, stroke, and visual impairment were important predictors of diabetes-related informal care. The total cost of informal caregiving for elderly individuals with diabetes in the United States was between $3 and $6 billion per year, similar to previous estimates of the annual paid long-term care costs attributable to DM.

DISCUSSION: Diabetes imposes a substantial burden on elderly individuals, their families, and society, both through increased rates of disability and the significant time that informal caregivers must spend helping address the associated functional limitations. Future evaluations of the costs of diabetes, and the cost-effectiveness of diabetes interventions, should consider the significant informal caregiving costs associated with the disease.

PB - 57B VL - 57 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11983744?dopt=Abstract U4 - Aged, 80 and Over/Caregivers/Cost of Illness/Costs and Cost Analysis/Diabetes Mellitus/Complications/Therapy/Disabled Persons/Female/Health Surveys/Hypoglycemic Agents/Insulin/Support, Non U.S. Government/Support, U.S. Government--non PHS/Support, U.S. Government--PHS/Time Factors ER - TY - JOUR T1 - A national study of the quantity and cost of informal caregiving for the elderly with stroke. JF - Neurology Y1 - 2002 A1 - Hickenbottom, S.L. A1 - A. Mark Fendrick A1 - Kutcher, J.S. A1 - Mohammed U Kabeto A1 - Steven J. Katz A1 - Kenneth M. Langa KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Confidence Intervals KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Multivariate Analysis KW - Stroke KW - United States AB -

BACKGROUND: As the US population ages, increased stroke incidence will result in higher stroke-associated costs. Although estimates of direct costs exist, little information is available regarding informal caregiving costs for stroke patients.

OBJECTIVE: To determine a nationally representative estimate of the quantity and cost of informal caregiving for stroke.

METHODS: The authors used data from the first wave of the Asset and Health Dynamics (AHEAD) Study, a longitudinal study of people over 70, to determine average weekly hours of informal caregiving. Two-part multivariable regression analyses were used to determine the likelihood of receiving informal care and the quantity of caregiving hours for those with stroke, after adjusting for important covariates. Average annual cost for informal caregiving was calculated.

RESULTS: Of 7,443 respondents, 656 (8.8%) reported a history of stroke. Of those, 375 (57%) reported stroke-related health problems (SRHP). After adjusting for cormorbid conditions, potential caregiver networks, and sociodemographics, the proportion of persons receiving informal care increased with stroke severity, and there was an association of weekly caregiving hours with stroke +/- SRHP (p < 0.01). Using the median 1999 home health aide wage (8.20 dollars/hour) as the value for family caregiver time, the expected yearly caregiving cost per stroke ranged from 3,500 dollars to 8,200 dollars. Using conservative prevalence estimates from the AHEAD sample (750,000 US elderly patients with stroke but no SRHP and 1 million with stroke and SRHP), this would result in an annual cost of up to 6.1 billion dollars for stroke-related informal caregiving in the United States.

CONCLUSIONS: Informal caregiving-associated costs are substantial and should be considered when estimating the cost of stroke treatment.

PB - 58 VL - 58 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12084872?dopt=Abstract U4 - Aged, 80 and Over/Caregivers/Economics/Statistics and Numerical Data/Cerebrovascular Accident/Economics/Epidemiology/Confidence Intervals/Female/Human/Longitudinal Studies/Multivariate Analysis/Support, Non U.S. Government/Support, U.S. Government--PHS/United States/Epidemiology ER - TY - JOUR T1 - Estimating the cost of informal caregiving for elderly patients with cancer. JF - J Clin Oncol Y1 - 2001 A1 - Hayman, James A. A1 - Kenneth M. Langa A1 - Mohammed U Kabeto A1 - Steven J. Katz A1 - DeMonner, Sonya M. A1 - M.E. Chernew A1 - Slavin, Mitchell B. A1 - A. Mark Fendrick KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Cost of Illness KW - Family KW - Female KW - Home Nursing KW - Humans KW - Male KW - Multivariate Analysis KW - Neoplasms KW - Regression Analysis KW - United States AB -

PURPOSE: As the United States population ages, the increasing prevalence of cancer is likely to result in higher direct medical and nonmedical costs. Although estimates of the associated direct medical costs exist, very little information is available regarding the prevalence, time, and cost associated with informal caregiving for elderly cancer patients.

MATERIALS AND METHODS: To estimate these costs, we used data from the first wave (1993) of the Asset and Health Dynamics (AHEAD) Study, a nationally representative longitudinal survey of people aged 70 or older. Using a multivariable, two-part regression model to control for differences in health and functional status, social support, and sociodemographics, we estimated the probability of receiving informal care, the average weekly number of caregiving hours, and the average annual caregiving cost per case (assuming an average hourly wage of $8.17) for subjects who reported no history of cancer (NC), having a diagnosis of cancer but not receiving treatment for their cancer in the last year (CNT), and having a diagnosis of cancer and receiving treatment in the last year (CT).

RESULTS: Of the 7,443 subjects surveyed, 6,422 (86%) reported NC, 718 (10%) reported CNT, and 303 (4%) reported CT. Whereas the adjusted probability of informal caregiving for those respondents reporting NC and CNT was 26%, it was 34% for those reporting CT (P <.05). Those subjects reporting CT received an average of 10.0 hours of informal caregiving per week, as compared with 6.9 and 6.8 hours for those who reported NC and CNT, respectively (P <.05). Accordingly, cancer treatment was associated with an incremental increase of 3.1 hours per week, which translates into an additional average yearly cost of $1,200 per patient and just over $1 billion nationally.

CONCLUSION: Informal caregiving costs are substantial and should be considered when estimating the cost of cancer treatment in the elderly.

PB - 19 VL - 19 IS - 13 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11432889?dopt=Abstract U4 - Activities of Daily Living/Aged, 80 and Over/Caregivers/Cost of Illness/Family/Psychology/Female/Home Nursing/Economics/Statistics and Numerical Data/Human/Multivariate Analysis/Neoplasms/Complications/Therapy/Regression Analysis/United States ER - TY - JOUR T1 - The explosion in paid home health care in the 1990s: who received the additional services? JF - Med Care Y1 - 2001 A1 - Kenneth M. Langa A1 - M.E. Chernew A1 - Mohammed U Kabeto A1 - Steven J. Katz KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Family Characteristics KW - Female KW - Financing, Government KW - Frail Elderly KW - Geriatric Assessment KW - Health Care Surveys KW - Health Expenditures KW - health policy KW - Home Care Services KW - Home Nursing KW - Humans KW - Longitudinal Studies KW - Male KW - Marital Status KW - Multivariate Analysis KW - Social Support KW - Socioeconomic factors KW - Surveys and Questionnaires KW - United States KW - Utilization Review AB -

OBJECTIVE: Public expenditures for home health care grew rapidly in the 1990s, but it remains unclear to whom the additional services were targeted. This study tests whether the rapidly increasing expenditures were targeted to the elderly with high levels of disability and low levels of social support, 2 groups that have historically been higher users of paid home health and nursing home services.

METHODS: The Asset and Health Dynamics Study, a nationally representative, longitudinal survey of people > or = 70 years of age (n = 7,443), was used to determine the association of level of disability and level of social support with the use of paid home care services in both 1993 and 1995. Multivariable regression models were used to adjust for sociodemographics, recent hospital or nursing home admissions, chronic medical conditions, and receipt of informal care from family members.

RESULTS: Those with higher levels of disability received more adjusted weekly hours of paid home care in both 1993 and 1995. In 1993, users of paid home care with the least social support (unmarried living alone) received more adjusted weekly hours of care than the unmarried elderly living with others (24 versus 13 hours, P < 0.01) and the married (24 versus 18 hours, P = 0.06). However, by 1995, those who were unmarried and living with others were receiving the most paid home care: 40 versus 26 hours for the unmarried living alone (P < 0.05) and 24 hours for the married (P < 0.05).

CONCLUSIONS: The recent large increase in formal home care services went disproportionately to those with greater social support. Home care policy changes in the early 1990s resulted in a shift in the distribution of home care services toward the elderly living with their children.

PB - 39 VL - 39 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11176552?dopt=Abstract U4 - Activities of Daily Living/Classification/Aged, 80 and Over/Chronic Disease/Family Characteristics/Female/Financing, Government/Frail Elderly/Geriatric Assessment/Health Care Surveys/Health Expenditures/Health Policy/Home Care Services/Home Nursing/Longitudinal Studies/Marital Status/Multivariate Analysis/Questionnaires/Social Support/Socioeconomic Factors/Support, Non U.S. Government/United States/Utilization Review ER - TY - JOUR T1 - Gender disparities in the receipt of home care for elderly people with disability in the United States. JF - JAMA Y1 - 2000 A1 - Steven J. Katz A1 - Mohammed U Kabeto A1 - Kenneth M. Langa KW - Activities of Daily Living KW - Aged KW - Disabled Persons KW - Family KW - Female KW - Geriatrics KW - Home Care Services KW - Home Nursing KW - Humans KW - Male KW - Regression Analysis KW - Sex Distribution KW - United States AB -

CONTEXT: Projected demographic shifts in the US population over the next 50 years will cause families, health care practitioners, and policymakers to confront a marked increase in the number of people with disabilities living in the community. Concerns about the adequacy of community support are particularly salient to women, who make up a disproportionate number of disabled elderly people and who may be particularly vulnerable because they are more likely to live alone with limited financial resources.

OBJECTIVE: To address gender differences in receipt of informal and formal home care.

DESIGN, SETTING, AND PARTICIPANTS: Nationally representative survey conducted in 1993 among 7443 noninstitutionalized people (4538 women and 2905 men) aged 70 years or older.

MAIN OUTCOME MEASURE: Number of hours per week of informal (generally unpaid) and formal (generally paid) home care received by survey participants who reported any activity of daily living (ADL) or instrumental activity of daily living (IADL) impairment (n = 3109) compared by gender and living arrangement and controlling for other factors.

RESULTS: Compared with disabled men, disabled women were much more likely to be living alone (45.4% vs 16.8%, P<.001) and much less likely to be living with a spouse (27.8% vs 73.6%, P<.001). Overall, women received fewer hours of informal care per week than men (15.7 hours; 95% confidence interval [CI], 14.5-16.9 vs 21.2 hours; 95% CI, 19. 7-22.8). Married disabled women received many fewer hours per week of informal home care than married disabled men (14.8 hours; 95% CI, 13.7-15.8 vs 26.2 hours; 95% CI, 24.6-27.9). Children (>80% women) were the dominant caregivers for disabled women while wives were the dominant caregivers of disabled men. Gender differences in formal home care were small (2.8 hours for women; 95% CI, 2.5-3.1 vs 2.1 hours for men; 95% CI, 1.7-2.4).

CONCLUSION: Large gender disparities appear to exist in the receipt of informal home care for disabled elderly people in the United States, even within married households. Programs providing home care support for disabled elderly people need to consider these large gender disparities and the burden they impose on families when developing intervention strategies in the community.

PB - 284 VL - 284 IS - 23 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11122589?dopt=Abstract U4 - Activities of Daily Living/Disabled Persons/Family/Female/Geriatrics/Home Care Services/Utilization/Home Nursing/Utilization/Regression Analysis/Sex Distribution/Support, Non U.S. Government/Support, U.S. Government--PHS/United States/Epidemiology ER -