title: Caregiver burden, health utilities, and institutional service costs among community-dwelling patients with Alzheimer disease.
abstract: This study examined the moderating effect of caregiver burden on the relationship between patients' health status and institutional costs in Alzheimer disease (AD). Data were obtained on whether 421 community-dwelling patients with AD in the CATIE-AD trial received institutional services in the month preceding baseline and at 3-month, 6-month, and 9-month follow-up. All participants had a caregiver who lived with or visited them regularly. Outcome variables include hospital, nursing home, residential, and combined institutional costs. Mixed models were employed to estimate the interaction of Health Utility Index (HUI)-III scores (a health status measure) and 5 measures of caregiver burden. Wherever significant, results indicate that greater caregiver burden weakens the inverse relationship between health utilities and institutional costs, leading to greater costs than would be expected at a given level of health. Altogether 45.0% of the models (9/20) showed this effect (positive coefficient on the burden-HUI interaction term). Interventions to support caregivers should be based on caregiver burden, regardless of care recipient health status, for even seemingly manageable patients may be at heightened risk for institutionalization if caregivers experience sufficiently high levels of burden.
authors.affiliation: *Department of Gerontology and Gerontology Institute, McCormack Graduate School of Policy Studies, University of Massachusetts, Boston, MA †Departments of Psychiatry and Epidemiology and Public Health, Yale University School of Medicine, New Haven §Departments of Psychiatry, Neurology, and Gerontology, University of Southern California Keck School of Medicine, Los Angeles, CA ‡New England Mental Illness, Research, Education, and Clinical Center, VA Connecticut System, West Haven, CT.
authors.forename: Edward Alan
authors.initials: EA
authors.lastname: Miller
authors.forename: Robert A
authors.initials: RA
authors.lastname: Rosenheck
authors.forename: Lon S
authors.initials: LS
authors.lastname: Schneider
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000628:therapy*; D017028:Caregivers / Q000191:economics / Q000523:psychology / Q000706:statistics & numerical data*; D017281:Cost of Illness; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011795:Surveys and Questionnaires; D055815:Young Adult