title: Caregiving for patients with Alzheimer's disease or dementia and its association with psychiatric and clinical comorbidities and other health outcomes in Brazil.
abstract: OBJECTIVE
  Individuals with dementia due to Alzheimer's disease often receive care from family members who experience associated burden. This study provides the first broad, population-based account of caregiving-related health outcome burden in Brazil.
  
  
  METHODS
  Data were analyzed from the 2012 National Health and Wellness Survey in Brazil (n = 12,000), an Internet-based survey of adults (aged 18+ years), using stratified sampling by sex and age to ensure demographic representation of Brazil's adult population. Caregivers of individuals with Alzheimer's disease or dementia were compared with non-caregivers on comorbidities, productivity impairment, health-related quality of life, resource utilization, sociodemographic/health characteristics and behaviors, and Charlson comorbidity index scores. Regression models assessed outcomes associated with caregiving, adjusting for potential confounds.
  
  
  RESULTS
  Among 10,853 respondents, caregivers' (n = 209) average age was 42.1 years, 53% were female, and 52% were married/living with a partner. Caregivers versus non-caregivers (n = 10,644) were more frequently obese, smokers, insured, employed, college-educated, and wealthier and had higher Charlson comorbidity index, all p < 0.05. Adjusting for covariates, caregiving was associated with significantly increased risk of depressive symptoms (odds ratio [OR] = 2.008), major depressive disorder (OR = 1.483), anxiety (OR = 1.714), insomnia (OR = 1.644), hypertension (OR = 1.584), pain (OR = 1.704), and diabetes (OR = 2.103), all p < 0.015. Caregiving was also associated with lower health utilities (-0.024 points) and mental health status (-1.70 points), higher rates of presenteeism-related impairment (32.7% greater) and overall work impairment (35.9% greater), and higher traditional provider visit rates (28.7% greater), all p < 0.035.
  
  
  CONCLUSIONS
  Caregiver status was found to be a factor associated with worse health outcomes and psychiatric and clinical disorders.
authors.affiliation: Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.|Center for Studies and Research on Aging, Institute Vital Brazil, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Jerson
authors.initials: J
authors.lastname: Laks
authors.affiliation: Health Outcomes Practice, Kantar Health, New York, NY, USA.
authors.forename: Amir
authors.identifier: http://orcid.org/0000-0002-4388-8869
authors.initials: A
authors.lastname: Goren
authors.affiliation: Lilly Emerging Markets, Eli Lilly de México, Mexico City, Mexico.
authors.forename: Héctor
authors.initials: H
authors.lastname: Dueñas
authors.affiliation: Global Patient Outcomes and Real World Evidence, Eli Lilly and Company, Windlesham, Surrey, UK.
authors.forename: Diego
authors.initials: D
authors.lastname: Novick
authors.affiliation: Global Patient Outcomes & Real World Evidence, Eli Lilly and Company, Indianapolis, IN, USA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Kahle-Wrobleski
mesh_terms: D000328:Adult; D000368:Aged; D000544:Alzheimer Disease / Q000451:nursing / Q000523:psychology; D001938:Brazil; D017028:Caregivers / Q000523:psychology; D015897:Comorbidity; D017281:Cost of Illness; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000209:etiology*; D008875:Middle Aged; D016017:Odds Ratio; D011788:Quality of Life; D012307:Risk Factors; D055815:Young Adult
keywords: Alzheimer's disease; Brazil; caregiving; dementia; health outcomes