title: Informal dementia care: Consequences for caregivers' health and health care use in 8 European countries.
abstract: BACKGROUND
  Informal (dementia) care has economic consequences throughout the health care system. Whilst the health and wellbeing of the care recipient might improve, the health of the caregiver might also change, typically for the worse. Therefore, this analysis aims to examine the association between caregiving intensity and caregivers' health and health care utilization.
  
  
  METHODS
  The empirical analysis is based on cross-sectional survey data generated by the European Project "RightTimePlaceCare" (RTPC). RTPC was a prospective cohort study conducted in eight European countries (Estonia, Finland, France, Germany, Netherlands, Sweden, Spain and the United Kingdom). The health status of 1029 informal caregivers was assessed by measures of psychological wellbeing (GHQ-12) and self-rated overall health (EQ-VAS). Health care utilization was measured by (i) the self-stated proportion of health care use influenced by caregiving and (ii) the probability of at least one visit to a general practitioner within in the last 30 days. The association between caregiving intensity and caregivers' health and health care utilization was assessed by descriptive analysis and multivariate OLS- and probit-models.
  
  
  RESULTS
  A higher amount of informal care was significantly related to negative health outcomes for informal caregivers. On average, one additional hour of informal caregiving per day was associated with a decrease of psychological wellbeing and self-rated overall health by 0.16 and 0.42 index points respectively. Furthermore, one more hour of informal caregiving corresponded with increased self-stated proportion of health care use by 0.56 percentage points. However, the claim of increased health care demand due to caregiving as measured by GP visits was only partly confirmed.
  
  
  CONCLUSIONS
  When evaluating the full economic effect of informal care, the impact of providing care on caregivers' health and health care utilization has to be taken into account.
authors.affiliation: University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany. Electronic address: patrick.bremer@uni-wh.de.
authors.forename: Patrick
authors.initials: P
authors.lastname: Bremer
authors.affiliation: Hospital Clínic de Barcelona, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Cabrera
authors.affiliation: University of Turku, Finland.
authors.forename: Helena
authors.initials: H
authors.lastname: Leino-Kilpi
authors.affiliation: Lund University, Sweden.
authors.forename: Connie
authors.initials: C
authors.lastname: Lethin
authors.affiliation: University of Tartu, Estonia.
authors.forename: Kai
authors.initials: K
authors.lastname: Saks
authors.affiliation: The University of Manchester, United Kingdom.
authors.forename: Caroline
authors.initials: C
authors.lastname: Sutcliffe
authors.affiliation: University Hospital de Toulouse, France.
authors.forename: Maria
authors.initials: M
authors.lastname: Soto
authors.affiliation: Maastricht University, The Netherlands.
authors.forename: Sandra M G
authors.initials: SM
authors.lastname: Zwakhalen
authors.affiliation: Rheinisch-Westfälisches Institut für Wirtschaftsforschung, University of Witten/Herdecke, Germany.
authors.forename: Ansgar
authors.initials: A
authors.lastname: Wübker
mesh_terms: D000328:Adult; D000368:Aged; D017028:Caregivers; D003430:Cross-Sectional Studies; D003704:Dementia; D036262:Empirical Research; D005060:Europe; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013315:Stress, Psychological; D011795:Surveys and Questionnaires
keywords: Caregivers’ health; Dementia; Europe; Health care utilization; Informal care