Home care versus institutionalization: family caregiving and senile brain disease

Abstract

Worldwide, the older population is increasing and predictions indicate the largest increase for the old old-age group of 75 and over (Brotman, 1977; Kop, 1980). One consequence of the life span prolongation points to an increase in the number of elderly with senile brain disease. The statistics agree that these brain syndromes become more frequent with rising age, until in the over 80 age group more than 20% of the population may be affected (Kay, 1972; Cooper and Sosna, 1981). The size and impact of this problem in human and in economic terms is staggering. While large numbers of old people with senile brain disease at different stages live in the community, either alone or with their families (Isaacs, Livingstone & Neville, 1972; Wang, 1977), at least half the population of the institutionalized aged suffer from irreversible brain disease. In an early study (Kay, Beamish & Roth, 1964) the ratio institutionalized:noninstitutionalized demented elderly was 1:5, while a recent Swedish study shows a ratio of 1:2 (Adolfsson, Gottfries, Nystrom and Winblad, 1981). More recently community studies have found 5-10070 demented among the total population over 65 years of age, living at home (Persson, 1980; Broe, Akhtar, Andrews, Caird, Gilmore and McLenna, 1978). Caring for a demented person at home exacts a heavy toll from the families. In a classical study of the gerontological literature, Sheldon (1948) described the severe and almost intolerable burden shouldered by relatives in caring for a mentally impaired elderly. Sainsbury and Grad de Alacron (1970), Isaacs (197 1), Sanford (1975), Archbold (1980) and most recently Klusmann, Bruder, Lauter and Ltiders (1981) all testify to both the great resilience and dignity, and the tremendous hardship, of families giving home care to their chronically ill elderly, particularly to those with mental impairment.