Abstract
BackgroundThis study assessed how family caregivers for patients with Alzheimer’s disease (AD) or dementia in Japan differed from non-caregivers in characteristics and health outcomes (i.e., comorbidities, health-related quality of life [HRQoL], productivity, and resource use). Caregivers were hypothesized to experience significantly poorer outcomes than non-caregivers.MethodsData were combined from the 2012 and 2013 National Health and Wellness Survey in Japan (n = 60000). Caregivers for adult relatives with AD or dementia were compared with non-caregivers on: comorbidities (including Patient Health Questionnaire (PHQ-9) cutoff scores suggesting presence/absence of major depressive disorder (MDD)), Work Productivity and Activity Impairment (WPAI), SF-36v2-based HRQoL, and healthcare resource utilization. Sociodemographic characteristics, health characteristics and behaviors, and Charlson comorbidity index (CCI) scores were compared across groups. Propensity matching, based on scores generated from a logistic regression predicting caregiving, was used to match caregivers with non-caregivers with similar likelihood of being caregivers. Bivariate comparisons across matched groups served to estimate outcomes differences due to caregiving.ResultsAmong 55060 respondents, compared with non-caregivers (n = 53758), caregivers (n = 1302) were older (52.6 vs. 47.5 years), more frequently female (53 % vs. 49 %), married/partnered, frequent alcohol drinkers, current smokers, exercisers, and not employed, and they averaged higher CCI scores (0.37 vs. 0.14), all p < 0.05. Propensity scores incorporated sex, age, body mass index (BMI), exercise, alcohol, smoking, marital status, CCI, insured status, education, employment, income, and children in household. A greedy matching algorithm produced 1297 exact matches, excluding 5 non-matched caregivers. Health utilities scores were significantly lower among caregivers (0.724) vs. non-caregivers (0.764), as were SF-36v2 Physical and Mental Component Summary scores. Caregivers vs. non-caregivers had significantly higher absenteeism, presenteeism-related impairment, overall work impairment (25.8 % vs. 20.4 %, respectively), and activity impairment (25.4 % vs. 21.8 %), more emergency room and traditional provider visits (7.70 vs. 5.35) in the past six months, and more frequent MDD (14 % vs. 9 %), depression, insomnia, anxiety, and pain.ConclusionsThose providing care for patients with AD or dementia in Japan experienced significantly poorer HRQoL and greater comorbid risk, productivity impairment, and resource use. These findings inform the need for greater support for caregivers and their patients.
Highlights
This study assessed how family caregivers for patients with Alzheimer’s disease (AD) or dementia in Japan differed from non-caregivers in characteristics and health outcomes
Presenteeism-related impairment results were available only for employed respondents who worked > 0 h in the past week (n = 1397: 709 caregivers and 688 non-caregivers) magnitude and significance of differences across health outcomes, the current study finds that caregivers for patients with AD in Japan experienced impairments comparable to those experienced by caregivers for patients with AD in other geographies (e.g., Brazil and US), as well as impairments experienced by caregivers for patients with other conditions across geographies [65,66,67]
Interventions focused on screening and treatment of depressive symptoms may offer another modality via which to identify and reach out to caregivers, perhaps focusing on strengthening the positive aspects of caregiving to better address the unique needs of this population. Those providing care for patients with dementia in Japan experience a broad range of care-related burden, with relatively greater comorbid risk, poorer health-related quality of life (HRQoL), greater productivity impairment, and higher rates of healthcare resource use
Summary
This study assessed how family caregivers for patients with Alzheimer’s disease (AD) or dementia in Japan differed from non-caregivers in characteristics and health outcomes (i.e., comorbidities, health-related quality of life [HRQoL], productivity, and resource use). Most notably, impaired cognition (e.g., memory difficulties), as well as impairments in daily activities and increasing functional dependence. This constellation of symptoms results in an increasing degree of care required, often provided by family caregivers [1]. Available treatment is aimed at improving cognitive function and managing behavioral symptoms [2]. Precise global prevalence estimates have been difficult to establish, but approximately 4.7 million older adults in the U.S have been estimated to have AD [5]. In Japan in 2010, 2.5 million adults were estimated to suffer from dementia, ranking Japan among nine countries with the highest number of sufferers [6]
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