New Reproductive Techniques: A Legal Perspective

Abstract

<h3>Objective:</h3> To describe the comorbidity burden of family caregivers of homebound individuals with advanced Parkinson’s Disease (PD). <h3>Background:</h3> People with advanced Parkinson’s Disease (PD) may become homebound and separated from usual care, requiring intensive caregiving at home. Caregiver strain is associated with adverse health outcomes for those with PD and for their caregivers. PD caregivers aged 18–64, themselves, incur significantly higher medical costs compared with matched controls, but little is known about such caregivers as PD progresses and those caregivers age. <h3>Design/Methods:</h3> Caregiver surveys assessing comorbidity characteristics were nested within a larger study of interdisciplinary hybrid in-home/telehealth visits to homebound patients with advanced PD and their caregivers (NCT 03189459). The assessments included age, sex, race, ethnicity, and education, relationship to individual with PD and duration of caregiving, and caregiver’s self-reported medical comorbidities. <h3>Results:</h3> Sixty-five caregivers enrolled in the study. Women accounted for 78.5% of caregivers. Caregivers had a median age of 67.2 (interquartile range (IQR) 58.0–76.3). Seventy-three percent were white, 15.4% Black, 9.2% Asian, and 3.1% declined to answer. Median duration of caregiving was 5 years (IQR 3–7). From a list of 14 possible categories of comorbidities, caregivers reported a mean of 3 comorbidities each (SD 1.9). Individual comorbidity prevalence: Hypertension – 52.3%; Back problems – 43.1%; Arthritis - 41.5%; Depression – 33.9%, Diabetes – 13.9%; Cardiovascular disease – 10.8%; Cancer – 9.2%; and 46% “other”. <h3>Conclusions:</h3> Family caregivers of people with advanced, homebound PD were older and more diverse than previously described PD caregiver cohorts. They reported a high prevalence of cardiovascular, musculoskeletal, and neuropsychiatric comorbidities. Given the demands of caring for someone with advanced PD, future work is needed to replicate these findings in larger cohorts, understand health care priorities and utilization among such caregivers, and incorporate such knowledge into the design of caregiver interventions. <b>Disclosure:</b> Dr. Fleisher has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. The institution of Dr. Fleisher has received research support from Parkinson’s Foundation. Dr. Fleisher has received research support from PCORI. The institution of Dr. Fleisher has received research support from CurePSP. The institution of Dr. Fleisher has received research support from NIH/NINDS. The institution of Dr. Fleisher has received research support from NIH/NINDS. The institution of Dr. Fleisher has received research support from American Neurological Association International Outreach Committee. Dr. Fleisher has received intellectual property interests from a publication relating to health care. Melissa Levin has nothing to disclose. Serena Hess has nothing to disclose. Ellen Klostermann has nothing to disclose. Jeanette Lee has nothing to disclose. Daniela Mitchem has nothing to disclose. Erica Myrick has nothing to disclose. Dr. Wilkinson has nothing to disclose. Bichum Ouyang has nothing to disclose. Dr. Hall has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Academy of Neurology. The institution of Dr. Hall has received research support from NIH. The institution of Dr. Hall has received research support from Parkinson’s Foundation. The institution of Dr. Hall has received research support from CHDI. The institution of Dr. Hall has received research support from Biohaven. The institution of Dr. Hall has received research support from Neurocrine. The institution of Dr. Hall has received research support from Fujifilm. Dr. Hall has received personal compensation in the range of $500-$4,999 for serving as a Study section with NIH. The institution of Dr. Chodosh has received research support from NIH-NIA. The institution of Dr. Chodosh has received research support from NIH-NIMHD. The institution of Dr. Chodosh has received research support from NIH-NINR. The institution of Dr. Chodosh has received research support from SCAN Health Plan. The institution of Dr. Chodosh has received research support from New York State Department of Health.