Abstract
BackgroundCaregivers of persons with dementia (PWD) face high caregiving burden, distress related to responsive behaviours, and psychiatric morbidity. The present paper examines how these are associated with healthcare utilization of the PWD in Singapore.MethodsThe data of 399 caregiver-PWD dyads were extracted from a national cross-sectional survey. PWD completed the Client Service Receipt Inventory, which provided information on their healthcare utilization (i.e. emergency service use, hospital admission, length of stay in hospital, and number of outpatient visits) within a frame of 3 months. The Zarit Burden Interview (ZBI), Neuropsychiatric Inventory Questionnaire (NPI-Q), and Self Reporting Questionnaire (SRQ-20) were administered to caregivers. Information on severity of dementia, physical multimorbidity of the PWD, household composition, and caregivers’ sociodemographic characteristics such as age, gender, and education were collected. Variables significantly associated with healthcare utilization in the univariate analyses were selected and included in the final regression models. Emergency service use and hospital admission were investigated using logistic regression analyses, whilst negative binomial models were utilized for length of stay in hospital and number of outpatient visits.ResultsAfter adjusting for significant correlates such as dementia severity and multimorbidity, only caregiver distress from responsive behaviours was positively associated with emergency room utilization, while caregiver burden was positively associated with length of hospital stay in the final regression model. Psychiatric morbidity was associated with healthcare utilization outcomes at the univariate level but did not reach statistical significance in final models.ConclusionThe study identifies caregiver variables associated with the healthcare utilization of PWD. Policy makers and healthcare professionals should provide interventions to ease burden and distress amongst caregivers of PWD.
Highlights
Caregivers of persons with dementia (PWD) face high caregiving burden, distress related to responsive behaviours, and psychiatric morbidity
Caregiver distress related to responsive behaviours Responsive behaviours, or Behavioural and Psychological Symptoms of Dementia (BPSD), were assessed with the Neuropsychiatric Inventory Questionnaire (NPI-Q [27];) that was administered to the caregivers by trained lay interviewers
Emergency service utilization and hospital admission Chi-square and Mann-Whitney-U analyses indicated that only multimorbidity, severity of dementia, psychiatric morbidity of caregiver, and caregiver distress from responsive behaviours were significantly associated with emergency service utilization at the univariate level (Additional file 1: Appendix A)
Summary
Caregivers of persons with dementia (PWD) face high caregiving burden, distress related to responsive behaviours, and psychiatric morbidity. Within Singapore alone, 10% of the older adults aged 60 years and above suffered from dementia based on a nationwide epidemiological survey conducted in 2013 [5]. In 2019, adults aged 60 years and above consisted 21.4% of Singapore’s population [6], and this percentage has been estimated by the United Nations to double to 40.1% by 2050 [7]. This means that in the future, even with prevalence remaining unchanged, the number of people living with dementia will likely increase. Dementia is not just a medical problem, but an economic and societal issue that concerns the individual, family and the state
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