The main objective of the study was to assess the cost of informal care in elderly with cognitive impairment (CI) and living in rural community.

Data & Methods

Retrospective, cross-sectional observational study with people over 64 year old and residing in the community. Resident Assessment Instrument Home Care (RAI-HC) was used to collect sociodemographic variables, informal caregiver characteristics, disease diagnostics, auditory and visual acuity, use of formal service (nurse, meal service, house work service, etc), walking aids used (cane, walker, or crutches), cognitive performance scale (CPS), and weekly hours of informal care (WHIC).

The CI was assessing, as in other studies, with at lest 3 points in CPS. WHIC was estimated using the items of the RAI-NH questionnaire that asked about how many hours of informal care were needed in the last week during daily days, weekend days and by principal caregiver and secondary caregiver. The neperian logarithm (nl) of the sum of all these items in which we limit daily hours of informal care to sixteen (because eight sleep hours) were depend variables in the analysis. Dummy variables being created with all susceptible variables.

Bivariate analysis was done. The variables potential associate with WHIC were introduced as control variables in OLS regresion models in which (nl) WHIC was dependent variable and CI dummy variable was the independent variable. Beta coefficient of CI in the OLS final regression model was retransformed through Manning WG et all methods in adjusted weekly hour of informal care and multiply by the cost of one hour of formal care in the Spanish market. In the same way the cost of informal care in elderly without cognitive impairment was calculate. Finally, we rest to elderly with CI to obtain the adjusted cost of CI.

Results

The study enrolled 242 people (mean age: 81.09+/-7.08 years). The prevalence of CI was 39.3%. The sociodemographic and clinical characteristics variables of the participants with and without CI was fairly similar with the exception of auditory and visual acuity (72.1% in CI for auditory acuity and 70.8% in CI for visual acuity), osteoporosis diagnostic (23.6% in CI) and emphysema/asthma/COD (18.8% in CI).

The OLS regression model accounts for 30.5% of the variance in (nl) weekly hours of informal care. Control variables in final OLS regression model were: problems with auditory acuity (standarized beta=0.19  ;p<0.001), used  walker (standarized beta=0.22  ;p<0.001), used crutches (standarized beta=0.29  ;p<0.001), have formal nurses service (standarized beta=0.19  ;p<0.001) and house work service (standarized beta= -0.14 ;p=0.01).

Standarized beta coefficient of CI was 0.29 (p<0.001). The mean of the weekly cost of informal care due to CI was 76.1 €/week (CI 55.7-102.9) if we use the maximum wage paid by specialized enterprize in Spain and 38.0 €/week (CI 27.8-51.4) if we use the minimun price paid to individual (persona particular) in Spain.

In conclusion, the care of elderly with CI is a big problem that families and governments could not be assumed only by one part.