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1.
Z Gerontol Geriatr ; 53(1): 22-28, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31832769

RESUMO

BACKGROUND: Against the background of demographic aging, the need for professional and private care will increase in the future. To contain costs many welfare states rely on the family as care provider and, in addition, people in need of care often prefer being cared for at home. Thus, the number of people who provide care privately and without pay in the home environment (referred to as family care in this article) is likely to increase. So far, however, research on the impact of family care on the labor market situation of caregivers in general and their wages in particular remains scarce. OBJECTIVE: This article examines whether and if so to what extent, family care affects the wages of women and men. MATERIAL AND METHODS: Using data from the German Socio-Economic Panel (2001-2017), fixed effects regressions were estimated separately for women and men, while accounting for important confounders. RESULTS: Both women (2.4%) and men (3%) suffer wage losses as a result of family care activities. CONCLUSION: The results indicate that care-related wage losses, net of relevant controls, exist.


Assuntos
Cuidadores , Emprego , Salários e Benefícios , Cuidadores/economia , Feminino , Humanos , Masculino , Ocupações , Dinâmica Populacional , Fatores Socioeconômicos
2.
BMC Health Serv Res ; 19(1): 763, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660961

RESUMO

BACKGROUND: The aim of this study was to estimate the mean cost per caregiver of informal care during the first year after myocardial infarction event in France. METHODS: We used the Handicap-Santé French survey carried out in 2008 to obtain data about MI survivors and their caregivers. After obtaining the total number of informal care hours provided by caregiver during the first year after MI event, we estimated the value of informal care using the proxy good method and the contingent valuation method. RESULTS: For MI people receiving informal care, an annual mean cost was estimated at €12,404 (SD = 13,012) with the proxy good method and €12,798 (SD = 13,425) with the contingent valuation method per caregiver during the first year after myocardial infarction event. CONCLUSIONS: The present study suggests that informal care should be included more widely in economic evaluations in order not to underestimate the cost of diseases which induce disability.


Assuntos
Cuidadores/economia , Análise Custo-Benefício , Infarto do Miocárdio/terapia , Assistência ao Paciente/economia , Idoso , Cuidadores/estatística & dados numéricos , Pessoas com Deficiência/estatística & dados numéricos , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Sobreviventes/estatística & dados numéricos
3.
Artigo em Alemão | MEDLINE | ID: mdl-31297549

RESUMO

BACKGROUND: Currently, there are 1.7 million people living with dementia (PwD) in Germany. This number is expected to double within the next decades. Estimates of the total societal economic burden of dementia are currently missing. OBJECTIVES: The aim was to estimate the current and future total cost and excess cost of dementia from a public payer and societal perspective. METHODS: Studies demonstrating the healthcare resource utilization of PwD in Germany were identified. Utilization data were aggregated using the sample size of different studies as a weight. Annual per capita costs of PwD and excess cost of dementia were calculated using standardized unit costs. Current and future costs were calculated based on published prevalence and population forecasts. RESULTS: PwD living at home had lower costs from a payer perspective compared to those who are institutionalized, but higher total societal cost due to the higher informal care time. The total cost for PwD from a payer perspective was 34 billion € in 2016. These costs could reach 90 billion € by 2060. The excess cost of dementia was 18 billion € in 2016 and is estimated to become 49 billion € by 2060 from a payer perspective, representing 54% of the total cost of PwD and up to 15% of the total costs associated with the elderly population. The total societal cost was 73 billion € in 2016 and is estimated to become 194 billion € by 2060. The excess cost of dementia was 54 billion € in 2016 and is estimated to become 145 billion € by 2060, representing 74% of the total societal cost of PwD and 36% of the total societal cost of the elderly. CONCLUSION: Dementia diseases represent a tremendous social and economic burden. Without a cure, supporting caregivers and implementing interventions that delay the functional and cognitive decline will be crucial to relieving the increasing costs.


Assuntos
Cuidadores/economia , Efeitos Psicossociais da Doença , Demência/economia , Demência/psicologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Cuidadores/estatística & dados numéricos , Alemanha , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Alocação de Recursos
4.
Int J Soc Psychiatry ; 65(7-8): 548-557, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31359844

RESUMO

BACKGROUND: Improving patients' perception of social support is significant not only for their re-adaptation to life but also for alleviating caregivers' burden. AIM: This study aims to examine an integrated model regarding social support, psychotic symptoms and caregiver burden. METHODS: Persons with schizophrenia (N1 = 300) and their family caregivers (N2 = 300) in Xinjin County, Chengdu, China, completed the survey to report their demographics, patients' perception of social support (Duke Social Support Index), psychotic symptoms (Positive and Negative Syndrome Scale) and caregiver burden (Burden Scale for Family Caregivers, Short Version). Structural equation modelling was utilised to test the proposed model. RESULTS: The degree of caregiver burden differed significantly within subgroups of patients' gender and education, as well as caregivers' gender, education and employment. Caregiver burden was negatively related to patients' age and household income. Social interaction partially mediated the relationship between instrumental and subjective social support (total effect = 0.451, p < .01). Subjective social support fully mediated the impact of social interaction on psychotic symptoms (total effect = -0.099, p < .05). In the final model, instrumental social support was positively associated with social interaction (p < .001) and increased subjective social support (p < .05). Increased subjective social support showed correlation with a lower degree of psychotic symptoms (p < .01), which was related to a lower level of caregiver burden (p < .001). CONCLUSION: This study shows the associations of patients' social support with psychotic symptoms and caregiver burden. Culture-specific psychosocial interventions should be provided for both patients and caregivers to enrich external support and reduce psychotic symptoms and caregivers' burden within the health care environment.


Assuntos
Cuidadores/psicologia , Esquizofrenia/terapia , Apoio Social , Adulto , Idoso , Cuidadores/economia , China , Efeitos Psicossociais da Doença , Feminino , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Análise de Regressão , Esquizofrenia/economia , Inquéritos e Questionários
5.
PLoS One ; 14(5): e0217016, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31112587

RESUMO

OBJECTIVE: The main aims of this paper are to analyse the monetary value of informal care time using different techniques and to identify significant variables associated with the number of caregiving hours. DATA AND METHODS: A multicentre study in two Spanish regions in adult caregivers was conducted. A total sample of 604 people was available. A multivariate analysis was performed to identify the variables associated with the number of hours of caregiving time. In the monetary valuation of informal care provided, three approaches were used: replacement cost method, opportunity cost and contingent valuation (willingness to pay and willingness to accept). RESULTS: The main determinants of the amount of time of informal care provided were age, gender, the level of care receiver´s dependence and the professional care services received (at home and out of home). The value estimated for informal care time ranges from EUROS 80,247 (replacement cost method) to EUROS 14,325 (willingness to pay), with intermediate values of EUROS 27,140 and EUROS 29,343 (opportunity cost and willingness to accept, respectively). Several sensitivity analyses were performed over the base cases, confirming the previous results. CONCLUSIONS: Time of informal care represents a great social value, regardless of the applied technique. However, the results can differ strongly depending on the technique chosen. Therefore, the choice of technique of valuation is not neutral. Among the determinants of informal care time, the professional care received at home has a complementary character to informal care, while the formal care outside the home has a substitute character.


Assuntos
Cuidadores/economia , Efeitos Psicossociais da Doença , Assistência Domiciliar/economia , Assistência ao Paciente/economia , Tempo , Idoso , Estudos Transversais , Epidemiologia , Feminino , Custos de Cuidados de Saúde , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Classe Social , Espanha/epidemiologia , Inquéritos e Questionários
6.
BMC Public Health ; 19(1): 598, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31101035

RESUMO

BACKGROUND: There is a growing interest in the costs of informal care; however, the results of previous studies mostly rely on self-reported data, which is subject to numerous biases. The aim of this study is to contribute to the topic by estimating the indirect costs of short-term absenteeism associated with informal caregiving in Poland with the use of social insurance data on care absence incidence. METHODS: The human capital method was used to estimate the indirect costs of caregiving from a societal perspective. The incidence of caregiving was identified based on the Social Insurance Institution's data on absence days attributable to care provided to children and other family members. Gross domestic product (GDP) per worker was used as a proxy of labour productivity. Deterministic one-way sensitivity analysis was performed. RESULTS: The indirect costs of short-term caregivers' absenteeism in Poland was €306.2 million (0.116% of GDP) in 2006 and increased to €824.0 million in 2016 (0.180% of GDP). The number of care absence days grew from 5.9 million (0.45 days per worker) in 2006 to 10.6 million (0.70 days per worker) in 2016. Approximately 85% of the total costs were attributable to child care. The results of the sensitivity analysis show that the indirect costs varied from the base scenario by - 30.8 to + 15.8%. CONCLUSION: Informal short-term caregiving leads to substantial productivity losses in the Polish economy, and the dynamic upward trend of care absence incidence suggests that the costs of caregiving are expected to rise in the future.


Assuntos
Absenteísmo , Cuidadores/economia , Cuidado da Criança/economia , Efeitos Psicossociais da Doença , Gastos em Saúde/estatística & dados numéricos , Adulto , Criança , Eficiência , Feminino , Produto Interno Bruto , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Polônia/epidemiologia , Previdência Social/economia , Fatores de Tempo
7.
Pediatr Rheumatol Online J ; 17(1): 20, 2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31060557

RESUMO

BACKGROUND: This study aims to describe current practice in identifying and measuring health care resource use and unit costs in economic evaluations or costing studies of juvenile idiopathic arthritis (JIA). METHODS: A scoping review was conducted (in July 2018) in PubMed and Embase to identify economic evaluations, costing studies, or resource utilization studies focusing on patients with JIA. Only English language peer-reviewed articles reporting primary research were included. Data from all included full-text articles were extracted and analysed to identify the reported health care resource use items. In addition, the data sources used to obtain these resource use and unit costs were identified for all included articles. RESULTS: Of 1176 unique citations identified by the search, 20 full-text articles were included. These involved 4 full economic evaluations, 5 cost-outcome descriptions, 8 cost descriptions, and 3 articles reporting only resource use. The most commonly reported health care resource use items involved medication (80%), outpatient and inpatient hospital visits (80%), laboratory tests (70%), medical professional visits (70%) and other medical visits (65%). Productivity losses of caregivers were much more often incorporated than (future) productivity losses of patients (i.e. 55% vs. 15%). Family borne costs were not commonly captured (ranging from 15% for school costs to 50% for transportation costs). Resource use was mostly obtained from family self-reported questionnaires. Estimates of unit costs were mostly based on reimbursement claims, administrative data, or literature. CONCLUSIONS: Despite some consistency in commonly included health care resource use items, variability remains in including productivity losses, missed school days and family borne costs. As these items likely substantially influence the full cost impact of JIA, the heterogeneity found between the items reported in the included studies limits the comparability of the results. Therefore, standardization of resource use items and unit costs to be collected is required. This standardization will provide guidance to future research and thereby improve the quality and comparability of economic evaluations or costing studies in JIA and potentially other childhood diseases. This would allow better understanding of the burden of JIA, and to estimate how it varies across health care systems.


Assuntos
Artrite Juvenil/terapia , Recursos em Saúde/estatística & dados numéricos , Assistência Ambulatorial/economia , Assistência Ambulatorial/estatística & dados numéricos , Artrite Juvenil/economia , Cuidadores/economia , Cuidadores/estatística & dados numéricos , Criança , Técnicas de Laboratório Clínico/economia , Técnicas de Laboratório Clínico/estatística & dados numéricos , Eficiência , Utilização de Instalações e Serviços , Custos de Cuidados de Saúde/estatística & dados numéricos , Recursos em Saúde/economia , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos
8.
Int J Geriatr Psychiatry ; 34(7): 1095-1103, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30950106

RESUMO

OBJECTIVES: This study measures the average per person and annual total costs of dementia in England in 2015. METHODS/DESIGN: Up-to-date data for England were drawn from multiple sources to identify prevalence of dementia by severity, patterns of health and social care service utilisation and their unit costs, levels of unpaid care and its economic impacts, and other costs of dementia. These data were used in a refined macrosimulation model to estimate annual per-person and aggregate costs of dementia. RESULTS: There are around 690 000 people with dementia in England, of whom 565 000 receive unpaid care or community care or live in a care home. Total annual cost of dementia in England is estimated to be £24.2 billion in 2015, of which 42% (£10.1 billion) is attributable to unpaid care. Social care costs (£10.2 billion) are three times larger than health care costs (£3.8 billion). £6.2 billion of the total social care costs are met by users themselves and their families, with £4.0 billion (39.4%) funded by government. Total annual costs of mild, moderate, and severe dementia are £3.2 billion, £6.9 billion, and £14.1 billion, respectively. Average costs of mild, moderate, and severe dementia are £24 400, £27 450, and £46 050, respectively, per person per year. CONCLUSIONS: Dementia has huge economic impacts on people living with the illness, their carers, and society as a whole. Better support for people with dementia and their carers, as well as fair and efficient financing of social care services, are essential to address the current and future challenges of dementia.


Assuntos
Demência/economia , Custos de Cuidados de Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Cuidadores/economia , Efeitos Psicossociais da Doença , Demência/epidemiologia , Inglaterra , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência
9.
Soc Psychiatry Psychiatr Epidemiol ; 54(11): 1353-1362, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30929041

RESUMO

PURPOSE: To examine the cost of psychotic disorders in Bulgaria prior to hospital admission and following discharge from two perspectives: healthcare and societal; and to evaluate the association between the costs and the patient's characteristics. METHODS: 96 individuals with psychosis experiencing psychotic exacerbation and their primary caregivers were evaluated upon the patients' hospital admission. The participants were followed up after 12 months. The costs were evaluated from healthcare and societal perspective using the Client's Sociodemographic and Service Receipt Inventory (CSSRI-EU). The psychopathology, functioning, quality of life and caregiver's burden were measured using standardized instruments. The mean differences in the costs and the associations with the clinical and socio-demographic characteristics of the patients were evaluated. RESULTS: The healthcare costs increase from EUR 120.66 (SD = 163.85) at baseline to EUR 177.54 (SD = 136.98) at follow-up. The total cost from societal perspective are up to sixfold higher than the healthcare costs at both assessments [EUR 717.41 (SD = 402.33) and 880.40 (SD = 1592.00), respectively] and do not change significantly. A major shift in the subtypes of costs, and significant associations of the costs with the socio-demographic and clinical characteristics, were found. CONCLUSIONS: Psychotic disorders and psychotic exacerbations have high societal costs. The underfunding of mental healthcare in Bulgaria is at the expense of high caregivers' and societal cost. The treatment of psychotic exacerbation is effective and investment in mental healthcare for the improvement of the psychopathology, social functioning, quality of life and the burden of informal care should be viewed as a sustainable investment.


Assuntos
Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Assistência ao Paciente/economia , Transtornos Psicóticos/economia , Adulto , Bulgária , Cuidadores/economia , Feminino , Humanos , Masculino , Qualidade de Vida
10.
J Autism Dev Disord ; 49(7): 2873-2900, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30976961

RESUMO

Autism is associated with a range of costs. This paper reviews the literature on estimating the economic costs of autism spectrum disorder (ASD). More or less 50 papers covering multiple countries (US, UK, Australia, Canada, Sweden, the Netherlands, etc.) were analysed. Six types of costs are discussed in depth: (i) medical and healthcare service costs, (ii) therapeutic costs, (iii) (special) education costs, (iv) costs of production loss for adults with ASD, (v) costs of informal care and lost productivity for family/caregivers, and (vi) costs of accommodation, respite care, and out-of-pocket expenses. A general finding is that individuals with ASD and families with children with ASD have higher costs. Education costs appear to be a major cost component for parents with children with ASD.


Assuntos
Transtorno do Espectro Autista/economia , Educação Especial/economia , Adulto , Austrália , Transtorno Autístico/economia , Canadá , Cuidadores/economia , Criança , Feminino , Gastos em Saúde , Humanos , Masculino , Países Baixos , Pais , Cuidados Intermitentes/economia , Suécia
12.
BMC Health Serv Res ; 19(1): 201, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-30922307

RESUMO

BACKGROUND: Outcomes-based policy and administration of public services present a compelling argument for the value of outcomes data. However, there are a number of challenges inherent in collecting these data from people who are unable to complete a paper-based survey or interview due to cognitive or communication impairments. In this paper, we explore the views of being a proxy from the perspective of unpaid carers and paid carers who may be asked to act as a proxy on behalf of the person(s) they care for. We consider the key issues that need to be addressed when adapting an instrument designed to measure social care outcomes, the Adult Social Care Outcomes Tool (ASCOT), into a proxy-report tool. METHODS: Participants took part in either a focus group (35 paid carers in eight focus groups), or a one-to-one interview (eight unpaid carers). All participants were recruited via carer organisations and care providers. Transcripts, field notes and audio data collected during focus groups and interviews were analysed using a thematic framework approach. RESULTS: Participants agreed that any person acting as a proxy would need to be very familiar with the care recipient, as well as their needs and care provision. A number of provisions for proxy respondents were proposed to improve face validity and acceptability of completing a questionnaire by proxy, and to ensure that any potential bias is reduced in the design of the questionnaire. These included: providing two sets of response options for each proxy perspective (the proxy themselves and the proxy view of how they think the care recipient would respond); a comments box to help people explain why they have selected a given response option (especially where these indicate unmet need); and providing clear guidance for the proxy respondent on how they should complete the questionnaire. CONCLUSIONS: This study has shown some of the challenges involved in assessing outcomes by proxy and explored some potential ways these can be mitigated. The findings highlight the benefits of developing and testing proxy measures in a robust way to widen participation in social care research.


Assuntos
Cuidadores/psicologia , Procurador/psicologia , Adulto , Idoso , Cuidadores/economia , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Procurador/estatística & dados numéricos , Pesquisa Qualitativa , Apoio Social
13.
Nurs Forum ; 54(2): 280-290, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30737798

RESUMO

The inclusion of caregivers in a holistic care approach represents a basic principle in palliative care. However, many palliative care professionals have a lack of understanding of difficulties or unmet needs among caregivers. To enhance the quality of life of caregivers and the quality of care for patients, healthcare professionals should be better informed about the constructs of caregiver burden. The aim of this study is to synthesize the concept of caregiver burden in palliative care, providing implications for the caregivers and their support systems. This concept analysis study adopts the integrative review approach and the basic text analysis method (ie, word frequency). The PubMed, CINAHL, Embase, and PsycINFO databases are explored for eligible studies. From this literature search, 66 articles from 1998 to 2018 are located. After data collection is completed, the two authors independently evaluate the quality of studies published before 1 September 2018. The caregiver burden is then redefined with its attributes, antecedents, consequences, empirical referents, and facilitators. It is recommended that the multidimensional concept of caregiver burden in palliative care be measured by considering caregiver characteristics and the caregiving context.


Assuntos
Cuidadores/psicologia , Cuidados Paliativos/métodos , Qualidade de Vida , Adaptação Psicológica , Idoso , Idoso de 80 Anos ou mais , Cuidadores/economia , Formação de Conceito , Mineração de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/economia , Cuidados Paliativos/psicologia
14.
BMC Geriatr ; 19(1): 50, 2019 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-30782127

RESUMO

BACKGROUND: Physical activity is linked to benefits such as increased physical fitness, cognition, emotional and social functioning, general health and well-being in older people. Some evidence suggests that this also applies to people living with dementia. However, it can be harder for them to perform physical activities, due to several barriers, such as issues with orientation and balance problems. A relatively new type of physical activity called exergaming may help them overcome these barriers. Exergaming is "physical exercise interactively combined with cognitive stimulation in a gaming environment". The aim of our study is to evaluate the effectiveness and cost-effectiveness of exergaming compared to regular activities in people living with dementia, who attend day-care centres. Additionally, we want to investigate whether the exergaming activity for the person living with dementia, also (indirectly) affects the informal caregiver, as well as which facilitators and barriers to implementation of exergames for this target group exist. METHODS: A cluster Randomized Controlled Trial (RCT), with economic and process evaluations alongside will be carried out. In the Netherlands, 24 day-care centres are randomized in the experimental or control group. The study group will consist of 224 dyads (community-dwelling participants with dementia and their informal caregivers), who are interviewed at baseline, and at 3 and 6 months of follow-up. The participant with dementia has to visit the day-care centre for at least two days per week, have a diagnosis of mild to moderate dementia and have an informal caregiver present, who is willing to participate. Societal cost data will be collected during interviews, using healthcare utilization diaries, and from day-care centres. The process evaluation will only involve the experimental group, and will include an online survey, qualitative interviews and focus groups. DISCUSSION: This study will contribute to the evidence base that more effective exercise among people with dementia will result in positive effects on their wellbeing and quality of life. This will motivate people with dementia to be physically active. We also envision that there might be a positive effect on the burden of care experienced by their informal caregivers. TRIAL REGISTRATION: This trial was registered at the Netherlands Trial Register (NTR) on December 10, 2015 (number: NTR5537 ), this publication is based on protocol amendment number 01, issue date 28 December 2018. This includes all items from the World Health Organization Trial Registration Data Set [see Additional file 1].


Assuntos
Cuidadores/economia , Análise Custo-Benefício/métodos , Demência/economia , Demência/terapia , Exercício/fisiologia , Jogos de Vídeo/economia , Idoso , Idoso de 80 Anos ou mais , Cuidadores/psicologia , Demência/psicologia , Exercício/psicologia , Feminino , Humanos , Vida Independente/economia , Vida Independente/psicologia , Masculino , Países Baixos/epidemiologia , Qualidade de Vida/psicologia , Inquéritos e Questionários , Jogos de Vídeo/psicologia
15.
Psychooncology ; 28(3): 525-532, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30600865

RESUMO

OBJECTIVE: Carers of people with cancer provide uncompensated care that is often physically, emotionally, and financially demanding, which results in neglect of their own health. This study's objective was to conduct an economic evaluation following a randomised control trial (RCT) involving a proactive telephone outcall intervention aimed at improving health outcomes among carers of cancer patients. METHODS: The trial was a single-blind, multicentre, RCT conducted across four Australian health services, comprising three outcalls from trained Cancer Council 131120 (Cancer Council telephone and information support services) nurses compared with three phone call reminders of the availability of 131120 services (control group). Outcalls consisted of telephone contacts to the caregivers initiated by the Cancer Council nurses. The primary trial outcome was reduced carer burden. Health care resource use was measured using a resource use questionnaire (RUQ), and costs were presented in 2013 $(AUS). Quality-adjusted-life-years (QALYs) were also used as health outcomes. An incremental cost-effectiveness ratio (ICER) was calculated, with bootstrapping used to quantify sampling variability. A $50 000 per QALY-gained willingness-to-pay threshold was used. Sensitivity analyses were conducted. RESULTS: Results showed that the total mean QALYs-gained were higher (0.02 QALYs, P = 0.01) in the control group, and total mean costs were lower in the control group ($477, P < 0.001) over the trial duration. The intervention group was dominated by the control group. Results were robust to sensitivity analyses. CONCLUSIONS: Results suggest policy makers should not adopt this intervention into routine health care in its current form. Further research into the efficacy and cost-effectiveness of telephone-based interventions for carers is required.


Assuntos
Cuidadores/economia , Promoção da Saúde/economia , Anos de Vida Ajustados por Qualidade de Vida , Consulta Remota/economia , Adaptação Psicológica , Adulto , Austrália , Cuidadores/psicologia , Análise Custo-Benefício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias , Qualidade de Vida/psicologia , Método Simples-Cego , Inquéritos e Questionários , Telefone
16.
Int Psychogeriatr ; 31(3): 341-349, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30099971

RESUMO

ABSTRACTObjective:With the aging of the population, the demand for long-term services is increasing accordingly and the recruitment of paid caregivers to older adults has become a critical issue. Hence, there is a great need to train people in the care of older adults. This study examined motivations to participate in a new program, which aims to train young people (ages 19-25) to become paid caregivers for older adults. METHODS: The study is based on focus groups with program participants (N = 33) and on phone interviews with former participants (N = 8) and face-to-face interviews with staff members (N = 14). Transcripts were analyzed using qualitative content analysis. RESULTS: Three major themes emerged: (1) "Motivations to participate in the program," referred to participants' motivations to work with older adults. (2) "Reduced motivations due to ambiguity of roles," referred to the unclear definition of the care worker's role, which created a decrease in participants' motivations to provide care. (3) "Inadequate financial compensation," concerned participants' reduced motivation to participate in the program as a result of financial promises that were not realized. CONCLUSIONS: Findings suggest that it is important to be cautious about the motivations for participation in the program because by emphasizing the difficult situation of older adults, one stresses the low status assigned to older adults, rather than positive attributes. It is also suggested that care workers should be financially rewarded, so that despite the difficulties that may arise during work, they will feel valued and will want to remain in the profession.


Assuntos
Cuidadores/economia , Cuidadores/educação , Motivação , Adulto , Idoso , Feminino , Pessoal de Saúde , Serviços de Saúde para Idosos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Confiança , Adulto Jovem
17.
Pharmacoeconomics ; 37(1): 93-103, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30151734

RESUMO

BACKGROUND: Families and friends provide a considerable proportion of care for patients and elderly people. Caregiving can have substantial effects on caregivers' lives, health, and well-being. However, because clinical trials rarely assess these effects, no information on caregiver burden is available when evaluating the cost effectiveness of treatments. OBJECTIVE: This study develops an algorithm for estimating caregiver time using information that is typically available in clinical trials: the EQ-5D scores of patients and their gender. METHODS: Four datasets with a total of 8012 observations of dyads of caregivers and a gamma model with a log-link estimated with the Bayesian approach were used to estimate the statistical association between patient scores on the EQ-5D-3L dimensions and the numbers of hours of care provided by caregivers during the previous week. The model predicts hours of care as mean point estimates with 95% credible intervals or entire distributions. RESULTS: Model predictions of hours of care based on the five EQ-5D dimensions ranged from 13.06 (12.7-14.5) h/week for female patients reporting no health problems but receiving informal care to 52.82 (39.38-66.26) for male patients with the highest level of problems on all EQ-5D dimensions. CONCLUSIONS: The iCARE algorithm developed in this study allows researchers who only have patient-level EQ-5D data to estimate the mean hours of informal care received per week, including a 95% Bayesian credible interval. Caregiver time can be multiplied with a monetary value for caregiving, enabling the inclusion of informal care costs in economic evaluations. We recommend using the tool for samples that fall within the confidence intervals of the characteristics of our samples: men (age range 47.0-104.2 years), women (age range 55-103 years).


Assuntos
Cuidadores/economia , Modelos Econométricos , Assistência ao Paciente/economia , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Humanos , Países Baixos , Qualidade de Vida , Mecanismo de Reembolso , Inquéritos e Questionários
18.
Int J Qual Health Care ; 31(3): 231-237, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30272131

RESUMO

OBJECTIVE: To analyze the chronological change in social burden of dementia in Japan for policy implications of appropriate resource allocation and quality improvement. DESIGN: National, population-based, observational study from 2002 to 2014. SETTING: Seven nationwide data sets from Japanese official statistics. METHOD: Comprehensive Cost of Illness method. MAIN OUTCOME MEASURES: The outcome variables included healthcare services, nursing care services, informal care (unpaid care offered by family and relatives), mortality cost and morbidity cost. RESULTS: The number of patients with dementia increased 2.50 times from 0.42 million in 2002 to 1.05 million in 2014. While the number of patients living in homes and communities increased by 3.22 times that of patients living in nursing care facilities increased by 1.42 times. The total social burden increased 2.06-2.27 times from JPY 1.84-2.42 to 3.79-5.51 trillion (JPY 1 trillion = US$ 100 billion). Regarding the total burden, the proportion of informal care provided increased from 36.6-51.9% to 37.7-57.2%. Furthermore, the proportion of primary caretakers aged ≥70 years increased from 27.6% to 37.6%. CONCLUSIONS: Owing to the promotion of 'Deinstitutionalization' (shift of nursing care site from in-facilities to in-home and in-community), 'Elderly care by the elderly,' and 'Earlier diagnosis of dementia,' the average cost per patient reduced by 0.82-0.91 times from JPY 4.37-5.77 to 3.60-5.24 million. Therefore, the management of informal care in a manner that does not exceed the acceptable limit of the patients' caretakers, while maintaining patient safety and quality of care, is imperative.


Assuntos
Cuidadores/economia , Efeitos Psicossociais da Doença , Demência/economia , Custos de Cuidados de Saúde/tendências , Idoso , Demência/epidemiologia , Demência/mortalidade , Demência/terapia , Feminino , Hospitalização/economia , Humanos , Japão , Masculino , Fatores de Tempo
19.
Dementia (London) ; 18(1): 210-227, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27554789

RESUMO

Effective home support in dementia is key in delaying nursing home admission. However, home support is frequently not tailored to the individual needs of people with dementia. Staff allocating home support services may not identify important care needs, which only be recognised by informal carers. The purpose of this study was to explore the balance of informal and formal home support and their associated costs from the perspectives of both informal carers and paid staff. Five case vignettes of people with dementia were designed based on an existing English data set from a European study into transition into long-term care (the RightTimePlaceCare programme), representing 42 per cent of the English sample. In total, 14 informal carers and 14 paid staff were consulted in separate groups, as expert panels, regarding their recommendations for home care services for each vignette. Care recommendations of carers and staff were costed based on nationally available unit costs and compared. Informal carers allocated fewer hours of care than staff. Personal and domestic home care and day care centres were the most frequently recommended formal services by both groups, and some vignettes of people with dementia were recommended for care home admission. The ratio of costs of informal versus formal support was relatively equal for paid staff, yet unbalanced from the perspectives of informal carers with a greater proportion of formal care costs. Recommendations from this study can help shape dementia care to be more tailored to the individual needs of people with dementia and their carers.


Assuntos
Demência/economia , Serviços de Assistência Domiciliar/economia , Assistência ao Paciente/economia , Atitude do Pessoal de Saúde , Cuidadores/economia , Feminino , Humanos , Masculino
20.
J Am Geriatr Soc ; 67(2): 277-283, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30452088

RESUMO

OBJECTIVES: To examine factors associated with caregiver burden from a multifactorial perspective by examining caregiver and care recipient characteristics and a full range of caregiving tasks. DESIGN: Nationally representative surveys of community-dwelling older adults and their family caregivers residing in the United States. SETTING: 2011 National Health and Aging Trends Study and National Study of Caregiving. PARTICIPANTS: Community-dwelling older adults and their family caregivers. MEASUREMENTS: Caregiver burden, comprising emotional, physical, and financial difficulties associated with caregiving. RESULTS: An estimated 14.9 million caregivers assisted 7.6 million care recipients. More than half of caregivers reported burden related to caregiving. In a multivariable regression model, caregivers who assisted with more activities of daily living and instrumental activities of daily living, health management tasks, and health system logistics were more likely to experience burden, as were female caregivers, adult child caregivers, caregivers in poor health, caregivers with anxiety symptoms, and those using respite care. Dementia was the only care recipient characteristic associated with burden. CONCLUSION: Caregiver characteristics and provision of caregiving tasks determine caregiver burden more than care recipient characteristics. Absence of an association between type of a care recipient's chronic conditions and burden, except for dementia, suggests that the tasks that caregivers who assist older adults with a variety of health conditions undertake shape the experience of caregiving. J Am Geriatr Soc 67:277-283, 2019.


Assuntos
Cuidadores/psicologia , Doença Crônica/psicologia , Efeitos Psicossociais da Doença , Atividades Cotidianas/psicologia , Crianças Adultas/psicologia , Idoso , Idoso de 80 Anos ou mais , Cuidadores/economia , Compensação e Reparação , Demência/psicologia , Feminino , Humanos , Vida Independente , Masculino , Análise de Regressão , Estados Unidos
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