A national study of the quantity and cost of informal caregiving for the elderly with stroke

56 Background: As the US population ages, increased stroke incidence will result in higher stroke-associated costs. While estimates of direct costs exist, little information is available regarding informal caregiving costs for stroke patients. Objective: To determine a nationally representative estimate of the quantity and cost of informal caregiving for elderly stroke patients. Methods: We used data from the first wave (1993) of the Asset and Health Dynamics (AHEAD) Study, a longitudinal study of people over 70 living in the community, to determine average weekly hours of informal caregiving. Multivariate and logistic regression analyses were performed to examine association of stroke and other covariates and assess the probability of receiving informal care. Average annual cost for informal caregiving was calculated. Results: Of the 7443 respondents, 656 (6%) reported a history of stroke. Of those, 375 (57%) reported stroke-related health problems (SRHP). After adjusting for cormorbid conditions, social support and sociodemographics, the proportion of patients receiving informal care increased with stroke severity, and there was a significant association of weekly hours of caregiving with stroke category (p<0.01). Using the mean 1998 wage for a home health aide ($8.20/hr.) as the value for family caregiver time, the expected yearly caregiving cost per stroke ranged from $3500 to $7600, which would result in an annual cost of more than $5.7 billion for stroke-related informal caregiving in the US. Conclusions: The economic burden of informal caregiving following stroke has not been studied previously. Informal caregiving occurs frequently; associated costs are substantial and should be considered when estimating the cost of stroke treatment.

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An Environmental Justice Analysis of British Air Quality

Environment and Planning A Economy and Space ◽

10.1068/a35240 ◽

2003 ◽

Vol 35 (5) ◽

pp. 909-929 ◽

Cited By ~ 138

Author(s):

Gordon Mitchell ◽

Danny Dorling

Keyword(s):

Air Pollution ◽

Air Quality ◽

Environmental Justice ◽

The Elderly ◽

Local Communities ◽

Car Ownership ◽

National Study ◽

Environmental Injustice ◽

The Usa ◽

History Of

This paper presents the results of the first national study of air quality in Britain to consider the implications of its distribution across over ten thousand local communities in terms of potential environmental injustice. We consider the recent history of the environmental justice debate in Britain, Europe, and the USA and, in the light of this, estimate how one aspect of air pollution, nitrogen dioxide (NO2) levels, affects different population groups differentially across Britain. We also estimate the extent to which people living in each community in Britain contribute towards this pollution, with the aid of information on the characteristics of the vehicles they own. We find that, although community NO x emission and ambient NO2 concentration are strongly related, the communities that have access to fewest cars tend to suffer from the highest levels of air pollution, whereas those in which car ownership is greatest enjoy the cleanest air. Pollution is most concentrated in areas where young children and their parents are more likely to live and least concentrated in areas to which the elderly tend to migrate. Those communities that are most polluted and which also emit the least pollution tend to be amongst the poorest in Britain. There is therefore evidence of environmental injustice in the distribution and production of poor air quality in Britain. However, the spatial distribution of those who produce and receive most of that pollution have to be considered simultaneously to see this injustice clearly.

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The Effect of Free Personal Care for the Elderly on Informal Caregiving

SSRN Electronic Journal ◽

10.2139/ssrn.2631566 ◽

2013 ◽

Cited By ~ 1

Author(s):

Sarah Karlsberg Schaffer

Keyword(s):

The Elderly ◽

Informal Caregiving ◽

Personal Care ◽

Care For The Elderly

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The relationship between elderly suicide rates, population density and room density

International Psychogeriatrics ◽

10.1017/s1041610209990172 ◽

2009 ◽

Vol 21 (6) ◽

pp. 1197-1198 ◽

Cited By ~ 4

Author(s):

Ajit Shah ◽

Tanuja Sinha ◽

Rajeswari Makena

Keyword(s):

Urban Areas ◽

Elderly Person ◽

The Elderly ◽

Household Size ◽

National Study ◽

Geographical Proximity ◽

Suicide Rates ◽

Elderly Suicide ◽

Extended Households ◽

Suicidal Plans

A recent cross-national study reported that elderly suicide rates in both sexes were significantly negatively correlated with household size and the percentage of extended households and positively correlated with the percentage of single-person households (Shah, 2009). Speculative explanations for these findings were based on cultural factors, including (i) a mismatch between the traditional dependence of elderly relatives on their children for emotional and financial support and their children's ability to provide this support (Yip et al., 1998, 2000; Liu et al., 2006); (ii) the unmet traditional expectation of the elderly person being able to live with their children or grandchildren (Yip et al., 2000; Liu et al., 2006); (iii) the effect on the elderly of their children's negative attitudes (Yip et al., 2000); (iv) the migration of children to urban areas or to other countries (Yip and Tan, 1998; Yip et al., 2000); and, (v) the number of available caregivers, household size and family size (Kua et al., 2003). Countries with larger household sizes and a greater number of extended households potentially have a greater number of people available within the household and within close geographical proximity who can contribute positively to these cultural issues, and this may ultimately lead to a reduction in elderly suicide rates – the “emotional proximity” explanation. However, there may also be other explanations for these findings (Shah, 2009). Having more people in a household implies that there are more people to identify suicidal ideation and support the suicidal individual in seeking approprate help. Also, in larger households elderly people are likely to be alone for shorter periods of time, which would reduce the opportunity to implement any suicidal plans. Both these possibilities form part of the “geographical proximity” explanation.

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Elderly suicide rates: the importance of a non-linear relationship with distal risk and protective factors

International Psychogeriatrics ◽

10.1017/s1041610212000750 ◽

2012 ◽

Vol 24 (9) ◽

pp. 1363-1367 ◽

Cited By ~ 3

Author(s):

Ajit Shah ◽

Ravi Bhat ◽

Sofia Zarate-Escudero

Keyword(s):

Public Health ◽

Protective Factors ◽

Population Level ◽

The Elderly ◽

Risk And Protective Factors ◽

Developed Countries ◽

Health Concern ◽

National Study ◽

Detailed Knowledge ◽

Suicide Rates

The elderly population size is increasing worldwide due to prolonged life expectancy and falling birth rates. Traditionally, suicide rates increase with age. For example, a recent cross-national study of 62 developing and developed countries reported an increase in suicide rates with aging in males and females in 25 and 27 countries respectively (Shah, 2007a). Thus, suicides in the elderly are an important public health concern. While much is known about proximal (individual level) risk and protective factors for elderly suicides (e.g. Conwell et al., 1991; Cattell and Jolley, 1995; Harwood et al., 2001), less is known about more distal (societal or population level) risk and protective factors (Rehkopf and Buka, 2006). Moreover, detailed knowledge of these distal factors may have greater public health relevance for the development of comprehensive prevention strategies (Knox et al., 2004).

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IDENTIFYING UNMET NEED IN INFORMAL CAREGIVING: DISPARITIES BY GENDER, EMPLOYMENT STATUS, AND RACE-ETHNICITY

Innovation in Aging ◽

10.1093/geroni/igz038.803 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S219-S220

Author(s):

Steven A Cohen ◽

Furong Xu ◽

Marissa R Meucci ◽

Symone Woodham ◽

Mary L Greaney

Keyword(s):

Older Adults ◽

Employment Status ◽

Informal Caregivers ◽

Unmet Need ◽

Informal Caregiving ◽

Care Recipient ◽

National Study ◽

Caregiver Health ◽

White Caregivers ◽

Race Ethnicity

Abstract Older adults, including those with dementia and other types of cognitive decline, often report a desire to remain in their homes. Over 50 million informal caregivers in the US provide needed in-home assistance to those in need, and there are well-documented disparities in informal caregiving responsibilities by sociodemographic factors , yet little is known about “unmet need” in informal caregiving. Therefore, the study’s objective is to examine discrepancies in unmet caregiving-related need by race/ethnicity, gender, and employment status. We abstracted data about caregivers from the 2017 National Study of Caregiving and linked these data to participants in the National Health and Aging Trends Study on caregivers of older adults (n=993). Generalized linear models were used to model the discrepancies between the number of activities of daily living for which the care recipient required assistance and the number of tasks caregivers provide, by race/ethnicity, gender, and employment status, accounting for confounders and complex sampling. Care recipients whose primary informal caregivers were employed were 69% more likely than those whose informal caregivers were not employed to experience unmet caregiving need (OR 1.69, 95%CI 1.19-2.41). A similar association between employment and unmet caregiving was observed among White caregivers (OR=1.79, 95% CI 1.16-2.69), while the association was not significant among Black caregivers (p=0.228). These findings suggest potentially addressable disparities in informal caregiving duties between Black and White caregivers, and can be used to inform and develop of policies and programs designed to improve caregiver health and reduce undue strain on caregiver health and wellbeing.

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CRANIOPHARYNGIOMA IN THE ELDERLY: A MULTICENTER AND NATION-WIDE STUDY IN SPAIN

Neuroendocrinology ◽

10.1159/000512161 ◽

2020 ◽

Author(s):

Pedro Iglesias ◽

Ignacio Nocete ◽

María Dolores Moure Rodríguez ◽

Eva Venegas-Moreno ◽

Jessica Ares ◽

...

Keyword(s):

Visual Field ◽

Clinical Symptoms ◽

The Elderly ◽

National Study ◽

Visual Field Defects ◽

Subtotal Resection ◽

Similar Distribution ◽

Tumor Diameter ◽

Maximum Tumor Diameter ◽

Field Defects

Background. Craniopharyngioma (CP) is a rare tumor in the elderly whose clinical features and prognosis are not well known in this population. Aim. To evaluate the clinicopathological features and therapeutic outcomes of CP diagnosed in the elderly. Patients and Methods. A retrospective, multicenter, national study of CP patients diagnosed over the age of 65 years and surgically treated was performed. Results. From a total of 384 adult CP patients, we selected 53 (13.8%) patients [27 women (50.9%), mean age 72.3 ± 5.1 years (range 65-83 yr)] diagnosed after the age of 65 years. The most common clinical symptoms were visual field defects (71.2%) followed by headache (45.3%). Maximum tumor diameter was 2.9 ± 1.1 cm. In most patients, the tumor was suprasellar (96.2%) and mixed (solid-cystic) (58.5%). The surgical approach most commonly used was transcranial surgery (52.8%) and more than half of the patients (54.7%) underwent subtotal resection (STR). Adamantinomatous CP (ACP) and papillary CP (PCP) were present in 51% and 45.1%, respectively, with mixed forms in the remaining. Surgery was accompanied by an improvement in visual field defects and in headaches; however, pituitary hormonal hypofunction increased, mainly at the expense of an increase in the prevalence of diabetes insipidus (DI) (from 3.9% to 69.2%). Near-total resection (NTR) was associated with a higher prevalence of DI compared with subtotal resection (87.5 vs 53.6%, p=0.008). Patients were followed for 46.7±40.8 months. Mortality rate was 39.6% with a median survival time of 88 (95% CI, 57-118) months. DI at last visit was associated with a lower survival. Conclusion. CP diagnosed in the elderly shows a similar distribution by sex and histologic forms than that diagnosed at younger ages. At presentation visual field alterations and headaches are the main clinical symptoms which improve substantially with surgery. However, surgery, mainly NTR, is accompanied by worsening of pituitary function, especially DI, which seems to be a predictor of mortality in this population.

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Patterns of long-term conditions in older age and subsequent mortality: a national study of inequalities in health

European Journal of Public Health ◽

10.1093/eurpub/ckz194 ◽

2019 ◽

Vol 30 (3) ◽

pp. 572-578

Author(s):

T Paul de Cock ◽

Michael Rosato ◽

Finola Ferry ◽

Emma Curran ◽

Gerard Leavey

Keyword(s):

Demographic Factors ◽

The Elderly ◽

Health Conditions ◽

National Study ◽

Latent Classes ◽

Ageing Population ◽

Long Term Conditions ◽

Specific Mortality ◽

Socio Demographic Factors

Abstract Background Multiple long-term health conditions in older people are associated with increased mortality. The study aims to identify patterns of long-term health in a national ageing population using a census-based self-reported indicator of long-term health conditions. We assessed associations with subsequent mortality and socio-economic and demographic risk factors. Methods Using linked administrative data from the Northern Ireland Mortality Study, we assessed the presence of latent classes of morbidity in self-reported data on 11 long-term health conditions in a population aged 65 or more (N = 244 349). These classes were associated with demographic and socio-economic predictors using multi-nomial logistic regression. In a 3.75-year follow-up, all-cause and cause-specific mortality were regressed on morbidity patterns. Results Four latent classes of long-term ill-health conditions were derived, and labelled: ‘low impairment’; ‘pain/mobility’; ‘cognitive/mental’; ‘sensory impairment’. Groupings reflecting higher levels of long-term ill-health were associated with class-specific increases in all-cause and cause-specific mortality. Strongest effects were found for the ‘cognitive/mental’ group, which predicted all-cause mortality [hazard ratio (HR) = 2.96: 95% confidence interval (CI) = 2.83, 3.10) as well as some cause-specific mortality (i.e. dementia-related death: HR = 10.78: 95% CI = 9.39, 12.15). Class membership was predicted by a range of socio-demographic factors. Lower socio-economic status was associated with poorer health. Conclusion Results indicate that long-term ill-health clusters in specific patterns, which are both predicted by socio-demographic factors and are themselves predictive of mortality in the elderly. The syndromic nature of long-term ill-health and functioning in ageing populations has implications for healthcare planning and public health policy in older populations.

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