Chronic Disease

Caregivers of individuals with Alzheimer's dementia are more likely to visit emergency departments or be hospitalized when depressed.

Of the nearly 4 million adults with Alzheimer's dementia (AD) in the United States, 3 million live in the community with 75 percent of their care needs delivered by family and friends. The stress associated with caring for these loved ones can take its toll on the caregiver. According to a new study, 24 percent of those caring for persons with AD will end up visiting emergency departments (ED) or be admitted to the hospital. In addition, the use of the acute care services is associated with being depressed.

In this study, 153 patients with AD were recruited from two large primary care practices. Family and friends caring for these individuals were interviewed to provide information on the patient's behaviors, actions, and activities of daily living. Caregivers also provided information about their own mood and the use of acute care services. Nearly a quarter (24 percent) of caregivers had either visited an ED or had been hospitalized in the 6 months prior to participating in the study. There was no association between the level of cognitive impairment in the patient with AD and the use of acute care services by the caregiver. However, ED visits and hospitalizations most often occurred in caregivers caring for patients with cognitive, functional, behavioral, and psychological symptoms. These caregivers were also likely to suffer from more symptoms of depression.

The researchers note that cognitive decline in a loved one is not as stressful to caregivers, probably because they expect and are prepared for such decline. Rather, it is the patient's agitation, aggression, and other symptoms that prove to be the biggest caregiver stressors. In fact, these are most often the reasons why caregivers resort to long-term care placement.

The researchers suggest that primary health care and collaborative programs need to include the caregiver's needs at the same time as they provide care to a patient with AD. The study was supported in part by the Agency for Healthcare Research and Quality (HS10884).

See "Acute care utilization by dementia caregivers within urban primary care practices," by Cathy C. Schubert, M.D., Malz Boustani, M.D., M.P.H., Christopher M. Callahan, M.D., and others, in the November 2008 Journal of General Internal Medicine 23(11), pp. 1736-1740.