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*233. Informal Caregiving for Diabetes Among Elderly Americans: Estimates from a Nationally Representative Sample

KM Langa, University of Michigan and Ann Arbor VA HSR&D; S Vijan, University of Michigan and Ann Arbor VA HSR&D; RA Hayward, University of Michigan and Ann Arbor VA HSR&D; C Blaum, University of Michigan; MU Kabeto, University of Michigan; ME Chernew, University of Michigan; SJ Katz, University of Michigan; RJ Willis, University of Michigan; AM Fendrick, University of Michigan

Objectives: Diabetes mellitus (DM) is a common chronic disease that causes significant morbidity and disability in the United States. While the direct medical costs for the treatment of DM and its complications have been studied, whether and how diabetes and its complications lead to increased levels of informal caregiving from family and friends has not been well assessed. Thus, our objective was to obtain nationally representative estimates of the time, and associated cost, of informal caregiving for the elderly with diabetes.

Methods: We estimated multivariable regression models using data from the 1993 Asset and Health Dynamics Study (AHEAD), a nationally representative survey of people aged 70 or older (N=7,443). The outcome measures were the weekly hours of informal caregiving, and imputed cost of caregiver time, for community-dwelling elderly who reported: 1) no prior diagnosis of DM; 2) a diagnosis of DM, but no current medical therapy; 3) a diagnosis of DM, taking oral hypoglycemic medication only; and 4) a diagnosis of DM, taking insulin.

Results: Thirteen percent of respondents reported having diabetes. After adjusting for sociodemographic characteristics, health status, and living situation, those without DM received an average of 6.4 hours per week of informal care, diabetics taking no medications received 8.9 hours, diabetics taking oral hypoglycemics received 9.9 hours, and diabetics taking insulin received 12.7 hours of care (P<.01). The associated additional yearly cost of informal care per case attributable to DM was $1,000 for diabetics taking no medications, $1,500 for those taking oral hypoglycemics only, and $2,700 for those taking insulin. This represents a national annual cost for diabetes-related informal caregiving of about $4.8 billion.

Conclusions: The quantity and associated economic cost of informal caregiving for the elderly with diabetes are substantial. Future evaluations of the costs of diabetes, and the cost-effectiveness of diabetes interventions, should include the informal caregiving costs attributable to the disease.

Impact: This analysis quantifies the signficant burden that diabetes imposes on both the person with this chronic disease AND the family members on whom that person depends for help with daily care. Clinicians and policymakers should recognize this considerable burden on family members and consider targeted interventions to help with caring for the growing number of elderly Americans with diabetes.