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NRI 95-218 – HSR&D Study

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NRI 95-218
Informal Caregivers of Veterans with Dementia: Cost, QOL and Service Use
Elizabeth C. Clipp RN PhD
Durham VA Medical Center, Durham, NC
Durham, NC
Funding Period: October 1997 - September 2001

BACKGROUND/RATIONALE:
The VHA faces an aging population which is placing increasingly strong demands on its long-term care system. Within VA, the number of veterans with severe dementia is expected to rise from 200,000 in 1983 to 600,000 in the year 2000. Equal or higher numbers of veterans are estimated to have mild to moderate dementia. The proposed research aims to decrease this demand by identifying targets of intervention in the informal care system (specifically the financial and quality of life (QOL) impacts of dementing illnesses) and predict which caregivers and under what conditions choose to institutionalize.

OBJECTIVE(S):
The major objective of this project is to determine the impact of dementia on veterans' families in terms of informal caregiving costs and QOL. Specific objectives are to determine, on a national level, the direct non-medical (e.g., caregiving) costs, indirect morbidity costs (e.g., lost productivity), and QOL dimensions of caregiving and to examine these factors in relation to amount and type of service use, and to decisions to institutionalize.

METHODS:
This is a national (all VAs), prospective, longitudinal study of informal caregivers of elderly male veterans with a diagnosis of Vascular Dementia (290.4) or Alzheimer’s Disease (331.0) recorded on VA Encounter Forms in the year prior to the initiation of the study. Next of Kin of 8498 veterans were approached to identify the veteran’s primary caregivers. This process identified 3664 caregivers and 2109 veterans ineligible for the study due to death, prior institutional placement or no available caregiver. A total of 2725 did not respond to the Caregiver Identification Letter. The National Longitudinal Caregiving Survey, covering psycho-social, health, and financial aspects of caregiving, was sent to the 3664 identified caregivers. A total of 2278 returned their baseline questionnaires. A total of 1317 Year 3 questionnaires were sent to those still caring for a veteran at the end of year two and the projected sample for Year 4 is 830 caregivers (who complete Year 3 surveys).

FINDINGS/RESULTS:
Final results are being analyzed at this time.

IMPACT:
An estimated $4 billion per year could be saved in the U.S. if institutionalization from dementing illnesses is delayed by one month. The VHA therefore stands to benefit greatly from an increase in the precision by which community care is monitored. Aside from the potential financial benefit to the VHA of extending informal care as long as possible, the ultimate benefactor of this research will be veterans with dementia who, with appropriately targeted interventions, will be more able to remain at home in environments that promote maximum independence for both caregivers and patients.

PUBLICATIONS:

Journal Articles

  1. Thorpe JM, Van Houtven CH, Sleath BL, Clipp EC. Barriers to Outpatient Care in Community-Dwelling Elderly with Dementia: The Role of Caregiver Life Satisfaction. Journal of applied gerontology : the official journal of the Southern Gerontological Society. 2009 Aug 1; 28(4):436-460.


DRA: Health Systems, Aging, Older Veterans' Health and Care
DRE: Epidemiology
Keywords: Long-term care, Nursing, Outpatient
MeSH Terms: Long-Term Care, Nursing

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