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A new study suggests caring for older Americans with dementia costs more than $18 billion a year in additional time spent by family and friends. The study is one of the first to use a large, nationally representative sample of older Americans to estimate the additional time and associated costs of providing informal care to those with dementia. . According to the University of Michigan study, published in the November issue of the Journal of General Internal Medicine, more than 7,000 Americans age 70 and over with cognitive impairments received substantially more informal help than those with normal cognitive function. This help includes assistance with basic daily activities such as bathing, dressing, eating, and fixing meals, and with less frequent activities including grocery shopping and managing money.

"We found that the care-giving burden on family members increased substantially as cognitive impairment worsened," says Kenneth M. Langa, M.D., Ph.D., lead author of the study. "Those with mild dementia received 8.5 more hours of care per week than elders with normal cognitive function, who received only 4.6 hours of help per week. And those with severe dementia received 41.5 more hours of help per week than elders with normal cognition."

With Alzheimer’s disease projected to more than triple in the United States over the next 50 years, from about 2.3 million to 8.7 million cases, the study findings underscore the importance of including valid estimates of unpaid care-giver time when evaluating future clinical and policy interventions aimed at reducing the impact of dementia on individuals, families, and society.

"Helping those with dementia places a significant burden on both families and society, and this burden increases sharply as the level of cognitive impairment progresses from mild to severe," says Langa, assistant professor of internal medicine at the U-M Medical School and faculty associate at the U-M Institute for Social Research.

Overall, the study showed that 10 percent of the respondents displayed evidence of cognitive impairments consistent with dementia. Of those, 43 percent were mildly impaired, 27 percent had moderate impairment, and 31 percent were severely impaired. To estimate the yearly costs of caring for older family members with dementia, the researchers calculated the number of weekly hours of help respondents reported receiving, adjusted for age, income, chronic health conditions besides dementia, and other factors, multiplied by the 1998 national average wage for a home health aide of $8.20 per hour, and then multiplied by 52 (weeks per year).

"Both physicians and policy makers will be confronted with difficult choices regarding the allocation of health care resources as the U.S. population ages and the prevalence of dementia increases," says A. Mark Fendrick, M.D., study co-author and U-M associate professor of internal medicine. "Since about 35 percent of the care-givers are spouses, elderly women may be especially vulnerable to the potential negative consequences of providing this level of care."