Resources Utilization In People With Dementia: A Community-based Cross-Sectional Study

Background Resources utilization and cost of care for people with dementia(PWD)have been an international concern.There are many international studies on the resources utilization and the cost of care for PWD.However,due to heterogeneity in the methods and the perspective of calculating costs,as well as regional differences,the results of these studies varied greatly.China has the highest number of PWD in the world.Most of them are cared by family caregivers.At present,there is no developed assessment tools for the resources utilization of care for PWD.And there are still few studies on the resources utilization of care and cost of care for PWD in China.Objectives This study aims to:(1)test the reliability and validity of the Chinese version of the Resource Utilisation in Dementia(RUD)Questionnaire to provide a reliable tool for the research on care resources utilization and the cost of care for PWD in China;(2)investigate the resource utilization and the cost of care for PWD in the community and explore their potential influencing factors;(3)analyze the utilization of public long-term care services by PWD.Methods(1)The Chinese version of the RUD questionnaire was formed through the translation,back translation and cultural adaptability test of the original RUD questionnaire,and the reliability and validity of the RUD questionnaire were tested.(2)Structured interviews were conducted using the Chinese version of RUD on 157 PWD and their primary family caregivers in neurological or geriatric psychiatric clinic of a tertiary psychiatric hospital in Guangzhou from March 2019 to September 2019.The utilization of care resources for PWD and the caregivers’ working hours were collected.The Barthel Index was used to evaluate the patients’ basic activities of daily living,the Lawton scale was used to evaluate the patients’ instrumental activities of daily living,and the Neuropsychiatric Inventory questionnaire was used to evaluate the patients’ behavioural and psycological symptoms of dementia.(3)By reviewing the claim data of appliciants during the pilot of the public long-term care insurance in Guangzhou from July 2018 to March 2019,the PWD’s utilization of LTCI was analyzed.Results(1)The reliability and validity of the care time in Chinese version of RUD are acceptable.The Cranbach’s α coefficient and ICC for BADL care time were greater than 0.75.The ICC for IADL care time was 0.89,Cranbach’s α coefficient was 0.45,and the ICC for supervision time was 0.66;the care time of BADL was strongly correlated with BI scores(r=-0.86,p<0.001);the care time of IADL was moderately correlated with the Lawton scale score(r=-0.39,p<0.001);the supervision time was weakly correlated with the NPI score(r=0.21,p<0.001).The average daily total care time for community-based PWD was 12.2±6.3 hours.Living with caregivers is an important predictor of care time.In addition,the BI score,the Lawton scale score and the score of irritability in NPI were associated with of BADL、IADL and supervision time,respectively.The average monthly total care cost was 5482.1±3469.2 yuan.The cost of informal care accounted for about 69%of the total care cost.(3)Among the beneficiaries with dementia of LTCI,the prevalence of chronic diseases(stroke and hemiplegia were 38.1%and 1.8%,respectively)and the severity of disability(moderate and severe disabilities accounted for 66.4%and 33.6%,respectively)were high.The result of rasch analysis showed that the ability of beneficiaries with dementia was low(Person location was-0.49±0.52 logit).More than 50%of the beneficiaries with dementia required full assistance on IADLs except feeding(21.5%),dressing(38.4%),and transfer(27.9%).And nearly all beneficaries need assistance in bathing(98.9%).Except foe ostomy care,the needs on medical care of beneficiaries with dementia were significantly lower than those of beneficiaries without dementia.Conclusion The Chinese version of RUD questionnaire is a reliable tool that can be used to study the utilization of care resources and cost of care for PWD.Living with caregivers is an important factor for care time.The cost of informal care is an important part of the total cost of PWD’s care.LTCI’s eligibility and assessment tools may limit the accessibility of public long-term care services for PWD.