Community care for demented and non-demented elderly people: a comparison study of financial burden, service use, and unmet needs in family supporters

BMJ 1995;310:1503-1506 (10 June)

General practice

Community care for demented and non-demented elderly people: a comparison study of financial burden, service use, and unmet needs in family supporters

I Philp, senior registrar,^a K J McKee, research fellow,^b P Meldrum, research assistant,^c B R Ballinger, consultant psychiatrist,^d M L M Gilhooly, lecturer,^e D S Gordon, research fellow,^b W J Mutch, consultant geriatrician,^a J E Whittick, consultant psychologist ^f

^a Department of Geriatric Medicine, Royal Victoria Hospital, Dundee, ^b University Department of Medicine, Section of Aging and Health, Ninewells Hospital and Medical School, Dundee, ^c University Department of Public Health, Health Economics Research Unit, Aberdeen, ^d Royal Dundee Liff Hospital, Dundee, ^e University Behavioural Sciences Group, Glasgow, ^f Bangor District General Hospital, Lothian

Correspondence to: Professor Ian Philp, University Department of Health Care for Elderly People, Brearly Wing, Northern General Hospital, Sheffield S5 7AU.

Abstract

Objective: To measure and compare perceived financial burden,use of services, and perceived unmet service needs of supportersof demented and non-demented elderly people.
Design: Comparison study of age and sex matched demented andnon-demented elderly people and their supporters.
Setting: 25 primary health care teams in Dundee.
Subjects: 114 community resident elderly (age over 65) peoplewith dementia, 114 age and sex matched comparators, and themain informal supporter of each elderly person.
Main outcome measures: Carers' perceptions of financial impactof looking after an old person, service use (from a list oflocally available services), unmet service needs, and needsfor three types of generic service (help with supervision, housework,or personal care).
Results: Financial impact was low, except for extra householdexpense in the dementia group. There was significantly greateruse of mainstream domiciliary and day care services in the dementiagroup. Dementia was nevertheless associated with a high levelof unmet need, mainly for more mainstream support and help withsupervision of the elderly person.
Conclusion: Supervisory care for demented elderly people shouldbe further developed within an expanded domiciliary serviceto meet supporters needs.

Key messages

Key messages
Community care for demented elderly people is thought to pose special problems for carers but comparison studies with non-demented elderly people are rare
The financial impact on family carers of demented elderly people in a Scottish city was not as high as expected
The use of mainstream domiciliary and day care services was significantly higher for demented than non-demented elderly people
Family carers of demented elderly people need more support in caring for these people

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