Economic analyses of dementia care in Ireland and Europe : perception of services and care, the market value of informal care and changes in service utilisation attributed to comorbid depression

Abstract

Dementia is a progressive syndrome causing cognitive decline and functional impairment. The economic burden of dementia is greater than that of stroke, heart disease and cancer combined: however, resources allocated to dementia care continue to be substantially lower than each of these individual disease groups. The World Health Organisation observes a growing gap between budget allocation and associated burden of mental health disorders, particularly in higher income countries. Ireland is currently estimated to provide half the OECD average level of dementia care. The aim of this thesis is to investigate the determinants of dementia care as they pertain to perception of care, value of informal care and the level of formal service utilisation. Through analysis of two datasets, the following three pieces of new evidence are obtained: 1. Perceptions of care in Ireland are determined by externalities such as socioeconomic status, and evidence suggests that access is unequal. This presents the risk of worsening symptoms and the transference of the burden of care to informal carers (e.g. friends or family). 2. Informal carers in Ireland report providing greater than 10 hours of care in 85% of cases, and this analysis finds daily care increases further with dementia progression. Estimated daily per day spend on informal dementia care is valued at the market rates and costs are found to range from €240 in early stage dementia to €570 in late stages. 3. Depression occurring in dementia substantially influences health services utilisation. Specifically, depression reduces the likelihood of accessing appropriate services but once services are accessed, increases the quantity of services required by 39%. In light of the evidence presented, this thesis draws the conclusion that greater policy focus is required to ensure ‘equal access for equal needs’, to ensure adequate community support services are available and that complicated psychiatric symptoms of dementia are appropriately detected and managed