gms | German Medical Science

Background: As Europe’s population is ageing; there is more and more demand for informal long-term care for people with dementia (PwD). In the interest of reducing health care spending, more PwD receive informal care from family and friends. Previous research has shown that informal caregivers experience significant increases in stress levels. However, many informal caregivers also have a paid job which leaves them struggling to do both at the same time. From theory it follows that formal employment in addition to informal caregiving results in more stress compared to people who only offer informal care. We therefore try to analyze the effect of formal employment and informal care for PwD on the stress levels of the informal caregivers.

Study Design: This empirical analysis is based on the primary data collected by the EU RP7 project “RightTimePlaceCare” (RTPC). It is a prospective cohort study, which was conducted in 8 European countries, Estonia, Finland, France, Germany, Netherlands, Spain, Sweden, and United Kingdom. Throughout this cohort, 949 PwD received informal care at home; 344 of the home caregivers also were in separate formal employment. Formal employment and working hours in this setting were assessed using the Resource Utilization in Dementia questionnaire (RUD). Stress levels in this setting were assessed using the Zarit Scale, which ranges from 0 (never stressed) to 4 (nearly always stressed).

Methods: We analyze the level of stress based on whether and how many hours per week the informal caregiver spends on formal employment at baseline measurement and follow up measurement. To identify this relationship, we run a regression framework with stress level as the dependent variable and formal employment and formal working hours as the independent variables. Furthermore, we include a wide range of demographical variables such as the patients’ health characteristics to account for possible influences on the caregiver’s stress level.

Results: The preliminary results of this analysis indicate that at baseline measurement (follow up measurement) informal caregivers who are also in formal employment experience, on average, an increased stress level of 0,3 (0,2) on the Zarit scale compared to the informal caregivers who are not in formal employment. However, the relationship between stress level and formal working hours for informal home caregivers at baseline measurement is not significant at a 5% significance level. The same phenomenon can be seen at the follow up measurement. This means while formal employment has an effect on the caregiver’s stress level, the total number of working hours do not prove to be significantly influential.

Conclusion: These preliminary findings have important implications for policy strategies intended to increase incentives for informal caregivers. More and less expensive informal caregiving in combination with formal employment efficiently reduces public health care spending by delaying and thus decreasing the need for nursing home services. Ergo, it is important for the informal caregiver to be able to flexibly adjust the formal working hours to the need of the caregiver’s patient in order to maximize the caregiver’s working hours.