Impact of additional community services provision on dementia caregiver burden: an interrupted time-series analysis of 12-year interRAI assessments in Hong Kong

Abstract

Objectives To evaluate the impact of providing additional dementia caregiver support services on caregiver burden.Design Interrupted time-series analysis using territory-wide panel data.Settings All public-funded district elderly community centres in Hong Kong (HK).Participants Primary caregivers for older adults (age over 65 years) living with dementia assessed through International Residential Assessment in HK between 1 October 2004 and 31 September 2016. Paid caregivers were excluded.Interventions In April 2014, US$280 million was allocated to provide additional psychological support, education and respite care for dementia caregivers in HK.Main outcome measures Caregiver burden was measured by two age-standardised rates: (1) caregivers in emotional distress; and (2) caregivers with long care time in a week (more than 20 hours a week). We fitted the two time-series into Autoregressive Integrated Moving Average models to evaluate intervention impacts, with follow-up analyses to consider a 6-month transition period of policy implementation. Segmented linear regressions and Holt-Winter exponential smoothening models were used as sensitivity analyses.Results 36 689 dementia caregivers were included in this study, of which 14.4% caregivers were distress and 31.9% were long-hours caregivers after the policy intervention in April 2014. Providing additional caregiver service significantly reduced standardised rates of caregivers in distress (β (95% CI)=−3.93 (−7.85 to −0.01), p<0.05), but the effect was not sustained (p=0.183). There was no significant impact on the level of age-standardised rates of caregiver with long care time (β (95 CI)=−4.25 (−9.61 to 1.10), p=0.120). Also, there was no significant delay of intervention impacts.Conclusion Our study finds that strengthening caregiver services provision could reduce distress rates among primary caregivers for older adults living with dementia. Expanding community services for caregiver could be a solution to the escalating burden of informal care for people living with dementia.