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Quality & Quantity

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01.01.2015

Analysis of the medical demands of elderly dementia patients considering the caregiver cost of medical accompaniment: an application of the travel cost method and altruistic utility function

verfasst von: Shou-Lin Yang, Chiung-Ying Lee

Erschienen in: Quality & Quantity | Ausgabe 1/2015

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Abstract

This study employed travel cost method, altruism concepts and negative binomial regression model to establish an outpatient medical demand model of the outpatient visits for elderly dementia patients with caregivers. We considered the time and transport costs of caregivers and evaluated the factors. We employed the MMSE, GDS-15, and Barthel index to conduct and evaluate the preliminary screenings of older adults in Tainan, Taiwan, and we selected 201 dependent older adults with a risk of developing Alzheimer’s disease to participate in this study. Our subsequent analysis examined participants’ dementia-related medical records from January 1, 2009 to December 31, 2010. The findings show that medical visits reduce as the time cost of the accompanying caregiver increases. However, the frequency of medical visits increases with the level of patients’ financial independence. In addition, patients that also suffer from other chronic illnesses further reduced the number of visits related chiefly to dementia.

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Data Source: Department of Household Registration, Ministry of the Interior 2012. http://sowf.moi.gov.tw/stat/month/m1-06.xls

Over 65 years of age, the prevalence of dementia is $\sim $5–10 %; above 70 years of age, dementia prevalence is $\sim $13.9 %; and above 80 years of age, dementia prevalence can reach greater than 20 % (Brookmeyer et al. 1998; Plassman et al. 2007).

The etiology of dementia includes: degenerative disorders, such as Alzheimer’s, forehead and temporal bone amnesia, Levi Body dementia, Pick’s disease, and Parkinson’s disease; vascular dementia or disturbances of the metabolic and endocrine systems, such as hyperthyroidism, hypothyroidism, uremic encephalopathy, and hepatic encephalopathy; vitamin deficiencies, including B12, folic acid, and nicotinic acid; infections, such as neurosyphilis, Creutzfeldt-Jacob Disease, HIV Dementia; and Toxin-Related Dementia, such as alcohol poisoning, heavy metal poisoning, and toxin-related dementia. Additional etiology includes post-traumatic encephalopathy, intra-cranial tumors, normal pressure hydrocephalus, subdural hematoma, and anoxic encephalopathy.

Damage to cognitive functions includes orientation, abstract reasoning, planning calculations, learning, understanding, judgment, and insight.

Emotional problems, including depression, anxiety, hypomania or mania, irritably, and bad temper; behavioral problems, such as soliloquize, repetitive movements, impulsive behavior, continuous movements, walking, wondering, inappropriate behavior, restlessness, injury to others or self; psychiatric problems, such as delusions of being stolen from, mistaken identities, jealousy, paranoia, grandiose religious thought, repetitive obstinate ideas, and confabulation; and hallucinations, such as auditory hallucinations, visual hallucinations, tactile hallucinations, olfactory hallucinations, and illusions can occur. Problems with biological drives include low motivation, insomnia or hypersomnia, overeating or anorexia, excessive sexual urges, and inappropriate sexual behavior. Symptoms of delirium include rapid attacks of fluctuating states of poor awareness coupled with disorientation, hallucinations, and delusions.

Sundowner syndrome describes the conditions or issues in awareness that drastically worsen in afternoons and evenings.

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Generally, to simplify the process of model derivation in the application of TCM, Pz is hypothesized as 1.

This includes a consultation for normal psychiatry and consultations for family medicine, neurology, and psychiatric problems.

The cost of time was calculated by multiplying the medical treatment time by the caregiver’s monthly salary to obtain an hourly wage. The medical treatment time consisted of 2 h of basic medical treatment and waiting plus the transport time was calculated as 30 min every 5 Km.

Sample cases that younger than 70 were charged with a registration fee of NTD $50 by medical facilities. Those who are 70 years or older are not charged registration fees.

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Titel: Analysis of the medical demands of elderly dementia patients considering the caregiver cost of medical accompaniment: an application of the travel cost method and altruistic utility function
verfasst von: Shou-Lin Yang
Chiung-Ying Lee
Publikationsdatum: 01.01.2015
Verlag: Springer Netherlands
Erschienen in: Quality & Quantity / Ausgabe 1/2015
Print ISSN: 0033-5177
Elektronische ISSN: 1573-7845
DOI: https://doi.org/10.1007/s11135-014-9994-x

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