Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48 Page 49 Page 50 Page 51 Page 52 Page 53 Page 54 Page 55 Page 56 Page 57 Page 58 Page 59 Page 60 Page 61 Page 62 Page 63 Page 64 Page 65 Page 66 Page 67 Page 68 Page 69 Page 70 Page 71 Page 72 Page 73 Page 74 Page 75 Page 76 Page 77 Page 78 Page 79 Page 80 Page 81 Page 82 Page 83 Page 84 Page 85 Page 86 Page 87 Page 88 Page 89 Page 90 Page 91 Page 92 Page 93 Page 94 Page 95 Page 96 Page 97 Page 98 Page 99 Page 100 Page 101 Page 102 Page 103 Page 104 Page 105 Page 106 Page 107 Page 108AGING IN THE 21S T CENTURY 46 Caregiver Burden As part of the in-home ADAMS assessment, informants who were present were asked to complete a question- naire about their role as a caregiver. Fisher et al. (2011) report on data from caregivers who report being a fam- ily member with primary responsibility for providing care to the person with dementia or CIND. Caregivers are asked a wide range of questions about their experiences providing care to their relative. Caregivers are most often female children of the care recipient. Sixty-two percent of caregivers live with the care recipient. The re- searchers compare the experiences of those caring for relatives with dementia and CIND. Those providing care to relatives with CIND report an average of 133.7 care hours per month. Care of a relative with dementia was twice as hard, involving an average of 278 hours per month. Around 44% of those caring for a relative with dementia report feeling depressed compared to 26% of those caring for someone with CIND. Despite this, caregivers also reported on the re- ward of caring for their relative, including feeling closer to the person they were caring for and more in control of their relative’s well-being. When dementia is accompa- nied by other neuropsychiatric symptoms like depression and anxiety, the number of care- giving hours increases. This is because these additional symptoms increase the num- ber of functional limitations the person with dementia experiences. Okura et al. (2010) show that the increased functional impairment associated with neuropsychiatric symptoms, like depression and anxiety that are common in dementia and CIND, translates into a higher number of caregiving hours. Caregiving for those with dementia may itself be a risk for cognitive decline. Husbands and wives who are caregivers for their spouse with dementia are themselves more likely to experience cognitive decline com- pared to caregivers of spouses with other diseases (Dassel et al. 2015). Women who are disabled from dementia are much less likely than men to receive informal home care (Katz et al. 2000). Women are more likely to be living alone, but even among married couples, wives receive less care than husbands. Among those receiving informal care, children are most likely to be providing care to mothers, and wives are most likely to be providing care to husbands. Because of lower birthrates among those in the Baby Boom generation, the resulting decline in available family caregivers (Ryan et al. 2012) may lead to a caregiving perfect storm severely straining families and public programs as dementia cases grow. Economic Costs One way that dementia represents a substantial economic burden is in out-of-pocket medical (OOPM) expenses. Delavande et al. (2013) show that OOPM costs for those with dementia are $8,440 per year (in 2016 dollars) compared to $2,570 for those with normal cognition at similar ages; increased expenses are mainly due to nurs- ing home care. Projecting this amount up to the US population over age 70 in 2009, which they estimate to be about 28 million based on census records, the excess cost of OOPM spending asso- ciated with dementia was $22 billion in 2010. Because of lower birthrates among those in the Baby Boom generation, the resulting decline in available family caregivers may lead to a caregiving perfect storm severely straining families and public programs as dementia cases grow.