84 Direct

costs include medical consultations, investigations, pharmaceuticals, provision of personal and nursing care, and often residential care in the later stages. In 2005 the care provided by caregivers of people with Alzheimer’s disease and other dementias cost the US at least 83 billion USD.7 Comparative ChemSelleck IKK inhibitor figures for Inhibitors,research,lifescience,medical Australia were approximately 3.2 billion AUD (approximately 2.6 billion USD) in 2002. 85 Cost estimates may omit or underestimate the substantial hidden unpaid costs borne by caregivers, which are substantial. Indirect costs include loss of earnings by patients and family caregivers as they relinquish or reduce employment, hours of informal care and mortality burden.85,86 Hie US Alzheimer’s Association7 estimated that direct and indirect costs total 148 billion USD annually based on 2005 estimates. In Australia total costs reached 7 billion AUD, or over 40 000 AUD in total costs for each individual with dementia.85 An important issue is balancing caregiving Inhibitors,research,lifescience,medical and work responsibilities. Almost 60% of US family caregivers of people with

dementia are also employed, of whom two thirds reported that they missed work, 8% that they turned down promotion opportunities, and up to 31% that they had given up work to attend to caregiving responsibilities.3-7 The economic disadvantage associated with caregiving Inhibitors,research,lifescience,medical in the developing world is significant.10 Wimo and colleagues estimated that direct costs of dementia in emerging markets and developing countries totaled 13 billion USD in 2003 .10 Total costs, including

those borne by families are likely to be much higher. On average, 32% of caregivers in the countries surveyed cut back on paid work to care for a family Inhibitors,research,lifescience,medical member with dementia (including 84% in Nigeria). Compensatory financial support was lacking, very few people received government Inhibitors,research,lifescience,medical pensions, and 45% to 80% received no informal support. While health care services are cheaper, in relative terms these families spend a greater proportion of their income on health care for the person with dementia. Moreover, caregivers from poorer countries tend to use the more expensive services of private doctors due Tolmetin to unsatisfactory public services.10 Predictors of and protectors from caregiver distress Evidence regarding which variables are associated with greater and lower levels of strain and psychological morbidity experienced by caregivers (Table I) sometimes conflicts. For example, greater caregiver strain has been linked to both shorter and longer duration of dementia, as explained by three theories. The adaptation hypothesis posits that over time caregivers adapt to the demands of their role.54-55 Alternatively, the “wear and tear” hypothesis proposes that the longer a caregiver remains in his or her role, the more likely negative outcomes are to occur.