Alistair Burns

Future costs of dementia-related long-term care: exploring future scenarios

BACKGROUNDnThis study explores how the views of a panel of experts on dementia would affect projected long-term care expenditure for older people with dementia in England in the year 2031.nnnMETHODSnA Delphi-style approach was used to gather the views of experts. The projections were carried out using a macro-simulation model of future demand and associated expenditure for long-term care by older people with dementia.nnnRESULTSnThe panel chose statements that suggested a small reduction in the prevalence of dementia over the next fifty years, a freeze in the numbers of people in care homes, and an increase in the qualifications and pay of care assistants who look after older people with dementia. Projections of expenditure on long-term care that seek to capture the views of the panel suggest that future expenditure on long-term care for this group will rise from 0.6% of GDP in 2002 to between 0.82% and 0.96% of GDP in 2031. This range is lower than the projected expenditure of 0.99% of GDP in 2031 obtained under a range of base case assumptions.nnnCONCLUSIONSnThis paper attempts to bridge the gap between qualitative forecasting methods and quantitative future expenditure modelling and has raised a number of important methodological issues. Incorporating the panels views into projections of future expenditure in long-term care for people with dementia would result in projected expenditure growing more slowly than it would otherwise.

037 Carer burden and distress in apathy and impulsivity in Parkinson's disease

Aims Carer distress in Parkinsons disease (PD) has been associated with psychiatric symptoms and levels of disability and disease severity in the PD sufferer. The specific contribution of behavioural phenotype in PD (impulsive vs apathetic) to carer burden has not yet been fully explored. Methods Non-demented (n=71) PD sufferer-carer dyads (spouse or child) were examined on various measures. The PD sufferers were divided into three behavioural groups: impulse control disorder (ICD) (n=21); apathy (n=22); and controls (n=28). Carer burden was rated using the Zarit Burden Scale and carer distress was determined from the Neuropsychiatric Inventory. PD sufferers were assessed for levels of disability, quality of life, clinical (motor and psychiatric), demographic variables and cognitive function. Correlations between variables were sought. Results The three behavioural groups differed significantly on measures of carer burden, with the ICD and apathy group carers’ having a greater burden of care. The PD groups differed significantly in levels of disability, psychiatric morbidity, cognitive functioning and clinical variables. Strong correlations were found between measures of psychiatric morbidity and carer burden (UPDRS Mental dysfunction score: ñ=0.453, p<0.001) and distress (Global Assessment of Functioning: ñ=−0.636, p<0.001). Conclusions Carer burden and distress differ according to behavioural phenotype, which appears to be driven by differences across several clinical factors.