Community care for demented and non-demented elderly people: a comparison study of financial burden, service use, and unmet needs in family supporters

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Abstract
Objective: To measure and compare perceived financial burden, use of services, and perceived unmet service needs of supporters of demented and non-demented elderly people. Design: Comparison study of age and sex matched demented and non-demented elderly people and their supporters. Setting: 25 primary health care teams in Dundee. Subjects: 114 community resident elderly (age over 65) people with dementia, 114 age and sex matched comparators, and the main informal supporter of each elderly person. Main outcome measures: Carers' perceptions of financial impact of looking after an old person, service use (from a list of locally available services), unmet service needs, and needs for three types of generic service (help with supervision, housework, or personal care). Results: Financial impact was low, except for extra household expense in the dementia group. There was significantly greater use of mainstream domiciliary and day care services in the dementia group. Dementia was nevertheless associated with a high level of unmet need, mainly for more mainstream support and help with supervision of the elderly person. Conclusion: Supervisory care for demented elderly people should be further developed within an expanded domiciliary service to meet supporters needs. Key messages Community care for demented elderly people is thought to pose special problems for carers but comparison studies with non-demented elderly people are rare The financial impact on family carers of demented elderly people in a Scottish city was not as high as expected The use of mainstream domiciliary and day care services was significantly higher for demented than non-demented elderly people Family carers of demented elderly people need more support in caring for these people