New research from Oxford University in England estimates the total cost of dementia across 15 western European countries in 2007 was 189 billion euros (£165 billion), most of which is made up of unpaid care from family and friends. The Alzheimer’s Research UK-funded study is currently in press and about to be published in the Journal of Alzheimer’s Disease.
Dr Ramon Luengo-Fernandez, of the University’s Health Economics Research Centre, led the work. He told the media:
“Dementia has a very significant impact across European countries, and the burden falls mainly on unpaid carers.”
He and his colleagues estimate that the cost of informal care came to more than two thirds of the total (68%), with 26% for social care such as nursing homes and residential care, and 5% for health care. Productivity losses due to loss of earnings and premature death account for the remaining 1%.
The 15 countries included in the analysis were those who were members of the European Union (EU-15) before the Eastern enlargement in 2004. These include: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain, Sweden, and the United Kingdom (UK).
All 15 countries had comparable data available, so the researchers could use the same methods with each one.
Health and social care costs were highest in Luxembourg, followed by Sweden and the UK. The average per patient across the 15 countries was €9,863 (£8,623), though it varied widely from country to country. For instance, for the UK it was £13,200.
The cost of informal care is that provided to care for the estimated 4.4 million people with dementia who are living in the community across these 15 countries of Europe. They receive a total of 11.9 billion hours of unpaid care from family members and friends.
Luengo-Fernandez said in essence this informal care cost is the “value put on people’s loving care”. In their calculations they used the “opportunity cost” of providing the care, which is the economic value of the time the informal carers could have spent doing things other than caring for their loved one with dementia.
The other main area of cost is the long term care provided by nursing and residential care homes. Luengo-Fernandez describes this as the “forgotten bit of the healthcare system”.
“As its funding in the UK is not centralised – bits of funding come from Whitehall, others from local authorities, some of it is private – it has probably not received the required attention. This is true for the majority of European countries,” he said.
The team found a large north-south divide: with northern European countries spending more per person with dementia than the Mediterranean countries. Luengo-Fernandez said this is probably because the northern countries are the richer nations:
“Richer countries tend to have higher costs, especially in medicine and health. Healthcare is a luxury good – the higher the income of a country, the greater the proportion of total income that will be devoted to healthcare. For example, salaries in the UK for consultants and GPs are markedly higher than for a comparable medical doctor in Spain,” he explained.
Luengo-Fernandez and colleagues also found there was a much higher proportion of care homes in the northern European countries.
Luengo-Fernandez suggests one of the reasons could be the low employment rates for women in Mediterranean countries, making it more likely that long-term care is provided by daughters and daughters-in-law, who will also bear much of the psychological stress.
Another reason could be cultural differences where families in southern European countries may regard placing their relatives in institutionalised care as uncaring and a failure.
Alzheimer’s Research UK’s Chief Executive, Rebecca Wood, said:
“This report shows the profound impact of dementia across Europe, particularly for unpaid carers – husbands, wives, sons and daughters – who bear such a burden in how society deals with the condition.”
She said it was worrying that these figures are going to grow as our population ages and dementia becomes more common.
“The only answer to dementia is research into treatments and preventions that can reduce its impact, improve individuals’ quality of life, or cure the condition,” she urged.
Written by Catharine Paddock PhD