Underscoring the significant toll of Alzheimer's disease on patients' families, researchers presenting at the recent International Conference on Alzheimer's Disease and Related Disorders reported that nearly half of family caregivers say their employment status has been affected by the demands of their unofficial "job." The employment impacts ranged from increased absenteeism to outright job loss. Researchers also reported a direct link between the amount of time spent on caregiving and the likelihood of an employment impact.
"The study quantifies a disturbing trend, showing significant consequences for the millions of family members caring for people with Alzheimer's disease, as well as society as a whole," said Jeffrey Markowitz, DrPH, lead study author; adjunct assistant professor at the Columbia University School of Public Health; and president of Health Data Analytics, a health-research organization in New Jersey.
More than 4 million Americans have Alzheimer's disease. That figure is expected to increase more than threefold (to 14 million) by mid-century, unless a cure or preventive agent is found.
A close relative nearly always shoulders caregiver responsibilities. In fact, 93 percent of caregivers are family members of the patient. The caregiver is normally either an adult child (44 percent) or spouse (40 percent) of the patient. More than three-quarters of these caregivers are women.
Dr. Markowitz notes that while currently available treatments for Alzheimer's disease are not a cure, they can delay progression of the symptoms and as a result, alleviate burden on the caregiver. Recent research has found that Reminyl™ (galantamine hydrobromide), the newest of the treatments approved for mild to moderate Alzheimer's, can reduce the amount of time required of caregivers to assist patients.
Work Days Lost, Careers Cut Short
In the employment-impact study, 3,804 Alzheimer's caregivers were surveyed, of which 37.6 percent were employed full time and 16.1 percent were working part-time. Participants reported that caregiving consumed an average of 46 hours per week. Approximately 40 percent of respondents reported missing three or more days of work in the previous six months and 16.5 percent were absent from work for 10 or more days.
Approximately half of the respondents reported that their caregiving responsibilities had become so intense that their employment was negatively affected. The most common consequences included resignation, early retirement and transition to part-time status.
The likelihood of a negative impact on employment increased with the number of hours required for caregiving duties. For example, about a third of respondents who reported spending less than 10 hours per week on caregiving said their employment was negatively affected. Among those who reported spending 70 or more hours per week on caregiving, approximately two-thirds experienced a negative impact on their employment.
"Increased time spent providing care was associated with higher rates of adverse employment outcomes," concluded Dr. Markowitz. "Employers nationwide must examine how they can help the increasing number of employees who are struggling to balance work and caregiver responsibilities."
An analysis presented at the 2002 American Psychiatric Association meeting in May demonstrated the potential benefit of one Alzheimer's drug, Reminyl, in reducing caregiver time.
The analysis pooled data from two randomized, 6-month, double-blind trials involving mild-to-moderate Alzheimer's disease patients. Daily time spent by caregivers assisting and supervising patients was recorded on a monthly basis using the Allocation of Caregiver Time Survey. Included in the analysis were 411 patients who received 24 mg of Reminyl daily and 414 who took placebo (inactive medication for comparison).
In the study, a significantly greater proportion of people caring for patients treated with Reminyl reported a maintenance of or a reduction in the amount of time spent assisting the patient with activities of daily living, compared to those caring for patients who took placebo (60 percent vs. 50 percent). When evaluating this outcome for patients with moderate (rather than mild) Alzheimer's disease, the benefit was more pronounced (61 percent vs. 43 percent).
"These findings support a growing body of data that medications for Alzheimer's disease can provide meaningful, practical benefit," said Mary Sano, PhD, lead author of the analysis and associate professor of clinical neuropsychology at the Sergievsky Center and Taub Institute for Alzheimer's Disease Research at Columbia University College of Physicians and Surgeons in New York City.
The newest approved treatment for mild to moderate Alzheimer's disease, Reminyl is thought to inhibit an enzyme that breaks down acetylcholine – a critical chemical in the brain that plays a key role in memory and learning. In addition, it is believed that Reminyl modulates the brain's nicotinic receptors, to which acetylcholine binds. Laboratory research suggests that through this action, Reminyl stimulates greater release of the chemical. However, the significance of this finding in humans is currently unknown and further research is underway.