Impact of additional community services provision on dementia caregiver burden: an interrupted time-series analysis of 12-year interRAI assessments in Hong Kong

OBJECTIVES: To evaluate the impact of providing additional dementia caregiver support services on caregiver burden. DESIGN: Interrupted time-series analysis using territory-wide panel data. SETTINGS: All public-funded district elderly community centres in Hong Kong (HK). PARTICIPANTS: Primary caregivers for older adults (age over 65 years) living with dementia assessed through International Residential Assessment in HK between 1 October 2004 and 31 September 2016. Paid caregivers were excluded. INTERVENTIONS: In April 2014, US$280 million was allocated to provide additional psychological support, education and respite care for dementia caregivers in HK. MAIN OUTCOME MEASURES: Caregiver burden was measured by two age-standardised rates: (1) caregivers in emotional distress; and (2) caregivers with long care time in a week (more than 20 hours a week). We fitted the two time-series into Autoregressive Integrated Moving Average models to evaluate intervention impacts, with follow-up analyses to consider a 6-month transition period of policy implementation. Segmented linear regressions and Holt-Winter exponential smoothening models were used as sensitivity analyses. RESULTS: 36 689 dementia caregivers were included in this study, of which 14.4% caregivers were distress and 31.9% were long-hours caregivers after the policy intervention in April 2014. Providing additional caregiver service significantly reduced standardised rates of caregivers in distress (β (95% CI)=−3.93 (−7.85 to −0.01), p<0.05), but the effect was not sustained (p=0.183). There was no significant impact on the level of age-standardised rates of caregiver with long care time (β (95 CI)=−4.25 (−9.61 to 1.10), p=0.120). Also, there was no significant delay of intervention impacts. CONCLUSION: Our study finds that strengthening caregiver services provision could reduce distress rates among primary caregivers for older adults living with dementia. Expanding community services for caregiver could be a solution to the escalating burden of informal care for people living with dementia.