Economic Burden of Informal Caregivers for Elderly Chinese in Hong Kong

To the Editor: In Hong Kong, the majority of elderly people living in the community receive care from informal caregivers.1 Informal caregivers form the backbone of caregiving and provide unpaid daily assistance, especially for elderly people who are unable to afford paid caregivers. They are vital for the maintenance of elderly people with mental or functional limitations in the community, and their support saves society a large amount of resources. With the fast-growing elderly population, the extent and amount of caregiving of elderly people can give rise to a substantial economic burden on primary caregivers (PCGs). The objectives of this study were to describe the economic burden of PCGs for caring elderly people and to identify predictors of high PCG economic burden in Hong Kong. A cross-sectional telephone survey of the Hong Kong Chinese adult population aged 35 and older was conducted from January 2003 to July 2004.2 PCGs who provided unpaid assistance to an elderly person in at least one activity of daily living (ADL) or instrumental activity of daily living (IADL) and spent at least 4 hours per week in caregiving activities were identified. The care recipients were aged 65 and older and were household members, relatives, or friends with functional or cognitive impairment requiring assistance in ADLs or IADLs. Two hundred fifty-two PCGs were interviewed; 169 (67.1%) were female, and 133 (52.8%) were aged 35 to 49, 91 (36.1%) were aged 50 to 64, and 28 (11.1%) were aged 65 and older. The reported effect of caregiving on the work and finances of PCGs included income reduction (n=45, 17.9%), taking leave or absence from work (n=38, 15.1%), working part time (n=35, 13.9%), routinely leaving work early (n=27, 10.7%), and early retirement (n=22, 8.7%). Regarding self-reported monthly expenses (not including income loss) on caregiving over the previous 12 months, 84 (33.3%) PCGs spent less than $64 (HKD 500), 47 (18.7%) spent $64 to $128 (HKD 500–1,000), 88 (34.9%) spent $128 to $641 (HKD 1,001–5,000), 21 (8.3%) spent $641 to $1,282 (HKD 5,001–10,000), and 12 (4.8%) spent $1,282 (HKD 10,001) or more. The PCGs (n=114, 45%) and the Government Comprehensive Social Security Assistance (n=42, 17%) were the most commonly reported major sources of financial support for caregiving to elderly people. Associations between a number of factors and the monthly expense of caregiving (<$128 (HKD 1,000) vs ≥$128) were first evaluated using univariate analysis. These factors included demographics, social characteristics, tasks assisted by PCGs, duration and frequency of caregiving, the effect of caregiving on the work and finances of the PCGs, and the major source of financial support for caregiving. Approximately half of PCGs spent less than $128 and approximately half spent $128 or more, so the breakpoint of $128 was selected. A P-value <.05 was considered statistically significant. Univariate analysis indicated that 10 factors were significantly associated with monthly expenses of $128 or more (Table 1). These factors were further analyzed using stepwise multiple logistic regression analysis, which showed that higher level of education, administration of medications by the PCG, and reduced PCG income due to caregiving were significantly associated with monthly expenses of $128 or more. The data showed that PCGs in Hong Kong were the major source of financial support for caregiving to elderly care recipients in more than 40% of the households with elderly people. Nearly 50% of the PCGs claimed to spend $128 or more monthly, approximately 10% of the median monthly income in Hong Kong,3 although the accuracy of the self-reported expenditure has not been validated. More than half of the respondents also reported various effects of caregiving on work and income. This is consistent with findings that the financial effect of caregiving for elderly people was found in both income reduction and out-of-pocket expenses.4 Our findings further suggested that PCGs who reported income reduction due to caregiving for elderly people, provided assistance with medication administration and those caregivers with higher education level had higher monthly out-of-pocket expenses for caregiving. The present pilot study suggested that the economic burden of PCGs for elderly people in Hong Kong is potentially substantial. Future studies should further investigate the itemized spending of caregiving, such as cost of daily living and health-related spending. The effect of cognitive function and comorbidity of the elderly care recipients on the economic burden of caregivers should also be considered. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this letter. The study was supported by the Health Care and Promotion Fund, Health, Welfare and Food Bureau, Government of Hong Kong SAR (Ref: 218015) (Prof. S. Ho). Author Contributions: All authors contributed equally with all aspects of the study. Sponsor's Role: The supporting agency did not take part in any aspect of this letter.