BACKGROUND: While fragility fractures result in significant healthcare expenditure, the (in)direct costs of fracture-related informal care are rarely acknowledged. This study quantifies the economic value of informal care and the financial burden among working-age caregivers of older adult patients following a fracture-related hospital admission.
METHODS: This longitudinal cohort study included working-age (<67 years) informal caregivers of patients aged ≥ 65 years who were admitted for any fracture. Caregivers reported pre-fracture caregiving details and at 2 weeks, 4 weeks and 3 months post-discharge. The primary outcome measure was the economic value of informal care in Euro (€) per week, estimated using the opportunity cost method. Secondary outcomes included a composite financial burden score ranging from 0 (low) to 6 (high) and dichotomized (low vs. high) financial worry score. Linear mixed models were constructed to assess associations of time and caregiver/patient characteristics with informal caregiving costs.
RESULTS: The 67 included caregivers were on average 54 years old, mostly female (66%), and patients' children (79%). Mean weekly informal care costs were €91.66 (95%CI 54.62-128.71) before admission, €244.80 (95%CI 164.62-342.99) at 2 weeks, €214.57 (95%CI 149.46-279.68) at 4 weeks, and €133.58 (95%CI 92.01-175.16) at 3 months post-discharge. In linear mixed models, caregiving costs were significantly higher at 2 weeks (243%), at 4 weeks (286%), and at 3 months post-discharge (115%), compared to baseline. Adjusted for time, costs were significantly associated with pre-fracture Katz-ADL (p = .003), caregiver age (p = .007), impaired patient mobility (p = .013), and rib or upper extremity fractures (p = .043) compared to hip fractures. Mean financial burden composite score were 0.06 (SD 0.39) pre-fracture, and 0.03 (SD 0.25), 0.10 (SD 0.55), and 0.02 (SD 0.13) at 2 weeks, 4 weeks, and 3 months post-discharge, respectively. High financial worry was reported only once by a single caregiver at 2 weeks post-discharge.
CONCLUSION: Informal care provided by working-age healthcare proxies has considerable economic value, especially during the first month post-discharge, following a fracture-related admission of older adults. Nevertheless, caregivers rarely reported financial burden or worry. The large variation in caregiving intensity and high proportion of female caregivers may reflect inequality between individual informal caregiving responsibilities.
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