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Predictive Factors for the Objective Burden of Informal Care in People With Dementia: A Systematic Review

Wolfs, Claire A. G. PhD*; Kessels, Alfons MD, MSc; Severens, Johan L. PhD†,‡,§; Brouwer, Werner PhD§; de Vugt, Marjolein E. PhD*; Verhey, Frans R.J. PhD, MD; Dirksen, Carmen D. PhD

Alzheimer Disease & Associated Disorders:
doi: 10.1097/WAD.0b013e31823a6108
Review Article

Background: Informal care plays a substantial role in the provision of total care in dementia. Several reviews have been published on the predictive factors of subjective burden; however, such a review lacks information on objective burden, which refers to the amount and/or costs of informal care.

Objectives: The objectives of this study were to (1) give an overview of the predictive factors that are associated with the objective burden of informal care; (2) discuss whether these factors are similar to the predictive factors of subjective burden; and (3) examine whether they are modifiable.

Design: The literature in a number of international databases was systematically searched. Methodological quality and level of certainty were assessed.

Results: Ten studies were identified as relevant for the purpose of this review, describing a total of 39 predictive factors. Three factors (behavioral problems and impairments regarding daily functioning and cognition) were considered to be predictors of objective burden. Three factors were not related; 12 were potential predictors; and the results of the remaining 22 factors were inconclusive.

Conclusions: Many factors were found to be (potential) predictors of objective burden, reflecting its complex nature. Objective and subjective burdens are 2 different relevant aspects of informal care. Interventions aimed at countering behavioral problems and impairments regarding daily functioning could reduce objective burden.

Author Information

*Department of Psychiatry and Neuropsychology, Maastricht University, School for Mental Health and Neuroscience (MHeNS)/Alzheimer Centre Limburg

Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre (MUMC+)

Department of Health Organisation, Policy and Economics, Maastricht University, Maastricht

§Institute of Health Policy & Management (iBMG) and Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands

This study was funded by the Dutch Research Institute for Care-Medical Sciences.

The authors declare no conflicts of interest.

Reprints: Claire A. G. Wolfs, PhD, Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre (MUMC+)/Alzheimer Centre Limburg, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands (e-mail:

Received February 9, 2011

Accepted July 23, 2011

© 2012 Lippincott Williams & Wilkins, Inc.