Caregiving and Older Floridians

Transcription

1 Caregiving and Older Floridians Brad Cannell Florida Office on Disability and Health University of Florida August 1, 21 [Type the abstract of the document here. The abstract is typically a short summary of the contents of the document.] [Company Address]

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3 Prepared by: Brad Cannell, MPH Graduate Research Assistant Erin DeFries Bouldin, MPH Project Epidemiologist Claudia T. Kusano, MPH Graduate Research Assistant Claudia Tamayo, MPH Project Manager Elena M. Andresen, PhD Professor and Director For additional information, please contact: Florida Office on Disability and Health PO Box 1231 Gainesville, FL Phone: (352) Fax: (352) Funded by: This project was funded by a grant from the National Center on Birth Defects and Developmental Disabilities of the Centers for Disease Control and Prevention (#U59 DD273). Acknowledgements: We would like to thank Youjie Huang and Melissa Murray from the Florida BRFFS Office for their helpful support. i

4 Table of Contents INTRODUCTION 1 METHODS 2 RESULTS 3 CHARACTERISTICS OF CAREGIVERS 3 CHARACTERISTICS OF CARE RECIPIENTS 5 FIGURE 1. MEAN AGE OF CARE RECIPIENTS, FLORIDA, FIGURE 2. GENDER OF CARE RECIPIENTS, FLORIDA, FIGURE 3. CARE RECIPIENT S RELATIONSHIP TO THE CAREGIVER, FLORIDA, FIGURE 4. MAJOR HEALTH PROBLEM EXPERIENCED BY THE CARE RECIPIENT, FLORIDA, FIGURE 5. AREAS CARE RECIPIENTS NEED ASSISTANCE, FLORIDA, FIGURE 6. PERCENT OF CARE RECIPIENTS WHOSE MEMORY OR THINKING INTERFERES WITH QUALITY OF LIFE, FLORIDA, FIGURE 7. PERCENT OF CARE RECIPIENTS THAT HAVE HAD THINKING OR MEMORY PROBLEMS EVALUATED BY A PHYSICIAN, FLORIDA, DISCUSSION 9 REFERENCES 1 TABLE 1. WEIGHTED DEMOGRAPHIC AND HEALTH BEHAVIOR CHARACTERISTICS FOR CAREGIVERS AND NONCAREGIVERS, FLORIDA BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS), TABLE 2. CHARACTERISTICS OF CARE RECIPIENTS, FLORIDA BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM, ii

5 28 Caregiver Report Introduction, for the purposes of this report, are individuals who provide regular unpaid care or assistance to a family member or friend with a longterm illness or disability. Approximately 65.7 million people, impacting about 31% of all American households, nationwide have served as a caregiver in the past 12 months. 1 It has been estimated that the care provided by these individuals adds up to between $167 and $354 billion in unpaid care. 2 This integral, and often overlooked and underappreciated, part of our nation s longterm care infrastructure is likely to become more important in the coming decades for a combination of reasons. Our population is aging, and as the population of aging adults increases so does the need for caregivers. According to US Census Bureau projections, the age profile of Florida will change considerably by the year 23. In 2, 17.6% of Floridians, or 2.8 million people, were age 65 or older. This age group is expected to grow to 7.8 million people, or 27.1% of Florida s population, by As age increases, so too does the proportion of adults that experience activity limitations. 4 As these increasingly large numbers of older adults experience activity limitation, many of them will rely on informal caregivers for assistance. Finally, there is growing support for communitybased and aginginplace programs for older adults in the United States that prevent older adults from moving to institutional settings. Programs of this type rely heavily on the contributions of informal caregivers. Having an accurate understanding of who caregivers are and what hardships they face is important for many reasons. Perhaps the most important is the mounting evidence of the physical and emotional toll that caregivers pay. Studies consistently show that many caregivers report poorer health and higher stress as a result of caregiving. 1, 5, 6 At especially high risk are those who have the highest levels of caregiving demands, are already experiencing physiologic problems, are under the greatest amount of stress, and are caring for individuals with Alzheimer s disease or another form of dementia. 6, 7 Additionally, at least one study published in the Journal of the American Medical Association reports caregiving as an independent risk factor for mortality, even when controlling for disease and other risk factors. 7 Another important reason to better describe and understand caregiving is the impact it has on Florida's workforce. Multiple recent studies funded by the MetLife foundation have found that the relationship between caregiving and work is bidirectional. In other words, taking on the task of becoming a caregiver makes one less likely to be employed, while at the same time, being employed makes one less likely to become a caregiver. 8 Accurately measuring the proportion of caregivers who are employed is essential to understanding the impacts caregiving has on the workforce. It has been estimated that as many as 73% and as few as 32% of caregivers remain employed at least parttime after assuming caregiving responsibilities. 1, 9 One study estimates that adjustments to work schedules absenteeism, shifts to parttime employment, employee replacement, and workday interruptions cost American employers somewhere between $17.1 and $33.6 1

6 billion annually. 1 But indirect costs due to shifts in working patterns of employees are not the only costs to business. We know that caregiving itself is a risk factor for poorer health outcomes among caregivers. Understanding the health burden employment or changes in employment place on the caregiver is an important element in estimating these costs. Healthy People 21 and 22 both include objectives to conduct public health surveillance and health promotion programs for people with disabilities and caregivers. 11, 12 State and federal agencies as well as private organizations are concerned about issues surrounding caregiving and could employ populationbased caregiving data to design needed programs and interventions to address this increasingly important public health issue. Many community and public health groups also express interest in specific conditions as they relate to caregiving notably cancer, Alzheimer s disease and dementia, and developmental disabilities. Thus, there is an emerging and increasing audience requiring this information. Learning more about caregivers and how their caregiving activities impact their risk of poor health outcomes will improve our understanding of how to provide support to them, in turn improving the ability of care recipients to maintain independence and experience an improved quality of life. Methods This report on caregiving in Florida utilizes data from the 28 Florida Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is an annual telephone survey which collects demographic, health behavior, health outcome, and health care access data from randomly dialed noninstitutionalized adults age 18 and over in the United States and its territories. It consists of a core section of questions administered nationally and separate modules that states may choose to use. 13, 14 States may also design their own questions to include on the BRFSS. The survey is administered through state and territorial health agencies with assistance from the CDC. The data are weighted so respondents represent the population of their state based on gender, race, and age, making results generalizable to the entire state. During the past four years, the National Center on Birth Defects and Developmental Disabilities (NCBDDD) at the Centers for Disease Control and Prevention (CDC) has made a systematic attempt to identify and describe caregivers as part of the total health care system, and to identify public health dimensions of caregiving. One result of this work has been the development of the Caregiver Module, a series of questions about caregivers and their experiences that can be added to the BRFSS. 15 In 28, Florida had 1,874 respondents to the annual BRFSS, of which 94% (n=1,217) indicated whether or not they were a caregiver. 14% (n=1,461) of those that answered the caregiving question identified themselves as a caregiver. These respondents then answered the remaining Caregiver Module questions about themselves and their care recipient. (Note: if the caregiver reported providing care to more than one recipient, the caregiver was asked to answer the remaining questions based on the recipient who required the most care). 2

7 1,874 1,217 1,461 Total number of respondents to the 28 Florida BRFSS Number of respondents that answered the caregiving question Number of respondents indentihied as caregivers Questions on the Caregiver Module include the age and gender of the care recipient and their relationship to the caregiver. Module questions also assess the major health problem of the care recipient, and up to two areas in which the care recipient requires the most assistance. Other questions ask the caregiver how long they have provided care for the recipient, the average number of hours per week they provide care, how far they live from their care recipient, and their greatest difficulty faced as a caregiver. Finally, the Caregiver Module asks whether she has any concerns about the care recipient s memory or thinking, whether memory or thinking problems interfere with the care recipient s daily activities or quality of life, and whether the care recipient s memory or thinking has ever been formally evaluated by a health care professional. The sampling design used by the Florida BRFSS in 28 did not allow for descriptions at the county level as has been possible in other years. Finally because the purpose of this report is not only to understand caregiving in general, but to also better understand the impacts of caregiving among Florida s older adults, results are presented in the following categories: caregivers overall, noncaregivers overall, caregivers who are 6 or older caring for someone who is also 6 or older, caregivers who are 6 or older caring for someone younger than age 6, and caregivers under age 6 caring for someone who is 6 or older. All data reported are weighted to reflect the entire population of the state. Analyses were conducted using SAS version 9.2. Results Characteristics of In this sample there were 532 caregivers that were age 6 or over and cared for someone age 6 or above, 9 caregivers that were age 6 or over and cared for someone below age 6, and 552 caregivers that were under age 6 and cared for someone age 6 or above. The mean age of both caregivers and noncaregivers was 48 years old. under age 6 were equally likely to be male or female, while caregivers age 6 and over were more commonly female (64% of those caring for someone age 6 and over and 6% of 3

8 those caring for someone under age 6). All caregivers most commonly reported their race and ethnicity as white, nonhispanic (6184%); however, caregivers age 6 and over were less likely to report Hispanic ethnicity than caregivers under age 6. age 6 and over who cared for someone under age 6 had lower levels of education and income compared to other caregivers. Education levels were similar across all categories of caregivers except one: over 6 and caring for someone under 6 tended to have less formal education (23% did not graduate high school vs. 9% of caregivers overall). A similar trend is also present in income. While the distribution of income level is similar across most categories, caregivers age 6 or older and caring for someone under age 6 were more likely to be in the lowest income category than caregivers overall (26% vs. 15%). over age 6 were less likely to be employed than caregivers overall or noncaregivers; they were also much more likely to be retired. Only 27% of caregivers age 6 and older who cared for someone over 6 were divorced, separated, or widowed, while 49% of those 6 and older who care for someone under age 6 were divorced, separated or widowed. Not surprisingly the group with the highest proportion of never married individuals was the caregivers who were under age 6 (29%). Finally, caregivers age 6 and over had a higher proportion of veterans (19% of those caring for someone 6 and over and 3% of those caring for someone under 6) than caregivers under age 6 (9%). In addition to analyzing demographic information about Florida s caregivers, using the BRFSS also allows us to explore information about Health Related Quality of Life (HRQL) and selfreported health behaviors. were more likely to have a disability than noncaregivers, and caregivers age 6 and over had the highest frequency of disability (34% of those caring for someone age 6 and over and 37% of those caring for someone under age 6, compared with 23% of caregivers under 6 and 2% of noncaregivers). who were 6 and over caring for someone under age 6 had the highest proportion of individuals reporting that they always or usually received the emotional support needed (87%). However, they also have the lowest proportion reporting a high level of satisfaction with life (88%), the lowest proportion reporting good or better health (78%), the lowest proportion engaging in physical activity outside of work (74%), the highest proportion of obese individuals (32%), and the highest proportion of current smokers (3%). We were also curious as to whether or not satisfaction with life was correlated with reporting a lack of time for self as one of the primary difficulties of being a caregiver, and it was not (correlation coefficient =.236). All categories of caregivers were less likely to report being a heavy drinker than noncaregivers. However, binge drinking varied dramatically across caregiver categories. Those who were age 6 and over caring for someone who is 6 and over is almost onethird as likely to report being a binge drinker than caregivers who are under age 6 and caring for someone over age 6 (6% compared to 17%). who were age 6 and over had at least twice the proportion (64% of those caring for someone age 6 and above and 47% of those caring for someone under age 6) of individuals reporting they had received a flu vaccine as caregivers under age 6 (24%). While caregivers age 6 and over had a higher proportion of individuals reporting having fallen in the past 3 months (16.4% of those caring for someone age 6 or above and 14.7 for those caring for someone under age 6), it was similar to the proportion of falls among individuals who 4

9 were age 6 or above and not a caregiver (13.3%, not shown in table 1). However, caregivers under age sixty had a much lower proportion of individuals that experienced falls in the last 3 months (9.7%). The proportion of those injured from the fall was similar across all groups (. Those age 6 and above who cared for someone over age 6 faced the lowest financial barrier to seeing a physician (5%) compared to individuals in the other two groups of caregivers (29% and 23%). who were 6 and over were most likely to have been a caregiver for 5 years or more (37% and 47%), whereas caregivers who were under age 6 were most likely to have been a caregiver for 1 to 12 months (31%). A greater proportion of caregivers who were 6 and older caring for individuals who were under 6 spent the greatest amount of time with care recipients (35% are spending 3 hours or more per week). who were 6 and older and caring for someone under 6 had the highest proportion of individuals experiencing financial burden as one of their main difficulties (37%). This group also had the largest proportion of individuals who reported that caregiving did not leave enough time for themselves (35%) or that it interfered with work (18%). Also of interest was looking at the relationship between caregiver stress and Alzheimer s disease. Although 7.4% of caregivers that said that the stress created by caregiving was one of their top two difficulties were caring for someone with Alzheimer s disease or dementia, this was still lower than cancer (21%) and arthritis (12%). 6 and over have a proportionately higher amount of individuals living with care recipients (47% and 44%) than do caregivers under age 6 (34%). Finally, caregivers who were over age 6 had proportionately fewer individuals who were concerned about the memory or thinking ability of the care recipient (4% and 43%) than do caregivers who are under age 6 (56%). Characteristics of Care The gender profiles for all caregiver/recipient categories were similar, and consisted of a proportionately higher amount of female care recipients. age 6 and over who cared for a person age 6 or older most commonly provided care for a parent or parentinlaw (32%), a spouse (31%), or a friend or client (27%). age 6 and over who cared for a person under 6 most frequently provided care for a child (44%), a friend or client (3%), or a spouse (7%). under age 6 who cared for someone age 6 and over most often cared for a parent or parentinlaw (58%), a grandparent (19%), or a friend or client (16%). 5

10 Figure 1. Mean Age of Care, Florida, All Cagivers 6+, 6+ Cagivers 6+, <6 Cagivers <6, 6+ Figure 2. Gender of Care, Florida, Percent Male Female 1 All Cagivers 6+, 6+ Cagivers 6+, <6 Cagivers <6, 6+ 6

11 Figure 3. Care Recipient s Relationship to the Caregiver, Florida, Percent Grandparent Parent or Parent in law Spouse Sibling Child 1 All Cagivers 6+, 6+ Cagivers 6+, <6 Cagivers <6, 6+ Grandchild Other Relative Friend or Client Cancer was the most common health condition that necessitated care for recipients regardless of age (14% of care recipients age 6 and over and 15% of care recipients under age 6). Other common conditions among care recipients included arthritis (7% of recipients 6 and over whose caregivers were also 6 and over, 13% of recipients 6 and over whose caregivers were under 6, and 9% of recipients under 6) and heart disease (8% of recipients 6 and over whose caregivers were also 6 and over, 6% of recipients 6 and over whose caregivers were under 6, and 9% of recipients under 6). Alzheimer s disease was common among care recipients age 6 and older (13% of those with caregivers 6 or older and 1% of those with caregivers under age 6). Figure 4. Major Health Problem Experienced by the Care Recipient, Florida, Percent Alzheimer s disease Arthritis Cancer Cerebral Palsy All Cagivers 6+, 6+ Cagivers 6+, <6 Cagivers <6, 6+ Diabetes Heart Disease Stroke Traumatic Brain Injury 7

12 The needs of care recipients were similar across categories. Most often, care recipients needed assistance with moving around (41% of recipients 6 and over whose caregivers were also 6 and over, 48% of recipients 6 and over whose caregivers were under 6, and 39% of recipients under 6) or with selfcare activities like eating, bathing, and dressing (4% of recipients 6 and over whose caregivers were also 6 and over, 3% of recipients 6 and over whose caregivers were under 6, and 4% of recipients under 6). Care recipients under age 6 were more likely to need assistance with feeling anxious or depressed (31%) while recipients age 6 and over more frequently needed assistance with learning, remembering, and confusion (23% of recipients 6 and over whose caregivers were also 6 and over and 2% of recipients 6 and over whose caregivers were under 6) and with seeing or hearing (1% of recipients 6 and over whose caregivers were also 6 and over and 13% of recipients 6 and over whose caregivers were under 6, compared to 4% of care recipients under age 6). The proportion of recipients reported as having memory or thinking problems that interfered with their quality of life was slightly lower among care recipients age 6 and over with caregivers age 6 and over (34%) than among other recipients (44% of care recipients age 6 and over with caregivers under age 6 and 46% of care recipients under age 6). The proportion of care recipients who were reported as having their memory or thinking evaluated by a physician was similar across all groups (5658%). Figure 5. Areas Care Need Assistance, Florida, 27. Percent Learning, remembering, & confusion Seeing or hearing Self care (such as eating, bathing, dressing) Communicating with others 1 All Cagivers 6+, 6+ Cagivers 6+, <6 Cagivers <6, 6+ Moving around Getting along with people Feeling anxious or depressed 8

13 Figure 6. Percent of Care Whose Memory or Thinking Interferes with Quality of Life, Florida, All Cagivers 6+, 6+ Cagivers 6+, <6 Cagivers <6, 6+ Figure 7. Percent of Care that have had Thinking or Memory Problems Evaluated by a Physician, Florida, All Cagivers 6+, 6+ Cagivers 6+, <6 Cagivers <6, 6+ Discussion There were many similarities and some notable differences among caregivers in Florida based on their ages and the age of their care recipients. were similar in life satisfaction, emotional support, and the type of care provided. Differences existed in demographic variables and in some attributes of the caregiving experience. The 9

14 difference in gender, race, and ethnicity between caregivers age 6 and older and caregivers under age 6 should be considered when designing and delivering services to caregivers of different ages. As the state becomes more diverse and more older adults require caregivers, it is likely that the profile of caregivers will increase in diversity as well. The higher prevalence of disability among caregivers, particularly older caregivers, is potentially a concern because individuals who may need assistance themselves are providing care to others. If the health or physical ability of these caregivers falter it is possible that two individuals would require assistance (the caregiver and the care recipient). Likewise, caregivers may need additional financial support to maintain their health; caregivers under age 6 and caregivers age 6 and older caring for someone under age 6 more frequently reported not being able to see a doctor because of cost. If caregivers neglect their own health it may be detrimental to the care recipient. In our sample roughly 59% of Floridians who were caregivers also were employed at least parttime. However, among those who provided 2 or more hours of care per week, only 48% worked at least parttime. This is important to note because it has been reported that caregivers often have to make major work adjustments once their caregiving reaches 2 hours per week. 8 These work adjustments can result in increased stress and a decrease in annual income. In this report, as respondents are subcategorized based on their characteristics (see table 1), the small number of people who meet that criteria can lead to our providing descriptive percentage estimates based on small or undetectable frequencies. In cases where a is reported in the table, the data should not be interpreted to mean that no one in the state of Florida experiences a health event we report on, but that the sample size was not sufficient to statistically detect or estimate the small frequencies. As such, the estimates provided in this report should be interpreted with some caution, since the precision of each statistic varies by the size of the group of respondents. This is particularly true of the column for caregivers age 6 and over providing care for someone under age 6 since estimates are based on information collected from only 9 respondents. References 1. National Alliance for Caregiving and AARP. Caregiving in the U.S. 29. Washington, DC: National Alliance for Caregiving and AARP; AARP Public Policy Institute. Valuing the Invaluable: A New Look at the Economic Value of Family Caregiving. Washington, DC: AARP Public Policy Institute; US Census Bureau. US Population Projections, Table 5: Interim Projections: Population under age 18 and 65 and older: 2, 21, and 23. 1

15 Published April 25. Accessed August U.S. Department of Health and Human Services, Center for Disease Control and Prevention, National Center for Health Statistics. Health, United States, 28 with Chartbook. Hyattsville, MD: U.S. Government Printing Office National Alliance for Caregiving and AARP. Caregiving in the U.S. 24. Washington, DC: National Alliance for Caregiving and AARP; Pinquart M, Sörensen S. Correlates of physical health of informal caregivers: A metaanalysis. J Gerontol B Psychol Sci Soc Sci. 27 Mar;62(2):P Schultz R, Beach SR. Caregiving as a risk factor for mortality: The caregiver health effects study. JAMA Dec 15;282(23): Albert SM, Schulz R, Colombia A. The MetLife Study of Working and Employer Health Care Costs: New insights for Reducing Health Care Costs for Employers. New York: MetLife; Wolff JL, Kasper JD. of frail elders: Updating a national profile. Gerontologist. 26 Jun;46(3): MetLife Mature Market Institute and National Alliance for Caregiving. The MetLife Caregiving Cost Study: Productivity Losses to U.S. Business. Published July 26. Accessed August US Department of Health and Human Services. Healthy People 21 (conference ed, in 2 vols). Washington, DC: US Department of Health and Human Services; US Department of Health and Human Services. Proposed Healthy People 22 Objectives. Updated October 29. Accessed August Gentry EM, Kalsbeek WD, Hogelin GC, et al. The behavioral risk factor surveys: II. Design, methods, and estimates from combined state data. Am J Prev Med Nov Dec;1(6): Remington PL, Smith MY, Williamson DF, et al. Design, characteristics, and usefulness of statebased behavioral risk factor surveillance: Public Health Reports 13(4) Neugaard B, Andresen EM, DeFries EL, et al. The characteristics of caregivers and care recipients: North Carolina, 25. MMWR 27; 56(21):

16 Table 1. Weighted demographic and health behavior characteristics for caregivers and noncaregivers, Florida Behavioral Risk Factor Surveillance System (BRFSS), 28 Overall (n=1,461) Non Overall (n=8,756) (n=532) 6+ <6 (n=9) <6 6+ (n=552) Demographic Characteristics Age (Mean Years) Age categories (%) Gender (%) Male Female Race / Ethnicity (%) White, nonhispanic Black, nonhispanic Hispanic Other racial groups, non Hispanic Education status (%) Less than high school High school graduate Some college College graduate Household income (%) $19,999 or less $2, to $24,999 $25, to $34,999 $35, to $49,999 $5, to $74,999 $75, or more Missing Employment status (%) Employed for wages Unemployed Retired

17 Marital status (%) Married or coupled Divorced, widowed, or separated Never married Overall (n=1,461) Non Overall (n=8,756) (n=532) <6 (n=9) <6 6+ (n=552) Veteran (%) Health Indicators and Health Behaviors Has disability (%) Very satisfied or satisfied with life (%) Always or usually receive the emotional support needed (%) Excellent, very good, or good general health (%) Engage in physical activity outside of work (%) Body Mass Index (%) Neither overweight nor obese Overweight Obese Smoking status (%) Current smoker Former smoker Never smoked Heavy drinker (%) Binge drinker (%) Had flu vaccine (%) Had fall (%) 12.8 Injured from fall (%) Could not see doctor because of cost in past year (%)

18 Caregiving Duration (%) 1 month or less 1 12 months 1 year 2 years 3 5 years 5 years Weekly time spent on caregiving (%) 9 hours 1 2 hours hours 3 hours or more Caregiver difficulty (%) 4 Financial burden Not enough time for self Not enough time for family Interferes with work Creates or aggravates health problems Affects family relationships Creates stress Other Distance from care recipient (%) In same house < 2 minutes away 2 6 minutes away 1 2 hours away More than 2 hours Concerns about care recipient s memory or thinking (%) Overall (n=1,461) Non Overall (n=8,756) (n=532) <6 (n=9) <6 6+ (n=552) Heavy drinkers: Adult men having more than two drinks per day and adult women having more than one drink per day. 2. Binge drinkers: Adult men having five or more drinks on one occasion and adult women having four or more drinks on one occasion. 14

19 3. The denominator used to attain the proportion of those injured from falls, were caregivers who reported a falling incident, as opposed to all caregivers. 4. were asked to identify the two greatest difficulties they experience as a result of caregiving. For example, 23.7% of caregivers overall said that the financial burden of caregiving was either their first or second biggest difficulty. This should not be interpreted to mean that the other 76.3% of caregivers overall experience no financial burden from caregiving. Table 2. Characteristics of Care, Florida Behavioral Risk Factor Surveillance System, 28 Overall (n=1,461) (n=532) 6+ <6 (n=9) <6 6+ (n=552) Age (Mean Years) Age (%) < Gender (%) Male Female Relationship to Caregiver (%) Grandparent Parent or Parentinlaw Spouse Sibling Child Grandchild Other Relative Friend or Client

20 Major health problem (%) 1 Alzheimer s disease Arthritis Cancer Cerebral Palsy Diabetes Heart Disease Stroke Traumatic Brain Injury Care recipient needs help with (%) 2 Learning, remembering, & confusion Seeing or hearing Self care (such as eating, bathing, dressing) Communicating with others Moving around Getting along with people Feeling anxious or depressed Memory or thinking interferes with quality of life (%) Had memory or thinking problems evaluated by a physician (%) Overall (n=1,461) (n=532) <6 (n=9) <6 6+ (n=552) Only selected, frequently reported, health problems listed in this table; however, other health problems were reported by respondents. 2. were asked to identify the two areas that the person they provide care for requires the most help with. For example, 2.% of care recipients overall were reported as needing help with learning, remembering, and confusion; however, it is possible that if more than two selections were allowed the frequency would be higher. 16