Financial Toxicity in Dementia Caregiving: Sociodemographic Predictors in a U.S. Nationally-Representative Survey.

Abstract

Background & objectives: "Financial toxicity" describes the negative effects of medical expenses on financial security and health-related quality of life. Beyond dementia, financial toxicity is used to address the financial and health consequences of illness. Here, we utilize the Comprehensive Score for financial Toxicity (COST) to examine the experience of financial toxicity in dementia caregiving.

Research design & methods: We conducted a nationally-representative survey of 317 dementia caregivers. Financial toxicity was defined as COST <26 and categorized as mild (COST ≥14 & <26), moderate (COST >0 & <14), or severe (COST = 0). Nested multivariable regression examined potential predictors of financial toxicity. Mediation analyses were performed to assess whether the influence of basic caregiver demographic predictors were mediated by care recipient clinical characteristics, caregiver socioeconomic demographics, or relational characteristics.

Results: 52.7% of dementia caregivers in the U.S. experience financial toxicity. Of those, 73.1% endure mild, 25.7% moderate, and 1.2% severe toxicity. 69.5% of Black, 54.1% of Hispanic, and 42.3% of White caregivers report financial toxicity, with prevalence significantly higher in Black caregivers compared to White caregivers (p = 0.017). Older caregiver age was associated with less financial toxicity (p = 0.024). Caregiver employment status mediated this effect, with retirement associated with less financial toxicity (p <0.001) and unemployment associated with greater financial toxicity (p <0.001).

Discussion & implications: Most dementia caregivers in the US experience financial toxicity, with Black caregivers bearing the highest risk. Older caregiver age protects against financial toxicity, reflecting the relationship between age and employment status.