caring for people with dementia caring for people with dementia as populations age, caring for people with dementia has become more common. elderly caregiving may consist of formal care and informal care. formal care involves the services of community and medical partners, while informal care involves the support of family, friends, and local communities. in most mild-to-medium cases of dementia, the caregiver is a spouse or an adult child. over time, more professional care in the form of nursing and other supportive care may be required medically, whether at home or in a long-term care facility. there is evidence that case management can improve care for individuals with dementia and the experience of their caregivers. furthermore, case management may reduce overall cost and institutional care in the medium term. millions of people living in the united states take care of a friend or family member with alzheimer’s disease or a related dementia. family caregivers the role of family caregivers is becoming increasingly important; care in the familiar surroundings of home may delay onset of some symptoms and postpone or eliminate the need for more professional and costly levels of care. however, home-based care may entail tremendous economic, emotional costs. family caregivers often give up time from work and forego pay in order to spend an average of 47 hours per week with an affected loved one, especially if they cannot be left alone. in a 2006 survey of patients with long-term care insurance, the direct and indirect costs of caring for an alzheimer's disease patient averaged $77,500 per year in the united states. caregivers themselves are subject to increased incidence of depression, anxiety, and in some cases, physical health issues. according to a uk-based study, almost two out of three caregivers of those with dementia feel lonely. most of the caregivers in the study were family members or friends. research shows that african americans face a more significant burden in alzheimer’s care management and will face more negative life changes and health outcomes due to providing care. african americans are twice as likely to be diagnosed with dementia than other ethnic groups, and caregivers often materialize as secondary patients due to the severe impact of caregiving on their health and well-being. additionally, according to the alzheimer’s association and nac/aarp, 60% of alzheimer’s disease and dementia caregivers are typically female and are 55 or older. this data emphasizes that african americans are disproportionately affected by alzheimer’s disease and other forms of dementia. schulz et al. concluded in a us study that "the transition to institutional care is particularly difficult for spouses, almost half of whom visit the patient daily and continue to provide help with physical care during their visits. clinical interventions that better prepare the caregiver for a placement transition and treat their depression and anxiety following placement may be of great benefit to these individuals." thommessen et al. found in a norwegian study that the most common stressors reported were "disorganization of household routines, difficulties with going away for holidays, restrictions on social life, and the disturbances of sleep..." and that this was common to carers for dementia, stroke and parkinson's disease patients. in a japanese study, hirono et al. assessed that "the patients' functional and neuropsychiatric impairments were the main patient factors which increased the caregiver's burden." activities are important for the dementia patient because it keeps them cognitive functioning. the caregiver should aid them in their activities, but should not do it for them. an italian study by marvardi et al. found "that patients' behavioral disturbances and disability were the major predictors of the time-dependent burden; the psychophysical burden was explained mainly by caregiver anxiety and depression." caregivers may experience anticipatory grief and ambiguous loss, and research shows that african american caregivers are less likely to seek help for grief and depression than their caucasian counterparts. furthermore, physiological changes such as increased cortisol levels, the body’s primary stress hormone, contribute to impaired cognitive function, perpetuating the problem of alzheimer’s disease within the african american community since stress is a known causal. while family caregivers often care for patients with dementia at home, they also provide a helpful function within nursing or residential aged care facilities. findings from a 2021 systematic review found caregivers of these patients in nursing homes with dementia do not have sufficient tools or clinical guidance for helping to manage multiple interventions, such as behavioral and psychological symptoms of dementia (bpsd) and medication use. nurses should provide information to the caregiver on how to take care of the dementia patient so the caregiver does not neglect them. respite or day care caring for someone with dementia is accompanied by many emotional and physical challenges. respite care is designed to give rest or relief to caregivers and can take place in many different settings depending on the needs of those involved. respite services are offered at adult daycare facilities, nursing homes, or in-home. a 2014 study did not report any benefits or detrimental effects from the use of these interventions. however, these results may be due to the lack of high quality studies in this field. according to a more recent 2016 review, respite services provided to families caring for a family member with dementia had positive effects such as stress reduction, increased time for relaxation, socialization, and focusing on personal tasks. this is an important finding as caregivers often experience burnout.