Investigating the economic case of a service to support carers of people with dementia: A cross-sectional survey-based feasibility study in England

Francesco Longo*, Rita Faria, Gillian Parker, Kate Gridley, Fiona Aspinal, Bernard van den Berg, Helen Weatherly

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


Carers contribute essential support to enable people with dementia to continue living within the community. Admiral Nurses provide specialist dementia support for carers of people with dementia, including offering expert emotional support and guidance, and work to join up different parts of the health and social care system to address needs in a co-ordinated way. The cost-effectiveness of this service is not clear. We undertook a feasibility study to explore related outcomes and costs for these carers. A cross-sectional, clustered survey was undertaken in England in 2017, in areas with and without Admiral Nursing (AN). The survey questionnaire included questions on the characteristics of the carers and the person with dementia, outcomes (care-related quality of life [CRQoL], self-efficacy and subjective well-being), use of health and social care services, out-of-pocket costs and time spent on informal care. We used different econometric techniques to compare the outcomes and the costs of the carers with and without AN services: linear regression, propensity score matching and instrumental variables analysis. These techniques allowed us to control for differences in observed and unobserved characteristics between the two groups of carers which determined outcomes and costs. We concluded that AN services might have a positive effect on carers' CRQoL, self-efficacy and subjective well-being. Furthermore, we found little difference in costs between carers using AN and those using usual care, or in the costs of the people with dementia they care for. Our findings provided an initial indication as to whether AN services could be good value for money. The key limitation of the study was the difficulty in controlling for unobserved characteristics because of the cross-sectional nature of our observational data. To diminish this limitation, our survey could be used in future studies following carers with and without AN services over time.

Original languageEnglish
Pages (from-to)e734-e743
JournalHealth and Social Care in the Community
Issue number5
Publication statusPublished - 1 Jan 2019


This project presents ?ndings from research funded by the National Institute for Health Research Health Services and Delivery Research Programme. The views and opinions expressed are those of the research team and do not necessarily re?ect those of the HS&DR Programme, NIHR, NHS or the Department of Health.

FundersFunder number
National Institute for Health and Care Research


    • Admiral Nursing
    • carers
    • costs
    • economic evaluation
    • outcomes
    • social care


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