Economic burden of long-term care of the elderly and its determinants among the caregivers in Sarawak : a quantitative study

Abstract

Introduction: Malaysia’s transition towards an ageing society has intensified the demand for long-term elderly care, placing substantial economic pressure on informal caregivers. Despite strong cultural expectations of family-based caregiving, rising healthcare utilisation, prolonged duration of care, and productivity loss have increasingly challenged the sustainability of this care model. This study aimed to estimate the economic burden of long-term elderly care among caregivers in Sarawak and to identify its determinant factors. Methods: A cross-sectional quantitative study design was employed involving 239 caregivers recruited from selected nursing homes and caregiver support platforms in Sarawak. Data were collected using a structured questionnaire covering caregiver characteristics, service utilisation, direct medical costs, direct non-medical costs, and indirect costs related to productivity loss. Prior to data collection, the questionnaire underwent content validity assessment by five experts using the Content Validity Index (CVI) and face validity assessment involving ten participants to ensure clarity and comprehensibility. Data analysis included descriptive statistics, bivariate analyses, and multiple linear regression. Results: The estimated annual economic burden per caregiver ranged from RM 600 to RM 474,893 (USD 142– 112,365), with a mean of RM 90,408 (USD 21,392). Direct healthcare costs constituted the largest proportion of total expenditure, particularly inpatient services and institutional care, while indirect costs reflected substantial productivity losses. Multiple linear regression analysis identified duration of care, type of healthcare services utilised, employment status, and household income as significant determinants of economic burden. Conclusion: Caregivers of older persons in Sarawak experience a substantial economic burden associated with long-term care, driven by both direct healthcare expenditures and indirect productivity losses. These findings underscore the need for targeted policy interventions, including financial assistance, healthcare subsidies, and caregiver support programmes, to reduce the economic strain on families and enhance the sustainability of long-term elderly care in Malaysia.