**3. Results**

### *3.1. Demographic Characteristics of Persons with Dementia and Informal Caregivers*

Mean age among study participants with dementia was higher in Italy compared to Sweden (81.5 vs. 78.4, *p* < 0.001). Nonetheless, the largest age group in both countries was that of people between 80 and 89 years old (Table 1). Most people in both countries were female and living with their spouses. However, people with dementia in Sweden tend to live alone more frequently (47.2% in Sweden vs. 15.1% in Italy, *p* < 0.001). In Italy, it was frequent that a person with dementia lives with an adult child, which was really uncommon in the Swedish context (only in 1.1% of the cases). From a clinical and functional point of view, the Italian participants seem characterized by an overall worse condition. Cognitive function was slightly lower in Italy where the mean MMSE value is 17.8 (SD = 2.3) (vs. 19 ± 3.7 in Sweden). Additionally, the Italian group was characterized by a higher number of comorbidities as well as by higher level of dependency measured using the ADL and IADL scale.

The majority of informal caregivers were women, although in Italy women were more represented than in the Swedish context (68.8% vs. 52.3%). Caregivers in Italy were younger, and more often an adult child living with the person with dementia. In Sweden, the informal caregivers more often were spouses, which tend to be more frequently engaged in a working occupation.


**Table 1.** Baseline characteristics of persons with dementia and informal caregivers.


**Table 1.** *Cont*.

Data source for Sweden: TECH@HOME questionnaire. Data source for Italy: UP-TECH questionnaire; ADL, activities of daily living; IADL, instrumental activities of daily living; n, number of observations; MMSE, mini mental state examination; *p* value of significance; SD, standard deviation. a missing values, n = 6; b missing values, n = 2; c missing values, n = 4; d missing values, n = 1; e missing values, n = 3; f long term sick leave. \* *p* < 0.05 was regarded as significant; significant *p*-values are underlined. Underlined values indicate positive results, e.g., 0–30.

### *3.2. Resource Utilization by Persons with Dementia and Their Caregivers*

Results showed that the Swedish participants more frequently used healthcare and social service than the Italian sample, except for emergency care (Table 2). However, hospital admissions were more frequent in Sweden compared to Italy (5.6 vs. 1.6, *p* < 0.001). The most frequently used services in Sweden were day care centers (used by 39.8% of the sample), social services (65.9%) and home care (38.6%). In Italy, the main support for the people with dementia and their caregiver was the use of privately paid home help services (used by 28.7% of the sample).


**Table 2.** Resource utilization the last 30 days of healthcare and social services by persons with dementia.

Data source for Sweden: TECH@HOME questionnaire. Data source for Italy: UP-TECH questionnaire. ITA, Italy; *p*, *p*-value; SD, standard deviation; SWE, Sweden. a Median and interquartile range is only provided in case the variable was non-normally distributed: b missing values, n = 1; c missing values, n = 2. \* *p* < 0.05 was regarded as significant; significant *p*-values are underlined.

### *3.3. Time Spent in Informal Caregiving*

Italian informal caregivers spent significantly more time in all caring activities than Swedish ones and had a mean of 6.27 h per day (vs. 3.5 h per day spent by Swedish caregivers) (Table 3). In Italy, the number of hours spent in caregiving activities is higher when the person with dementia is a male (7.47 vs. 5.76, *p* = 0.006) and the caregiver is a female (6.49 vs. 5.81, *p* value is not significant). In both countries, the hours of caregiving provided increase with the level of dependency in ADL and IADL. Living with the person with dementia is not associated with a higher amount of care provided either in Sweden or in Italy.




**Table 3.** *Cont*.

Data source for Sweden: TECH@HOME questionnaire. Data source for Italy: UP-TECH questionnaire. HADS, hospital anxiety and depression scale; *p* = *p*-value; n.a, not applicable; *p*, *p*-value; PwD, person with dementia; MMSE, mini mental state examination; SD, standard deviation. \* *p* < 0.05 was regarded as significant; significant *p*-values are underlined. Underlining of values indicates positive results, e.g., 0–30.

The results of the multiple regression model showed that higher IADL dependence, working status of the caregiver, use of formal home care, and the country of origin were factors associated with the number of hours of informal care provided (Table 4). The lower the IADL dependence, the higher the amount of care provided (+4.6 h per day, among people with dementia with an IADL score between 44 and 48 (*p* < 0.001). Conversely, working carers provided 4.2 h less care compared to the non-working ones (*p* < 0.001). Compared to Italian couples not using any type of formal care support, those Italians using private care help provided - 1.8 h care/day. Being Swedish, even if not using home help from

the municipality, was associated with a reduction of the number of daily hours of care equal to 2.6 (*p* < 0.001).


**Table 4.** Factors associated with hours of informal caregiving.

Data source: TECH@HOME and UP-TECH questionnaire. ADL, activities of daily living; B (SE), Beta coefficient (standard error); CI, confidence intervals; MMSE, mini mental state examination; PwD, person with dementia. IADL, instrumental activities of daily living. Country of origin: 1 = Sweden, 0 = Italy. Living with the person with dementia: 1 = no, 0 = yes. Utilization of formal caregiver: 1 = yes, 0 = no. Informal caregiver actively working: 1 = yes, 0 = no. \* *p* < 0.05 was regarded as significant; significant *p*-values are underlined.
