Clinical and Functional Determinants of Caregiver Burden in Elderly Patients with Atopic Dermatitis: A Multicentre...

This multicentre cross-sectional study aimed to quantify caregiver burden among elderly patients with atopic dermatitis (AD) and to identify its principal clinical, functional, and symptomatic determinants. Specifically, we evaluated the relative contributions of functional impairment, caregiving intensity, and inflammatory severity to overall caregiver burden.

A total of 213 patient-caregiver dyads were consecutively recruited from four tertiary dermatology centers in Italy. Eligible patients were aged ≥65 years with dermatologist-confirmed AD. Clinical assessments were performed by board-certified dermatologists at each participating centre and included the Eczema Area and Severity Index (EASI), body surface area (BSA), pruritus and sleep disturbance (numeric rating scales), comorbidities, and functional status measured by Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). Caregivers completed a structured questionnaire on caregiving responsibilities and the Caregiver Burden Inventory (CBI). Associations were examined using Spearman correlation and multivariable linear regression models.

Patients had a mean age of 73.3 ± 7.3 years and moderate disease severity (mean EASI 13.3 ± 11.2). Functional impairment was common (median ADL 4.0), and caregivers reported a median of 2.5 daily hours of assistance. Overall burden was moderate (mean CBI 32.0 ± 14.0). CBI correlated most strongly with ADL impairment (ρ = -0.50) and daily caregiving hours (ρ = 0.47), with additional associations for sleep disturbance (ρ = 0.35) and EASI (ρ = 0.31). In multivariable analysis, ADL impairment (p < 0.001), caregiving hours (p = 0.031), sleep disturbance (p < 0.001), and EASI (p = 0.005) remained independently associated with burden; pruritus was not significant after adjustment.

Caregiver burden in elderly AD is primarily driven by functional dependence and caregiving intensity, with additional contributions from sleep disturbance and inflammatory severity. Integrating functional assessment and caregiver-focused strategies into routine care may improve outcomes for both patients and caregivers.