BackgroundExtremity injuries (EI) and dementia are important causes of long-term care (LTC), but they can also cause each other and are often present concurrently. Mobility-limiting EI can increase the risk of dementia, and dementia increases the risk for falls, which are often the cause of EI. When EI and dementia are present together, they can increase their negative effect on long-term care risk. This study aims to assess the strength of this interaction and the role of different body regions and severities of EI regarding LTC risk.MethodsWe use Cox proportional-hazard models on LTC as dependent variable. EI (primarily fractures) and dementia (all types) are the central independent variables. We control for age, sex, rehabilitation and 18 relevant comorbidities. Analyses are based on health claims records for 2004–2010 for a random sample of about 122.000 insurants of Germany's largest public health insurance "AOK" aged 65+, about 25.000 of whom entered LTC.ResultsWithout concurrent dementia, non-severe EI (NSEI) of the lower and both extremities and all kinds of severe EI (SEI) increase LTC risk (HR: hazard ratio with 95% confidence interval. Lower NSEI: HR = 1.09 [1.05–1.14]; both NSEI: HR = 1.36 [1.29–1.44]. Lower SEI: HR = 1.67 [1.57–1.79]; upper SEI: HR = 1.27 [1.19–1.37]; both SEI: HR = 1.94 [1.81–2.07]). Dementia alone increases LTC risk more than fourfold (HR = 4.23 [4.11–4.35]).Taking the interaction of EI and dementia into account, the concurrent presence of EI and dementia tends to increase the LTC risk more than expected for lower as well as upper NSEI and SEI. Summarily, when lower or upper EI and dementia are both present, the LTC risk tends to be higher than expected, suggesting synergistic effects.ConclusionsEI and dementia are important independent risk factors for long-term care. When lower or upper EI and dementia are present together, the resulting long-term care risk is increased disproportionately. Since the concurrent presence of both conditions increases the risk for care need, and a working treatment for dementia is not in sight, preventing EI, lessening the impact of EI and improving the outlook after an EI could help to reduce LTC need in the coming decades.

This paper uses rich administrative data from the Deutsche Rentenversicherung (German Pension Fund) to describe changes in the timing and the spacing of births that occurred in the period following German reunification. We examine differences in the birth dynamics of East Germans, West Germans, and women who migrated between the two parts of Germany in these years. As the pension registers provide monthly records on whether a person is living in East or West Germany, they also allow us to examine the role of regional mobility in birth behaviour. In particular, we test the “salmon hypothesis”, which suggests that migrants are likely to postpone having a child until after or around the time they return to their region of origin. Our investigation shows that a large fraction of the cohorts born in 1965-74 migrated to West Germany after reunification, but that around 50% of these migrants returned to East Germany before reaching age 40. The first birth risks of those who returned were elevated, which suggests that the salmon hypothesis explains the behaviour of a significant fraction of the East German population in the period following German reunification.

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In the more than two decades since German reunification, a convergence of total fertility rates in the eastern and western parts of the country has occurred. However, east-west differences remain in the timing, number, and spacing of births. The aim of this paper was to gain a better understanding of the relative importance of cultural norms and institutional contexts in the persistence of these differences by examining the fertility behaviour patterns of east-west migrants. Using data from the German Socio-Economic Panel for the years 1990-2011, and applying event history modelling, the first and second birth behaviour patterns of female east-west German migrants are compared to those of the non-mobile populations in the eastern and western parts of the country. The migrants' first and second birth risks were found to lie between those of non-mobile eastern and western Germans. It is known that migrants are a selected group with respect to their socio-economic characteristics, value orientations, and partners' characteristics. This selectivity appears to explain the second birth behaviour of migrants. For first births, the differences between the migrants and the eastern Germans were shown to be even greater after controlling for selective characteristics. For both birth orders, there is evidence for socialisation and adaptation effects, but not for progressive adaptation over time. The effect of an east-west migrant being partnered with a western German was accounted for, but did not seem to accelerate adaptation.

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