Extremity injuries and dementia disproportionately increase the risk for long-term care at older age in an analysis of German Health Insurance routine data for the years 2006 to 2010

Barth, Alfred; Vatterrott, Anja; Zhou, Ying; Fink, Anne; Doblhammer, Gabriele

doi:10.1186/s11556-016-0169-8

Cited by 4 publications

(6 citation statements)

References 34 publications

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“…This specification guarantees that we measure the long‐term effect of chronic disease on mortality rather than the short‐term effect related to a specific quarter. Extremity injuries were also coded as described above because they have long‐term effects on mortality and on the other diseases, in particular dementia . All acute diseases were assigned a value of 1 in the quarter of diagnosis and 0 otherwise.…”

Section: Methodsmentioning

confidence: 63%

Prevalence of Morbidity at Extreme Old Age in Germany: An Observational Study Using Health Claims Data

Doblhammer

Barth

2018

J American Geriatrics Society

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We assessed the prevalence of morbidity in long-lived individuals according to age and age at death and explored the association between dementia and other diseases and surviving to age 90 and 100. Using health claims data from the largest German health insurer from 2004 to 2013, we followed birth cohorts from 1908 to 1913 from age 95 until death or survival to age 100 (n=2,865) and compared them with birth cohorts from 1918 to 1923 and their survival from age 85 to age 90 (n=17,013). We observed their exact date of death and main categories of morbidity based on International Classification of Diseases, Tenth Revision, diagnoses. For all diseases studied, when differentiated according to age at death, prevalence continued to increase with age. Nonagenarians and centenarians had significantly lower disease prevalence at each age. Dementia was associated with the highest risk of dying before becoming a centenarian (hazard ratio (HR)=1.63, 95% confidence interval (CI)=1.50-1.78), followed closely by the residual category other chronic heart disease (HR=1.42, 95% CI=1.30-1.56). Results were even stronger for the younger cohort. Our study shows that exceptionally long-lived individuals are different in terms of good health. Survival at these high ages depends primarily on the absence of dementia and chronic heart disease, with acute heart disease and pneumonia playing important roles as diseases leading directly to death.

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Section: Methodsmentioning

confidence: 63%

Prevalence of Morbidity at Extreme Old Age in Germany: An Observational Study Using Health Claims Data

Doblhammer

Barth

2018

J American Geriatrics Society

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“…This may be because lower extremity fractures lead to mobility limitation. 8,11) Indeed, the likelihood of returning to the previous level of mobility is low in hip fracture patients. Only 34% of older adults who sustained a hip fracture returned to pre-fracture mobility function.…”

Section: Discussionmentioning

confidence: 99%

“…5) The study in Germany reported a higher rate of LTC initiation in people who experienced both dementia and extremity injuries compared to that in those who experienced each disease independently. 8) Dementia may affect fractures and is a major factor associated with an increased rate of hospitalization due to fracture. [18][19][20] The difference in LTC initiation by fracture site was shared between men and women.…”

Section: Discussionmentioning

confidence: 99%

“…A study in Germany predicted that disability and increased dependency caused by extremity injuries would increase the incidence of initiation of LTC among older adults. 8) The incidence rate of LTC is 2.5 times higher in older adults with extremity injuries and even higher for both lower and upper extremity and severe injuries. 8) However, we do not know the net long-term effect of fracture on care needs among the older population.…”

Section: Introductionmentioning

confidence: 98%

“…8) The incidence rate of LTC is 2.5 times higher in older adults with extremity injuries and even higher for both lower and upper extremity and severe injuries. 8) However, we do not know the net long-term effect of fracture on care needs among the older population. It is particularly important to elaborate on the impact of geriatric fall-related inju-ries because fractures account for a high proportion of deaths from injuries.…”

Section: Introductionmentioning

confidence: 98%

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Fracture Experiences and Long-Term Care Initiation among Older Population: Analysis of Korean National Health Insurance Service-Senior Cohort Study

Kim

Lee

2019

Ann Geriatr Med Res

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Background: Long-term care is a burden on individuals, families, and society. It is important to find ways to delay the onset of disability to lessen the burden of long-term care in aging societies. Fracture is one of the risk factors that affect physical functions and make older people dependent. This study aimed to examine how much more often older adults who experienced fractures initiated long-term care compared to those who did not, and whether the risk of entering long-term care differed significantly by fracture site. Methods: The analyses included insurants aged 65 years and over from the Korean National Health Insurance Service-senior cohort study (2002-2013). Cox proportional hazard models were used to calculate the hazard ratios of the first certification of initiation of long-term care after fracture, by fracture site, and for multiple recurrent fractures. Results: The incidence rate of initial long-term care beneficiaries was approximately 2.5 times higher when older people had experienced fractures; these individuals entered long-term care beneficiary status 3 years earlier compared to those who had no fracture events. Lower extremity fracture and multiple recurrent fractures more than doubled the risk for long-term care. Conclusion: Additional attention to fracture sites in prevention and rehabilitation settings is warranted to reduce disability and the related long-term care burden.

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The Impact of Dementia and Extremity Injuries on the Plasticity of Long-term Care Demand: An Analysis of Counterfactual Projection Scenarios Based on German Health Insurance Routine Data

Barth

2019

CPoS

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Although demand for long-term care (LTC) in Germany is expected to increase over the coming decades, the LTC sector will struggle to provide sufficient capacity. Evaluating the impact of different risk factors on future LTC demand is necessary in order to make informed policy decisions. With regard to LTC need, dementia and lower extremity injuries (LEI) are common risk factors. Both are used to demonstrate their maximum attainable efficacy in mitigating the future increase in overall LTC need, both at home and in nursing homes.We use a multi-state projection model for which the estimation of the underlying transition and mortality rates is based on longitudinal health claims data from AOK, Germany’s largest public health insurance provider, between 2004 and 2010. We project six different scenarios of LTC for ages 75+ in Germany for the period from 2014 to 2044, including counterfactual scenarios that remove the effects of LEI, dementia, or both. Our multi-state projections distinguish between home-based and institutional LTC.Removing the effect of LTC risk factors mitigates the increase in total LTC demand and postpones demand until a later age. Removing dementia markedly shifts future care demand from institutional LTC to LTC at home and even increases demand for LTC at home at older ages beyond the baseline projection due to the dual function of dementia as a risk factor for both LTC demand and mortality. Removing LEI has less of an effect on overall and sectoral LTC demand. Removing both risk factors at the same time results in the greatest impact, which is even more marked than that of both individual scenarios combined, thus indicating a synergistic relationship between dementia and LEI on LTC risk.The type of LTC demand (home-based or institutional) shows considerable plasticity when specific risk factors are removed. We demonstrate the degree to which LTC demand can be affected in favour of LTC at home, using dementia and LEI as examples of potentially modifiable risk factors, and thus show how the efficacy of potential intervention targets for policy-makers can be assessed.This study provides evidence on the degree of plasticity of future long-term care demand at home and in institutions that would hypothetically be attainable when completely removing specific cognitive or physical risk factors of care need (dementia or lower EI). It is based on large-scale health claims data, which contain longitudinal individual level data on morbidity and long-term care status. A close link exists between the cognitive risk factor of dementia and the type of LTC, as its absence shifts care demand to home-based care at older ages. The study also demonstrates the usefulness of counterfactual projections based on health claims data in assessing the hypothetical maximum efficacy of different intervention strategies.

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Extremity injuries and dementia disproportionately increase the risk for long-term care at older age in an analysis of German Health Insurance routine data for the years 2006 to 2010

Cited by 4 publications

References 34 publications

Prevalence of Morbidity at Extreme Old Age in Germany: An Observational Study Using Health Claims Data

Prevalence of Morbidity at Extreme Old Age in Germany: An Observational Study Using Health Claims Data

Fracture Experiences and Long-Term Care Initiation among Older Population: Analysis of Korean National Health Insurance Service-Senior Cohort Study

The Impact of Dementia and Extremity Injuries on the Plasticity of Long-term Care Demand: An Analysis of Counterfactual Projection Scenarios Based on German Health Insurance Routine Data

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