How does age affect the care dependency risk one year after stroke? A study based on claims data from a German health insurance fund

Abstract

BackgroundThe objective of this study is to investigate the effect of age on care dependency risk 1 year after stroke. Two research questions are addressed: (1) How strong is the association between age and care dependency risk 1 year after stroke and (2) can this association be explained by burden of disease?MethodsThe study is based on claims data from a German statutory health insurance fund. The study population was drawn from all continuously insured members with principal diagnoses of ischaemic stroke, hemorrhagic stroke, or transient ischaemic attack in 2007 who survived for 1 year after stroke and who were not dependent on care before their first stroke (n = 2864). Data were collected over a 1-year period. People are considered to be dependent on care if they, due to a physical, mental or psychological illness or disability, require substantial assistance in carrying out activities of daily living for a period of at least 6 months. Burden of disease was assessed by stroke subtype, history of stroke, comorbidities as well as geriatric multimorbidity. Regression models were used for data analysis.Results21.6 % of patients became care dependent during the observation period. Post-stroke care dependency risk was significantly associated with age. Relative to the reference group (0–65 years), the odds ratio of care dependency was 11.30 (95 % CI: 7.82–16.34) in patients aged 86+ years and 5.10 (95 % CI: 3.88–6.71) in patients aged 76–85 years. These associations were not explained by burden of disease. On the contrary, age effects became stronger when burden of disease was included in the regression model (by between 1.1 and 28 %).ConclusionsOur results show that age has an effect on care dependency risk that cannot be explained by burden of disease. Thus, there must be other underlying age-dependent factors that account for the remaining age effects (e.g., social conditions). Further studies are needed to explore the causes of the strong age effects observed.

Risk Profiles for Care Dependency: Cross-Sectional Findings of a Population-Based Cohort Study in Germany

“…The association between age and CD/functional impairments is well established (Hajek & König, 2016; Schnitzer et al, 2015). By contrast, research findings on gender-specific differences are less consistent, varying according to whether they are adjusted for age and morbidities (Hajek et al, 2016; Schnitzer et al, 2017).…”

Multimorbidity and care dependence in older adults: a longitudinal analysis of findings from the 10/66 study

“…The risk of disability in those with multimorbidity has been explored [1, 12, 13] and the risk of dependence in relation to frailty has been investigated [14, 15] but there have been no longtidudinal studies from LMICs looking at the risk of care dependence in people with multimorbidity, and only one study from a high income country (HIC) examining this relationship [16]. Aside from a marked association with older age [17], care dependence has important social determinants, including education and socioeconomic position [6, 10]. It is therefore relevant, while controlling for these factors, to compare associations of multimorbidity with incident dependence among countries with diverse economic and health systems.…”

Care Dependency of Post-stroke Patients and Its Affecting Factors

“…간호의존도는 (Kang, 2017;Oh, Sung, Park, Lee, & Kim, 2016) 대상 자의 간호의존도 상태에 대한 고려없이 도움이 필요한 영역만을 제시하므로써 간호사가 필요로 하는 구체적인 정보를 제공하는 데 제한점이 있다 (Dijkstra et al, 2005). 국외에서는 Nursiswati 등(2017)이 종단적 연구를 시행하여 뇌졸중 환자의 간호의 존도 변화를 규명하였고, 뇌졸중 환자를 대상으로 한 나이가 간 호의존도에 미치는 영향 (Schnitzer et al, 2015), 파킨슨 환자 를 대상으로 나이, 질병기간, 질병 정도가 간호의존도에 미치 는 영향 (Riedel et al, 2012), 장기수용시설에서 인지기능과 간 호의존도의 관계 (Caljouw, Cools, & Gussekloo, 2014), 허혈 성 뇌졸중 환자에서 우울과 인지기능이 간호의존도에 미치는 영향 (Kemper, Koller, Glaeske, & Bussche, 2011), 노인 에서 영양장애와 간호의존도의 관계 (Wojszel, 2006) (Dijkstra et al, 2005;Nurisiswati et al, 2017). CDS의 psychometric property는 욕창 환자, 간호요양원 노인 등에게서 검증되었다 (Dijkstra et al, 2000;Dijkstra et al, 2005 (Kim et al, 2006) (Guigoz et al, 1994).…”

“…SPMSQ의 신뢰도와 타당 도는 인지기능과 우울을 측정하는 다른 도구들과의 높은 상관 관계로 입증되었다 (Cho et al, 1998;Pfeiffer, 1975 Figure 1). 다고 보고한 연구 (Dijkstra et al, 2015;Schnitzer et al, 2015),…”