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

Schnitzer, Susanne; Deutschbein, Johannes; Nolte, Christian H.; Köhler, Martin; Kuhlmey, Adelheid; Schenk, Liane

doi:10.1080/10749357.2017.1305645

Cited by 12 publications

(11 citation statements)

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“…An explanation for different findings in other studies could be that sex‐specific morbidity structures underlie the finding that men experience onset in care level 1 less often. This is also confirmed by a study of Schnitzer et al (2017) which indicates that women have a higher risk of becoming care‐dependent after stroke than men because they are older on average and suffer more often from geriatric conditions, especially from urinary incontinence.…”

Section: Discussionsupporting

confidence: 70%

“…Care dependency is determined by the amount of time needed daily for substantial assistance in at least two ADLs in the personal hygiene, nutrition, and mobility categories, and, additionally, assistance with domestic tasks (at least 90 min per day over a period of at least 6 months; Schnitzer et al, 2017). We considered two levels of care dependency as outcomes: Level 1 (90 min of assistance per day), and levels 2 and 3, which were combined because of the small sample size ( n = 47) for level 3 (at least 3 hr assistance per day).…”

Section: Methodsmentioning

confidence: 99%

“…The relevance of age as a key determinant of need for care has been described repeatedly (Hajek & König, 2016; Schnitzer et al, 2015). The research findings on sex‐specific differences are less consistent, varying according to whether they are adjusted for age and morbidities (Hajek, Brettschneider, Lange et al, 2016; Schnitzer et al, 2017). The role of socioeconomic factors (education, income, and occupation) has not been fully explained (Ramsay, Whincup, Morris, Lennon, & Wannamethee, 2008; Sulander et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

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Is there an association between social determinants and care dependency risk? A multi‐state model analysis of a longitudinal study

Schneider

Blüher

Grittner

et al. 2020

Research in Nursing & Health

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Despite a growing body of knowledge about the morbidities and functional impairment that frequently lead to care dependency, the role of social determinants is not yet well understood. The purpose of this study was to examine the effect of social determinants on care dependency onset and progression. We used data from the Berlin Initiative Study, a prospective, population-based cohort study including 2,069 older participants living in Berlin. Care dependency was defined as requiring substantial assistance in at least two activities of daily living for 90 min daily (level 1) or 3+ hours daily (level 2). Multi-state time to event regression modeling was used to estimate the effects of social determinants (partnership status, education, income, and sex), morbidities, and health behaviors, characteristics, and conditions. During the study period, 556 participants (27.5%) changed their status of care dependency. Participants without a partner at baseline were at a higher risk to become care-dependent than participants with a partner (hazard ratio [HR], 95% confidence interval [CI]: 1.24 (1.02-1.51)). After adjustment for other social determinants, morbidities and health behaviors, characteristics, and conditions the risk decreased to a HR of 1.19 (95% CI: 0.79-1.79). Results indicate that older people without a partner may tend to be at higher risk of care dependency onset but not at higher risk of care dependency progression.Clinicians should inquire about and consider patients' partnership status as they evaluate care needs. K E Y W O R D S activities of daily living, care dependency, cohort studies, marital status, proportional hazards models, social determinants of health --This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. contributed equally to this study. d Kidney disease: eGFR <60 ml/min/1.73 m 2 (GFR estimated by the CKD-EPI(crea) equation). 234 | SCHNEIDER ET AL.

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Section: Discussionsupporting

confidence: 70%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is there an association between social determinants and care dependency risk? A multi‐state model analysis of a longitudinal study

Schneider

Blüher

Grittner

et al. 2020

Research in Nursing & Health

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“…The current study also observed a history of previous stroke/TIA to be associated with increased fracture risk over follow-up, which may be explained by the reduced bone mass of stroke survivors ( 6 – 8 , 27 ). Female sex has been previously linked to increased risk of being care dependent at 1 year after stroke as they are older and suffer from more geriatric comorbidities, female sex could, therefore, be seen as a marker of such factors not included in our study, which could further explain the associations shown ( 28 ). Finally, the current study found that hyperlipidemia was associated with increased risk of falls.…”

Section: Discussionmentioning

confidence: 92%

Long-Term Factors Associated With Falls and Fractures Poststroke

et al. 2018

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BackgroundRisk factors for poststroke falls and fractures remain poorly understood. This study aimed to evaluate which factors increased risk of these events after stroke.MethodsData from 7,267 hospitalized stroke patients were acquired from the Norfolk and Norwich University Hospital Stroke Register from 2003–2015. The impacts of multiple patient level and stroke characteristics and comorbidities on post-discharge falls and fractures were assessed. Univariate and multivariable models were constructed, adjusting for multiple confounders, using binary logistic regression for short-term analysis (up to 1-year post-discharge) and Cox-proportional hazard models for longer term analysis (1–3, 3–5, and 0–10 years follow-up).ResultsThe mean age (SD) was 76.3 ± 12.1 years at baseline. 1,138 (15.7%) participants had an incident fall; and 666 (9.2%) an incident fracture during the 10-year follow-up (total person years = 64,447.99 for falls and 67,726.70 for fractures). Half of the sample population were females (50.6%) and the majority had an ischemic stroke (89.8%). After adjusting for confounders: age, sex, previous history of falls, and atrial fibrillation were associated with an increased risk of both falls and fractures during follow-up. Furthermore, chronic kidney disease and hyperlipidemia were associated with an increased risk of falls, while previous stroke/transient ischemic attack increased fracture risk. Total anterior circulation stroke and a prestroke modified Rankin Scale score of 3–5 were associated with decreased risk of both events, with hypertension and cancer decreasing risk of falls only.ConclusionWe identified demographic, stroke-related, and comorbid factors associated with poststroke falls and fracture incidence. Further studies are required to examine and establish the relationship between reversible factors and further explore the role of preventative measures to prevent poststroke falls and fractures.

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“…The level of care to be provided is determined by an expert assessment conducted in the applicant’s home and may be reviewed at a later date (Buchmann, 2014; Koller et al, 2014). Care services are provided regardless of where the person lives, whether at home or in a retirement or nursing care facility (Schnitzer et al, 2017). In this study, the information about the need for care was obtained from claims data supplied by the participant’s health insurance provider (data were linked to patient survey data).…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2019

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Background: Rising life expectancy in Western societies is accompanied by a rising incidence of care dependency (CD) among older people. Objective: The aim of the study was to examine which health-related and social determinants were associated with CD. Method: We used cross-sectional data from the first follow-up ( N = 1,699) of a prospective, population-based cohort study of older participants (≥70 years). CD was assessed if participants required substantial assistance in at least two activities of daily living for 90+ minutes daily. Multivariate logistic regressions were applied. Results: Participants’ mean age was 82 years; 18.9% were care-dependent. CD was significantly associated with older age, urinary incontinence, stroke, falls, cancer, diabetes, education level, having no partner, limited mobility, and limited physical activity. Discussion: Our research highlights the importance of promoting mobility, even in care-dependent people. Further research should investigate the role of partnership in terms of the prevention and delay of CD.

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

Cited by 12 publications

References 46 publications

Is there an association between social determinants and care dependency risk? A multi‐state model analysis of a longitudinal study

Is there an association between social determinants and care dependency risk? A multi‐state model analysis of a longitudinal study

Long-Term Factors Associated With Falls and Fractures Poststroke

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

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