Gender-linked determinants for utilization of long-term care in community-dwelling adults 65+ in Germany: Results from the population-based KORA-Age study

Steinbeißer, Kathrin; Schwarzkopf, Larissa; Grill, Eva; Schwettmann, Lars; Peters, Annette; Seidl, Hildegard

doi:10.1016/j.exger.2021.111500

Cited by 4 publications

(9 citation statements)

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“…Our results suggest that being physically active is associated with reduced odds of utilization of LTC. Due to the lack of studies on the association of the outcome “utilization of LTC” with PA, and given that utilization of LTC is a complex construct, influenced by various determinants [ 18 , 34 ], comparison with current evidence is limited. Until now, research mainly focused on the impact of PA on need factors (e. g., physical or cognitive problems) leading to utilization of health care services [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…Covariates related to LTC and PA were identified based on Andersen's Behavioral Model of Health Services Use (ABMHS) [18,[31][32][33][34], the GNPAR [35], and common correlates of PA in adults [36].…”

Section: Covariatesmentioning

confidence: 99%

“…In the first step, we analyzed the association of distinct types of PA with utilization of LTC in the entire cohort (n = 4812 observations: sum of t 1 (n = 800) and t 2 (n = 4012)). As the existence of differences between sexes for utilization of health care services and lifestyle habits is well-known [17,18,34], in the second step we applied two sex-stratified models: one for females (n = 2499 observations: t 1 : n = 395, t 2 : n = 2104) and one for males (n = 2313 observations: t 1 : n = 405, t 2 : n = 1908). As disability (expressed as, e. g., "poor health" or "impaired general physical functioning" [43][44][45][46]) is one of the major barriers to PA, we applied the sensitivity analysis (SA) SA1 to each model (entire cohort, females, males).…”

Section: Statistical Analysesmentioning

confidence: 99%

“…However, comprehensive evidence about the role of PA with respect to utilization of LTC in this subpopulation is sparse. Furthermore, deeper knowledge about the implications of distinct types of PA, which, in old age, might be, e. g., walking or exercise, as well as the consideration of sexspecific particularities in regard to utilization of LTC, is lacking [15][16][17][18]. Additionally, detailed analyses comparing older community-dwelling adults with and without utilization of LTC meeting PA recommendations are still missing.…”

Section: Introductionmentioning

confidence: 99%

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Association of physical activity with utilization of long-term care in community-dwelling older adults in Germany: results from the population-based KORA-Age observational study

Steinbeißer

Schwarzkopf

Schwettmann

et al. 2022

Int J Behav Nutr Phys Act

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Background Physical activity (PA) is a proven strategy to prevent chronic diseases and reduce falls. Furthermore, it improves or at least maintains performance of activities of daily living, and thus fosters an independent lifestyle in older adults. However, evidence on the association of PA with relevant subgroups, such as older adults with utilization of long-term care (LTC), is sparse. This knowledge would be essential for establishing effective, need-based strategies to minimize the burden on healthcare systems due to the increasing need for LTC in old age. Methods Data originate from the 2011/12 (t1) baseline assessment and 2016 (t2) follow-up of the population-based Cooperative Health Research in the Region of Augsburg (KORA-)Age study in southern Germany. In 4812 observations of individuals ≥65 years, the association between various types of PA (walking, exercise (i. e., subcategory of PA with the objective to improve or maintain one or more components of physical fitness), walking+exercise) and utilization of LTC (yes/no) was analyzed using generalized estimating equation logistic models. Corresponding models stratified by sex (females: 2499 observations; males: 2313 observations) examined sex-specific associations. Descriptive analyses assessed the proportion of individuals meeting the suggested minimum values in the German National Physical Activity Recommendations for older adults (GNPAR). Results All types of PA showed a statistically significant association with non-utilization of LTC in the entire cohort. “Walking+exercise” had the strongest association with non-utilization of LTC in the entire cohort (odds ratio (OR): 0.52, 95% confidence interval (CI): 0.39–0.70) and in males (OR: 0.41, CI: 0.26–0.65), whereas in females it was “exercise” (OR: 0.58; CI: 0.35–0.94). The proportion of individuals meeting the GNPAR was higher among those without utilization of LTC (32.7%) than among those with LTC (11.7%) and group differences were statistically significant (p ≤ 0.05). Conclusions The GNPAR are rarely met by older adults. However, doing any type of PA is associated with non-utilization of LTC in community-dwelling older adults. Therefore, older adults should be encouraged to walk or exercise regularly. Furthermore, future PA programs should consider target-groups’ particularities to reach individuals with the highest needs for support.

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Section: Discussionmentioning

confidence: 99%

Section: Covariatesmentioning

confidence: 99%

Section: Statistical Analysesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association of physical activity with utilization of long-term care in community-dwelling older adults in Germany: results from the population-based KORA-Age observational study

Steinbeißer

Schwarzkopf

Schwettmann

et al. 2022

Int J Behav Nutr Phys Act

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“…In addition, the use of professional home care is known to increase with age (12,16). Furthermore, previous studies showed that social factors, especially living alone or having children, are important factors that influence use of the services (12,16,(18)(19)(20). Importantly, those factors may influence women to a greater extent than men, owing to greater life expectancy, higher probability of being widowed, different health status, and also different needs for community services (14,18).…”

Section: Introductionmentioning

confidence: 99%

Frequency and gender differences in the use of professional home care in late life. Findings from three German old-age cohorts

et al. 2022

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AimThe aim of this study was to investigate the frequency of and the gender differences in the use of professional home care in Germany.MethodsWe used harmonized data from three large cohort studies from Germany (“Healthy Aging: Gender-specific trajectories into the latest life”; AgeDifferent.de Platform). Data were available for 5,393 older individuals (75 years and older). Mean age was 80.2 years (SD: 4.1 years), 66.6% were female. Professional homecare outcome variables were use of outpatient nursing care, paid household assistance, and meals on wheels' services. Logistic regression models were used, adjusting for important sociodemographic variables.ResultsAltogether 5.2% of older individuals used outpatient nursing care (6.2% women and 3.2% men; p < 0.001), 24.2% used paid household assistance (26.1% women and 20.5% men; p < 0.001) and 4.4% used meals on wheels' services (4.5% women and 4.0% men; p = 0.49). Regression analysis revealed that women had higher odds of using paid household assistance than men (OR = 1.48, 95% CI: [1.24–1.76]; p < 0.001), whereas they had lower odds of using meals on wheels' services (OR = 0.64, 95% CI: [0.42–0.97]; p < 0.05). No statistically significant differences in using outpatient nursing care between women and men were found (OR = 1.26, 95% CI: [0.87–1.81]; p = 0.225). Further, the use of home care was mainly associated with health-related variables (e.g., stroke, Parkinson's disease) and walking impairments.ConclusionsOur study showed that gender differences exist in using paid household assistance and in culinary dependency. For example, meals on wheels' services are of great importance (e.g., for individuals living alone or for individuals with low social support). Gender differences were not identified regarding outpatient nursing care. Use of professional home care services may contribute to maintaining autonomy and independence in old age.

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Inequities in home care use among older Canadian adults: Are they corrected by public funding?

et al. 2023

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Background Although care use should parallel needs, enabling and predisposing circumstances including the socio-demographic inequities of socioeconomic status (SES), gender, or isolation often intervene to diminish care. We examine whether availability of state-funded medical and support services at home can rebalance these individual and social inequities, and do this by identifying if and how intersecting social identities predict homecare use among older Canadian adults. Methods Using the Canadian Longitudinal Study on Aging (CLSA) of 30,097 community-dwelling adults aged 45 to 85, we performed recursive partitioning regression tree analysis using Chi-Squared automatic interaction detection (CHAID). Combinations of individual and social characteristics including sociodemographic, family-related, physical and psychological measures and contextual indicators of material and social deprivation were explored as possible predictors of formal and informal care use. Results Diminished function i.e. increased need, indicated by Activities of Daily Living, was most strongly aligned with formal care use while age, living arrangement, having no partner, depression, self-rated health and chronic medical conditions playing a lesser role in the pathway to use. Notably, sex/gender, were not determinants. Characteristics aligned with informal care were first—need, then country of birth and years since immigration. Both ‘trees’ showed high validity with low risk of misclassification (4.6% and 10.8% for formal and informal care, respectively). Conclusions Although often considered marginalised, women, immigrants, or those of lower SES utilised formal care equitably. Formal care was also differentially available to those without the financial or human resources to receive informal care. Need, primarily medical but also arising from living arrangement, rather than SES or gender predicted formal care, indicating that universal government-funded services may rebalance social and individual inequities in formal care use.

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Gender-linked determinants for utilization of long-term care in community-dwelling adults 65+ in Germany: Results from the population-based KORA-Age study

Cited by 4 publications

References 41 publications

Association of physical activity with utilization of long-term care in community-dwelling older adults in Germany: results from the population-based KORA-Age observational study

Association of physical activity with utilization of long-term care in community-dwelling older adults in Germany: results from the population-based KORA-Age observational study

Frequency and gender differences in the use of professional home care in late life. Findings from three German old-age cohorts

Inequities in home care use among older Canadian adults: Are they corrected by public funding?

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