Morbiditätsunterschiede bei Pflegebedürftigen in Abhängigkeit von Pflegesektor und Pflegestufe

Heinen, Ines; Bussche, Hendrik van den; Koller, Daniela; Wiese, Birgitt; Schäfer, Ingmar; Scherer, Martin; Schön, Gerhard; Kaduszkiewicz, Hanna

doi:10.1007/s00391-013-0556-y

Cited by 14 publications

(3 citation statements)

References 16 publications

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“…While we cannot conclude from our data whether these differences in specialist utilization represent unmet needs of older people, it seems plausible to assume that older people in need of long-term care may perceive access barriers. Many of them suffer from frailty and/or cognitive impairment [ 6 ], and are therefore limited in their mobility and more dependent on others in activities of daily living [ 38 , 39 ]. This may also limit them in their ability to organize adequate health care and to visit a specialist practice, especially if the distance is perceived to be long [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Claims data analysis of medical specialist utilization among nursing home residents and community-dwelling older people

Schulz

Tsiasioti

Czwikla

et al. 2020

BMC Health Serv Res

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Background: Most older people, and especially those in need of long-term care, suffer from one or more chronic diseases. Consequently, older people have an increased need of medical care, including specialist care. There is little evidence as yet whether older people with greater medical care needs obtain adequate medical care because existing studies do not sufficiently control for differences in morbidity. In this study we investigate whether differences in medical specialist utilization exist between older people with and without assessed long-term care need in line with Book XI of the German Social Code, while at the same time controlling for individual differences in morbidity. Methods: We used data from the 11 German AOK Statutory Health and Long-term Care Insurance funds of 100,000 members aged 60 years or over. Zero-inflated Poisson regression analyses were applied to investigate whether the need for long-term care and the long-term care setting are associated with the probability and number of specialist visits. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner (GP) utilization. Results: Older people in need of long-term care are more likely to have no specialist visit than people without the need for long-term care. This applies to nearly all medical specialties and for both care settings. Yet, despite these differences in utilization probability the number of specialist medical care visits between older people with and without the need for long-term care is similar. Conclusion: Older people in need of long-term care might face access barriers to specialist care. Once a contact is established, however, utilization does not differ considerably between those who need long-term care and those who don't; this indicates the importance of securing an initial contact.

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Section: Discussionmentioning

confidence: 99%

Claims data analysis of medical specialist utilization among nursing home residents and community-dwelling older people

Schulz

Tsiasioti

Czwikla

et al. 2020

BMC Health Serv Res

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“…Worldwide, 48 million people currently live with dementia; due to the aging population, its prevalence is expected to triple by 2050 [12]. Dementia not only causes disability and death, but also increases the risk of requiring nursing home care [13] and contributes to burden on caregivers [14]. Despite an increasing global disease prevalence, effective therapy to treat dementia is still lacking [15].…”

Section: Introductionmentioning

confidence: 99%

Cumulative use of therapeutic bladder anticholinergics and the risk of dementia in patients with lower urinary tract symptoms: a nationwide 12-year cohort study

et al. 2019

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BackgroundStudies have shown an association between lower urinary tract symptoms (LUTS) and an increased risk of dementia. Whether anticholinergic use contributes to the development of dementia in patients with LUTS remains unknown, especially in Asian populations. This study aims to investigate the association between anticholinergic use and dementia in patients with LUTS.MethodsThis study included patients aged 50 years and over with newly diagnosed LUTS (January 2001 to December 2005), divided into four groups according to their cumulative defined daily doses (cDDDs) of anticholinergics: < 28 cDDDs, 28–84 cDDDs, 85–336 cDDDs, ≥337 cDDDs. Patients were followed up until dementia developed or until the end of 2012.ResultsWe recruited a total of 16,412 patients. The incidence of dementia was 10% in the < 28 cDDD group, 8.9% in the 28–84 cDDD group, 11.5% in the 85–336 cDDD group, and 14.4% in the ≥337 cDDD group (p = .005). In a Cox proportional hazards analysis, the adjusted hazard ratio of dementia was 1.15 (95% CI = 0.97–1.37) in the 85–336 cDDD group, and 1.40 (95% CI = 1.12–1.75) in the ≥337 cDDD group after adjusting for covariates.ConclusionsOur study indicates that higher cumulative anticholinergic exposure is associated with an increase in the risk of incident dementia in patients with LUTS aged 50 years of age and over. Either using one anticholinergic agent or switching anticholinergic agents cumulatively increases this risk. Therapeutic risks and benefits of using anticholinergics in LUTS treatment should be clinically reviewed and weighed.

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“…Chronic lower urinary tract symptoms (LUTS) are common in the older population and are associated with an increased risk of functional decline, falls, or diseases, such as metabolic syndrome and cardiovascular events [1–4]. LUTS also have a negative impact on health-related quality of life (HRQoL) [5, 6], and increase care-giver burden [7], dependency, and healthcare costs [8]. The adverse effects of LUTS on HRQoL were shown to be more than those of common comorbid illnesses, including diabetes, hypertension, and gout [9, 10].…”

Section: Introductionmentioning

confidence: 99%

Depression is a major risk factor for the development of dementia in people with lower urinary tract symptoms: A nationwide population-based study

Huang

Wang

et al. 2019

PLoS ONE

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Background/Objectives Studies have shown a strong relationship between depression and dementia. Lower urinary tract symptoms (LUTS) were reported to be independently associated with depression and dementia. However, the relationship between depression and cognitive dysfunction in patients with LUTS is not well characterized. Method We conducted a matched cohort study by using a one-million population-based dataset in Taiwan. A total of 15,944 patients with LUTS aged 50 or older were included from 2001 to 2005 and followed up until their death or the end of 2012. During the follow-up period, 1958 cases developed depression subsequently and were defined as the study group. 7832 patients without depression were then identified as control group, matching by age, gender, insurance premium, status of catastrophic illness certificate, and the index year in a 1:4 ratio. The primary outcome was the onset of dementia. LUTS, depression, dementia, and other comorbidities were defined by the International Classification of Disease, 9th Revision, Clinical Modification coding system. Cox hazards models and Aalen Johansen curves were applied to measure the influence of depression on the risk of dementia in patients with LUTS. Results The crude incidence of depression among people with LUTS was 12.3%. The incidence of dementia in the depression group was significantly higher than that in the control group (12.2% versus 8.9%; P < 0.001). Depression was associated with a significantly greater risk of subsequent dementia after adjusted for socioeconomic status, number of outpatient visits and multiple comorbidities (adjusted hazard ratio: 1.32; 95% confidence interval: 1.13–1.54). Conclusions Depression is a major risk factor for the onset of subsequent dementia in patients with LUTS. Early screening and interventions for depression in patients with LUTS may be important to maintain cognitive function.

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Morbiditätsunterschiede bei Pflegebedürftigen in Abhängigkeit von Pflegesektor und Pflegestufe

Cited by 14 publications

References 16 publications

Claims data analysis of medical specialist utilization among nursing home residents and community-dwelling older people

Claims data analysis of medical specialist utilization among nursing home residents and community-dwelling older people

Cumulative use of therapeutic bladder anticholinergics and the risk of dementia in patients with lower urinary tract symptoms: a nationwide 12-year cohort study

Depression is a major risk factor for the development of dementia in people with lower urinary tract symptoms: A nationwide population-based study

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