Extremity injuries and dementia disproportionately increase the risk for long-term care at older age. An analysis based on German health insurance routine data

Alexander Barth, Universität Rostock
Gabriele Doblhammer-Reiter, Universität Rostock
Anja Vatterrott, Max-Planck Institute for Demographic Research

Background Extremity injuries (EI), e.g. due to falls, and dementia are known risk factors for long term care need and mortality. Since they often occur in relation, their combined effects warrant additional attention, because they may present opportunities for targeted intervention. Data & Methods Our analyses are based on a random sample of health claims records of 122.000 individuals of persons aged 65+ of Germany's largest public health insurance AOK, covering all diagnoses in the time span between 2004 and 2010. We use multivariate Cox proportional hazard models and calculated state-specific mortality rates and transition rates between the states no care, home care and institutional care, which we use for a set of counter-factual scenarios (and later for a set of prognostic scenarios for Germany). Results Dementia and concurrent EI increase the care and mortality risks beyond those caused by dementia alone. Especially lower EI increase both risks. Mortality is highest in institutional care (about 0.4 for men 80-84 and 0.26 for women), and higher in home care (about 0.3 for men 80-84 and 0.17 for women) than without care. The dementia-free counter-factual scenario is more effective in reducing mortality for those without care need than the EI-free scenario, and more effective in reducing the transition from no care to home care. Combining both scenarios, the transition from home to institutional care is reduced beyond the dementia free scenario. Conclusions Reducing dementia could decrease the transition into care in general and especially from home care to institutional care, while the reduction of EI could help to decrease the entry into home care and the transition to institutional care for dementia patients. Targeted prevention and treatment of extremity injuries might help to reduce long-term care need in the future, even if a treatment for dementia is not forthcoming.