Multimorbidity and long-term care dependency—a five-year follow-up

BMC Geriatrics

Research Article

Daniela Koller¹  Gerd Glaeske¹  Gerhard Schön²  Ingmar Schäfer³  Heike Hansen³  Hendrik van den Bussche³ 

[1] Centre for Social Policy Research, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany;Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20246, Hamburg, Germany;Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20246, Hamburg, Germany;

关键词: Long-term care;    Multimorbidity;    Claims data;    Cox regression;   

DOI  :  10.1186/1471-2318-14-70

 received in 2013-10-31, accepted in 2014-05-23,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundNot only single, but also multiple, chronic conditions are becoming the normal situation rather than the exception in the older generation. While many studies show a correlation between multimorbidity and various health outcomes, the long-term effect on care dependency remains unclear. The objective of this study is to follow up a cohort of older adults for 5 years to estimate the impact of multimorbidity on long-term care dependency.MethodsThis study is based on claims data from a German health insurance company. We included 115,203 people (mean age: 71.5 years, 41.4% females). To identify chronic diseases and multimorbidity, we used a defined list of 46 chronic conditions based on ICD-10 codes. Multimorbidity was defined as three or more chronic conditions from this list. The main outcome was “time until long-term care dependency”. The follow-up started on January 1st, 2005 and lasted for 5 years until December 31st, 2009. To evaluate differences between those with multimorbidity and those without, we calculated Kaplan–Meier curves and then modeled four distinct Cox proportional hazard regressions including multimorbidity, age and sex, the single chronic conditions, and disease clusters.ResultsMean follow-up was 4.5 years. People with multimorbidity had a higher risk of becoming care dependent (HR: 1.85, CI 1.78–1.92). The conditions with the highest risks for long-term care dependency are Parkinson’s disease (HR: 6.40 vs. 2.68) and dementia (HR: 5.70 vs. 2.27). Patients with the multimorbidity pattern “Neuropsychiatric disorders” have a 79% higher risk of care dependency.ConclusionsThe results should form the basis for future health policy decisions on the treatment of patients with multiple chronic diseases and also show the need to introduce new ways of providing long-term care to this population. A health policy focus on chronic care management as well as the development of guidelines for multimorbidity is crucial to secure health services delivery for the older population.

【 授权许可】

CC BY   
© Koller et al.; licensee BioMed Central Ltd. 2014