Extremity injuries and dementia disproportionately increase the risk for long-term care at older age in an analysis of German Health Insurance routine data for the years 2006 to 2010

Changing educational gradient in long-term care-free life expectancy among German men, 1997-2012

BACKGROUND

The inverse association between mortality and individual socioeconomic status is well-documented. Due to the lack of appropriate data, little is known about the nature of this association among individuals with long-term care (LTC) needs.

OBJECTIVES

We aim to fill in this knowledge gap by estimating life expectancy (LE), life expectancy without (CFLE) and with (CLE) long-term care by education for older German men; and by assessing the trends in the education-LE/CFLE/CLE gradient over time.

DATA AND METHODS

We apply survival analysis and Gompertz regression to German Socioeconomic Panel data (1997-2012) to estimate the mortality levels and to construct the life tables for three educational categories. Using the administrative data from the health insurance, we adjust mortality rates upward to account for the institutionalized population. We estimate age-specific LTC prevalence from the German Microcensus data (2004, 2012) and compute life expectancy with and without LTC by employing Sullivan's method. Slope and Relative Indices of Inequality are computed to evaluate the magnitude of educational inequalities in CFLE.

RESULTS

There is a clear and growing educational gradient in LE and CFLE among older men in Germany. In 2004, LE at age 65 among men with low education was 14.2 years, or 3.3 years lower than among highly educated individuals. The CFLE of these two educational categories ranged from 13.6 to almost 17 years. The gradient increased over time and in 2012 the difference constituted 4.6 years. The gaps between educational groups were not pronounced for CLE. The declining health ratio of years without LTC to remaining LE suggests the expansion of LTC needs, irrespective of the educational level.

CONCLUSIONS

Growing inequalities by educational status among older German men with care needs demand the attention of policy-makers. Prompt actions are needed to increase the survival chances of the most vulnerable groups.

Fracture Experiences and Long-Term Care Initiation among Older Population: Analysis of Korean National Health Insurance Service-Senior Cohort Study

BACKGROUND

Long-term care is a burden on individuals, families, and society. It is important to find ways to delay the onset of disability to lessen the burden of long-term care in aging societies. Fracture is one of the risk factors that affect physical functions and make older people dependent. This study aimed to examine how much more often older adults who experienced fractures initiated long-term care compared to those who did not, and whether the risk of entering long-term care differed significantly by fracture site.

METHODS

The analyses included insurants aged 65 years and over from the Korean National Health Insurance Service-senior cohort study (2002-2013). Cox proportional hazard models were used to calculate the hazard ratios of the first certification of initiation of long-term care after fracture, by fracture site, and for multiple recurrent fractures.

RESULTS

The incidence rate of initial long-term care beneficiaries was approximately 2.5 times higher when older people had experienced fractures; these individuals entered long-term care beneficiary status 3 years earlier compared to those who had no fracture events. Lower extremity fracture and multiple recurrent fractures more than doubled the risk for long-term care.

CONCLUSION

Additional attention to fracture sites in prevention and rehabilitation settings is warranted to reduce disability and the related long-term care burden.

Prevalence of Morbidity at Extreme Old Age in Germany: An Observational Study Using Health Claims Data

We assessed the prevalence of morbidity in long-lived individuals according to age and age at death and explored the association between dementia and other diseases and surviving to age 90 and 100. Using health claims data from the largest German health insurer from 2004 to 2013, we followed birth cohorts from 1908 to 1913 from age 95 until death or survival to age 100 (n=2,865) and compared them with birth cohorts from 1918 to 1923 and their survival from age 85 to age 90 (n=17,013). We observed their exact date of death and main categories of morbidity based on International Classification of Diseases, Tenth Revision, diagnoses. For all diseases studied, when differentiated according to age at death, prevalence continued to increase with age. Nonagenarians and centenarians had significantly lower disease prevalence at each age. Dementia was associated with the highest risk of dying before becoming a centenarian (hazard ratio (HR)=1.63, 95% confidence interval (CI)=1.50-1.78), followed closely by the residual category other chronic heart disease (HR=1.42, 95% CI=1.30-1.56). Results were even stronger for the younger cohort. Our study shows that exceptionally long-lived individuals are different in terms of good health. Survival at these high ages depends primarily on the absence of dementia and chronic heart disease, with acute heart disease and pneumonia playing important roles as diseases leading directly to death.