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Institutionalization in incident dementia cases in comparison to age- and sex- matched controls: a 5-year follow-up from Germany

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Abstract

Background

Dementia is a main reason for nursing home admission. Information on institutionalization is often based on studies of limited methodological quality. We aimed to analyze time until nursing home admission since first coding of dementia diagnosis and factors associated with institutionalization in incident dementia patients compared to non-demented controls.

Methods

We analyzed claims data of a German Health insurance company including a cohort of 1,440 patients with a first diagnosis of dementia and 6,988 age- and sex-matched controls aged 65 years and older. The follow-up was up to 5 years. We used Kaplan–Meier analysis for examining time until nursing home admission and cox regression for estimating crude and adjusted Hazard ratios.

Results

Dementia patients and controls were on average 78 years and about 55 % were males. The mean time to nursing home admission was 4.0 years in patients with dementia and 4.6 years for controls. After the 5-years observation-period 62.7 % (95 % CI 59.0–66.1) of dementia patients still lived in the community in comparison to 86.2 % (95 % CI 85.2–87.2) of controls. Cox regression models show that the risk for institutionalization is 3.45 (95 % CI 3.05–3.90) times higher in dementia patients in comparison to controls when adjusted for sex, age, and comorbidity.

Conclusions

Our analysis shows a significant influence of dementia on institutionalization in comparison to age- and sex-matched controls, especially in the youngest age groups. Hence, the results add substantial information on the disease progression of dementia and are, therefore, of great importance for health-care as well as long-term care planning.

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References

  1. Deutsches Institut für Medizinische Dokumentation und Information (2013) ICD-10-GM. Version 2013. Systematisches Verzeichnis. Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme, 10. Revision. German Modification. Deutscher Aerzte-Verlag

  2. Peters E, Pritzkuleit R, Beske F, Katalinic A (2010) Demographic change and disease rates: a projection until 2050. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 53:417–426. doi:10.1007/s00103-010-1050-y

    Article  CAS  PubMed  Google Scholar 

  3. Schwarzkopf L, Menn P, Leidl R et al (2012) Excess costs of dementia disorders and the role of age and gender—an analysis of German health and long-term care insurance claims data. BMC Health Serv Res 12:165. doi:10.1186/1472-6963-12-165

    Article  PubMed Central  PubMed  Google Scholar 

  4. Agüero-Torres H, von Strauss E, Viitanen M et al (2001) Institutionalization in the elderly. J Clin Epidemiol 54:795–801

    Article  PubMed  Google Scholar 

  5. Luppa M, Luck T, Weyerer S et al (2010) Prediction of institutionalization in the elderly. A systematic review. Age Ageing 39:31–38. doi:10.1093/ageing/afp202

    Article  PubMed  Google Scholar 

  6. Schoenmakers B, Buntinx F, Devroey D et al (2009) The process of definitive institutionalization of community dwelling demented vs non demented elderly: data obtained from a network of sentinel general practitioners. Int J Geriatr Psychiatry 24:523–531. doi:10.1002/gps.2147

    Article  PubMed  Google Scholar 

  7. Reuther S, van Nie N, Meijers J et al (2013) Malnutrition and dementia in the elderly in German nursing homes. Results of a prevalence survey from the years 2008 and 2009. Z Gerontol Geriatr 46:260–267. doi:10.1007/s00391-012-0346-y

    Article  CAS  PubMed  Google Scholar 

  8. Luppa M, Luck T, Brähler E et al (2008) Prediction of institutionalisation in dementia. A systematic review. Dement Geriatr Cogn Disord 26:65–78. doi:10.1159/000144027

    Article  PubMed  Google Scholar 

  9. Gaugler JE, Yu F, Krichbaum K, Wyman JF (2009) Predictors of nursing home admission for persons with dementia. Med Care 47:191–198. doi:10.1097/MLR.0b013e31818457ce

    Article  PubMed  Google Scholar 

  10. Andel R, Hyer K, Slack A (2007) Risk factors for nursing home placement in older adults with and without dementia. J Aging Health 19:213–228. doi:10.1177/0898264307299359

    Article  PubMed  Google Scholar 

  11. Brodaty H, Connors MH, Xu J et al (2014) Predictors of institutionalization in dementia: a three year longitudinal study. J Alzheimers Dis 40:221–226. doi:10.3233/JAD-131850

    PubMed  Google Scholar 

  12. Bharucha AJ, Pandav R, Shen C et al (2004) Predictors of nursing facility admission: a 12-year epidemiological study in the United States. J Am Geriatr Soc 52:434–439

    Article  PubMed  Google Scholar 

  13. Eaker ED, Vierkant RA, Mickel SF (2002) Predictors of nursing home admission and/or death in incident Alzheimer’s disease and other dementia cases compared to controls: a population-based study. J Clin Epidemiol 55:462–468

    Article  PubMed  Google Scholar 

  14. Luppa M, Riedel-Heller SG, Stein J et al (2012) Predictors of institutionalisation in incident dementia—results of the German Study on ageing, cognition and dementia in primary care patients (AgeCoDe study). Dement Geriatr Cogn Disord 33:282–288. doi:10.1159/000339729

    Article  PubMed  Google Scholar 

  15. Luck T, Luppa M, Weber S et al (2008) Time until institutionalization in incident dementia cases—results of the Leipzig longitudinal study of the aged (LEILA 75+). Neuroepidemiology 31:100–108. doi:10.1159/000146251

    Article  PubMed  Google Scholar 

  16. Hébert R, Dubois MF, Wolfson C et al (2001) Factors associated with long-term institutionalization of older people with dementia: data from the Canadian Study of health and aging. J Gerontol A Biol Sci Med Sci 56:M693–M699

    Article  PubMed  Google Scholar 

  17. De Vugt ME, Stevens F, Aalten P et al (2005) A prospective study of the effects of behavioral symptoms on the institutionalization of patients with dementia. Int Psychogeriatr 17:577–589. doi:10.1017/S1041610205002292

    Article  PubMed  Google Scholar 

  18. The National Association of the Statutory Health (2012) Responsibility for healthcare. www.gkv-spitzenverband.de/media/dokumente/presse/publikationen/Imagebroschuere_GKV-Spitzenverband_Einzelseiten_Englisch_2012.pdf. Accessed 21 April 2014

  19. Hoffmann F, Icks A (2011) Diabetes prevalence based on health insurance claims: large differences between companies. Diabet Med 28:919–923. doi:10.1111/j.1464-5491.2011.03305.x

    Article  CAS  PubMed  Google Scholar 

  20. Hoffmann F, Icks A (2012) Structural differences between health insurance funds and their impact on health services research: results from the Bertelsmann health-care monitor. Gesundheitswesen 74:291–297. doi:10.1055/s-0031-1275711

    Article  CAS  PubMed  Google Scholar 

  21. Eisele M, van den Bussche H, Koller D et al (2010) Utilization patterns of ambulatory medical care before and after the diagnosis of dementia in Germany—results of a case-control study. Dement Geriatr Cogn Disord 29:475–483. doi:10.1159/000310350

    Article  PubMed  Google Scholar 

  22. World Health Organisation (2014) International statistical classification of diseases and related health problems 10th Revision. http://apps.who.int/classifications/icd10/browse/2010/en. Accessed 14 April 2014

  23. SGB XI (2012) Soziale Pflegeversicherung. C.H.BECK, München

    Google Scholar 

  24. BAG, DGG, DGGG—Bundesarbeitsgemeinschaft der Klinisch-Geriatrischen Einrichtungen e. V., Deutsche Gesellschaft für Geriatrie e. V. DG für G und G e. V. (2004) Abgrenzungskriterien der Geriatrie. Version V1.3. www.dggg-online.de/pdf/abgrenzungskriterien_geriatrie_v13.pdf Accessed 26 Nov 2013

  25. Beekmann M, van den Bussche H, Glaeske G, Hoffmann F (2012) Geriatric morbidity patterns and need for long-term care in patients with dementia. Psychiatr Prax 39:222–227. doi:10.1055/s-0032-1305010

    Article  PubMed  Google Scholar 

  26. Hoffmann F, van den Bussche H, Wiese B et al (2011) Impact of geriatric comorbidity and polypharmacy on cholinesterase inhibitors prescribing in dementia. BMC Psychiatry 11:190. doi:10.1186/1471-244X-11-190

    Article  PubMed Central  PubMed  Google Scholar 

  27. Vandenbroucke JP, von Elm E, Altman DG et al (2007) Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. PLoS Med 4:e297. doi:10.1371/journal.pmed.0040297

    Article  PubMed Central  PubMed  Google Scholar 

  28. AGENS, Arbeitsgruppe Erhebung und Nutzung von Sekundärdaten (2012) Gute Praxis Sekundärdatenanalyse (GPS) Leitlinien und Empfehlungen. Revision 2012. http://dgepi.de/fileadmin/pdf/leitlinien/GPS_fassung3.pdf Accessed 06 Jan 2014

  29. Wimo A, Jönsson L, Bond J et al (2013) The worldwide economic impact of dementia 2010. Alzheimers Dement 9(1–11):e3. doi:10.1016/j.jalz.2012.11.006

    PubMed  Google Scholar 

  30. Prince MJ, Bryce R, Albanese E et al (2013) The global prevalence of dementia: a systematic review and metaanalysis. Alzheimers Dement 9(63–75):e2. doi:10.1016/j.jalz.2012.11.007

    PubMed  Google Scholar 

  31. Van den Bussche H, Heinen I, Koller D et al (2013) Die Epidemiologie von chronischen Krankheiten und Pflegebedürftigkeit. Z Gerontol Geriatr. doi:10.1007/s00391-013-0519-3

    Google Scholar 

  32. Koller D, Kaduszkiewicz H, van den Bussche H et al (2012) Survival in patients with incident dementia compared with a control group: a five-year follow-up. Int psychogeriatrics 24:1522–1530. doi:10.1017/S1041610212000361

    Article  Google Scholar 

  33. Smith GE, O’Brien PC, Ivnik RJ et al (2001) Prospective analysis of risk factors for nursing home placement of dementia patients. Neurology 57:1467–1473

    Article  CAS  PubMed  Google Scholar 

  34. Rothgang H, Iwansky S, Müller R et al (2010) BARMER GEK Pflegereport 2010. Schriftenreihe zur Gesundheitsanalyse, Band 5. Asgard-Verlag, St. Augustin

  35. Bond J, Stave C, Sganga A et al (2005) Inequalities in dementia care across Europe: key findings of the facing dementia survey. Int J Clin Pract Suppl 8–14

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Acknowledgments

We thank the Gmünder ErsatzKasse (GEK, now BARMER GEK) for providing the data analyzed in our study. Preliminary work was funded as part of the German Research Network on Degenerative Dementia (KNDD) by the German Federal Ministry of Education and Research (grants: O1GI0710, 01GI0716, 01GI0717). This study was supported by Grants from the Jackstädt-Stiftung.

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The authors declare that they have no competing interests.

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Correspondence to Jana Schulze.

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Schulze, J., van den Bussche, H., Kaduszkiewicz, H. et al. Institutionalization in incident dementia cases in comparison to age- and sex- matched controls: a 5-year follow-up from Germany. Soc Psychiatry Psychiatr Epidemiol 50, 143–151 (2015). https://doi.org/10.1007/s00127-014-0911-3

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