Abstract
Abstract
Background
People prefer to age in place and not move into a nursing home as long as possible. The prevention of cognitive and functional impairments is feasible to support this goal. Health services play a key role in providing support for underlying medical conditions. We examined differentials in nursing home admissions between patient sharing networks in Germany and whether potential variations can be attributed to indicators of health care provision.
Methods
We conducted an ecological study using data of patients of 65 years and above from all 11 AOK statutory health insurance companies in Germany. Nursing home admissions were observed in a cohort of persons becoming initially care-dependent in 2006 (n = 118,213) with a follow-up of up to 10 years. A patient sharing network was constructed and indicators for quality of health care were calculated based on data of up to 6.6 million patients per year. Community detection was applied to gain distinct patient populations. Analyses were conducted descriptively and through regression analyses to identify the variation explained by included quality indicators.
Results
The difference in the proportion of nursing home admissions between identified clusters shows an interquartile range (IQR) of 12.6% and the average time between onset of care-dependency and admission to a nursing home an IQR of 10,4 quarters. Included quality indicators attributed for 40% of these variations for the proportion of nursing home admissions and 49% for the time until nursing home admission, respectively. Indicators of process quality showed the single highest contribution. Effects of single indicators were inconclusive.
Conclusions
Health services can support persons in their preference to age in place. Research and discussion on adequate health care for care-dependent persons and on conditions, where nursing home admission may be beneficial, is necessary.
Publisher
Springer Science and Business Media LLC
Reference49 articles.
1. Lehnert T, Heuchert M, Hussain K, König H-H. Stated preferences for long-term care: a literature review. Ageing Soc. 2018:1–41.
2. Santos-Eggimann B, Meylan L. Older Citizens' opinions on long-term care options: a vignette survey. J Am Med Dir Assoc. 2017;18(4):326–34.
3. Hajek A, Lehnert T, Wegener A, Riedel-Heller SG, Konig HH. Long-term care preferences among individuals of advanced age in Germany: results of a population-based study. Gesundheitswesen. 2018;80(8–09):685–92.
4. Spangenberg L, Glaesmer H, Brahler E, Kersting A, Strauss B. Nachdenken über das Wohnen im Alter: Einflussfaktoren auf wohnbezogene Zukunftspläne und Wohnpräferenzen in einer repräsentativen Stichprobe ab 45-Jähriger. Z Gerontol Geriatr. 2013;46(3):251–9.
5. Toot S, Swinson T, Devine M, Challis D, Orrell M. Causes of nursing home placement for older people with dementia: a systematic review and meta-analysis. Int Psychogeriatr. 2017;29(2):195–208.