Claudia Schulz1, Gisela Büchele2, Martin Rehm2, Dietrich Rothenbacher2, Patrick Roigk3, Kilian Rapp3, Christian Günster4, Hans-Helmut König5, Katrin Reber5. 1. Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: c.schulz@uke.de. 2. Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany. 3. Robert-Bosch-Hospital, Department of Clinical Gerontology, Stuttgart, Germany. 4. Wissenschaftliches Institut der AOK (WIdO), Berlin, Germany. 5. Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Abstract
OBJECTIVES: Hip fractures are common consequences of falls in older adults and, among other negative health outcomes, often lead to care dependence in the long term. Until 2016, the German long-term care insurance classified care recipients according to a standardized classification system consisting of 3 care levels. It was based on required assistance in performing activities of daily living and assessed by a qualified physician or nurse. Thus, care level reflects the degree of care dependence. The aim of this study was to determine relevant patient characteristics, which are related to the likelihood of increasing care dependence in terms of worsening care level after hip fracture. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Statutory health insurance claims data including 122,922 insured individuals living in Germany and aged 65 years or older, who sustained a hip fracture from 2009 through 2011. MEASURES: The association of patient characteristics with worsening care level in the quarterly period after hip fracture was investigated by means of multinomial logit regression analysis. Death constitutes a competing risk and was modeled as additional nominal outcome. RESULTS: Among all patients, crude rates were 30.9% for worsening care level, 54.8% for unchanged care level, and 14.4% for death after hip fracture. The multivariate analysis revealed that patient factors male sex, increasing age, increasing comorbidity, increasing inpatient length of stay, and a lack of inpatient rehabilitation were significantly associated with a worsening care level. CONCLUSIONS/IMPLICATIONS: This study uses the German standardized measurement of care dependence in terms of worsening care level after hip fracture and finds various related patient characteristics. Knowledge of these characteristics helps to identify possible risk groups for care dependence after hip fracture, for which special attention can be provided regarding treatment and prevention of hip fractures.
OBJECTIVES:Hip fractures are common consequences of falls in older adults and, among other negative health outcomes, often lead to care dependence in the long term. Until 2016, the German long-term care insurance classified care recipients according to a standardized classification system consisting of 3 care levels. It was based on required assistance in performing activities of daily living and assessed by a qualified physician or nurse. Thus, care level reflects the degree of care dependence. The aim of this study was to determine relevant patient characteristics, which are related to the likelihood of increasing care dependence in terms of worsening care level after hip fracture. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Statutory health insurance claims data including 122,922 insured individuals living in Germany and aged 65 years or older, who sustained a hip fracture from 2009 through 2011. MEASURES: The association of patient characteristics with worsening care level in the quarterly period after hip fracture was investigated by means of multinomial logit regression analysis. Death constitutes a competing risk and was modeled as additional nominal outcome. RESULTS: Among all patients, crude rates were 30.9% for worsening care level, 54.8% for unchanged care level, and 14.4% for death after hip fracture. The multivariate analysis revealed that patient factors male sex, increasing age, increasing comorbidity, increasing inpatient length of stay, and a lack of inpatient rehabilitation were significantly associated with a worsening care level. CONCLUSIONS/IMPLICATIONS: This study uses the German standardized measurement of care dependence in terms of worsening care level after hip fracture and finds various related patient characteristics. Knowledge of these characteristics helps to identify possible risk groups for care dependence after hip fracture, for which special attention can be provided regarding treatment and prevention of hip fractures.
Authors: Eliseo Ramírez-García; Guadalupe S García de la Torre; Erika Judith Rodríguez Reyes; Karla Moreno-Tamayo; María Claudia Espinel-Bermudez; Sergio Sánchez-García Journal: Clin Interv Aging Date: 2021-08-17 Impact factor: 4.458
Authors: Carl Neuerburg; Stefan Förch; Johannes Gleich; Wolfgang Böcker; Markus Gosch; Christian Kammerlander; Edgar Mayr Journal: BMC Geriatr Date: 2019-11-27 Impact factor: 3.921
Authors: Claudia Schulz; Gisela Büchele; Raphael Simon Peter; Dietrich Rothenbacher; Patrick Roigk; Kilian Rapp; Katrin Christiane Reber; Hans-Helmut König Journal: PLoS One Date: 2020-03-23 Impact factor: 3.240