[Prevalence of dementia of insured persons with and without German citizenship : A study based on statuatory health insurance data]

Pathways of care: a qualitative study of barriers and facilitators to engaging dementia care among underserved and minority populations in the US and Germany

OBJECTIVE

To identify barriers and facilitators to the use of formal dementia services among underserved and minority groups (UMG) in the United States and Germany.

METHOD

Semi-structured qualitative interviews with caregivers (N = 18) of persons with dementia in the United States and Germany. Data were analyzed using thematic analysis.

RESULTS

Caregivers described their experiences in three stages of seeking, initiating, and utilizing care, and different factors served to hinder or enable the use of care services in each stage. The most important factors included limited knowledge about dementia, challenges interacting with healthcare systems, and how closely formal services met the expectations and needs of caregivers, particularly with regard to accommodating cultural or ethnic/racial identity. Caregivers preferred interacting with service care providers who shared a similar identity to receive information or services.

CONCLUSION

Barriers and facilitators to using dementia care services vary by stage of engaging services and may be shared across different healthcare contexts. Targeting specific barriers and strengthening facilitators could help reduce disparities in dementia care among UMG.

Cultural traits and second-generation immigrants' value of informal care

Many European studies find that immigrants and the native population differ in their long-term care use. These differences have been attributed to immigrants' cultural preferences, among others. However, the cultural integration process of immigrants may result in a potential caregiving conflict between foreign-born immigrants' preferences for long-term care and their children's willingness to provide long-term care. In this study, we empirically assess to what extent cultural factors that prevail in foreign-born immigrants' country of origin are reflected in their children's value of informal care. Using data from the German Family Panel and the World Values Survey/European Values Study, we regressed second-generation immigrants' value of informal care on the cultural strength of family ties that prevails in their parents' country of birth. Probit models were estimated and individual characteristics were accounted for. The results show that second-generation immigrants who originate from cultures with stronger family ties are more likely to express a high value of informal care than second-generation immigrants who come from cultures with weaker family ties. We conclude that immigrants' values of informal care are deeply shaped by their country of origin. Policy makers should keep immigrants' needs and preferences in mind when implementing long-term care interventions. The same set of long-term care interventions can have very different effects, depending on immigrants' values.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10433-022-00730-1.

Stability of individual dementia diagnoses in routine care: implications for epidemiological studies

PURPOSE

Epidemiological and health care research frequently rely on diagnoses from routine care, but the intra-individual stability of diagnoses of Alzheimer's disease (AD), vascular dementia (VD) or other forms of dementia (oD) in patients over time is understudied. More data on the diagnostic stability is needed to appraise epidemiological findings from such studies.

METHODS

Using health claims data of the years 2004-2016 from the German Pharmacoepidemiological Research Database, 160 273 patients aged ≥50 with incident dementia were identified and followed for four years. According to the incident ICD-10 codes patients were assigned to the categories AD, VD or oD. Changes between categories during follow-up were calculated.

RESULTS

Overall, 18.8% had incident AD (VD: 21.5%, oD: 59.7%). 15 842 patients had only one dementia diagnosis during four years (AD: 7.4%, VD: 12,4%, oD: 9.8%). Among those with more than one diagnosis, the incident diagnosis matched the last diagnosis in 65.1% (AD), 53.9% (VD) and 73.8% (oD) of patients. Changes in the diagnostic category were higher in patients with AD (mean: 5.1) than in patients with VD (3.6) or oD (3.3). Patients with stable AD diagnoses during the observation period were younger (median: 76 vs. 79 years) and had less inpatient treatment days (median: 14 days) than patients with changes from an AD diagnosis to another category or from another category to AD (27 days).

CONCLUSIONS

While health claims data are feasible for estimating the incidence of dementia in general, the substantial number of changes in dementia diagnoses during the course of the disease warrant caution on the interpretation of epidemiological data on specific dementia types.

Differences in medical specialist utilization among older people in need of long-term care - results from German health claims data

BACKGROUND

Elderly in need of long-term care tend to have worse health and have higher need of medical care than elderly without need for long-term care. Yet, characteristics associated with long-term care need can impede health care access: Higher levels of long-term care need come with physical and cognitive decline such as frailty and memory loss. Yet, it has not been investigated whether level of long-term care need is related to medical care utilization.

METHODS

We investigated the association between the level of long-term care and medical specialist utilization among nursing home residents and home care recipients. We applied zero-inflated Poisson regression with robust standard errors based on a sample of statutory health insurance members. The sample consisted of 100.000 elderly over age 60. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner utilization.

RESULTS

We found a strong gradient effect of the level of long-term care for 9 out of 12 medical specialties: A higher level of long-term care need was associated with a lower probability of having a medical specialist visit. Yet, we did not find clear effects of the level of long-term care need on the intensity of medical specialist care. These findings were similar for both the nursing home and home care setting.

CONCLUSION

The findings indicate that inequalities in medical specialist utilization exist between elderly with differing levels of long-term care need because differences in morbidity were controlled for. Elderly with higher need of long-term care might face more access barriers to specialist medical care.

Palliative Care in Advanced Dementia

Dementia syndrome is common and expected to increase significantly among older people and characterized by the loss of cognitive, psychological and physical functions. Palliative care is applicable for people with dementia, however they are less likely to have access to palliative care. This narrative review summarizes specifics of palliative care in advanced dementia. Most people with advanced dementia live and die in institutional care and they suffer a range of burdensome symptoms and complications. Shortly before dying people with advanced dementia suffer symptoms as pain, eating problems, breathlessness, neuropsychiatric symptoms, and complications as respiratory or urinary infections and frequently experience burdensome transitions. Pharmacological and nonpharmacological interventions may reduce symptom burden. Sensitive observation and appropriate assessment tools enable health professionals to assess symptoms and needs and to evaluate interventions. Due to lack of decisional capacity, proxy decision making is often necessary. Advanced care planning is an opportunity establishing values and preferences and is associated with comfort and decrease of burdensome interventions. Family carers are important for people with advanced dementia they also experience distress and are in need for support. Recommendations refer to early integration of palliative care, recognizing signs of approaching death, symptom assessment and management, advanced care planning, person-centered care, continuity of care, and collaboration of health care providers.

[The future development of dementia diseases in Germany-a comparison of different forecast models]

Dementia is one of the most frequent diseases of people aged 65 and older. As a result of the upcoming demographic transition, a significant increase is expected to the current number of around 1.7 million dementia patients. A precise estimate of this increase is especially important for decision-makers and payers to the health-care system. This study examined the effects of different assumptions on the future frequency of disease using a time-discrete Markov model with population-related and disease-specific components. Based on health insurers' administrative data from AOK Baden-Württemberg, we determined age- and gender-specific prevalence rates, incidence rates, and mortality differences of dementia patients and combined them with demographic components from German population statistics. As a result, our Markov model showed a 20 to 25% higher number of dementia patients in 2030, compared to the results of the status quo projection applied in most previous studies, with the assumption of constant prevalence rates over time. Hence, our results indicate that even in the medium term payers will have to face significant increases in dementia-related health expenditures. By 2060, the number of dementia patients in Germany would rise to 3.3 million assuming a further increase to life expectancy and constant incidence rates over time. The assumption of a compression of the morbidity would reduce this number to 2.6 million.

Diagnosis and treatment of cognitive impairment

As a result of the aging population dementia is a growing challenge, especially in healthcare. Nevertheless, cognitive disorders are often not systematically evaluated, especially during hospital stays for other reasons; however, cognitive impairment is associated with a number of geriatric syndromes, including falls, delirium, dysphagia and lack of adherence to treatment plans. This article considers the current state of diagnosis and treatment of dementia. Non-pharmacological therapeutic approaches as well as current and future pharmacological treatment options are discussed. The drugs of choice for the symptomatic treatment of cognitive deficits in Alzheimer's disease and Parkinson-associated dementia are cholinesterase inhibitors and memantine; there is no specific pharmacological treatment for other types of dementia. Prevention and treatment of cardiovascular risk factors can potentially retard the progression of possibly all forms of dementia.

[Trends in the Prevalence of Dementia and Parkinson's Disease: An Analysis Based on Health Claims Data from all German Statutory Health Insurance Funds for Persons aged 65+in Germany 2009-2012]

OBJECTIVES

There will be an increase in the number of people with dementia (DEM) and Parkinson's disease (PD) with the ageing of the population. The aim of the study was to calculate prevalences and trends of prevalences for DEM and PD in Germany to enable reliable public health planning.

METHODS

For the years 2009-2012, sex-specific period prevalences of DEM and PD for 5-year age-groups based on health claims data from all German statutory health insurance funds were calculated. Time trends were estimated using a negative binomial regression.

RESULTS

In 2012 and for persons aged 65 or older, the crude prevalence was 7.9% for DEM and 2.2% for PD. Between 2009 and 2012, a mean decrease of the DEM prevalence by 1.2% per year was found for women and men above age 65. For PD we found constant rates between 2009-2012 among men and an annual mean decrease of PD prevalence of 0.5% among women.

CONCLUSION

A reduction of the DEM prevalence by 1.2% per year could partially counterbalance the increase of people with dementia resulting from ageing population. For PD we found decreasing prevalences only among women.