Modification of Hospitalization Risk by Gender and Dementia Status Between the Ages of 85 and 95 in a German Cohort...

Hospitalizations among older adults differ by dementia status, gender, and living arrangements. Understanding these differences, particularly in advanced age (age 85 and above), can inform appropriate healthcare strategies.

Using health claims data for Germany, we followed the 1918 to 1923 birth cohort (n = 4,065 men and 13,302 women), who reached age 85 between 2004 and 2009 until death or age 95. Two-level mixed-effects linear probability models with repeated observations were conducted, adjusting for age, gender, dementia status, nursing home residency, dependency on long-term care, comorbidities, and quarter of death.

Men consistently exhibited higher probabilities of hospitalization compared to women, and individuals with dementia (PwD) had a greater probability of hospitalization than those without dementia (non-PwD). Specifically, when compared to male non-PwD, the probability of hospitalization increased by 0.10 (p ≤ 0.001) for male PwD; female non-PwD demonstrated a 0.02 (p ≤ 0.001) lower probability of hospitalization, while female PwD had an increased probability of 0.06 (p ≤ 0.001). Hospitalization probabilities increased with age among non-PwD (men: +0.052 from p₈₅=0.14 [95%CI = 0.13-0.14] to p₉₅=0.19 [95%CI = 0.18-0.20]), women: +0.021 from p₈₅=0.12 [95%CI = 0.12-0.13] to p₉₅=0.14 [95%CI = 0.14-0.15]), remained almost stable among male PwD (+ 0.018 from p₈₅=0. 24 [95%CI = 0.23-0.26] to p₉₅=0.26 [95%CI = 0.24-0.28]), but declined among female PwD (-0.023 from p₈₅=0.22 [95%CI = 0.21-0.22] to p₉₅=0.20 [95%CI = 0.19-0.20). The quarter of death strongly elevated hospitalization probabilities for all groups, though less so among women with dementia who had a lower probability than women without dementia (-0.04; p_non-PwD=0.58 [0.58-0.59], p_PwD=0.54 [0.53-0.55]). Dependence on long-term care significantly reduced hospitalization risk among women, especially those with dementia (-0.5; p_{no long-term care}=0.21 [0.21-0.21], p_{long-term care} =0.16 [0.16-0.17]), but showed no substantial effect for men. Nursing home residency increased hospitalization probabilities mainly for women without dementia (+ 0.02), but slightly decreased probabilities for women with dementia (-0.01). Higher comorbidity was consistently associated with greater hospitalization risk.

Gender and dementia status significantly modulate hospitalization risks in advanced age. A gender-sensitive healthcare approach that accounts for dementia status and care needs is crucial for ensuring adequate hospital care in advanced age.